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Abstract
Pregnancy and lactation-associated osteoporosis (PLO) with predominantly subsequent vertebral fracture is a rare but severe disease with an estimated incidence of 0.4 in 100,000. In the past, patients with PLO have been predominantly treated with oral and i.v. bisphosphonates to reduce subsequent fracture risk. Hereby, the use of bisphosphonates in premenopausal women is controversial, as bisphosphonates know to persist in bone for many years and can be exposed and circulate in maternal serum and subsequently pass the placenta barrier and may have a detrimental effect on fetal bone health. Here we report the effects of denosumab on the bone mineral density (BMD) and subsequent fracture risk in PLO. In this case presentation, denosumab was administered postpartum with 3000 IE vitamin D and 1000 mg of calcium daily in a patient with PLO and vertebral fracture of L1 and L4. After 18 months of treatment with denosumab, we could demonstrate a clinical significant increase of BMD at the lumbar spine, femoral neck, and total hip of 32.2%, 13.0%, and 11.5% respectively with no further subsequent fractures. As the patient had regular menstrual cycles and considered a further pregnancy, denosumab treatment was terminated and soon a second pregnancy occurred. After the second pregnancy, BMD decreased at the lumbar spine, femur neck, and total hip by -8.8%, -6.9%, and -7.0% respectively compared to the maximum values during treatment with denosumab, but was still significantly higher compared to baseline levels with no further fractures.
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Affiliation(s)
- U Stumpf
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Campus Innenstadt, Nussbaumstrasse, 20 80336, Munich, Germany.
| | - M Kraus
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Campus Innenstadt, Nussbaumstrasse, 20 80336, Munich, Germany
| | - P Hadji
- Frankfurt Center of Bone Health, Frankfurt, Germany and Philipps-University of Marburg, Marburg, Germany
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Brown JE, Wood SL, Confavreux C, Abe M, Weilbaecher K, Hadji P, Johnson RW, Rhoades JA, Edwards CM, Croucher PI, Juarez P, El Badri S, Ariaspinilla G, D'Oronzo S, Guise TA, Van Poznak C. Management of bone metastasis and cancer treatment-induced bone loss during the COVID-19 pandemic: An international perspective and recommendations. J Bone Oncol 2021; 29:100375. [PMID: 34131559 PMCID: PMC8192265 DOI: 10.1016/j.jbo.2021.100375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 02/02/2023] Open
Abstract
Optimum management of patients with cancer during the COVID-19 pandemic has proved extremely challenging. Patients, clinicians and hospital authorities have had to balance the risks to patients of attending hospital, many of whom are especially vulnerable, with the risks of delaying or modifying cancer treatment. Those whose care has been significantly impacted include patients suffering from the effects of cancer on bone, where delivering the usual standard of care for bone support has often not been possible and clinicians have been forced to seek alternative options for adequate management. At a virtual meeting of the Cancer and Bone Society in July 2020, an expert group shared experiences and solutions to this challenge, following which a questionnaire was sent internationally to the symposium's participants, to explore the issues faced and solutions offered. 70 respondents, from 9 countries (majority USA, 39%, followed by UK, 19%) included 50 clinicians, spread across a diverse range of specialties (but with a high proportion, 64%, of medical oncologists) and 20 who classified themselves as non-clinical (solely lab-based). Spread of clinician specialty across tumour types was breast (65%), prostate (27%), followed by renal, myeloma and melanoma. Analysis showed that management of metastatic bone disease in all solid tumour types and myeloma, adjuvant bisphosphonate breast cancer therapy and cancer treatment induced bone loss, was substantially impacted. Respondents reported delays to routine CT scans (58%), standard bone scans (48%) and MRI scans (46%), though emergency scans were less affected. Delays in palliative radiotherapy for bone pain were reported by 31% of respondents with treatments often involving only a single dose without fractionation. Delays to, or cancellation of, prophylactic surgery for bone pain were reported by 35% of respondents. Access to treatments with intravenous bisphosphonates and subcutaneous denosumab was a major problem, mitigated by provision of drug administration at home or in a local clinic, reduced frequency of administration or switching to oral bisphosphonates taken at home. The questionnaire also revealed damaging delays or complete stopping of both clinical and laboratory research. In addition to an analysis of the questionnaire, this paper presents a rationale and recommendations for adaptation of the normal guidelines for protection of bone health during the pandemic.
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Affiliation(s)
- J E Brown
- Academic Unit of Clinical Oncology, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.,Directorate of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S L Wood
- Academic Unit of Clinical Oncology, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - C Confavreux
- Department of Rheumatology South of Hospices Civils de Lyon and INSERM UMR1033, University of Lyon, Lyon, France
| | - M Abe
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School, Japan
| | - K Weilbaecher
- Division of Oncology, Washington University, St. Louis, USA
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Krankenhaus Nordwest, Frankfurt, Germany
| | - R W Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - J A Rhoades
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.,Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, USA
| | - C M Edwards
- Nuffield Department of Surgical Sciences, Oxford, UK
| | - P I Croucher
- Bone Biology, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - P Juarez
- Biomedical Innovation Department, Center for Scientific Research and Higher Education, Ensenada, Mexico
| | - S El Badri
- Directorate of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G Ariaspinilla
- Directorate of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S D'Oronzo
- Department of Biomedical Sciences and Clinical Oncology, University of Bari Aldo Moro, Italy
| | - T A Guise
- M.D. Anderson Cancer Center, Houston, USA
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Kendler DL, Body JJ, Brandi ML, Broady R, Cannata-Andia J, Cannata-Ortiz MJ, El Maghraoui A, Guglielmi G, Hadji P, Pierroz DD, de Villiers TJ, Ebeling PR, Rizzoli R. Osteoporosis management in hematologic stem cell transplant recipients: Executive summary. J Bone Oncol 2021; 28:100361. [PMID: 33996429 PMCID: PMC8095179 DOI: 10.1016/j.jbo.2021.100361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 01/09/2023] Open
Abstract
Hematopoietic stem cell transplant (HSCT) patients are living longer. Bone health is an important long-term comorbidity post-HSCT. HSCT patients are at high risk of bone loss and fragility fracture. HSCT patients are at high risk of bone loss and fragility fracture. Recommendations are provided for better monitoring of bone health. Recommendations include bone assessment, dietary advice and osteoporosis medication.
Background Treatment advances have reduced the adverse events associated with hematopoietic stem cell transplant (HSCT) and led to an increased number of transplants performed. HSCT patients are living longer with concerns on long-term outcomes. Bone fragility and fracture are at the forefront for long-term morbidities post-HSCT. Results In HSCT recipients, evidence has accumulated to support recommendations for more extensive monitoring of bone fragility and more appropriate administration of osteoporosis pharmacotherapies for patients at high risk of bone loss and/or fracture. Conclusion This executive summary reports and summarizes the main recommendations published previously, including bone assessment, dietary and lifestyle recommendations and osteoporosis medication.
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Affiliation(s)
- D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, Canada
| | - J J Body
- CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M L Brandi
- Mineral and Bone Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - R Broady
- Department of Medicine, Division of Hematology, University of British Columbia, Vancouver, Canada
| | - J Cannata-Andia
- Servicio de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - M J Cannata-Ortiz
- Haematology Department, Hospital de la Princesa, IIS Princesa, Madrid, Spain
| | - A El Maghraoui
- Rheumatology Department, Military Hospital Mohammed V, Mohammed V-Souissi University, Rabat, Morocco
| | - G Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy
| | - P Hadji
- Frankfurt Center of Bone Health, Frankfurt/Main, Germany
| | - D D Pierroz
- International Osteoporosis Foundation (IOF), Nyon, Switzerland
| | - T J de Villiers
- Department of Gynaecology, Faculty of Health Sciences, Stellenbosch University and Mediclinic Panorama, Cape Town, South Africa
| | - P R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals & Faculty of Medicine, Geneva, Switzerland
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McCloskey E, Rathi J, Heijmans S, Blagden M, Cortet B, Czerwinski E, Hadji P, Payer J, Palmer K, Stad R, O'Kelly J, Papapoulos S. The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study. Osteoporos Int 2021; 32:251-259. [PMID: 32829471 PMCID: PMC7838133 DOI: 10.1007/s00198-020-05557-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/21/2020] [Indexed: 01/15/2023]
Abstract
UNLABELLED This study in 8 countries across Europe found that about 75% of elderly women seen in primary care who were at high risk of osteoporosis-related fractures were not receiving appropriate medication. Lack of osteoporosis diagnosis appeared to be an important contributing factor. INTRODUCTION Treatment rates in osteoporosis are documented to be low. We wished to assess the osteoporosis treatment gap in women ≥ 70 years in routine primary care across Europe. METHODS This cross-sectional observational study in 8 European countries collected data from women 70 years or older visiting their general practitioner. The primary outcome was treatment gap: the proportion who were not receiving any osteoporosis medication among those at increased risk of fragility fracture (using history of fracture, 10-year probability of fracture above country-specific Fracture Risk Assessment Tool [FRAX] thresholds, T-score ≤ - 2.5). RESULTS Median 10-year probability of fracture (without bone mineral density [BMD]) for the 3798 enrolled patients was 7.2% (hip) and 16.6% (major osteoporotic). Overall, 2077 women (55%) met one or more definitions for increased risk of fragility fracture: 1200 had a prior fracture, 1814 exceeded the FRAX threshold, and 318 had a T-score ≤ - 2.5 (only 944 received a dual-energy x-ray absorptiometry [DXA] scan). In those at increased fracture risk, the median 10-year probability of hip and major osteoporotic fracture was 11.2% and 22.8%, vs 4.1% and 11.5% in those deemed not at risk. An osteoporosis diagnosis was recorded in 804 patients (21.2%); most (79.7%) of these were at increased fracture risk. The treatment gap was 74.6%, varying from 53% in Ireland to 91% in Germany. Patients with an osteoporosis diagnosis were found to have a lower treatment gap than those without a diagnosis, with an absolute reduction of 63%. CONCLUSIONS There is a large treatment gap in women aged ≥ 70 years at increased risk of fragility fracture in routine primary care across Europe. The gap appears to be related to a low rate of osteoporosis diagnosis.
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Affiliation(s)
- E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | - J Rathi
- Carrig Medical Centre, Cork, Ireland
| | | | - M Blagden
- Ashgate Medical Practice, Chesterfield, UK
| | - B Cortet
- Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France
| | - E Czerwinski
- Department of Bone and Joint Diseases, FHS, Jagiellonian University Medical College, Kopernika 32, 31-501, Krakow, Poland
| | - P Hadji
- Frankfurt Center of Bone Health, Frankfurt, Germany
- Philipps-University of Marburg, Marburg, Germany
| | - J Payer
- Faculty of Medicine, 5th Department of Internal Medicine in University Hospital Bratislava, Comenius University, Bratislava, Slovakia
| | | | - R Stad
- Amgen Europe GmbH, Rotkreuz, Switzerland
| | | | - S Papapoulos
- Leiden University Medical Center, Leiden, Netherlands
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Coleman R, Hadji P, Body JJ, Santini D, Chow E, Terpos E, Oudard S, Bruland Ø, Flamen P, Kurth A, Van Poznak C, Aapro M, Jordan K. Bone health in cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2020; 31:1650-1663. [PMID: 32801018 DOI: 10.1016/j.annonc.2020.07.019] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- R Coleman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - P Hadji
- Frankfurt Centre of Bone Health, Frankfurt, Germany; Philipps University of Marburg, Marburg, Germany
| | - J-J Body
- CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - D Santini
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
| | - E Chow
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - E Terpos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - S Oudard
- Department of Medical Oncology, Georges Pompidou Hospital, Paris Descartes University, Paris, France
| | - Ø Bruland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - P Flamen
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - A Kurth
- Department of Orthopaedic and Trauma Surgery, Campus Kemperhof, Community Clinics Middle Rhine, Koblenz, Germany; Major Teaching Hospital of the University Medicine Mainz, Mainz, Germany
| | | | - M Aapro
- Genolier Cancer Centre, Genolier, Switzerland
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
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Wilms M, Lövey G, Wilms M, Wetzig S, Stephanou M, Shaheen M, Kolberg-Liedtke C, Hadji P, Kolberg HC. MRI guided high-focused ultrasound (MRgFUS) as treatment for symptomatic uterine fibroids – experiences of 339 cases. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Wilms
- Marienhospital Wesel, Klinik für Kardiologie, Angiologie und Pneumologie
| | | | | | | | | | | | | | - P Hadji
- Frankfurter Hormon und Osteoporosezentrum
- Philipps Universität Marburg
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Kyvernitakis I, Kostev K, Thomasius F, Stumpf U, Hadji P. Effect of progestogen-only contraception on premenopausal fracture risk: a case-control study. Osteoporos Int 2020; 31:1801-1806. [PMID: 32377808 DOI: 10.1007/s00198-020-05437-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED Our study demonstrated that progestogen-only oral and intrauterine contraceptives are not associated with fracture risk independent from age. PURPOSE The use of progestogen-only contraception, resulting in a hypoestrogenic state, has been associated with impaired bone acquisition and increased fracture risk. The aim of this large population-based study was to assess the fracture risk in association with the use of progestogen-only contraceptives (progestogen-only pills (POPs) and progestogen-containing IUDs (LNG-IUD)). METHODS We identified 14,421 women between 16 and 55 years of age with a first-time diagnosis of fracture and matched them with 14,421 random controls using the Disease Analyzer Database. RESULTS The results of the first adjusted logistic regression model (ever use vs. never use of progestogen-only contraceptives) revealed that there was no significant association between the use of POPs (OR = 0.98, 95% CI 0.90-1.07, p = 0.657) or LNG-IUDs (OR = 0.99, 95% CI 0.81-1.21, p = 0.945) and fracture incidence. Also, in the second regression model, we observed no effect of duration of use of POPs (OR = 1.01, 95% CI 0.98-1.03, p = 0.672) or LNG-IUDs (OR = 0.94, 95% CI 0.87-1.02, p = 0.177) on fracture occurrence. We also observed no effect in different age groups. CONCLUSION Our study results indicate that progestogen-only contraception (either POPs or LNG-IUPs) is not associated with fracture risk and may be considered a bone-safe option for adults and adolescents.
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Affiliation(s)
- I Kyvernitakis
- Department of Obstetrics and Prenatal Medicine, Asklepios Clinics Barmbek, Heidberg-Nord and Wandsbek, Hamburg, Germany.
- Department of Obstetrics and Prenatal Medicine, Asklepios Clinic Barmbek, Rübenkamp 220, 22307, Hamburg, Germany.
- Philipps University of Marburg, Marburg, Germany.
| | - K Kostev
- Department of Epidemiology,, IQVIA, Frankfurt, Germany
| | - F Thomasius
- Frankfurt Center of Bone Health, Frankfurt, Germany
| | - U Stumpf
- Department of General, Trauma, and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - P Hadji
- Philipps University of Marburg, Marburg, Germany
- Frankfurt Center of Bone Health, Frankfurt, Germany
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Marcucci G, Beltrami G, Tamburini A, Body JJ, Confavreux CB, Hadji P, Holzer G, Kendler D, Napoli N, Pierroz DD, Rizzoli R, Brandi ML. Bone health in childhood cancer: review of the literature and recommendations for the management of bone health in childhood cancer survivors. Ann Oncol 2020; 30:908-920. [PMID: 31111878 DOI: 10.1093/annonc/mdz120] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In the past decades, new cancer treatment approaches for children and adolescents have led to a decrease in recurrence rates and an increase in long-term survival. Recent studies have focused on the evaluation of the late effects on bone of pediatric cancer-related treatments, such as chemotherapy, radiation and surgery. Treatment of childhood cancer can impair the attainment of peak bone mass, predisposing to premature onset of low bone mineral density, or causing other bone side-effects, such as bone quality impairment or avascular necrosis of bone. Lower bone mineral density and microarchitectural deterioration can persist during adulthood, thereby increasing fracture risk. Overall, long-term follow-up of childhood cancer survivors is essential to define specific groups at higher risk of long-term bone complications, identify unrecognized long-term adverse effects, and improve patient care. Children and adolescents with a cancer history should be carefully monitored, and patients should be informed of possible late complications of their previous medical treatment. The International Osteoporosis Foundation convened a working group to review the bone complications of pediatric cancer survivors, outlining recommendations for the management of bone health, in order to prevent and treat these complications.
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Affiliation(s)
- G Marcucci
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence
| | - G Beltrami
- Department of Pediatric Orthopaedic Oncology
| | - A Tamburini
- Hematology-Oncology Service, Department of Pediatrics, University Hospital AOU-Careggi, Florence, Italy
| | - J J Body
- Université Libre de Bruxelles, Brussels, Belgium
| | - C B Confavreux
- University of Lyon - INSERM UMR 1033-Lyos - Expert Center for Bone Metastases and Secondary Bone Oncology (CEMOS), Rheumatology Department Hospices Civils de Lyon, Pierre Bénite, France
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nord West Hospital, Frankfurt, Germany
| | - G Holzer
- Department of Orthopedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - D Kendler
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - N Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Roma, Italy; Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, USA
| | - D D Pierroz
- International Osteoporosis Foundation (IOF), Nyon
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M L Brandi
- Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence.
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Stumpf U, Hadji P, van den Boom L, Böcker W, Kostev K. Incidence of fractures in patients with type 1 diabetes mellitus-a retrospective study with 4420 patients. Osteoporos Int 2020; 31:1315-1322. [PMID: 32090278 DOI: 10.1007/s00198-020-05344-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/11/2020] [Indexed: 01/28/2023]
Abstract
UNLABELLED This retrospective study investigated the incidence of fracture in 4420 type 1 diabetes (T1DM) patients. Our findings indicate that patients with T1DM have an increased incidence of fractures. Further studies and preventive measures are urgently needed. INTRODUCTION The aim of this study was to investigate the incidence of fracture in patients with type 1 diabetes mellitus (T1DM). METHODS This study is based on the German Disease Analyzer database and included 4258 adult individuals with a T1DM diagnosis documented between January 2000 and December 2015 in 1203 general practices in Germany. Individual matching of T1DM and non-diabetic patients was performed. The cumulative incidence of new fractures was shown for up to 10 years after the index date using Kaplan-Meier curves. Cox proportional hazard models (dependent variable: incident fracture) were used to estimate the effect of T1DM on fracture incidence, as well as the effect of predefined variables on fracture incidence. RESULTS After 10 years of follow-up, the cumulative fracture incidence was 18.4% for T1DM patients and 9.9% for non-diabetic patients (p < 0.001). A strong association between T1DM and fractures was found (HR, 2.01 (95% CI, 1.70-2.38) p < 0.001) in both female and male patients. Significant differences between T1DM and non-diabetes patients were found in lower leg/ankle, foot and toe, shoulder/upper arm, and rib(s), sternum and thoracic spine fractures. A significant association between higher age and fracture incidence was observed in T1DM patients. CONCLUSIONS In summary, we found that patients with T1DM have a twofold increased fracture rate compared with healthy controls. Furthermore, fractures were associated with increased age and high HbA1c values.
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Affiliation(s)
- U Stumpf
- Department of General, Trauma, and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - P Hadji
- Frankfurt Center of Bone Health and Philips-University of Marburg, Marburg, Germany
| | - L van den Boom
- Clementine Children's Hospital, Division of Pediatric Diabetes, Frankfurt, Germany
| | - W Böcker
- Department of General, Trauma, and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - K Kostev
- Epidemiology, IQVIA, Main Airport Center, Unterschweinstiege 2-14, 60549, Frankfurt am Main, Germany.
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10
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Hadji P, Colli E, Regidor PA. Correction to: Bone health in estrogen-free contraception. Osteoporos Int 2020; 31:1399. [PMID: 35133469 PMCID: PMC7370893 DOI: 10.1007/s00198-020-05426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P. Hadji
- Frankfurter Center of Bone Health, Goethestr. 23, 60313 Frankfurt/ Main, Germany
- Philipps University of Marburg, Marburg, Germany
| | - E. Colli
- Exeltis HealthCare Madrid, C/ Manuel Pombo Angulo 28, 4th Floor, 28050 Madrid, Spain
| | - P.-A. Regidor
- Exeltis Europe, Adalperostr. 84, 85737 Ismaning, Germany
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12
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Abstract
Estrogens and progestogens influence the bone. The major physiological effect of estrogen is the inhibition of bone resorption whereas progestogens exert activity through binding to specific progesterone receptors. New estrogen-free contraceptive and its possible implication on bone turnover are discussed in this review. Insufficient bone acquisition during development and/or accelerated bone loss after attainment of peak bone mass (PBM) are 2 processes that may predispose to fragility fractures in later life. The relative importance of bone acquisition during growth versus bone loss during adulthood for fracture risk has been explored by examining the variability of areal bone mineral density (BMD) (aBMD) values in relation to age. Bone mass acquired at the end of the growth period appears to be more important than bone loss occurring during adult life. The major physiological effect of estrogen is the inhibition of bone resorption. When estrogen transcription possesses binds to the receptors, various genes are activated, and a variety modified. Interleukin 6 (IL-6) stimulates bone resorption, and estrogen blocks osteoblast synthesis of IL-6. Estrogen may also antagonize the IL-6 receptors. Additionally, estrogen inhibits bone resorption by inducing small but cumulative changes in multiple estrogen-dependent regulatory factors including TNF-α and the OPG/RANKL/RANK system. Review on existing data including information about new estrogen-free contraceptives. All progestins exert activity through binding to specific progesterone receptors; hereby, three different groups of progestins exist: pregnanes, gonanes, and estranges. Progestins also comprise specific glucocorticoid, androgen, or mineralocorticoid receptor interactions. Anabolic action of a progestogen may be affected via androgenic, anti-androgenic, or synadrogenic activity. The C 19 nortestosterone class of progestogens is known to bind with more affinity to androgen receptors than the C21 progestins. This article reviews the effect of estrogens and progestogens on bone and presents new data of the currently approved drospirenone-only pill. The use of progestin-only contraceptives leading to an estradiol level between 30 and 50 pg/ml does not seem to lead to an accelerate bone loss.
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Affiliation(s)
- P. Hadji
- Frankfurter Center of Bone Health, Goethestr. 23, 60313 Frankfurt/Main, Germany
- Philipps University of Marburg, Marburg, Germany
| | - E. Colli
- Exeltis HealthCare Madrid, C/ Manuel Pombo Angulo 28, 4th Floor, 28050 Madrid, Spain
| | - P.-A. Regidor
- Exeltis Europe, Adalperostr. 84, 85737 Ismaning, Germany
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Hiligsmann M, Cornelissen D, Vrijens B, Abrahamsen B, Al-Daghri N, Biver E, Brandi ML, Bruyère O, Burlet N, Cooper C, Cortet B, Dennison E, Diez-Perez A, Gasparik A, Grosso A, Hadji P, Halbout P, Kanis JA, Kaufman JM, Laslop A, Maggi S, Rizzoli R, Thomas T, Tuzun S, Vlaskovska M, Reginster JY. Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF). Osteoporos Int 2019; 30:2155-2165. [PMID: 31388696 PMCID: PMC6811382 DOI: 10.1007/s00198-019-05104-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
Abstract
UNLABELLED Many patients at increased risk of fractures do not take their medication appropriately, resulting in a substantial decrease in the benefits of drug therapy. Improving medication adherence is urgently needed but remains laborious, given the numerous and multidimensional reasons for non-adherence, suggesting the need for measurement-guided, multifactorial and individualized solutions. INTRODUCTION Poor adherence to medications is a major challenge in the treatment of osteoporosis. This paper aimed to provide an overview of the consequences, determinants and potential solutions to poor adherence and persistence to osteoporosis medication. METHODS A working group was organized by the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) to review consequences, determinants and potential solutions to adherence and to make recommendations for practice and further research. A systematic literature review and a face-to-face experts meeting were undertaken. RESULTS Medication non-adherence is associated with increased risk of fractures, leading to a substantial decrease in the clinical and economic benefits of drug therapy. Reasons for non-adherence are numerous and multidimensional for each patient, depending on the interplay of multiple factors, suggesting the need for multifactorial and individualized solutions. Few interventions have been shown to improve adherence or persistence to osteoporosis treatment. Promising actions include patient education with counselling, adherence monitoring with feedback and dose simplification including flexible dosing regimen. Recommendations for practice and further research were also provided. To adequately manage adherence, it is important to (1) understand the problem (initiation, implementation and/or persistence), (2) to measure adherence and (3) to identify the reason of non-adherence and fix it. CONCLUSION These recommendations are intended for clinicians to manage adherence of their patients and to researchers and policy makers to design, facilitate and appropriately use adherence interventions.
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Affiliation(s)
- M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - D Cornelissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - B Vrijens
- Research and Development, AARDEX Group and Department of Public Health, University of Liège, Liege, Belgium
| | - B Abrahamsen
- Open Patient Data Explorative Network, Institute of Clinical Resesarch, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- NDORMS, University of Oxford, Oxford, UK
| | - N Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - E Biver
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M L Brandi
- FirmoLab, Fondazione FIRMO e Università di Firenze, Florence, Italy
| | - O Bruyère
- Division of Public Health, Epidemiology and Health Economics, Liège, Belgium and WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liege, Belgium
| | - N Burlet
- Global Head of Patient Insights Innovation, Patient Solution Unit, Sanofi, Lyon, France
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - B Cortet
- Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - A Diez-Perez
- Musculoskeletal Research Unit, IMIM-Parc Salut Mar, CIBERFES, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Gasparik
- Department of Public Health, University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - A Grosso
- Patient partner, Geneva, Switzerland
| | - P Hadji
- Frankfurt Centre of Bone Health, Frankfurt, Germany & Philips-University of Marburg, Marburg, Germany
| | - P Halbout
- International Osteoporosis Foundation, Nyon, Switzerland
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Mary McKillop Health Institute, Catholic University of Australia, Melbourne, Australia
| | - J M Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - A Laslop
- Scientific Office, Austrian Federal Office for Safety in Health Care, Vienna, Austria
| | - S Maggi
- CNR Aging Branch-NI, Padua, Italy
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - T Thomas
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne and INSERM U1059, Université de Lyon-Université Jean Monnet, Saint-Etienne, France
| | - S Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, İstanbul University Cerrahpaşa, Istanbul, Turkey
| | - M Vlaskovska
- Medical Faculty, Department of Pharmacology, Medical University Sofia, Sofia, Bulgaria
| | - J Y Reginster
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
- Division of Public Health, Epidemiology and Health Economics, Liège, Belgium and WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liege, Belgium
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14
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Svedbom A, Hadji P, Hernlund E, Thoren R, McCloskey E, Stad R, Stollenwerk B. Cost-effectiveness of pharmacological fracture prevention for osteoporosis as prescribed in clinical practice in France, Germany, Italy, Spain, and the United Kingdom. Osteoporos Int 2019; 30:1745-1754. [PMID: 31270592 DOI: 10.1007/s00198-019-05064-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022]
Abstract
UNLABELLED This study estimated the cost-effectiveness of pharmacological fracture prevention as prescribed in the five largest European countries (EU5) using the IOF reference cost-effectiveness model. Pharmacological fracture prevention as prescribed in clinical practice was cost-saving (provided more QALYs at lower costs) compared to no treatment in each of the EU5. PURPOSE To estimate the real-world cost-effectiveness of pharmacological fracture prevention as prescribed in the five largest European countries by population size: France, Germany, Italy, Spain, and the United Kingdom (UK) (collectively EU5). MATERIALS AND METHODS We analyzed sales data on osteoporosis drugs in each of the EU5 to derive a hypothetical intervention that corresponds to the mix of osteoporosis medication prescribed in clinical practice. The costs for this treatment mix were obtained directly from the sales data, and the efficacy of the treatment mix was estimated by weighing the treatment-specific fracture risk reductions from a published meta-analysis. Subsequently, we estimated the cost-effectiveness using costs per quality adjusted life year (QALY) of the intervention compared to no treatment in each of the EU5 using the International Osteoporosis Foundation (IOF) reference cost-effectiveness model. The model population comprised postmenopausal women, mean age 72 years with established osteoporosis (T-score ≤ - 2.5) among whom 23.6% had a prevalent vertebral fracture. The model was populated with country-specific data from the literature. RESULTS Pharmacological fracture prevention as prescribed in clinical practice was cost-saving (provided more QALYs at lower costs) compared to no treatment in each country. The findings were robust in scenario analyses. CONCLUSIONS Pharmacological fracture prevention as prescribed in clinical practice is cost-saving in each of the EU5. Because of the under-diagnosis and under-treatment of post-menopausal osteoporosis, from a health economic perspective, further cost-savings may be reached by expanding treatment to those at increased risk of fracture currently not receiving any treatment.
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Affiliation(s)
| | - P Hadji
- Frankfurt Center of Bone Disease, Frankfurt/Main, Germany
- Philips-University of Marburg, Marburg, Germany
| | | | | | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - R Stad
- Amgen Europe (GmbH), Suurstoffi 22, P. O. Box 94, CH-6343, Rotkreuz, Switzerland
| | - B Stollenwerk
- Amgen Europe (GmbH), Suurstoffi 22, P. O. Box 94, CH-6343, Rotkreuz, Switzerland.
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15
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Nabieva N, Kellner S, Fehm T, Häberle L, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Fersis N, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauss T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Rauh C, Bayer CM, Jacob A, Schmidt K, Belleville E, Brucker SY, Kümmel S, Beckmann MW, Wallwiener D, Hadji P, Fasching PA. Influence of patient and tumor characteristics on early therapy persistence with letrozole in postmenopausal women with early breast cancer: results of the prospective Evaluate-TM study with 3941 patients. Ann Oncol 2019; 29:186-192. [PMID: 29045642 DOI: 10.1093/annonc/mdx630] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Patients' compliance and persistence with endocrine treatment has a significant effect on the prognosis in early breast cancer (EBC). The purpose of this analysis was to identify possible reasons for non-persistence, defined as premature cessation of therapy, on the basis of patient and tumor characteristics in individuals receiving adjuvant treatment with letrozole. Patients and methods The EvAluate-TM study is a prospective, multicenter, noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor-positive EBC in the early therapy phase. Treatment persistence was evaluated at two pre-specified study visits after 6 and 12 months. As a measure of early therapy persistence the time from the start to the end of treatment (TTEOT) was analyzed. Cox regression analyses were carried out to identify patient characteristics and tumor characteristics predicting TTEOT. Results Out of the total population of 3941 patients with EBC, 540 (13.7%) events involving treatment cessation unrelated to disease progression were observed. This was due to drug-related toxicity in the majority of cases (73.5%). Persistence rates were 92.2%, 86.9%, and 86.3% after 6, 12, and 15 months, respectively. The main factors influencing premature treatment discontinuation were older age [hazard ratio (HR) 1.02/year], comorbidities (HR 1.06 per comorbidity), low body mass index, and lower tumor grade (HR 0.85 per grade unit). Conclusion These results support the view that older, multimorbid patients with low tumor grade and low body mass index are at the greatest risk for treatment discontinuation and might benefit from compliance and support programs.
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Affiliation(s)
- N Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - S Kellner
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.,Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - L Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - J de Waal
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - M Rezai
- Luisen-Hospital Düsseldorf, Düsseldorf, Germany
| | - B Baier
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | | | | | - M Warm
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Clinics of Cologne gGmbH, Holweide, Cologne, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - R Wuerstlein
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - J-U Deuker
- Vinzenz-Hospital Hannover GmbH, Hannover, Germany
| | - P Dall
- Department of Gynecology, Lüneburg Clinic, Lüneburg, Germany
| | - B Richter
- Elbland Clinics, Meissen-Radebeul, Germany
| | - G Wachsmann
- County Hospital of Böblingen, Böblingen, Germany
| | - C Brucker
- Department of Gynecology, University Hospital, Paracelsus Private Medical University of Nuremberg, Nuremberg, Germany
| | - J W Siebers
- Department of Gynecology, St. Josef's Hospital, Offenburg, Germany
| | - N Fersis
- Department of Gynecology, Bayreuth Clinic GmbH, CCC ER-EMN, Bayreuth, Germany
| | - T Kuhn
- Karl-Olga-Hospital Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - C Wolf
- Medical Center Ulm, Ulm, Germany
| | - H-W Vollert
- Friedrichshafen Clinic, Friedrichshafen, Germany
| | - G-P Breitbach
- Department of Gynecology, Neunkirchen Clinic, Neunkirchen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - R Landthaler
- Gynecological Medical Practice of the County Hospital of Krumbach, Krumbach, Germany
| | - A Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - D Rezek
- Marien-Hospital Wesel, Wesel, Germany
| | - T Noesselt
- Department of Gynecology of the County Hospital of Hameln, Hameln, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - S Henschen
- HELIOS Kliniken Schwerin GmbH, Schwerin, Germany
| | - T Praetz
- Caritas-Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - V Heyl
- Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - T Kühn
- Department of Gynecology, Esslingen Clinics a.N., Esslingen, Germany
| | - T Krauss
- Department of Gynecology Lippe-Detmold, Lippe-Detmold, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - A Hohn
- County Hospital of Rendsburg, Rendsburg, Germany
| | - H Tesch
- Oncology Bethanien Frankfurt, Frankfurt, Germany
| | - C Mundhenke
- Department of Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - A Jacob
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | - K Schmidt
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | | | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - S Kümmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - M W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - D Wallwiener
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - P Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - P A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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16
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Müller V, Huober J, Volz B, Overkamp F, Kolberg HC, Hadji P, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lüftner DI, Wallwiener M, Taran FA, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt A, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Fehm TN, Brucker SY, Wallwiener D, Schneeweiss A, Fasching PA, Tesch H. Abstract OT1-11-02: PRAEGNANT - Real world evidence, translational research, big and smart data: A prospective academic translational research network for the optimization of the oncological health care quality in the adjuvant and advanced/ metastatic setting (NCT02338167). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-11-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
During the last decades the treatment of advanced breast cancer (ABC) patients has improved due to a variety of new treatment strategies. Nevertheless, many ABC patients are faced with limited prognosis, and their treatment remains a challenge. New targeted therapies complement the well-established treatment options for ABC (CDK4/6 inhibition, anti-endocrine, chemotherapy, antibody based and bone related therapies), leading to improved treatment regimens tailored to the needs of special patient sub-populations.
SPECIFIC AIMS/TRIAL DESIGN
The PRAEGNANT network study is conducted as an academic, prospective registry and diagnostic translational study, accompanied by biomaterial collection. The pilot phase in more than 60 centers aims at including 3500 ABC patients. The primary objective is to discover biomarkers, which predict progression free survival (PFS). Secondary objectives include overall survival (OS), breast cancer specific survival, objective response rate, patient reported outcomes (PRO), description of therapies used in the metastatic setting, therapy adherence, health economics for patients with ABC, incidence of (serious) adverse events and big data/ machine learning algorithms. The exploratory objectives comprise correlations of gene alterations and their influence on OS, PFS, side effects and PRO. Exploratory biomarkers are assessed at baseline and at every change of therapy. These biomarkers include gene expression profiling of the primary tumor and corresponding metastasis, somatic mutations (measured in the tumor and in circulating tumor DNA), germline genetic variations, epigenetic changes and miRNA variations. Furthermore, plasma and serum markers are assessed. If actionable molecular alterations are detected patients are informed and recruited into suitable studies if available.
ELIGIBILITY CRITERIA:
Any adult patient (>18 years) with the diagnosis of ABC and who is willing and able to sign the informed consent can be enrolled.
STATISTICAL METHODS/TARGET ACCRUAL:
The PRAEGNANT study as a prospective real world registry and diagnostic translational study aims to identify biomarkers in ABC patients, which may predict PFS. Target accrual for the pilot phase is 3500 patients. Each patient will be documented for up to 36 months with an estimated median PFS for all patients of 11 months across all treatment lines.
Citation Format: Müller V, Huober J, Volz B, Overkamp F, Kolberg H-C, Hadji P, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lüftner DI, Wallwiener M, Taran F-A, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt A, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Fehm TN, Brucker SY, Wallwiener D, Schneeweiss A, Fasching PA, Tesch H. PRAEGNANT - Real world evidence, translational research, big and smart data: A prospective academic translational research network for the optimization of the oncological health care quality in the adjuvant and advanced/ metastatic setting (NCT02338167) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-11-02.
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Affiliation(s)
- V Müller
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Huober
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - B Volz
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - F Overkamp
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - H-C Kolberg
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - P Hadji
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - L Haeberle
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Ettl
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - AD Hartkopf
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - MP Lux
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - DI Lüftner
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - F-A Taran
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - MW Beckmann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - E Belleville
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - P Wimberger
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Hielscher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Geberth
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Lermann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - A Abenhardt
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Kurbacher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - R Wuerstlein
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Thomssen
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Untch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - W Janni
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - TN Fehm
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - SY Brucker
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - D Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - A Schneeweiss
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - PA Fasching
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - H Tesch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
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Lux MP, Hartkopf AD, Huober J, Volz B, Taran FA, Overkamp F, Hadji P, Tesch H, Haeberle L, Ettl J, Lueftner DI, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Fasching PA, Janni W, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A, Kolberg HC. Abstract P6-17-37: Therapy landscape of patients with metastatic, HER2 positive breast cancer - Data from the real world breast cancer registry PRAEGNANT (NCT02338167). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:
This analysis describes comprehensive real-world data concerning the use of anti-HER2 therapies in HER2 positive metastatic breast cancer (MBC). Specifically, it describes the therapy patterns of treatments with trastuzumab (TZM), pertuzumab+trastuzumab (PTZ/TZM), lapatinib (LAP) and trastuzumab emtansine (T-DM1).
Methods:
The PRAEGNANT study is a real-time, real-world registry for patients with MBC. Patients can be registered for PRAEGNANT at any time during the course of their metastatic disease and are followed up until death. All therapy lines are documented. This analysis presents the utilization of anti-HER2 therapies as well as therapy sequences.
Results:
Of 1936 patients within PRAEGNANT at the time of database closure 451 were HER2 positive (23.3%). Within the analysis set (417 patients after an unilateral breast cancer diagnosis), of which 53% were included in PRAEGNANT in the 1stline setting, 241 were treated with TZM (58%), 237 with PTZ (57%), 85 with LAP (20%) and 125 with T-DM1 (30%) during the course of their therapies. The sequence PTZ/TZMàT-DM1 was given to 51 patients (12%). Worse ECOG, negative hormone receptor status, and visceral or brain metastases were associated with a more frequent use of this therapy sequence. Most patients received T-DM1 after a therapy with pertuzumab.
Conclusions:
Both novel therapies (PTZ/TZM and T-DM1) are utilized in a high proportion of HER2 positive breast cancer patients. As most patients receive T-DM1 after pertuzumab real world data might help to understand whether this sequence has similar efficacy like in the approval study.
Citation Format: Lux MP, Hartkopf AD, Huober J, Volz B, Taran F-A, Overkamp F, Hadji P, Tesch H, Haeberle L, Ettl J, Lueftner DI, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Fasching PA, Janni W, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A, Kolberg H-C. Therapy landscape of patients with metastatic, HER2 positive breast cancer - Data from the real world breast cancer registry PRAEGNANT (NCT02338167) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-37.
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Affiliation(s)
- MP Lux
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - AD Hartkopf
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Huober
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - B Volz
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - F-A Taran
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - F Overkamp
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - P Hadji
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - H Tesch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - L Haeberle
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Ettl
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - DI Lueftner
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - V Müller
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - MW Beckmann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - E Belleville
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - P Wimberger
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Hielscher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Geberth
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Lermann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - W Abenhardt
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Kurbacher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - R Wuerstlein
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Thomssen
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Untch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - PA Fasching
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - W Janni
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - TN Fehm
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - D Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - SY Brucker
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - A Schneeweiss
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - H-C Kolberg
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
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Schneeweiss A, Lux MP, Hartkopf AD, Volz B, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Lüftner DI, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Overkamp F, Huober J, Taran FA, Janni W, Wallwiener D, Brucker SY, Fasching PA, Fehm TN. Abstract P6-17-22: Progression free survival (PFS) and overall survival (OS) of patients treated with trastuzumab emtansine (T-DM1) after previous treatment with pertuzumab in patients with advanced breast cancer (NCT02338167). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Studies leading to the approval of trastuzumab emtansine (T-DM1) have been conducted without pertuzumab as previous therapy. Therefore data about patient characteristics and the efficacy of T-DM1 after a treatment with pertuzumab is scarce. Aim of this study was to analyze a real world patient cohort of advanced breast cancer (aBC) patients, who were treated with T-DM1 after a treatment containing pertuzumab in the metastatic setting with regard to patient characteristics and progression free survival (PFS).
Methods
The PRAEGNANT metastatic breast cancer registry (NCT02338167) is a prospective registry for metastatic breast cancer patients with focus on molecular biomarkers. Patients of all therapy lines with any kind of treatment are eligible for this registry. Collected data comprises all relevant patient and tumor characteristics, therapies, adverse events, quality of life, patient reported outcomes, response and survival (PFS/OS). Here we report on the patient characteristics and PFS data for HER2 positive patients treated with T-DM1 after a treatment with pertuzumab. Patients had to be included before or at the beginning of the T-DM1 therapy.
Results
A total of 58 patients could be identified, who were suitable for the analysis. Of those 34 were treated in the second line, 14 in the third line and 10 in the fourth line or higher. Most of the pertuzumab therapies before T-DM1 were conducted in first line (n=46; 79.3%). Median PFS for all patients was 4.8 months (95% CI: 3.0-7.8 months). Median PFS for patients treated in the 3rdline and 4thline or higher was 4.2 months(95%CI: 2.3 - NA) and 4.0 months (95%CI: 1.8-N.A.), respectively. In patients treated 2ndline with T-DM1 PFS was 7.7 months (95%CI: 2.8 – 12.2).
Conclusion
T-DM1 is effective as 2ndand further line therapy following pretreatment with pertuzumab. Overall PFS was about 5 months with 7.7 months as 2nd-line therapy. The PFS in higher therapy lines might be shorter. As the sample size of this real world cohort was rather low and analyses have to be considered exploratory, this data need to be confirmed in studies with a larger sample size.
Citation Format: Schneeweiss A, Lux MP, Hartkopf AD, Volz B, Kolberg H-C, Hadji P, Tesch H, Haeberle L, Ettl J, Lüftner DI, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Overkamp F, Huober J, Taran F-A, Janni W, Wallwiener D, Brucker SY, Fasching PA, Fehm TN. Progression free survival (PFS) and overall survival (OS) of patients treated with trastuzumab emtansine (T-DM1) after previous treatment with pertuzumab in patients with advanced breast cancer (NCT02338167) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-22.
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Affiliation(s)
- A Schneeweiss
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - MP Lux
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - AD Hartkopf
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - B Volz
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - H-C Kolberg
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - P Hadji
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - H Tesch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - L Haeberle
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - J Ettl
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - DI Lüftner
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - M Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - V Müller
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - MW Beckmann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - E Belleville
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - P Wimberger
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - C Hielscher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - M Geberth
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - J Lermann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - W Abenhardt
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - C Kurbacher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - R Wuerstlein
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - C Thomssen
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - M Untch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - F Overkamp
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - J Huober
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - F-A Taran
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - W Janni
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - D Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - SY Brucker
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - PA Fasching
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - TN Fehm
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
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19
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Kendler DL, Body JJ, Brandi ML, Broady R, Cannata-Andia J, Cannata-Ortiz MJ, El Maghraoui A, Guglielmi G, Hadji P, Pierroz DD, de Villiers TJ, Rizzoli R, Ebeling PR. Bone management in hematologic stem cell transplant recipients. Osteoporos Int 2018; 29:2597-2610. [PMID: 30178158 DOI: 10.1007/s00198-018-4669-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 08/13/2018] [Indexed: 12/13/2022]
Abstract
Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for patients with some malignant and non-malignant hematological diseases. Advances in transplantation techniques and supportive care measures have substantially increased the number of long-term HSCT survivors. This has led to an increasing patient population suffering from the late effects of HSCT, of which, bone loss and its consequent fragility fractures lead to substantial morbidity. Altered bone health, with consequent fragility fractures, and chronic graft-versus-host disease (GVHD) are factors affecting long-term quality of life after HSCT. Hypogonadism, HSCT preparative regimens, nutritional factors, and glucocorticoids all contribute to accelerated bone loss and increased fracture risk. Management strategies should include bone mineral density examination, evaluation of clinical risk factors, and general dietary and physical activity measures. Evidence has accumulated permitting recommendations for more attentiveness to evaluation and monitoring of bone health, with appropriate application of osteoporosis pharmacotherapies to patients at increased risk of bone loss and fracture.
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Affiliation(s)
- D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, 150 - 943 W. Broadway, Vancouver, V5Z 4E1, Canada.
| | - J J Body
- CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M L Brandi
- Mineral and Bone Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - R Broady
- Department of Medicine, Division of Hematology, University of British Columbia, Vancouver, Canada
| | - J Cannata-Andia
- Servicio de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - M J Cannata-Ortiz
- Haematology Department, IIS Princesa, Hospital de la Princesa, Madrid, Spain
| | - A El Maghraoui
- Rheumatology Department, Military Hospital Mohammed V, Mohammed V-Souissi University, Rabat, Morocco
| | - G Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nord West Hospital, Frankfurt, Germany
| | - D D Pierroz
- International Osteoporosis Foundation (IOF), Nyon, Switzerland
| | - T J de Villiers
- Department of Gynaecology, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Mediclinic Panorama, Cape Town, South Africa
| | - R Rizzoli
- Division of Bone Diseases, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland
| | - P R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
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20
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Kyvernitakis I, Kostev K, Hadji P. The tamoxifen paradox-influence of adjuvant tamoxifen on fracture risk in pre- and postmenopausal women with breast cancer. Osteoporos Int 2018; 29:2557-2564. [PMID: 30032359 DOI: 10.1007/s00198-018-4642-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED Our data demonstrate that tamoxifen does not reduce fracture risk. Close surveillance is necessary to prevent bone loss in premenopausal women with breast cancer upon treatment initiation. INTRODUCTION Endocrine treatment of breast cancer may interfere with bone turnover and influence fracture risk. METHODS Out of a cohort of almost 5 million patients in total, we identified 5520 women between 18 and 90 years of age with breast cancer receiving tamoxifen, matched them with 5520 healthy controls using the Disease Analyzer Database, and investigated the fracture risk. RESULTS We found a cumulative incidence of fractures of 6.3% in patients aged between 18 and 50 years (n = 3634) treated with tamoxifen versus a cumulative incidence of 3.6% in the control group (p < 0.001). As such, the risk of fracture was 75% higher for patients receiving tamoxifen than that for healthy controls (HR 1.75; 95% CI 1.25-2.48). With regard to patients aged between 55 and 90 years (n = 7406), the cumulative incidence of fractures in patients treated with tamoxifen was 10.1% compared to 9.3% in the control group (p = 0.740), i.e., there was no significant difference between the two groups (HR 0.97; 95% CI 0.81-1.16). CONCLUSIONS Compared to healthy controls, premenopausal women with breast cancer treated with tamoxifen showed an increased risk of fracture, while postmenopausal women on tamoxifen did not show any risk reduction.
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Affiliation(s)
- I Kyvernitakis
- Department of Obstetrics and Gynecology, Buergerhospital and Clementine Kinderhospital Frankfurt, Nibelungenallee 37-41, 60318, Frankfurt, Germany.
- Dr. Senckenberg Foundation and Goethe-University of Frankfurt, Frankfurt, Germany.
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - K Kostev
- Epidemiology, IQVIA, Frankfurt, Germany
| | - P Hadji
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
- Department of Bone Oncology, Gyn. Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt, Germany
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21
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Hadji P, Neulen J, Schaudig K, Schwenkhagen A, Dakovic R, Grimmbacher S, Munzel U, Wiegratz I. Wirksamkeit und Sicherheit von Ethinylestradiol (30 µg) und Levonorgestrel (150 µg) als Langzyklus-Regime vs. konventionellem Zyklus-Regime in der oralen Kontrazeption. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1670980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- P Hadji
- Nordwest Krankenhaus, Osteoporosezentrum, Frankfurt am Main, Deutschland
| | - J Neulen
- Uniklinik RWTH Aachen, Klinik für gynäkologische Endokrinologie und Reproduktionsmedizin, Aachen, Deutschland
| | | | | | - R Dakovic
- Meda Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Deutschland
| | - S Grimmbacher
- Meda Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Deutschland
| | - U Munzel
- Meda Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Deutschland
| | - I Wiegratz
- VivaNeo Kinderwunschpraxis Frankfurt, Frankfurt am Main, Deutschland
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22
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Thomasius F, Baum E, Bernecker P, Böcker W, Brabant T, Clarenz P, Demary W, Dimai HP, Engelbrecht M, Engelke K, Fratermann U, Grieser T, Gulich M, Hadji P, Henning J, Jehle PM, Kern PM, Ketteler M, Klatt G, Kraenzlin M, Maus U, Meier C, Moser U, Müller D, Peichl P, Pfeifer M, Rintelen B, Rueger JM, Schober HC, Schöffel D, Schwarz H, Siggelkow H, Suhm N, Wiese KG, Wörtler K, Kurth AA. DVO Leitlinie 2017 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und Männern. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1673537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDiese DVO Leitlinien, die in erster Linie für Allgemeinmediziner und Spezialisten für Knochenerkrankungen bestimmt sind, sollten von allen im klinischen und ambulanten Bereich tätigen medizinischen Fachkräften angewendet werden. Ziel der Leitlinie ist die Verbesserung der Diagnose, Prävention und Behandlung von Osteoporose und der Folgen der Erkrankung auf der Grundlage evidenzbasierter Medizin.Klare Empfehlungen, welche Patienten zu diagnostizieren und behandeln sind (basierend auf Risikofaktoren [einschließlich sekundärer Osteoporose]) sowie Primär-, Sekundär- oder Tertiärprävention werden dargestellt, mit dem Schwerpunkt auf der postmenopausalen Osteoporose und der Osteoporose bei Männern.Die Identifizierung von Patienten mit einem hohen Risiko für Frakturen wird hervorgehoben, und spezifische Schwellenwerte für die Intervention sind definiert (20 % Hüftfrakturrisiko innerhalb von 10 Jahren diagnostischer Schwellenwert, 30 % Hüftfrakturrisiko innerhalb von 10 Jahren therapeutische Schwelle). Die Diagnose von Osteoporose basiert auf der Anamnese des Patienten, der körperlichen Untersuchung, dem Funktionstest (z. B. Timed Up and Go Test), konventionellen Röntgenaufnahmen der Brust- und Lendenwirbelsäule und der Bestimmung der Knochenmineraldichte (BMD) durch das DXA Verfahren.Die Anamnese ist entscheidend für die Abschätzung des Frakturrisikos auf der Grundlage von 40 wissenschaftlich überprüften Risikofaktoren, die das Frakturrisiko mindestens verdoppeln (z. B. Begleiterkrankungen, Hüftfrakturen in der Familie, prävalente Frakturen an jedem Ort, Lebensstil, Anwendung von Medikamenten, körperliche Aktivität und Stürze). Röntgenaufnahmen der Brust- und Lendenwirbelsäule sind wichtig, um prävalente Wirbelkörperfrakturen zu erkennen. Beim Fehlen eines großen Traumas kann jede Fraktur bei Erwachsenen über dem Alter von 50 Jahren eine Diagnose von Osteoporose nahelegen, mit dem höchsten Risiko für eine nachfolgende Fraktur innerhalb einer kurzen Zeit nach der ersten Fraktur. BMD-Messungen mit DXA sind wichtig, um das individuelle Frakturrisiko besser abschätzen zu können. Eine grundlegende Laboruntersuchung ist obligatorisch, um verschiedene Formen der sekundären Osteoporose ausschließen zu können.Der DVO-Patientenfindungs-Algorithmus basiert auf dem Geschlecht, Alter, Knochenmineraldichte und vorbestehenden Frakturen als wichtigste Informationen. Die Indikation für eine aktive anti-osteoporotische Therapie kann durch multiple Risikofaktoren modifiziert und verfeinert werden. Dieser Algorithmus wurde seit dem Richtlinien-Update 2006 verwendet und wurde entsprechend der internationalen Literatur zu Risikofaktoren für Osteoporose und osteoporotische Frakturen aktualisiert und angepasst.Die Behandlung der Osteoporose enthält viele Therapiepfeiler. Zusammen mit Empfehlungen für Bewegung, Physiotherapie und Sturzprävention sowie Ernährung (z. B. Calcium, Vit. D), werden pharmakologische Behandlungen basierend auf evidenzbasierter Medizin empfohlen. Die aktiven Anti-Osteoporose-Medikamente müssen für die Indikation postmenopausale Osteoporose und männliche Osteoporose in Deutschland, Österreich und der Schweiz zugelassen sein. Das Management und die Vorbeugung von häufigen oder seltenen Nebenwirkungen aufgrund von Anti-Osteoporose-Behandlungen, die in der klinischen Praxis angewendet werden, werden ebenfalls detailliert behandelt.
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23
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Nabieva N, Fehm T, Häberle L, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Popovic M, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauss T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Hack CC, Schmidt K, Belleville E, Brucker SY, Kümmel S, Beckmann MW, Wallwiener D, Hadji P, Fasching PA. Influence of side-effects on early therapy persistence with letrozole in post-menopausal patients with early breast cancer: Results of the prospective EvAluate-TM study. Eur J Cancer 2018; 96:82-90. [PMID: 29679775 DOI: 10.1016/j.ejca.2018.03.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endocrine treatment (ET) with an aromatase inhibitor (AI) is the treatment of choice in post-menopausal patients with hormone receptor-positive early breast cancer (EBC). However, adverse events (AEs) often lead to treatment discontinuation. This analysis aimed to identify side-effects that lead to patients failing to persist with letrozole treatment. PATIENTS AND METHODS Post-menopausal hormone receptor-positive EBC patients starting ET with letrozole were enroled in EvAluate-TM, a non-interventional study. Information regarding treatment compliance and persistence was gathered in months 6 and 12. Persistence was defined as the time from 30 d after the start to the end of treatment. The influence on persistence of musculoskeletal syndrome, menopausal disorder, sleep disorder and other AEs within the first 30 d was analysed using Cox regression analyses. RESULTS Among 3887 patients analysed, the persistence rate after 12 months was >85%. In all, 568 patients (14.6%) discontinued the treatment, 358 of whom (63.0%) did so only because of side-effects. The main AEs influencing persistence were musculoskeletal symptoms (hazard ratio [HR] 2.55; 95% confidence interval [CI], 1.90-3.42), sleep disorders (HR 1.95; 95% CI, 1.41-2.70) and other AEs (HR 2.03; 95% CI, 1.51-2.73). Menopausal disorder was not associated with non-persistence (HR 1.17; 95% CI, 0.74-1.84). CONCLUSIONS These results suggest that side-effects of AIs such as musculoskeletal syndrome and sleep disorder lead to ET discontinuation within the first treatment year in significant numbers of EBC patients. Compliance programmes adapted for subgroups that are at risk for early non-persistence might help to ensure the recommended therapy duration. CLINICAL TRIALS NUMBER CFEM345DDE19.
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Affiliation(s)
- N Nabieva
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - L Häberle
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - J de Waal
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - M Rezai
- Luisen-Hospital Düsseldorf, Düsseldorf, Germany
| | - B Baier
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | | | | | - M Warm
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; Breast Center, Clinics of Cologne GmbH, Holweide, Cologne, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - R Wuerstlein
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - J-U Deuker
- Vinzenz-Hospital Hannover GmbH, Hannover, Germany
| | - P Dall
- Department of Gynecology, Lüneburg Clinic, Lüneburg, Germany
| | - B Richter
- Elbland Clinics, Meissen-Radebeul, Germany
| | - G Wachsmann
- County Hospital of Böblingen, Böblingen, Germany
| | - C Brucker
- Department of Gynecology, University Hospital, Paracelsus Private Medical University of Nuremberg, Nuremberg, Germany
| | - J W Siebers
- Department of Gynecology, St. Josef's Hospital, Offenburg, Germany
| | - M Popovic
- Department of Gynecology, Bayreuth Clinic GmbH, CCC ER-EMN, Bayreuth, Germany
| | - T Kuhn
- Karl-Olga-Hospital Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - C Wolf
- Medical Center Ulm, Ulm, Germany
| | - H-W Vollert
- Friedrichshafen Clinic, Friedrichshafen, Germany
| | - G-P Breitbach
- Department of Gynecology, Neunkirchen Clinic, Neunkirchen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - R Landthaler
- Gynecological Medical Practice of the County Hospital of Krumbach, Krumbach, Germany
| | - A Kohls
- Evangelic County Hospital Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - D Rezek
- Marien-Hospital Wesel, Wesel, Germany
| | - T Noesselt
- Department of Gynecology of the County Hospital of Hameln, Hameln, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - S Henschen
- Johanniter Hospital Genthin Stendal gGmbH, Hansestadt Stendal, Germany
| | - T Praetz
- Caritas-Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - V Heyl
- Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - T Kühn
- Department of Gynecology, Esslingen Clinics a.N., Esslingen, Germany
| | - T Krauss
- Department of Gynecology Passau, Passau, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - A Hohn
- County Hospital Kiel GmbH, Kiel, Germany
| | - H Tesch
- Oncology Bethanien Frankfurt, Frankfurt, Germany
| | - C Mundhenke
- Department of Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Hein
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C C Hack
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - K Schmidt
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | | | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - S Kümmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - M W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - D Wallwiener
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - P Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - P A Fasching
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
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Huober J, Fasching PA, Taran FA, Volz B, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lueftner D, Wallwiener M, Mueller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Wallwiener D, Brucker SY, Schneeweiss A, Fehm TN. Abstract P3-11-07: Factors associated with first line chemotherapy use in patients with hormone receptor positive, HER2 negative metastatic breast cancer – data from the PRAEGNANT breast cancer registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-11-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
For breast cancer patients with metastases which are not life threatening national and international guidelines recommend the exhaustion of all antihormonal therapeutic options before recommending chemotherapy. In Germany up to now only everolimus was an additional option to overcome endocrine resistance. CDK4/6 inhibitors recently became available in Germany (Nov 2011). Aim of this analysis was the identification of predictors for a decision against an antihormonal treatment.
Methods
The PRAEGNANT metastatic breast cancer registry (NCT02338167) is a prospective registry for metastatic breast cancer patients. Besides biomarker research the description of real-world treatment data was one of the main study aims. This analysis was restricted to first line metastatic patients who were hormone receptor (HR) positive and HER2 negative. First, predictors were identified with a multiple logistic regression model. Then patients, who received chemo or not ,were compared with regard to overall survival using Cox regression analysis with the predictors for chemotherapy from above and additionally chemo status (yes/no)
Results
A total of 389 HR-positive and HER2-negative patients with detailed treatment information were included during the 1st line therapy into PRAEGNANT. Of those 173 (44.5%) received a chemotherapy, 190 an antihormone therapy (AHT) (48.8%), and 26 (6.7%) everolimus+AHT. In the multiple logistic regression model, older patients, lower graded tumors, bone only disease and previous adjuvant chemotherapy were associated with a lower rate of first line chemotherapies. BMI and number of concomitant diseases had no influence on the choice of first line metastatic therapy. In patients with visceral metastases 58.1% were treated with a 1st line chemo, while in patients with brain metastases or bone only metastases these numbers were 55.6% and 26.9%. Grading had an influence with patients having a G1, G2 and G3 tumor receiving 1st line chemo in 28.0%, 38.4% and 63.2% of the cases respectively. Patients who received chemo seemed to have a worse overall survival than patients who did not receive chemo (adjusted HR 1.58; 95% CI, 0.89 to 2.18). However, this result was not signifcant (p = 0.12). Overall survival was primarily influenced by ECOG and location of metastasis
Conclusion
The usage of chemotherapy can be predicted with age, metastasis pattern, grading and previous use of chemotherapy. However, we could not show that patients benefited from chemotherapy. On contrary, there was a tendency that patients treated with chemotherapy had poorer overall survival. Further studies with larger sample sizes are needed to confirm this claim.
Citation Format: Huober J, Fasching PA, Taran F-A, Volz B, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lueftner D, Wallwiener M, Mueller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Wallwiener D, Brucker SY, Schneeweiss A, Fehm TN. Factors associated with first line chemotherapy use in patients with hormone receptor positive, HER2 negative metastatic breast cancer – data from the PRAEGNANT breast cancer registry [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-11-07.
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Affiliation(s)
- J Huober
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - PA Fasching
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - F-A Taran
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - B Volz
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - F Overkamp
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - HC Kolberg
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - P Hadji
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - H Tesch
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - L Haeberle
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - J Ettl
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - AD Hartkopf
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - MP Lux
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - D Lueftner
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - M Wallwiener
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - V Mueller
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - MW Beckmann
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - E Belleville
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - P Wimberger
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - C Hielscher
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - M Geberth
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - N Fersis
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - W Abenhardt
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - C Kurbacher
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - R Wuerstlein
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - C Thomssen
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - M Untch
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - W Janni
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - D Wallwiener
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - SY Brucker
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - A Schneeweiss
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - TN Fehm
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
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Szeto C, Benz S, Nguyen A, Rübner M, Wallwiener D, Tesch H, Hadji P, Fehm TN, Janni W, Overkamp F, Lueftner D, Lux MP, Wallwiener M, Beckmann MW, Huebner H, Ettl J, Hartkopf AD, Mueller V, Taran FA, Belleville E, Schneeweiss A, Soon-Shiong P, Rabizadeh S, Fasching PA. Abstract P1-07-20: Developing prognostic indicators of poor outcomes in PRAEGNANT metastatic breast cancer cohort. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Despite novel, targeted therapies, metastatic breast cancer patients have an extremely unfavourable prognosis. Prognostic and predictive factors for patients with advanced breast cancer are not well understood. Molecular assessment of the patient and the tumor in the metastatic situation is not routinely performed despite advances in molecular precision medicine indicating great benefit to this patient group. Here we present early findings from the first 142 patients of a prospective molecular breast cancer registry with completed transcriptomic profiling.
Methods: The PRAEGNANT study proctocol (NCT02338767) is a molecular registry designed to provide an infrastructure for the real-time comprehensive analysis of tumor and patient molecular characteristics under study conditions. Formalin fixed paraffin embedded tumors have been used from this registry to identify molecular, transcriptomic predictors for overall survival (OS).
Known clinical correlates for OS (e.g. hormone-receptor status, age at diagnosis, and BMI) were analyzed by Cox proportional hazard ratios, and compared to transcriptomic markers of outcomes. Transcriptomes for all patient tumors were sequenced on the Illumina sequencing platform, and analyzed by RSEM to estimate transcripts per million (TPM) values for each gene isoform. Log-TPM values were used in established (PAM50) and novel (hierarchical clustering) expression-based subtyping of tumor samples. Expression-based subtypes were demonstrated to be strong prognostic indicators by Cox analysis. A Lasso regression machine learning algorithm was used to develop an expression-based predictive model of OS.
Results: Hormone receptor positivity (HR=0.7, p<0.006) and TNBC status (HR=1.4, p<0.01) were significantly associated with outcomes. PAM50 subtypes were also strong indicators of outcomes (e.g. Basal disease compared to Luminal-A subtype has HR=1.4, p<0.017). A novel expression-based high-risk cluster in this cohort was more indicative of poor prognosis than clinical variates or Basal-type, with a HR=2.7 (p<0.009) when compared to Luminal-A subtype. An expression-based survival prediction model achieved a concordance-index of 0.65 in an unseen validation cohort. Patients predicted as having the shortest survival times were in the high-risk cluster.
Conclusions: Here we demonstrate using molecular profiling to develop prognostic signatures that out-perform standard clinical correlates of poor outcomes, even in a small subset of the total cohort. As the PRAEGNANT cohort expands these prognostic tools will continue to improve and supplement physician knowledge to improve patient outcomes.
Citation Format: Szeto C, Benz S, Nguyen A, Rübner M, Wallwiener D, Tesch H, Hadji P, Fehm TN, Janni W, Overkamp F, Lueftner D, Lux MP, Wallwiener M, Beckmann MW, Huebner H, Ettl J, Hartkopf AD, Mueller V, Taran FA, Belleville E, Schneeweiss A, Soon-Shiong P, Rabizadeh S, Fasching PA. Developing prognostic indicators of poor outcomes in PRAEGNANT metastatic breast cancer cohort [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-20.
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Affiliation(s)
- C Szeto
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - S Benz
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - A Nguyen
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - M Rübner
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - D Wallwiener
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - H Tesch
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - P Hadji
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - TN Fehm
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - W Janni
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - F Overkamp
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - D Lueftner
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - MP Lux
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - M Wallwiener
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - MW Beckmann
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - H Huebner
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - J Ettl
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - AD Hartkopf
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - V Mueller
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - FA Taran
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - E Belleville
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - A Schneeweiss
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - P Soon-Shiong
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - S Rabizadeh
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - PA Fasching
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
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Taran FA, Fasching PA, Volz B, Huober J, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Lux MP, Hartkopf AD, Lueftner D, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A. Abstract P5-21-09: Overall survival of metastatic breast cancer patients – data from the PRAEGNANT breast cancer registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-21-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Breast Cancer registries can help to understand how patient groups are treated outside clinical trials and what outcome is to expected for specific patient groups and therapy lines, which are not included into clinical trials. Here we present overall survival data according to therapy lines, patient and tumor characteristics.
Methods
The PRAEGNANT metastatic breast cancer registry (NCT02338167) is a prospective registry for breast cancer patients with focus on molecular biomarkers. Patients of all therapy lines with any kind of treatment are eligible for this registry. Collected data comprises therapies, adverse events, quality of life and other patient reported outcomes. Here we report on the comparison of overall survival data for different patient groups. For that analysis was restricted to patients included in the first therapy line for subgroup comparisons. Only for the analysis of the effect of therapy line on overall survival the complete dataset was used.
Results
A total of 1854 patients took part in this analysis. Of those 1016 were included first line, and 340, 213 and 285 patients 2nd line, 3rd lin4 and 4th line or higher respectively. A total of 339 deaths were observed. Two year survival rates (2Y-OS) for these groups were 75%, 65%, 57% and 36% (p(log-rank)<0.001). All further analyses were done only for the subset of first line treated patients with a total of 127 events. HER2 positive patients had the highest 2Y-OS rate of 84% and TNBC had the worst with 60% (see figure 1). Absolute numbers of deaths for TNBC, luminal A like, luminal B like and HER2 posives were 21, 48, 25, and 21. According to metastastic pattern the following survival rates were seen: brain (48%), other locations (69%), visceral (78%) and bone only (81%). ECOG was another factor that had a large influence on OS with ECOG 0: 83%, ECOG 1: 67% and EGOG 2+: 63% 2Y-OS. Age, BMI, number of concomitant diseases, and primary metastatic status did not have an influence on 2Y-OS.
Conclusion
This breast registry included patients over all therapy lines however mainly during the 1st line of therapy. Simple patient and tumor characteristics can classify patients into patients with differently favourable prognosis. Patients with HER2 positive disease had the best overall survival, while TNBC and luminal B like patients had the worst prognosis. As most of the patients were luminal A like 43% of all deaths occured within the group of luminal A like patients, which will need further focus for therapy development in the future.
Citation Format: Taran F-A, Fasching PA, Volz B, Huober J, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Lux MP, Hartkopf AD, Lueftner D, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A. Overall survival of metastatic breast cancer patients – data from the PRAEGNANT breast cancer registry [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-21-09.
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Affiliation(s)
- F-A Taran
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - PA Fasching
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - B Volz
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - J Huober
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - F Overkamp
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - HC Kolberg
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - P Hadji
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - H Tesch
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - L Haeberle
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - J Ettl
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - MP Lux
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - AD Hartkopf
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - D Lueftner
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - M Wallwiener
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - V Müller
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - MW Beckmann
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - E Belleville
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - P Wimberger
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - C Hielscher
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - M Geberth
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - N Fersis
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - W Abenhardt
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - C Kurbacher
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - R Wuerstlein
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - C Thomssen
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - M Untch
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - W Janni
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - TN Fehm
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - D Wallwiener
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - SY Brucker
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - A Schneeweiss
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
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Wallwiener M, Nabieva N, Haeberle L, Taran FA, Hartkopf AD, Volz B, Overkamp F, Brandl AL, Kolberg HC, Hadji P, Tesch H, Ettl J, Lux MP, Lueftner D, Belleville E, Fasching PA, Janni W, Beckmann MW, Wimberger P, Hielscher C, Fehm T, Brucker SY, Wallwiener D, Schneeweiss A, Mueller V. Abstract P6-11-10: Impact of disease progression on health-related quality of life in patients with metastatic breast cancer in the PRAEGNANT breast cancer registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-11-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Improved progression-free survival is considered as treatment goal for patients with metastatic breast cancer (MBC) since it is assumed to delay or prevent deterioration of quality of life.Aim of our analysis was to examine the influence of disease progression on health-related quality of life (HRQoL).
Methods: The PRAEGNANT study comprises a real-life registry for patients with MBC. HRQoL was assessed with the EORTC-QLQ-C30 Version 3.0 questionnaire at study entry and every 3 months thereafter. The primary endpoint was minimally important deterioration (MID) in global HRQoL score by ≥ five points between baseline and any follow-up assessment. A logistic regression model was built with MID (yes/no) at a follow-up timepoint as outcome variable and several covariates as predictors.
Results: In total, 329 patients were included in this analysis, with disease progression in 63 patients. Concerning the primary study aim, progression status predicted MID of global HRQoL status in addition to the other covariates. The adjusted odds ratio for the effect of progression status on MID was 2.22 (95% CI: 1.04 – 4.73). Comparisons of mean differences of QoL domains/scales yielded no differences.
Conclusions: We provide evidence that disease progression in patients with metastatic breast cancer in a real-world registry has a significant negative impact on HRQoL as measured by MID of HRQoL. This study emphasizes the relevance of avoiding progression and prolonging PFS to maintain QoL.
Citation Format: Wallwiener M, Nabieva N, Haeberle L, Taran FA, Hartkopf AD, Volz B, Overkamp F, Brandl AL, Kolberg H-C, Hadji P, Tesch H, Ettl J, Lux MP, Lueftner D, Belleville E, Fasching PA, Janni W, Beckmann MW, Wimberger P, Hielscher C, Fehm T, Brucker SY, Wallwiener D, Schneeweiss A, Mueller V. Impact of disease progression on health-related quality of life in patients with metastatic breast cancer in the PRAEGNANT breast cancer registry [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-10.
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Affiliation(s)
- M Wallwiener
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - N Nabieva
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - L Haeberle
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - FA Taran
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - AD Hartkopf
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - B Volz
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - F Overkamp
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - AL Brandl
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - H-C Kolberg
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - P Hadji
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - H Tesch
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - J Ettl
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - MP Lux
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - D Lueftner
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - E Belleville
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - PA Fasching
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - W Janni
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - MW Beckmann
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - P Wimberger
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - C Hielscher
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - T Fehm
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - SY Brucker
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - D Wallwiener
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - A Schneeweiss
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - V Mueller
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
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28
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Kyvernitakis I, Reuter TC, Hellmeyer L, Hars O, Hadji P. Subsequent fracture risk of women with pregnancy and lactation-associated osteoporosis after a median of 6 years of follow-up. Osteoporos Int 2018; 29:135-142. [PMID: 28965212 DOI: 10.1007/s00198-017-4239-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/21/2017] [Indexed: 12/22/2022]
Abstract
Almost a quarter of patients with PAO will sustain a subsequent fracture; patients need to be informed about potential risks before deciding for further pregnancies. INTRODUCTION Pregnancy and lactation-associated osteoporosis (PAO) is a severe type of premenopausal osteoporosis which predominantly occurs in the last trimester of pregnancy or immediately postpartum. Long-term follow-up data including subsequent fracture risk have yet to be reported. METHODS This single-center prospective cohort study investigated the subsequent fracture risk of all 107 patients with PAO who were referred to our institution. RESULTS Overall, 107 presented with at least one fracture. Each patient sustained on average four fractures most commonly at the thoracolumbar spine. During a median of 6 years of follow-up, 26 (24.3%) of patients who had a fracture at baseline reported a subsequent fracture. Overall, 30 PAO patients (28%) reported a further pregnancy. In subsequent pregnancies, 6 (20%) of patients reported a subsequent fracture. Patients with up to 1 vs. > 1 fracture at time of diagnosis showed a 3 (10%) and 25 (27%) subsequent fracture rate, respectively (p = 0.047). There was a significant correlation between the number of fractures at time of diagnosis and subsequent fracture risk (N = 26,p= 0.56, p = 0.003). CONCLUSIONS Almost a quarter of patients with PAO will sustain a subsequent fracture, and this fracture risk correlates with the number of fractures at time of diagnosis. Patients with PAO need to be informed about their potential subsequent fracture risk before deciding for further pregnancies.
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Affiliation(s)
- I Kyvernitakis
- Department of Obstetrics and Gynecology, Buergerhospital and Clementine Kinderhospital Frankfurt, Goethe-University of Frankfurt, Nibelungenallee 37-41, 60318, Frankfurt a.M., Germany.
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - T C Reuter
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - L Hellmeyer
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
- Department of Obstetrics and Gynecology, Vivantes Klinikum Berlin, Berlin, Germany
| | - O Hars
- Stastistical Institute, Berlin, Germany
| | - P Hadji
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
- German Reference Centre for Pregnancy-Associated Osteoporosis, Department of Osteoporosis, Endocrinology and Reproductive Medicine, Frankfurt, Germany
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29
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Kanis JA, Cooper C, Rizzoli R, Abrahamsen B, Al-Daghri NM, Brandi ML, Cannata-Andia J, Cortet B, Dimai HP, Ferrari S, Hadji P, Harvey NC, Kraenzlin M, Kurth A, McCloskey E, Minisola S, Thomas T, Reginster JY. Erratum to: Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int 2017; 28:3285-3286. [PMID: 28785979 PMCID: PMC6829798 DOI: 10.1007/s00198-017-4161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J A Kanis
- Centre forMetabolic Bone Diseases, University of SheffieldMedical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia.
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - B Abrahamsen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - N M Al-Daghri
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - M L Brandi
- Department of Surgery and Translational Medicine, Unit of Bone and Mineral Diseases, University of Florence, Florence, Italy
| | - J Cannata-Andia
- Bone and Mineral Research Unit, Instituto "Reina Sofía" de Investigación, REDinREN ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Asturias, Spain
| | - B Cortet
- Department of Rheumatology, Lille University Hospital, Lille, France
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - S Ferrari
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Krankenhaus Nordwest, Frankfurt, Germany
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - M Kraenzlin
- Endonet, Endocrine Clinic and Laboratory, Basel, Switzerland
| | - A Kurth
- Department of Orthopaedic Surgery and Osteology, Klinikum Frankfurt, Frankfurt, Germany
- Mayor Teaching Hospital, Charitè Medical School, Berlin, Germany
| | - E McCloskey
- Centre forMetabolic Bone Diseases, University of SheffieldMedical School, Beech Hill Road, Sheffield, S10 2RX, UK
- MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - S Minisola
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Università di Roma, Rome, Italy
| | - T Thomas
- INSERM U1059, Laboratoire Biologie Intégrée du Tissu Osseux, Rheumatology Department, CHU Saint-Etienne, Université de Lyon, Saint-Etienne, France
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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30
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Dombrowski S, Jacob L, Hadji P, Kostev K. Oral contraceptive use and fracture risk-a retrospective study of 12,970 women in the UK. Osteoporos Int 2017; 28:2349-2355. [PMID: 28409216 DOI: 10.1007/s00198-017-4036-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/31/2017] [Indexed: 01/01/2023]
Abstract
UNLABELLED In the present retrospective case-control study, we compared 6485 women with fractures and 6485 women without fractures from 135 general practitioner offices in the UK. Women without bone fractures were statistically more likely to have been exposed to oral contraception, depending on their age and therapy duration. INTRODUCTION The aim of this analysis was to compare the risk of bone fracture in women using hormonal contraception with that in women who have never used hormonal contraception. METHODS A total of 6485 women (mean age 37.8 years) with an initial diagnosis of fracture between January 2010 and December 2015 were identified in 135 doctors' offices in the UK Disease Analyzer database. In this nested case-control study, each case with a fracture was matched (1:1) to a control without a fracture for age, index year, and follow-up time. In total, 12,970 individuals were available for analysis. The main outcome of the study was the risk of fracture as a function of combined oral contraceptive (OC) therapy. Multivariate logistic regression models were used to determine the effect of OC therapy and its duration on the risk of fracture in the entire population and in four age-specific subgroups. RESULTS Women without bone fractures were significantly more likely to have used oral contraception (OR 0.81). The usage of oral contraception was associated with a significantly lower risk of bone fracture (OR 0.81, 95% CI 0.74-0.90). This effect was strongest in the age groups 18-25 and 26-35 and in patients with an OC treatment duration of more than 1 year. CONCLUSIONS The present study revealed that women without bone fractures were significantly more likely to have had exposure to combined oral contraception, especially where the duration of intake was at least 5 years.
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Affiliation(s)
- S Dombrowski
- Department of Epidemiology, QuintilesIMS, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany
| | - L Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt, Germany
| | - K Kostev
- Department of Epidemiology, QuintilesIMS, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany.
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31
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Kanis JA, Cooper C, Rizzoli R, Abrahamsen B, Al-Daghri NM, Brandi ML, Cannata-Andia J, Cortet B, Dimai HP, Ferrari S, Hadji P, Harvey NC, Kraenzlin M, Kurth A, McCloskey E, Minisola S, Thomas T, Reginster JY. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int 2017; 28:2023-2034. [PMID: 28451733 PMCID: PMC5483332 DOI: 10.1007/s00198-017-4009-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/10/2017] [Indexed: 12/21/2022]
Abstract
Osteoporosis represents a significant and increasing healthcare burden in Europe, but most patients at increased risk of fracture do not receive medication, resulting in a large treatment gap. Identification of patients who are at particularly high risk will help clinicians target appropriate treatment more precisely and cost-effectively, and should be the focus of future research. INTRODUCTION The purpose of the study was to review data on the identification and treatment of patients with osteoporosis at increased risk of fracture. METHODS A working group convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review current data on the epidemiology and burden of osteoporosis and the patterns of medical management throughout Europe. RESULTS In Europe in 2010, the cost of managing osteoporosis was estimated at €37 billion and notably the costs of treatment and long-term care of patients with fractures were considerably higher than the costs for pharmacological prevention. Despite the availability of effective treatments, the uptake of osteoporosis therapy is low and declining, in particular for secondary fracture prevention where the risk of a subsequent fracture following a first fracture is high. Consequently, there is a significant treatment gap between those who would benefit from treatment and those who receive it, which urgently needs to be addressed so that the burden of disease can be reduced. CONCLUSIONS Implementation of global fracture prevention strategies is a critical need. Future research should focus on identifying specific risk factors for imminent fractures, periods of high fracture risk, patients who are at increased risk of fracture and therapies that are most suited to such high-risk patients and optimal implementation strategies in primary, secondary and tertiary care.
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Affiliation(s)
- J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia.
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - B Abrahamsen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - N M Al-Daghri
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - M L Brandi
- Department of Surgery and Translational Medicine, Unit of Bone and Mineral Diseases, University of Florence, Florence, Italy
| | - J Cannata-Andia
- Bone and Mineral Research Unit, Instituto "Reina Sofía" de Investigación, REDinREN ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Asturias, Spain
| | - B Cortet
- Department of Rheumatology, Lille University Hospital, Lille, France
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - S Ferrari
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Krankenhaus Nordwest, Frankfurt, Germany
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - M Kraenzlin
- Endonet, Endocrine Clinic and Laboratory, Basel, Switzerland
| | - A Kurth
- Department of Orthopaedic Surgery and Osteology, Klinikum Frankfurt, Frankfurt, Germany
- Mayor Teaching Hospital, Charitè Medical School, Berlin, Germany
| | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
- MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - S Minisola
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Università di Roma, Rome, Italy
| | - T Thomas
- INSERM U1059, Laboratoire Biologie Intégrée du Tissu Osseux, Rheumatology Department, CHU Saint-Etienne, Université de Lyon, Saint-Etienne, France
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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32
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Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I. Pregnancy-associated osteoporosis: a case-control study. Osteoporos Int 2017; 28:1393-1399. [PMID: 28074248 DOI: 10.1007/s00198-016-3897-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED The etiology and underlying mechanisms of pregnancy-associated osteoporosis (PAO) are still unknown, since no systematic analyses exist. Our results indicate that PAO is a heterogeneous, rare but severe disease including a substantial number of fractures with a significant delay from first symptom to diagnose. INTRODUCTION Pregnancy-associated osteoporosis (PAO) is a rare but severe type of premenopausal osteoporosis. Most common symptom includes acute lower back pain due to vertebral fracture predominantly occurring in the last trimester of pregnancy or immediately postpartum. The exact underlining mechanisms and risk factors of PAO are still unknown, and up to date, there are no published systematic analyses. METHODS We identified 102 PAO patients and matched them with 102 healthy controls according to age, region, and gravidity to evaluate risk factors in a large and homogenous population of women. RESULTS The baseline characteristics and anthropometric data of the two study groups were similar. Eighty-eight percent of the patients with PAO suffered from one or more fractures with a mean of 3.3 fractures per patient. The most common fracture site was the thoracolumbar spine, whereas 29, 37, 48, and 35% of the patients reported fractures at TH11, TH12, L1, and L2, respectively. PAO patients suffered more frequently from excessive dental problems in childhood (p < 0.001). The control group performed significantly more frequently sports both before (p < 0.002) and after puberty (p < 0.01). Compared to the controls, the patients with PAO reported twice as often severe diseases during pregnancy (p < 0.029). Hereby, the frequency of immobilization was twice as often in the PAO group compared to that in the control group (p < 0.005). CONCLUSIONS Our results indicate that PAO is a heterogeneous, rare but severe disease including a substantial number of fractures with a significant delay from first symptom to diagnose. Increased awareness is warranted to immediately start effective treatment.
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Affiliation(s)
- P Hadji
- Department of Bone Oncology, Gynecological Endocrinology and Reproductive Medicine, German Reference Centre for Pregnancy-Associated Osteoporosis, Nordwest Hospital of the Goethe-University of Frankfurt, Steinbacher Hohl 2-26, 60488, Frankfurt a. M, Germany.
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - J Boekhoff
- Department of Obstetrics and Gynecology, Philipps-University of Marburg, Marburg, Germany
| | - M Hahn
- Department of Obstetrics and Gynecology, Philipps-University of Marburg, Marburg, Germany
| | - L Hellmeyer
- Department of Obstetrics and Gynecology, Vivantes Klinikum Friedrichshain, Berlin, Germany
| | - O Hars
- Statistical Institute Dr. Hars, Berlin, Germany
| | - I Kyvernitakis
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
- Department of Obstetrics and Gynecology, Buergerhospital of the Goethe-University of Frankfurt, Frankfurt, Germany
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Diez-Perez A, Naylor KE, Abrahamsen B, Agnusdei D, Brandi ML, Cooper C, Dennison E, Eriksen EF, Gold DT, Guañabens N, Hadji P, Hiligsmann M, Horne R, Josse R, Kanis JA, Obermayer-Pietsch B, Prieto-Alhambra D, Reginster JY, Rizzoli R, Silverman S, Zillikens MC, Eastell R. International Osteoporosis Foundation and European Calcified Tissue Society Working Group. Recommendations for the screening of adherence to oral bisphosphonates. Osteoporos Int 2017; 28:767-774. [PMID: 28093634 PMCID: PMC5302161 DOI: 10.1007/s00198-017-3906-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 01/02/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Adherence to oral bisphosphonates is low. A screening strategy is proposed based on the response of biochemical markers of bone turnover after 3 months of therapy. If no change is observed, the clinician should reassess the adherence to the treatment and also other potential issues with the drug. INTRODUCTION Low adherence to oral bisphosphonates is a common problem that jeopardizes the efficacy of treatment of osteoporosis. No clear screening strategy for the assessment of compliance is widely accepted in these patients. METHODS The International Osteoporosis Foundation and the European Calcified Tissue Society have convened a working group to propose a screening strategy to detect a lack of adherence to these drugs. The question to answer was whether the bone turnover markers (BTMs) PINP and CTX can be used to identify low adherence in patients with postmenopausal osteoporosis initiating oral bisphosphonates for osteoporosis. The findings of the TRIO study specifically address this question and were used as the basis for testing the hypothesis. RESULTS Based on the findings of the TRIO study, specifically addressing this question, the working group recommends measuring PINP and CTX at baseline and 3 months after starting therapy to check for a decrease above the least significant change (decrease of more than 38% for PINP and 56% for CTX). Detection rate for the measurement of PINP is 84%, for CTX 87% and, if variation in at least one is considered when measuring both, the level of detection is 94.5%. CONCLUSIONS If a significant decrease is observed, the treatment can continue, but if no decrease occurs, the clinician should reassess to identify problems with the treatment, mainly low adherence.
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Affiliation(s)
- A Diez-Perez
- Department of Internal Medicine, Hospital del Mar-IMIM-Universitat Autònoma and CIBERFES-ISCIII, P Maritim 25-29, 08003, Barcelona, Spain.
| | - K E Naylor
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - B Abrahamsen
- Institute of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - D Agnusdei
- Independent Scientific Consultant, Florence, Italy
| | - M L Brandi
- Mineral and Bone Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, and CIBERFES-ISCIII, Oxford, UK
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - E F Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - D T Gold
- Duke University Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - N Guañabens
- Rheumatology Department, Hospital Clínic, University of Barcelona, CIBERehd, Barcelona, Spain
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt, Germany
| | - M Hiligsmann
- Department of Health Services Research, School for Public Health & Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - R Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - R Josse
- Department of Nutritional Sciences and Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - J A Kanis
- Centre for Metabolic Bone Diseases, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
| | - B Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - D Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - R Rizzoli
- Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - S Silverman
- Cedars-Sinai/University of California, Los Angeles, USA
| | - M C Zillikens
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - R Eastell
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
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Kyvernitakis I, Kostev K, Nassour T, Thomasius F, Hadji P. The impact of depot medroxyprogesterone acetate on fracture risk: a case-control study from the UK. Osteoporos Int 2017; 28:291-297. [PMID: 27461017 DOI: 10.1007/s00198-016-3714-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED There has been concerning about women receiving depot medroxyprogesterone acetate (DMPA) contraception because of the prolonged hypoestrogenemic state regarding the potential negative effects on bone health. This study showed that DMPA exposure is associated with increased fracture risk and that fracture risk increases with longer DMPA exposure. INTRODUCTION DMPA has been associated with impaired bone mineral acquisition during adolescence and accelerated bone loss in later life. We performed this large population-based study to assess the association between use of DMPA or combined oral contraceptives and the incident risk of fracture. METHODS We identified 4189 women between 20 and 44 years of age with a first-time fracture diagnosis, matched them with 4189 random controls using the Disease Analyzer database and investigated the relation with DMPA exposure. RESULTS Overall, 11 % of the fracture cases and 7.7 % of the controls had DMPA use recorded. The adjusted OR for developing a fracture in patients with current use of DMPA compared to non-users was 0.97 (95 % CI 0.51-1.86), 2.41 (95 % CI 1.42-4.08), and 1.46 (95 % CI 0.96-2.23) for 1-2, 3-9, and ≥10 prescriptions, respectively. The adjusted OR for developing a fracture in patients with past use of DMPA compared to non-users was 0.96 (95 % CI 0.73-1.26), 1.14 (95 % CI 0.86-1.51), and 1.55 (95 % CI 1.07-2.27) for 1-2, 3-9, and ≥10 prescriptions, respectively. The highest fracture risk was identified in young patients less than 30 years with longer DMPA exposure (≥10 prescriptions; OR 3.04, 95 % CI 1.36-6.81), as well as in patients in the late reproductive years with past use of DMPA (OR 1.72, 95 % CI 1.13-2.63). CONCLUSIONS Our results indicate that DMPA exposure is associated with increased fracture risk and may have negative effects on bone metabolism, resulting in impaired bone mineral acquisition during adolescence and accelerated bone loss in adult life.
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Affiliation(s)
- I Kyvernitakis
- Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt, Goethe-University of Frankfurt, Nibelungenallee 37-41, 60318, Frankfurt am Main, Germany.
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - K Kostev
- IMS HEALTH GmbH & Co. OHG, Epidemiology, Real World Evidence Solutions, Darmstädter Landstraße 108, 60598, Frankfurt, Germany
| | - T Nassour
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - F Thomasius
- Department of Bone Oncology, Gyn. Endocrinology and Reproductive Medicine, Nordwest Hospital, Goethe-University of Frankfurt, Frankfurt a.M., Germany
| | - P Hadji
- Department of Bone Oncology, Gyn. Endocrinology and Reproductive Medicine, Nordwest Hospital, Goethe-University of Frankfurt, Frankfurt a.M., Germany
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Fahrleitner-Pammer A, Papaioannou N, Gielen E, Feudjo Tepie M, Toffis C, Frieling I, Geusens P, Makras P, Boschitsch E, Callens J, Anastasilakis AD, Niedhart C, Resch H, Kalouche-Khalil L, Hadji P. Factors associated with high 24-month persistence with denosumab: results of a real-world, non-interventional study of women with postmenopausal osteoporosis in Germany, Austria, Greece, and Belgium. Arch Osteoporos 2017; 12:58. [PMID: 28643265 PMCID: PMC5486684 DOI: 10.1007/s11657-017-0351-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Persistence with osteoporosis therapy is vital for fracture prevention. This non-interventional study of postmenopausal women receiving denosumab in Germany, Austria, Greece, and Belgium found that persistence with denosumab remains consistently high after 24 months in patients at high risk of fracture. PURPOSE Continued persistence with osteoporosis therapy is vital for fracture prevention. This non-interventional study of clinical practice evaluated medication-taking behavior of postmenopausal women receiving denosumab in Germany, Austria, Greece, and Belgium and factors influencing persistence. METHODS Subcutaneous denosumab (60 mg every 6 months) was assigned according to prescribing information and local guidelines before and independently of enrollment; outcomes were recorded during routine practice for up to 24 months. Persistence was defined as receiving the subsequent injection within 6 months + 8 weeks of the previous injection and adherence as administration of subsequent injections within 6 months ± 4 weeks of the previous injection. Medication coverage ratio (MCR) was calculated as the proportion of time a patient was covered by denosumab. Associations between pre-specified baseline covariates and 24-month persistence were assessed using multivariable logistic regression. RESULTS The 24-month analyses included 1479 women (mean age 66.3-72.5 years) from 140 sites; persistence with denosumab was 75.1-86.0%, adherence 62.9-70.1%, and mean MCR 87.4-92.4%. No covariate had a significant effect on persistence across all four countries. For three countries, a recent fall decreased persistence; patients were generally older with chronic medical conditions. In some countries, other covariates (e.g., older age, comorbidity, immobility, and prescribing reasons) decreased persistence. Adverse drug reactions were reported in 2.3-6.9% patients. CONCLUSIONS Twenty-four-month persistence with denosumab is consistently high among postmenopausal women in Europe and may be influenced by patient characteristics. Further studies are needed to identify determinants of low persistence.
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Affiliation(s)
- A Fahrleitner-Pammer
- Department of Endocrinology and Metabolism, Medical University Graz, Graz, Austria
| | - N Papaioannou
- Medical School, Laboratory for the Research of Musculoskeletal System, KAT Hospital, University of Athens, Athens, Greece
| | - E Gielen
- Department of Geriatrics and Center for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium
| | | | | | | | - P Geusens
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- University Hasselt, Diepenbeek, Belgium
| | - P Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Airforce and VA General Hospital, Athens, Greece
| | - E Boschitsch
- Ambulatorium KLIMAX, Menopause and Osteoporosis Clinic, Vienna, Austria
| | - J Callens
- Department of Orthopedics, Rheumatology and Physical Medicine and Rehabilitation, AZ Zeno, Knokke, Belgium
| | - A D Anastasilakis
- Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece
| | | | - H Resch
- Medical Department II, St Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Vienna, Austria
| | | | - P Hadji
- Department of Obstetrics and Gynecology, Krankenhaus Nordwest, Frankfurt, Germany.
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Body J, Terpos E, Tombal B, Hadji P, Arif A, Young A, Aapro M, Coleman R. Bone health in the elderly cancer patient: A SIOG position paper. Cancer Treat Rev 2016; 51:46-53. [DOI: 10.1016/j.ctrv.2016.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 01/13/2023]
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Hack CC, Fasching PA, Fehm T, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Fersis N, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauß T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Rauh C, Bayer CM, Jacob A, Schmidt K, Belleville E, Hadji P, Brucker SY, Wallwiener D, Paepke D, Kümmel S, Beckmann MW. Interest in integrative medicine among postmenopausal hormone receptor-positive breast cancer patients receiving letrozole treatment in the EvAluate-TM study. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Nestoriuc Y, von Blanckenburg P, Schuricht F, Barsky A, Hadji P, Albert US, Rief W. Is it best to expect the worst? Influence of patients' side-effect expectations on endocrine treatment outcome in a 2-year prospective clinical cohort study. Ann Oncol 2016; 27:1909-15. [DOI: 10.1093/annonc/mdw266] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/25/2016] [Indexed: 12/11/2022] Open
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Hadji P, Kyvernitakis I, Kann PH, Niedhart C, Hofbauer LC, Schwarz H, Kurth AA, Thomasius F, Schulte M, Intorcia M, Psachoulia E, Schmid T. GRAND-4: the German retrospective analysis of long-term persistence in women with osteoporosis treated with bisphosphonates or denosumab. Osteoporos Int 2016; 27:2967-78. [PMID: 27172934 PMCID: PMC5042990 DOI: 10.1007/s00198-016-3623-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/28/2016] [Indexed: 11/02/2022]
Abstract
UNLABELLED This retrospective database study assessed 2-year persistence with bisphosphonates or denosumab in a large German cohort of women with a first-time prescription for osteoporosis treatment. Compared with intravenous or oral bisphosphonates, 2-year persistence was 1.5-2 times higher and risk of discontinuation was significantly lower (P < 0.0001) with denosumab. INTRODUCTION Persistence with osteoporosis therapies is critical for fracture risk reduction. Detailed data on long-term persistence (≥2 years) with bisphosphonates and denosumab are sparse. METHODS From the German IMS® database, we included women aged 40 years or older with a first-time prescription for bisphosphonates or denosumab between July 2010 and August 2014; patients were followed up until December 2014. The main outcome was treatment discontinuation, with a 60-day permissible gap between filled prescriptions. Two-year persistence was estimated using Kaplan-Meier survival curves, with treatment discontinuation as the failure event. Denosumab was compared with intravenous (i.v.) and oral bisphosphonates separately. Cox proportional hazard ratios (HRs) for the 2-year risk of discontinuation were calculated, with adjustment for age, physician specialty, health insurance status, and previous medication use. RESULTS Two-year persistence with denosumab was significantly higher than with i.v. or oral bisphosphonates (39.8 % [n = 21,154] vs 20.9 % [i.v. ibandronate; n = 20,472] and 24.8 % [i.v. zoledronic acid; n = 3966] and 16.7-17.5 % [oral bisphosphonates; n = 114,401]; all P < 0.001). Patients receiving i.v. ibandronate, i.v. zoledronic acid, or oral bisphosphonates had a significantly increased risk of treatment discontinuation than did those receiving denosumab (HR = 1.65, 1.28, and 1.96-2.02, respectively; all P < 0.0001). CONCLUSIONS Two-year persistence with denosumab was 1.5-2 times higher than with i.v. or oral bisphosphonates, and risk of discontinuation was significantly lower with denosumab than with bisphosphonates. A more detailed understanding of factors affecting medication-taking behavior may improve persistence and thereby reduce rates of fracture.
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Affiliation(s)
- P Hadji
- Department of Bone Oncology, Endocrinology, and Reproductive Medicine, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
| | - I Kyvernitakis
- Department of Bone Oncology, Gynecological Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt am Main, Germany
| | - P H Kann
- Centre for Internal Medicine - Endocrinology & Diabetes, Philipps University of Marburg, Marburg, Germany
| | | | - L C Hofbauer
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine 3 and Center for Healthy Aging, TU Dresden Medical Center, Dresden, Germany
| | - H Schwarz
- Facharztpraxis für Orthopädie und Physiotherapie, Freudenstadt, Germany
| | - A A Kurth
- Themistocles Gluck Hospital, Ratingen, Germany
| | - F Thomasius
- Department of Bone Oncology and Osteoporosis Center, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - M Schulte
- Amgen (Europe) GmbH, Munich, Germany
| | | | | | - T Schmid
- Amgen (Europe) GmbH, Munich, Germany
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Drosselmeyer J, Rapp MA, Hadji P, Kostev K. Depression risk in female patients with osteoporosis in primary care practices in Germany. Osteoporos Int 2016; 27:2739-2744. [PMID: 27026332 DOI: 10.1007/s00198-016-3584-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/22/2016] [Indexed: 01/07/2023]
Abstract
UNLABELLED Thirty-five thousand four hundred eighty-three female osteoporosis patients were compared with 35,483 patients without osteoporosis regarding the incidence of depression. The risk of depression is significantly increased for patients with osteoporosis compared with patients without osteoporosis in primary care practices within Germany. INTRODUCTION The objectives of the present study were to analyze the incidence of depression in German female patients with osteoporosis and to evaluate the risk factors for depression diagnosis within this patient population. METHODS This study was a retrospective database analysis conducted in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 70,966 patients between 40 and 80 years of age from 1072 primary care practices. The observation period was between 2004 and 2013. Follow-up duration was 5 years and was completed in April 2015. A total of 35,483 osteoporosis patients were selected after applying exclusion criteria, and 35,483 controls were chosen and then matched (1:1) to osteoporosis patients based on age, sex, health insurance coverage, depression diagnosis in the past, and follow-up duration after index date. The analyses of depression-free survival were carried out using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models (dependent variable: depression) were used to adjust for confounders. RESULTS Depression diagnoses were presented in 33.0 % of the osteoporosis group and 22.7 % of the control group after the 5-year follow-up (p < 0.001). Dementia, cancer, heart failure, coronary heart disease, and diabetes were associated with a higher risk of developing depression (p < 0.001). Private health insurance was associated with a lower risk of depression. There was no significant effect of fractures on depression risk. CONCLUSION The risk of depression is significantly increased for patients with osteoporosis in primary care practices within Germany.
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Affiliation(s)
- J Drosselmeyer
- Fresenius University of Applied Sciences, Idstein, Germany
| | - M A Rapp
- Department of Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt am Main, Germany
| | - K Kostev
- Epidemiology, IMS Health GmbH & Co. OHG, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany.
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Hadji P, Ryan KA, Yu CR, Mirkin S, Komm BS. CE/BZA effects on bone and quality of life in European postmenopausal women: a pooled analysis. Climacteric 2016; 19:482-7. [DOI: 10.1080/13697137.2016.1216958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- P. Hadji
- Krankenhaus Nordwest, Frankfurt, Germany
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Abstract
OBJECTIVES To analyze the association between the use of proton pump inhibitors (PPIs) and osteoporosis in German postmenopausal women. METHODS This study included 3092 women with osteoporosis and 3092 women without osteoporosis. Cases and controls were matched on the basis of age, health insurance, index year, and physician. The main outcome of the study was the risk of osteoporosis dependent on predefined risk factors. Gastrointestinal disorders potentially associated with osteoporosis were determined. The presence of PPIs including the duration of therapy was also assessed. Multivariate logistic regression models were fitted with osteoporosis as a dependent variable. RESULTS The mean age was 72.3 years; 5.6% of both osteoporosis patients and controls had private health insurance coverage. Gastrointestinal disorders occurred significantly more frequently in osteoporosis patients than in controls. The use of PPI drugs was also significantly more common in osteoporosis patients than in matched controls. Osteoporosis development was found to be associated with disorders of the esophagus (odds ratio (OR) 1.19, p = 0.013) and gastritis/duodenitis (OR 1.14; p = 0.045). Interestingly, the use of PPIs also led to an increase in the risk of developing osteoporosis (OR 1.62; p < 0.001). Finally, the odds of being diagnosed with osteoporosis increased with the duration of PPI therapy from 1.58 for 1 year of therapy or less to 1.72 for at least 5 years of treatment. CONCLUSIONS The use of PPIs was a risk factor for osteoporosis and this risk increased with therapy duration in German women. Esophagus disorders and gastritis/duodenitis also increased the risk of developing this chronic condition.
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Affiliation(s)
- L Jacob
- a Department of Biology , École Normale Supérieure de Lyon , Lyon , France
| | - P Hadji
- b Department of Bone Oncology, Endocrinology and Reproductive Medicine , Nordwest Hospital Frankfurt , Germany
| | - K Kostev
- c IMS Health , Real World Evidence Solutions , Frankfurt , Germany
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Abstract
OBJECTIVES To compare the effects on bone mineral density (BMD) measured by dual-energy X-ray absorptiometry at the lumbar spine, the femoral neck and the total hip following 2 years of treatment with a low-dose combined hormone therapy (HT) comprised of 1 mg estradiol and 0.5 mg norethisterone acetate (E2/NETA) versus 2.5 mg tibolone in postmenopausal women. Additionally, quantitative ultrasonometry (QUS) of the os calcaneus and of the phalanges was performed. METHODS Changes in BMD, QUS and side-effects were assessed at baseline, 6, 12 and 24 months in 50 postmenopausal women who received either E2/NETA (n = 26) or tibolone (n = 24) for 2 years. RESULTS Compared to women on tibolone, women receiving E2/NETA showed a significant increase in BMD from baseline to 12 and 24 months at the lumbar spine (3.07%, 3.86%; p < 0.01 vs. 1.13%, 2.23%; p < 0.05), and at the total hip (1.33%, 1.69%; p < 0.01 vs. 0.76%, 0.70%) and at the femoral neck from baseline to 24 months (1.10%; p < 0.05). QUS indices only showed a significant change with the ultrasound bone profile index with E2/NETA at 6 months (-2.32%; p < 0.001). CONCLUSIONS Low-dose E2/NETA showed a significantly higher increase in BMD compared to tibolone. QUS measurement was not considered to comprise beneficial effects in monitoring drug-induced bone changes.
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Affiliation(s)
- M Kalder
- a Department of Obstetrics and Gynecology , Philipps University of Marburg , Germany
| | - I Kyvernitakis
- a Department of Obstetrics and Gynecology , Philipps University of Marburg , Germany
| | - O Hars
- b Statistical Institute , Berlin , Germany
| | - A Kauka
- a Department of Obstetrics and Gynecology , Philipps University of Marburg , Germany
| | - P Hadji
- c Department of Bone Oncology, Endocrinology and Reproductive Medicine , Nordwest Hospital , Frankfurt , Germany
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Jacob L, Hadji P, Kostev K. Age-related differences in persistence with bisphosphonates in women with metastatic breast cancer. J Bone Oncol 2016; 5:63-6. [PMID: 27335773 PMCID: PMC4908184 DOI: 10.1016/j.jbo.2016.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022] Open
Abstract
Aims To investigate age-related persistence with bisphosphonates (BIS) in women with breast cancer (BC) and bone metastases. Methods We included a dataset of 1541 patients diagnosed with BC and bone metastases and initially treated with BIS between 1994 and 2013. The primary outcome measure was the age-related rate of BIS discontinuation within 12 months after treatment initiation. Therapy discontinuation was defined as a period of at least 90 days without treatment. A multivariate Cox regression model was created to determine the influence of age on the risk of discontinuation. Health insurance coverage (private/statutory), type of care (gynecological/general), region (West/East Germany), depression, chemotherapy, hormone therapy, pain medication, antidepressants, and the number of co-medications were included as covariates. Results The mean ages in the group of women <70 and that of women ≥70 years of age were 55.7 (SD: 9.8) and 76.7 (SD: 5.1) years respectively. Within 12 months after treatment initiation, 44.3% of women <70 and 34.8% of women ≥70 had terminated treatment (p-value<0.001). Patients aged ≥70 were at a lower risk of treatment discontinuation than patients <70 (HR=0.78, 95% CI: 0.67–0.91). Furthermore, treatment in gynecological practices, chemotherapy, hormone therapy, pain medication, and number of co-medications decreased the risk of discontinuation. By contrast, residing in West Germany and private health insurance coverage increased discontinuation risk. Conclusions Women with metastatic BC aged ≥70 are at a lower risk of BIS treatment discontinuation than younger women.
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Affiliation(s)
- L Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | - P Hadji
- Nordwest Hospital Frankfurt, Germany
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Jacob L, Dreher M, Kostev K, Hadji P. Increased treatment persistence and its determinants in women with osteoporosis with prior fracture compared to those without fracture. Osteoporos Int 2016; 27:963-969. [PMID: 26519418 DOI: 10.1007/s00198-015-3378-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/20/2015] [Indexed: 01/18/2023]
Abstract
SUMMARY The purpose of this study is to analyze treatment persistence in patients with osteoporosis after fracture diagnosis in German primary care practices. We found that pain increased treatment persistence. One key next step is to demonstrate whether or not this pain is related to fracture. INTRODUCTION To analyze treatment persistence in patients with osteoporosis after fracture diagnosis in German primary care practices. METHODS This study included postmenopausal women with osteoporosis aged between 40 and 90 years from 1188 general and 175 orthopedist practices in Germany. Treatment started between 2004 and 2013. The primary outcome measure was treatment persistence within 12 months after therapy initiation. Discontinuation of treatment was defined as a period of at least 90 days without therapy. Persistence analyses were carried out using Kaplan-Meier curves and log-rank tests, and the analyses of the impact of fracture on discontinuation risk were based on Cox regression models (with and without adjustment for pain medications). RESULTS Thirteen thousand nine hundred seventy-five subjects (mean age = 74.8 years) were included in the group with fracture before therapy initiation and 18,138 (mean age = 72.7 years) in the group without fracture. Within 12 months after treatment initiation, therapy persistence increased with the delay between osteoporosis diagnosis and therapy initiation, rising from 40.7% when the delay was lower than or equal to 12 months to 44.3% when it exceeded 36 months (p value <0.0001). Fracture only decreased the risk of treatment discontinuation when the model was not adjusted for pain medications (HR = 0.95, 95% CI 0.93-0.98, p value <0.0001). CONCLUSIONS Pain increased treatment persistence in women with osteoporosis and fracture. Further studies are needed to better understand factors influencing persistence.
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Affiliation(s)
- L Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | - M Dreher
- Department of Gynecology and Obstetrics, Philipps-Universität Marburg, Marburg, Germany
| | - K Kostev
- IMS Health Epidemiology, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany.
| | - P Hadji
- Nordwest Hospital, Philipps-University of Marburg, Frankfurt, Germany
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Hadji P, Coleman RE, Wilson C, Powles TJ, Clézardin P, Aapro M, Costa L, Body JJ, Markopoulos C, Santini D, Diel I, Di Leo A, Cameron D, Dodwell D, Smith I, Gnant M, Gray R, Harbeck N, Thurlimann B, Untch M, Cortes J, Martin M, Albert US, Conte PF, Ejlertsen B, Bergh J, Kaufmann M, Holen I. Adjuvant bisphosphonates in early breast cancer: consensus guidance for clinical practice from a European Panel. Ann Oncol 2015; 27:379-90. [PMID: 26681681 DOI: 10.1093/annonc/mdv617] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022] Open
Abstract
Bisphosphonates have been studied in randomised trials in early breast cancer to investigate their ability to prevent cancer treatment-induced bone loss (CTIBL) and reduce the risk of disease recurrence and metastasis. Treatment benefits have been reported but bisphosphonates do not currently have regulatory approval for either of these potential indications. This consensus paper provides a review of the evidence and offers guidance to breast cancer clinicians on the use of bisphosphonates in early breast cancer. Using the nominal group methodology for consensus, a systematic review of the literature was augmented by a workshop held in October 2014 for breast cancer and bone specialists to present and debate the available pre-clinical and clinical evidence for the use of adjuvant bisphosphonates. This was followed by a questionnaire to all members of the writing committee to identify areas of consensus. The panel recommended that bisphosphonates should be considered as part of routine clinical practice for the prevention of CTIBL in all patients with a T score of <-2.0 or ≥2 clinical risk factors for fracture. Compelling evidence from a meta-analysis of trial data of >18,000 patients supports clinically significant benefits of bisphosphonates on the development of bone metastases and breast cancer mortality in post-menopausal women or those receiving ovarian suppression therapy. Therefore, the panel recommends that bisphosphonates (either intravenous zoledronic acid or oral clodronate) are considered as part of the adjuvant breast cancer treatment in this population and the potential benefits and risks discussed with relevant patients.
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Affiliation(s)
- P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Philipps-University of Marburg, Frankfurt, Germany
| | - R E Coleman
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield
| | - C Wilson
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield
| | | | - P Clézardin
- INSERM, Research Unit UMR403, University of Lyon, School of Medicine Lyon-Est, Lyon, France
| | - M Aapro
- Breast Center of the Multidisciplinary Oncology Institute, Genolier, Switzerland
| | - L Costa
- Hospital de Santa Maria & Lisbon School of Medicine, Institute of Molecular Biology, Lisbon, Potugal
| | - J-J Body
- CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - C Markopoulos
- Medical School, National University of Athens, Athens, Greece
| | - D Santini
- Medical Oncology, University Campus Bio-medico, Rome, Italy
| | - I Diel
- Institute for Gynaecological Oncology, Centre for Comprehensive Gynecology, Mannheim, Germany
| | - A Di Leo
- Sandro Pitigliani Medical Oncology Unit, Department of Oncology, Hospital of Prato, Prato, Italy
| | - D Cameron
- University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh
| | - D Dodwell
- Institute of Oncology, Bexley Wing, St James Hospital Leeds, Leeds
| | - I Smith
- The Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - M Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - R Gray
- Clinical Trials and Epidemiological Unit, University of Oxford, Oxford, UK
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynaecology, University of Munich, Munich, Germany
| | - B Thurlimann
- Kantonsspital St Gallen, Breast Center, St Gallen, Switzerland
| | - M Untch
- Interdisciplinary Breast Cancer Center HELIOS Klinikum Berlin-Buch Germany, Gynecologic Oncology and Obstetrics, Berlin, Germany
| | - J Cortes
- Department of Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - M Martin
- Department of Medical Oncology, Institute of Investigation Sanitaria Gregorio Marañón, University Complutense, Madrid, Spain
| | - U-S Albert
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Philipps-University of Marburg, Frankfurt, Germany
| | - P-F Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - B Ejlertsen
- Danish Breast Cancer Cooperative Group Statistical Center Department of Oncology Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Bergh
- Karolinska Institute and University Hospital, Stockholm, Sweden
| | - M Kaufmann
- Institute for Obstetrics and Gynaecology, Goethe University, Frankfurt, Germany
| | - I Holen
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield
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Kyvernitakis I, Kostev K, Hars O, Albert US, Kalder M, Hadji P. Persistency with estrogen replacement therapy among hysterectomized women after the Women’s Health Initiative study. Climacteric 2015; 18:826-34. [DOI: 10.3109/13697137.2015.1081164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hadji P, Papaioannou N, Gielen E, Feudjo Tepie M, Zhang E, Frieling I, Geusens P, Makras P, Resch H, Möller G, Kalouche-Khalil L, Fahrleitner-Pammer A. Persistence, adherence, and medication-taking behavior in women with postmenopausal osteoporosis receiving denosumab in routine practice in Germany, Austria, Greece, and Belgium: 12-month results from a European non-interventional study. Osteoporos Int 2015; 26:2479-89. [PMID: 26018090 PMCID: PMC4575374 DOI: 10.1007/s00198-015-3164-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/01/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED Persistence with and adherence to osteoporosis therapy are critical for fracture reduction. This non-interventional study is evaluating medication-taking behavior of women with postmenopausal osteoporosis (PMO) receiving denosumab in Germany, Austria, Greece, and Belgium. Patients were representative of the PMO population and highly persistent with and adherent to denosumab at 12 months. INTRODUCTION Persistence with and adherence to osteoporosis therapy are important for optimal treatment efficacy, namely fracture reduction. This ongoing, non-interventional study will evaluate medication-taking behavior of women with postmenopausal osteoporosis (PMO) receiving denosumab in routine practice in four European countries. METHODS The study enrolled women who had been prescribed subcutaneous denosumab (60 mg every 6 months) in accordance with prescribing information and local guidelines. Persistence was defined as receiving the subsequent injection within 6 months + 8 weeks of the previous injection. Adherence was defined as receiving two consecutive injections within 6 months ± 4 weeks of each other. Medication coverage ratio (MCR) was calculated using the time a patient was covered with denosumab, as assessed from prescription records. Treatment was assigned prior to and independently of enrollment; outcomes are recorded during routine practice. RESULTS These planned 12-month interim analyses included data from 1500 patients from 141 sites. Mean age was 66.4-72.4 years, mean baseline total hip T-scores ranged from -2.0 to -2.1 and femoral neck T-scores from -2.2 to -2.6, and 30.7-62.1% of patients had prior osteoporotic fracture. Persistence was 87.0-95.3%, adherence 82.7-89.3%, and MCR 91.3-95.4%. In a univariate analysis, increased age, decreased mobility, and increased distance to the clinic were associated with significantly decreased persistence; parental history of hip fracture was associated with significantly increased persistence. CONCLUSIONS These data extend the real-world evidence regarding persistence with and adherence to denosumab, both of which are critical for favorable clinical outcomes, including fracture risk reduction.
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Affiliation(s)
- P Hadji
- Department of Obstetrics and Gynecology, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt, Germany.
| | - N Papaioannou
- Medical School, Laboratory of Research of Myoskeletal Diseases, KAT Hospital, University of Athens, Athens, Greece
| | - E Gielen
- Department of Geriatrics and the Centre for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium
| | | | | | | | - P Geusens
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- University Hasselt, Diepenbeek, Belgium
| | - P Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Airforce and VA General Hospital, Athens, Greece
| | - H Resch
- St Vincent Hospital, Medical Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria
| | - G Möller
- Practice for Preventive and Regenerative Medicine, Staufen im Breisgau, Germany
| | | | - A Fahrleitner-Pammer
- Department of Endocrinology and Metabolism, Medical University Graz, Graz, Austria
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Kyvernitakis I, Kostev K, Hars O, Albert US, Hadji P. Discontinuation rates of menopausal hormone therapy among postmenopausal women in the post-WHI study era. Climacteric 2015; 18:737-42. [PMID: 25845443 DOI: 10.3109/13697137.2015.1037267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Many women are reluctant to take menopausal hormone therapy (MHT) and discontinue the treatment within 12 months. The aim of this study was to investigate the persistence rates of combined MHT in the last decade, reflecting changes in the post-Women's Health Initiative era. METHODS We analyzed 17 020 patients receiving combined MHT from 2004 to 2013 using the Disease Analyzer database. RESULTS After 12 months of follow-up, 44.6% and 33.5% of patients receiving 1 mg and 2 mg, respectively, of oral combined MHT were still on treatment (p < 0.0001). The persistence rate of patients receiving < 50 μg of transdermal MHT was 39.1% after 1 year of treatment and presented no differences compared to patients receiving ≥ 50 μg of transdermal MHT with a persistence rate of 38.2%. MHT start in the years 2007-2009 was associated with higher discontinuation rates (hazard ratio 1.04, p = 0.0709) than MHT start in the years 2010-2013 (hazard ratio 0.90, p = 0.0001). CONCLUSIONS Our results indicate that patients beginning their treatments in the years 2010-2013 were more treatment-persistent than patients beginning with MHT in the early years after publication of the Women's Health Initiative study (2004-2009). Administration of low-dose oral MHT and transdermal MHT is associated with increased persistency compared to higher doses of oral MHT.
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Affiliation(s)
- I Kyvernitakis
- a Department of Gynecological Endocrinology , Reproductive Medicine and Osteoporosis, Philipps-University of Marburg , Germany
| | - K Kostev
- b * IMS Health , Frankfurt , Germany.,c Fresenius University of Applied Sciences, Health & Social Faculty , Idstein , Germany
| | - O Hars
- d Statistical Institute , Berlin , Germany
| | - U-S Albert
- e Department of Gynecology and Obstetrics , Nordwest-Hospital , Frankfurt , Germany
| | - P Hadji
- f Department of Bone Oncology , Endocrinology and Reproductive Medicine, Nordwest-Hospital , Frankfurt , Germany
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Abstract
This review assesses (1) the potential role of calcium supplements in the prevention and treatment of osteoporosis and osteoporotic fractures, and (2) the safety of calcium supplements with respect to cardiovascular health as well. With regard to (1), a total calcium intake of < 800 mg/day is associated with increased loss of bone mineral density in peri- and postmenopausal women with an increase in fracture risk. Hereby, the effect of calcium supplements on fracture prevention is dependent primary on baseline calcium intake. The strongest protective effect has been reported in individuals with a calcium intake < 700 mg/day and in high-risk groups. A calcium intake of about 1000-1200 mg/day seems to be sufficient for general fracture prevention. With regard to (2), an analysis of the data based on the Hill criteria does not demonstrate convincing evidence that calcium supplements increase cardiovascular risk. In the long term, total calcium intake of 2500 mg/day (from food and supplements) continues to be classified as safe. This value should not be exceeded for an extended period of time.
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Affiliation(s)
- A Ströhle
- a Nutrition Physiology and Human Nutrition Unit, Institute of Food Science and Human Nutrition, Leibniz University of Hannover , Hannover , Germany
| | - P Hadji
- b * Department of Osteooncology , Gynecological Endocrinology and Reproductive Medicine, Krankenhaus Nordwest , Frankfurt , Germany
| | - A Hahn
- a Nutrition Physiology and Human Nutrition Unit, Institute of Food Science and Human Nutrition, Leibniz University of Hannover , Hannover , Germany
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