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Wimmer K, Sachet M, Ramos C, Frantal S, Birnleitner H, Brostjan C, Exner R, Filipits M, Bago-Horvath Z, Rudas M, Bartsch R, Gnant M, Singer CF, Balic M, Egle D, Oehler R, Fitzal F. Differential immunomodulatory effects of epirubicin/cyclophosphamide and docetaxel in breast cancer patients. J Exp Clin Cancer Res 2023; 42:300. [PMID: 37957750 PMCID: PMC10644559 DOI: 10.1186/s13046-023-02876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Epirubicin/cyclophosphamide (EC) and docetaxel (D) are commonly used in a sequential regimen in the neoadjuvant treatment of early, high-risk or locally advanced breast cancer (BC). Novel approaches to increase the response rate combine this treatment with immunotherapies such as PD-1 inhibition. However, the expected stimulatory effect on lymphocytes may depend on the chemotherapy backbone. Therefore, we separately compared the immunomodulatory effects of EC and D in the setting of a randomized clinical trial. METHODS Tumor and blood samples of 154 patients from the ABCSG-34 trial were available (76 patients received four cycles of EC followed by four cycles of D; 78 patients get the reverse treatment sequence). Tumor-infiltrating lymphocytes, circulating lymphocytes and 14 soluble immune mediators were determined at baseline and at drug change. Furthermore, six BC cell lines were treated with E, C or D and co-cultured with immune cells. RESULTS Initial treatment with four cycles of EC reduced circulating B and T cells by 94% and 45%, respectively. In contrast, no comparable effects on lymphocytes were observed in patients treated with initial four cycles of D. Most immune mediators decreased under EC whereas D-treatment resulted in elevated levels of CXCL10, urokinase-type plasminogen activator (uPA) and its soluble receptor (suPAR). Accordingly, only the exposure of BC cell lines to D induced similar increases as compared to E. While treatment of BC cells with E was associated with cell shrinkage and apoptosis, D induced cell swelling and accumulation of cells in G2 phase. CONCLUSION The deleterious effect of EC on lymphocytes indicates strong immunosuppressive properties of this combination therapy. D, in contrast, has no effect on lymphocytes, but triggers the secretion of stimulatory proteins in vivo and in vitro, indicating a supportive effect on the immune system. Underlying differences in the induced cell death might be causal. These divergent immunomodulatory effects of epirubicin/cyclophosphamide and docetaxel should be considered when planning future combinations with immunotherapies in breast cancer.
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Affiliation(s)
- Kerstin Wimmer
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Monika Sachet
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Cristiano Ramos
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Sophie Frantal
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Hanna Birnleitner
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Christine Brostjan
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Ruth Exner
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Martin Filipits
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Center for Cancer Research, Medical University of Vienna, 1090, Vienna, Austria
| | - Zsuzsanna Bago-Horvath
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Pathology, Medical University of Vienna, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rupert Bartsch
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, 1090, Vienna, Austria
| | - Michael Gnant
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christian F Singer
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Department of Gynecology, Medical University of Vienna, 1090, Vienna, Austria
| | - Marija Balic
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Oncology, Medical University of Graz, Graz, Austria
| | - Daniel Egle
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Rudolf Oehler
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria.
| | - Florian Fitzal
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
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Marhold M, Udovica S, Halstead A, Hirdler M, Ferner M, Wimmer K, Bago-Horvath Z, Exner R, Fitzal F, Strasser-Weippl K, Robinson T, Bartsch R. Emergence of immune-related adverse events correlates with pathological complete response in patients receiving pembrolizumab for early triple-negative breast cancer. Oncoimmunology 2023; 12:2275846. [PMID: 38025838 PMCID: PMC10653620 DOI: 10.1080/2162402x.2023.2275846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Based upon results of the KEYNOTE-522 trial and following approval by regulatory authorities, the addition of pembrolizumab to chemotherapy is now the standard-of-care for the treatment of early triple-negative breast cancer (eTNBC) (Clinical stage II-III). Pembrolizumab is a programmed cell death protein 1 monoclonal antibody, known to cause immune-related adverse events (irAEs) in a significant subset of patients. Real-world data on incidence, type and treatment strategies of irAEs in the setting of eTNBC treatment are sparse. In this multicenterretrospective analysis, we characterized real-world incidence of irAEs and treatment outcomes such as pathological complete response (pCR) from the combination of pembrolizumab and chemotherapy as neoadjuvant treatment for eTNBC. We found a rate of irAEs of all grades of 63.9% and of 20% for irAEs of grade 3 or higher. In the overall population, a pCR rate of 57.1% was observed. The emergence of irAEs correlated significantly with pCR (72.2% versus 30.8%; p =.03). Discontinuation of neoadjuvant chemotherapy before week 12 correlated significantly with a lower pCR rate. To our knowledge, this is the first study evaluating the real-world efficacy and safety of a neoadjuvant combination of chemotherapy and pembrolizumab in eTNBC, demonstrating a significant correlation between irAEs and pCR. Early discontinuation of neoadjuvant therapy due to AEs resulted in a lower pCR rate.
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Affiliation(s)
- Maximilian Marhold
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Vienna, Austria
| | - Simon Udovica
- Department of Medicine I, Center for Oncology and Hematology, Clinic Ottakring, Vienna, Austria
| | - Anna Halstead
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Mona Hirdler
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Linz, Austria
- Institute for Pathology, Medical University of Vienna, Vienna, Austria
| | - Muna Ferner
- Department of Medicine I, Center for Oncology and Hematology, Clinic Ottakring, Vienna, Austria
| | - Kerstin Wimmer
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Ruth Exner
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Kathrin Strasser-Weippl
- Department of Medicine I, Center for Oncology and Hematology, Clinic Ottakring, Vienna, Austria
| | - Tim Robinson
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rupert Bartsch
- Division of Oncology, Department for Medicine I, Medical University of Vienna, Vienna, Austria
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Ostapenko E, Nixdorf L, Devyatko Y, Exner R, Wimmer K, Fitzal F. The Impact of Adjuvant Radiotherapy on Immediate Prepectoral Implant-Based Breast Reconstruction. Aesthetic Plast Surg 2023:10.1007/s00266-023-03661-z. [PMID: 37737875 DOI: 10.1007/s00266-023-03661-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/12/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Immediate prepectoral implant-based breast reconstruction (IBBR) rates have increased in recent years owing to improved cosmetic and psychological benefits. However, there is a lack of studies regarding complications rates following adjuvant radiotherapy (RT) among patients undergoing immediate prepectoral IBBR. METHODS We conducted a retrospective monocentric analysis of a cohort of consecutively treated patients who underwent NSM following immediate prepectoral IBBR at our institution between March 2017 and November 2021. Patient demographics, quality of life, complication rates, and oncological safety were evaluated in the RT and non-RT groups. Data analysis was performed using IBM SPSS Version 24 (IMB Corp., Armonk, NY, USA). RESULTS A total of 98 patients were examined: 70 were assigned to have prepectoral IBBR without RT and 28 to the group who had prepectoral IBBR with RT. There was a statistically significant difference in overall capsular contracture rate between the RT and non-RT group (18% vs. 4.3%, p=0.04). The total implant loss in the cohort was 4% (10.7% vs. 1.4%, p=0.05). We obtained a high percentages of all BREAST-Q categories in both groups; however, satisfaction with the breast and sexual well-being was higher in the non-RT group. The three-year overall survivals were 97.4% in the RT group and 98.5% in the non-RT group. CONCLUSION Our findings showed that patients in the RT group had a higher rate of capsular contracture and implant loss than those in the non-RT group. However, complication rates were within acceptable range and with accurate preoperative information patients have more benefits from immediate reconstruction showing excellent overall quality of life irrespectively of radiation. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Edvin Ostapenko
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Larissa Nixdorf
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Yelena Devyatko
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Kerstin Wimmer
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Atomos Klinik Währing, Vienna, Austria
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Ostapenko E, Nixdorf L, Devyatko Y, Exner R, Math P, Wimmer K, Haeusler T, Fitzal F. Ptotic versus Nonptotic Breasts in Nipple-sparing Mastectomy and Immediate Prepectoral Breast Reconstruction. Plast Reconstr Surg Glob Open 2023; 11:e5032. [PMID: 37250830 PMCID: PMC10219702 DOI: 10.1097/gox.0000000000005032] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/06/2023] [Indexed: 05/31/2023]
Abstract
In recent years, nipple-sparing mastectomy followed by implant-based breast reconstruction has gained popularity due to improved cosmetic and psychological benefits. However, patients with ptotic breasts remain the main challenge for surgeons, owing to the potential risk of postoperative complications. Methods A retrospective chart review was performed for patients who underwent nipple-sparing mastectomy and prepectoral implant-based breast reconstruction between March 2017 and November 2021. Patient demographics, incidence of complications, and quality of life assessed using the BREAST-Q questionnaire were compared between the two different incisions [inverted-T for ptotic versus inframammary fold (IMF) for nonptotic breasts]. Results A total of 98 patients were examined: 62 in the IMF cohort and 36 in the inverted-T cohort. The results demonstrated equivalence in the safety metrics between the two groups, including hematoma (p=0.367), seroma (p=0.552), infection (P = 1.00), skin necrosis (P = 1.00), local recurrence (P = 1.00), implant loss (P = 0.139), capsular contracture (P = 1.00), and nipple-areolar complex necrosis (P = 0.139). The BREAST-Q scores were equally high in both groups. Conclusion Our results suggest that inverted-T incision for ptotic breasts is a safe modality with similar complication rates and high aesthetic results compared with IMF incision for nonptotic breasts. A higher rate of nipple-areolar complex necrosis in the inverted-T group, although not significant, should be considered during careful preoperative planning and patient selection.
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Affiliation(s)
- Edvin Ostapenko
- From the Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Larissa Nixdorf
- From the Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Yelena Devyatko
- From the Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- From the Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Pia Math
- From the Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Kerstin Wimmer
- From the Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Theresa Haeusler
- From the Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- From the Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Ostapenko E, Nixdorf L, Devyatko Y, Exner R, Wimmer K, Fitzal F. P192 Ptotic versus non ptotic breasts in nipple-sparing mastectomy and immediate prepectoral breast reconstruction. Breast 2023. [DOI: 10.1016/s0960-9776(23)00310-7] [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: 03/17/2023] Open
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Ostapenko E, Nixdorf L, Devyatko Y, Wimmer K, Exner R, Fitzal F. Abstract P2-15-05: Prepectoral versus subpectoral implant-based breast reconstruction: A systemic review and meta-analysis. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-15-05] [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: 03/06/2023]
Abstract
Abstract
Prepectoral versus subpectoral implant-based breast reconstruction: A systemic review and meta-analysis. Edvin Ostapenko, MD1,2, Larissa Nixdorf, MD1, Yelena Devyatko, MD1, Ruth Exner, MD1, Kerstin Wimmer, MD1, Florian Fitzal, MD1 1Department of General Surgery and Breast Health Center, Medical University of Vienna, Vienna, Austria. 2Faculty of Medicine, Vilnius University, Vilnius, Lithuania Abstract Background Implant-based breast reconstruction (IBBR) is still standard and most popular option for women undergoing breast reconstruction after mastectomy worldwide. Recently, prepectoral IBBR has resurged in popularity, despite limited data comparing prepectoral with subpectoral IBBR. Methods A systematic search of PubMed and Cochrane Library from January 1, 2011, to December 31, 2021, was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guideline, data were extracted by independent reviewers. Random and fixed-effect models were applied to obtain pooled proportions and 95% CIs. The Risk of Bias in Nonrandomized Studies- of Interventions (ROBINS-I) tool was used for critical appraisal of cohorts and funnels plots, and the Egger bias test were used for evaluating the publication bias. Studies that compared prepectoral IBBR with subpectoral IBBR for breast cancer were included. Results Overall, 15 studies with 3101 patients were included in this meta-analysis. Our results showed that patients receiving prepectoral IBBR experienced fewer capsular contracture (odds ratio [OR], 0.54; 95% CI, 0.32-0.92; P=.02), animation deformity (OR, 0.02; 95% CI, 0.00-0.25; P=.002), and prosthesis failure (OR, 0.58; 95% CI, 0.42-0.80; P=.001). There was no significant difference between prepectoral and subpectoral IBBR in overall complications (OR, 0.83; 95% CI, 0.64-1.09; P=.19), seroma (OR, 1.21; 95% CI, 0.59-2.51; P=.60), hematoma (OR, 0.76 95% CI, 0.49-1.18; P=.22), infection (OR, 0.87; 95% CI, 0.63-1.20; P=.39), skin flap necrosis (OR, 0.70 95% CI, 0.45-1.08; P=.11), and recurrence (OR, 1.31; 95% CI, 0.52-3.39; P=.55). Similarly, no significant difference was found in Breast-Q scores between prepectoral and subpectoral IBBR groups. Conclusion The results of our systematic review and meta-analysis demonstrated that prepectoral implant-based breast reconstruction is a safe modality and have similar outcomes with significantly lower rates of capsular contracture, prosthesis failure and animation deformity compared to subpectoral implant-based breast reconstruction. Future research should include randomized clinical trials or well-designed prospective matched studies with adequate follow-up to assess long-term as well as oncologic outcomes between comparative groups. Key Words: immediate implant-based breast reconstruction, breast cancer, outcomes, prepectoral, subpectoral;
Citation Format: Edvin Ostapenko, Larissa Nixdorf, Yelena Devyatko, Kerstin Wimmer, Ruth Exner, Florian Fitzal. Prepectoral versus subpectoral implant-based breast reconstruction: A systemic review and meta-analysis. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-15-05.
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Affiliation(s)
- Edvin Ostapenko
- 1Department of General Surgery and Breast Health Center, Medical University of Vienna, Vienna, Austria; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Kerstin Wimmer
- 4Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Florian Fitzal
- 6Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Ostapenko E, Nixdorf L, Devyatko Y, Exner R, Wimmer K, Fitzal F. Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction: A Systemic Review and Meta-analysis. Ann Surg Oncol 2023; 30:126-136. [PMID: 36245049 PMCID: PMC9726796 DOI: 10.1245/s10434-022-12567-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Implant-based breast reconstruction (IBBR) remains the standard and most popular option for women undergoing breast reconstruction after mastectomy worldwide. Recently, prepectoral IBBR has resurged in popularity, despite limited data comparing prepectoral with subpectoral IBBR. METHODS A systematic search of PubMed and Cochrane Library from January 1, 2011 to December 31, 2021, was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines, data were extracted by independent reviewers. Studies that compared prepectoral with subpectoral IBBR for breast cancer were included. RESULTS Overall, 15 studies with 3,101 patients were included in this meta-analysis. Our results showed that patients receiving prepectoral IBBR experienced fewer capsular contractures (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.32-0.92; P = 0.02), animation deformity (OR, 0.02; 95% CI, 0.00-0.25; P = 0.002), and prosthesis failure (OR, 0.58; 95% CI, 0.42-0.80; P = 0.001). There was no significant difference between prepectoral and subpectoral IBBR in overall complications (OR, 0.83; 95% CI, 0.64-1.09; P = 0.19), seroma (OR, 1.21; 95% CI, 0.59-2.51; P = 0.60), hematoma (OR, 0.76; 95% CI, 0.49-1.18; P = 0.22), infection (OR, 0.87; 95% CI, 0.63-1.20; P = 0.39), skin flap necrosis (OR, 0.70; 95% CI, 0.45-1.08; P = 0.11), and recurrence (OR, 1.31; 95% CI, 0.52-3.39; P = 0.55). Similarly, no significant difference was found in Breast-Q scores between the prepectoral and subpectoral IBBR groups. CONCLUSIONS The results of our systematic review and meta-analysis demonstrated that prepectoral, implant-based, breast reconstruction is a safe modality and has similar outcomes with significantly lower rates of capsular contracture, prosthesis failure, and animation deformity compared with subpectoral, implant-based, breast reconstruction.
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Affiliation(s)
- Edvin Ostapenko
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria ,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Larissa Nixdorf
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Yelena Devyatko
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Kerstin Wimmer
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
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Steindl A, Schweighart K, Zach C, Grisold A, Gatterbauer B, Dieckmann K, Bago-Horvath Z, Exner R, Fitzal F, Pfeiler G, Singer C, Widhalm G, Bartsch R, Preusser M, Berghoff A. 307P Incidence of neurological symptoms in brain metastases from breast cancer and its impact on prognosis: An analysis of 968 patients with brain metastases. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.441] [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: 11/01/2022] Open
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9
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Kornauth C, Pemovska T, Vladimer GI, Bayer G, Bergmann M, Eder S, Eichner R, Erl M, Esterbauer H, Exner R, Felsleitner-Hauer V, Forte M, Gaiger A, Geissler K, Greinix HT, Gstöttner W, Hacker M, Hartmann BL, Hauswirth AW, Heinemann T, Heintel D, Hoda MA, Hopfinger G, Jaeger U, Kazianka L, Kenner L, Kiesewetter B, Krall N, Krajnik G, Kubicek S, Le T, Lubowitzki S, Mayerhoefer ME, Menschel E, Merkel O, Miura K, Müllauer L, Neumeister P, Noesslinger T, Ocko K, Öhler L, Panny M, Pichler A, Porpaczy E, Prager GW, Raderer M, Ristl R, Ruckser R, Salamon J, Schiefer AI, Schmolke AS, Schwarzinger I, Selzer E, Sillaber C, Skrabs C, Sperr WR, Srndic I, Thalhammer R, Valent P, van der Kouwe E, Vanura K, Vogt S, Waldstein C, Wolf D, Zielinski CC, Zojer N, Simonitsch-Klupp I, Superti-Furga G, Snijder B, Staber PB. Functional Precision Medicine Provides Clinical Benefit in Advanced Aggressive Hematologic Cancers and Identifies Exceptional Responders. Cancer Discov 2022; 12:372-387. [PMID: 34635570 PMCID: PMC9762339 DOI: 10.1158/2159-8290.cd-21-0538] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/22/2021] [Accepted: 09/24/2021] [Indexed: 01/07/2023]
Abstract
Personalized medicine aims to match the right drug with the right patient by using specific features of the individual patient's tumor. However, current strategies of personalized therapy matching provide treatment opportunities for less than 10% of patients with cancer. A promising method may be drug profiling of patient biopsy specimens with single-cell resolution to directly quantify drug effects. We prospectively tested an image-based single-cell functional precision medicine (scFPM) approach to guide treatments in 143 patients with advanced aggressive hematologic cancers. Fifty-six patients (39%) were treated according to scFPM results. At a median follow-up of 23.9 months, 30 patients (54%) demonstrated a clinical benefit of more than 1.3-fold enhanced progression-free survival compared with their previous therapy. Twelve patients (40% of responders) experienced exceptional responses lasting three times longer than expected for their respective disease. We conclude that therapy matching by scFPM is clinically feasible and effective in advanced aggressive hematologic cancers. SIGNIFICANCE: This is the first precision medicine trial using a functional assay to instruct n-of-one therapies in oncology. It illustrates that for patients lacking standard therapies, high-content assay-based scFPM can have a significant value in clinical therapy guidance based on functional dependencies of each patient's cancer.See related commentary by Letai, p. 290.This article is highlighted in the In This Issue feature, p. 275.
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Affiliation(s)
- Christoph Kornauth
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Tea Pemovska
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Gregory I Vladimer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Exscientia GmbH, Vienna, Austria
| | - Günther Bayer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Michael Bergmann
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Sandra Eder
- Department of Internal Medicine and Hematology/Oncology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Ruth Eichner
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Martin Erl
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Austria
| | - Harald Esterbauer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Maurizio Forte
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Klaus Geissler
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Hildegard T Greinix
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - Wolfgang Gstöttner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Alexander W Hauswirth
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Tim Heinemann
- Department of Biology, Institute of Molecular Systems Biology, ETH Zürich, Zürich, Switzerland
| | - Daniel Heintel
- Division of Medicine I, Klinik Ottakring, Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Georg Hopfinger
- Third Medical Department, Centre for Oncology and Haematology, Klinik Favoriten, Vienna, Austria
| | - Ulrich Jaeger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Lukas Kazianka
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Lukas Kenner
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Krall
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Exscientia GmbH, Vienna, Austria
| | - Gerhard Krajnik
- Department of Medicine I, Universitätsklinikum St. Pölten, St. Pölten, Austria
| | - Stefan Kubicek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Trang Le
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elisabeth Menschel
- Third Medical Department, Hematology & Oncology, Hanusch Hospital, Vienna, Austria
| | - Olaf Merkel
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Katsuhiro Miura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Peter Neumeister
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - Thomas Noesslinger
- Third Medical Department, Hematology & Oncology, Hanusch Hospital, Vienna, Austria
| | - Katharina Ocko
- Pharmacy Department, Vienna General Hospital, Vienna, Austria
| | - Leopold Öhler
- Internal Medicine I, Department of Oncology, St. Josef Hospital, Vienna, Austria
| | - Michael Panny
- Third Medical Department, Hematology & Oncology, Hanusch Hospital, Vienna, Austria
| | - Alexander Pichler
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Edit Porpaczy
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Gerald W Prager
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Julius Salamon
- Department of Medicine, Landesklinikum Waidhofen a.d. Ybbs, Waidhofen-Ybbs, Austria
| | - Ana-Iris Schiefer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Ann-Sofie Schmolke
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Ilse Schwarzinger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Edgar Selzer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian Sillaber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Cathrin Skrabs
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang R Sperr
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Ismet Srndic
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Emiel van der Kouwe
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Katrina Vanura
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Stefan Vogt
- Department of Medicine and Oncology, LKH Wiener Neustadt, Wiener Neustadt, Austria
| | - Cora Waldstein
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Dominik Wolf
- Department of Internal Medicine V, Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Niklas Zojer
- Division of Medicine I, Klinik Ottakring, Vienna, Austria
| | | | - Giulio Superti-Furga
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Berend Snijder
- Department of Biology, Institute of Molecular Systems Biology, ETH Zürich, Zürich, Switzerland
| | - Philipp B Staber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
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10
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Bergen ES, Berghoff AS, Steindl A, Rajky O, Mercea PA, Kiesel B, Tendl-Schulz K, Bago-Horvath Z, Exner R, Fitzal F, Dieckmann K, Widhalm G, Steger GG, Preusser M, Bartsch R. Androgen Receptor is Expressed in Breast Cancer Brain Metastases. Appl Immunohistochem Mol Morphol 2021; 29:728-733. [PMID: 34121071 DOI: 10.1097/pai.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Androgen receptor (AR) expression is a potential therapeutic target in breast cancer (BC) as it is frequently expressed in the luminal A and B subtypes and in approximately one third of basal-like cancers. As AR-positive BC displays a distinct biological behavior, we aimed to analyze AR expression in the particular context of BC brain metastases (BM). MATERIALS AND METHODS Patients with newly diagnosed BC BM treated with neurosurgical resection were identified from the Vienna Brain Metastasis Registry and clinical data including patient characteristics, biological tumor subtypes and overall survival were obtained by retrospective chart review. Formalin-fixed and paraffin-embedded specimen containing BM tissue were retrieved from the Neuro-Biobank. Immunohistochemical staining of AR was performed and AR expression in the tumor-cell nucleus was evaluated. RESULTS Fifty-seven BM samples from 57 individual patients with BC were available for this analysis. AR expression of ≥1% tumor cells was evident in 20/57 (35.1%) BM specimens; the median AR-expression rate was 10% (range: 1% to 60%). AR expression was observed in 11/21 (52.4%) BM of the luminal/human epidermal growth factor receptor 2 (HER2)-negative subtype, 3/13 (23.1%) of the luminal/HER2-positive subtype, 2/7 (28.6%) of the HER2-positive subtype and 4/16 (25.0%) of the triple-negative subtype (P=0.247). Median survival from diagnosis of BM was 10 months (range: 0 to 104 mo) in the entire cohort. No significant association of overall survival and AR expression ≥1% was observed (15 vs. 13 mo; P>0.05). CONCLUSION AR is expressed in more than one third of BC BM with the highest rates among the luminal/HER2-negative BC subtype and may therefore be a potential prognostic and predictive biomarker in this particular BC population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Karin Dieckmann
- Radiooncology, Medical University of Vienna, Vienna, Austria
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11
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Weber WP, Matrai Z, Hayoz S, Tausch C, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Seiler S, Maddox C, Ruhstaller T, Muenst S, Ackerknecht M, Kuemmel S, Bjelic-Radisic V, Kurzeder C, Újhelyi M, Vrieling C, Satler R, Meyer I, Becciolini C, Bucher S, Simonson C, Fehr PM, Gabriel N, Maráz R, Sarlos D, Dedes KJ, Leo C, Berclaz G, Dubsky P, Exner R, Fansa H, Hager C, Reisenberger K, Singer CF, Reitsamer R, Reinisch M, Winkler J, Lam GT, Fehr MK, Naydina T, Kohlik M, Clerc K, Ostapenko V, Fitzal F, Nussbaumer R, Maggi N, Schulz A, Markellou P, Lelièvre L, Egle D, Heil J, Knauer M. Tailored axillary surgery in patients with clinically node-positive breast cancer: Pre-planned feasibility substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Breast 2021; 60:98-110. [PMID: 34555676 PMCID: PMC8463904 DOI: 10.1016/j.breast.2021.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
Aim We developed tailored axillary surgery (TAS) to reduce the axillary tumor volume in patients with clinically node-positive breast cancer to the point where radiotherapy can control it. The aim of this study was to quantify the extent of tumor load reduction achieved by TAS. Methods International multicenter prospective study embedded in a randomized trial. TAS is a novel pragmatic concept for axillary surgery de-escalation that combines palpation-guided removal of suspicious nodes with the sentinel procedure and, optionally, imaging-guided localization. Pre-specified study endpoints quantified surgical extent and reduction of tumor load. Results A total of 296 patients were included at 28 sites in four European countries, 125 (42.2%) of whom underwent neoadjuvant chemotherapy (NACT) and 71 (24.0%) achieved nodal pathologic complete response. Axillary metastases were detectable only by imaging in 145 (49.0%) patients. They were palpable in 151 (51.0%) patients, of whom 63 underwent NACT and 21 had residual palpable disease after NACT. TAS removed the biopsied and clipped node in 279 (94.3%) patients. In 225 patients with nodal disease at the time of surgery, TAS removed a median of five (IQR 3–7) nodes, two (IQR 1–4) of which were positive. Of these 225 patients, 100 underwent ALND after TAS, which removed a median of 14 (IQR 10–17) additional nodes and revealed additional positive nodes in 70/100 (70%) of patients. False-negative rate of TAS in patients who underwent subsequent ALND was 2.6%. Conclusions TAS selectively reduced the tumor load in the axilla and remained much less radical than ALND. Tailored axillary surgery is a novel concept for clinically node-positive breast cancer Tailored axillary surgery selectively removes positive lymph nodes Tailored axillary surgery is much less radical than axillary dissection Tailored axillary surgery removes the clipped node in the vast majority of patients
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Affiliation(s)
- Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Zoltan Matrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary; University of Szeged, H-6725 Szeged, Hungary
| | | | | | - Guido Henke
- Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland; Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Günther Gruber
- Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Frank Zimmermann
- University of Basel, Basel, Switzerland; Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Simone Muenst
- University of Basel, Basel, Switzerland; Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Markus Ackerknecht
- University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Mihály Újhelyi
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Conny Vrieling
- Department of Radiation Oncology, Hirslanden Clinique des Grangettes, Geneva, Switzerland
| | - Rok Satler
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Inna Meyer
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Charles Becciolini
- Breast Center, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Susanne Bucher
- Breast Center, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Colin Simonson
- Department of Gynecology, Centre Hospitalier du Haut-Valais (SZO), Sion, Switzerland
| | - Peter M Fehr
- Breast Center Graubünden, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - Robert Maráz
- Department of Oncology, Bacs-Kiskun Country Hospital, Kecskemet, Hungary
| | - Dimitri Sarlos
- Breast Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Konstantin J Dedes
- Breast Cancer Center, University Hospital of Zurich, Zurich, Switzerland
| | - Cornelia Leo
- Breast Center, Cantonal Hospital Baden, Baden, Switzerland
| | | | - Peter Dubsky
- Breast Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland; Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hisham Fansa
- Breast Center Zürich, Bethanien & Spital Zollikerberg, Zurich, Switzerland
| | - Christopher Hager
- Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Klaus Reisenberger
- Department of Gynecology and Obstetrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Christian F Singer
- Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Roland Reitsamer
- Breast Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Jelena Winkler
- Breast Center, Basel Bethesda Hospital, Basel, Switzerland
| | - Giang Thanh Lam
- Breast Center, University Hospital of Geneva, Geneva, Switzerland
| | | | | | | | - Karine Clerc
- Brustzentrum Freiburg, Centre du sein Fribourg, Fribourg, Switzerland
| | | | - Florian Fitzal
- Department of Surgery and Breast Health Center, Medical University of Vienna, Vienna, Austria
| | - Rahel Nussbaumer
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Alexandra Schulz
- University of Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Pagona Markellou
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | | | - Daniel Egle
- Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Jörg Heil
- Breast Center Heidelberg, Heidelberg, Germany
| | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
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12
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Gampenrieder SP, Pircher M, Fesl C, Rinnerthaler G, Mlineritsch B, Greil-Ressler S, Steger GG, Sagaster V, Fitzal F, Exner R, Devyatko Y, Balic M, Stöger H, Suppan C, Bauernhofer T, Singer CF, Pfeiler G, Seifert M, Helfgott R, Heck D, Rumpold H, Kwasny W, Wieder U, Gnant M, Greil R. Influence of Height on Risk and Outcome of Patients with Early Breast Cancer: A Pooled Analysis of 4,925 Patients from 5 Randomized Trials of the Austrian Breast and Colorectal Cancer Study Group (ABCSG). Breast Care (Basel) 2021; 17:137-145. [PMID: 35707180 PMCID: PMC9149458 DOI: 10.1159/000516157] [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] [Received: 06/03/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Associations between height, cancer risk and worse outcome have been reported for several cancers including breast cancer. We hypothesized that in breast cancer clinical trials, tall women should be overrepresented and might have worse prognosis. <b><i>Methods:</i></b> Data of 4,935 women, included from 1990 to 2010 in 5 trials of the Austrian Breast and Colorectal Cancer Study Group (ABCSG), were analyzed retrospectively. The primary objective was to determine differences in height distribution between the ABCSG cohort and the Austrian female population according to a cross-sectional health survey conducted by the Austrian Statistic Center in 2006 and 2007. Secondary endpoints were disease-free survival (DFS) and overall survival (OS) in different height classes and differences of body mass index (BMI) distribution. <b><i>Results:</i></b> Breast cancer patients in the ABCSG cohort were only slightly but statistically significantly smaller compared to unselected Austrian adult females (mean 164.3 vs. 164.8 cm; <i>p</i> < 0.0001) and significantly more patients were seen in the lower body height class (50 vs. 46%; <i>p</i> < 0.0001) when using the median as a cutoff. However, after adjustment for age, the difference in body height between the two cohorts was no longer significant (<i>p</i> = 0.089). DFS and OS in the two upper height groups (≥170 cm) compared to the two lowest height groups (<160 cm) was not significantly different (5-year DFS: 84.7 vs. 83.0%; HR 0.91, 95% CI 0.73–1.13, <i>p</i> = 0.379; 5-year OS: 94.8 vs. 91.7%; HR 0.74, 95% CI 0.55–1.00, <i>p</i> = 0.051). The BMI of ABCSG patients was significantly higher than in the reference population (mean BMI 24.64 vs. 23.96; <i>p</i> < 0.0001). <b><i>Conclusions:</i></b> Our results do not confirm previous findings that greater body height is associated with a higher breast cancer risk and worse outcome.
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Affiliation(s)
- Simon P Gampenrieder
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Magdalena Pircher
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sigrun Greil-Ressler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Günther G Steger
- Department of Internal Medicine 1, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Verena Sagaster
- Department of Internal Medicine 1, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Yelena Devyatko
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christoph Suppan
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Bauernhofer
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Seifert
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Helfgott
- Department of Surgery and Breast Health Center, Ordensklinikum Linz, Sisters of Charity Linz, Linz, Austria
| | - Dietmar Heck
- Department of Surgery and Breast Health Center, Ordensklinikum Linz, Sisters of Charity Linz, Linz, Austria
| | - Holger Rumpold
- Department of Internal Medicine 2 with Medical Oncology, Hematology, Gastroenterology and Rheumatology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Werner Kwasny
- Department of Surgery, Wiener Neustadt Hospital, Vienna, Austria
| | - Ursula Wieder
- Department of Surgery, Hanusch Hospital Vienna, Vienna, Austria
| | - Michael Gnant
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
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13
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Bartsch R, Singer CF, Pfeiler G, Hubalek M, Stoeger H, Pichler A, Petru E, Bjelic-Radisic V, Greil R, Rudas M, Muy-Kheng TM, Wette V, Petzer AL, Sevelda P, Egle D, Dubsky PC, Filipits M, Fitzal F, Exner R, Jakesz R, Balic M, Tinchon C, Bago-Horvath Z, Frantal S, Gnant M. Conventional versus reverse sequence of neoadjuvant epirubicin/cyclophosphamide and docetaxel: sequencing results from ABCSG-34. Br J Cancer 2021; 124:1795-1802. [PMID: 33762716 PMCID: PMC8144560 DOI: 10.1038/s41416-021-01284-2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 11/26/2020] [Accepted: 12/10/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Preoperative chemotherapy containing anthracyclines and taxanes is well established in early-stage breast cancer. Previous studies have suggested that the chemotherapy sequence may matter but definitive evidence is missing. ABCSG trial 34 evaluated the activity of the MUC1 vaccine tecemotide when added to neoadjuvant treatment; the study provided the opportunity for the second randomisation to compare two different anthracycline/taxane sequences. METHODS HER2-negative early-stage breast cancer patients were recruited to this randomised multicentre Phase 2 study. Patients in the chemotherapy cohort (n = 311) were additionally randomised to a conventional or reversed sequence of epirubicin/cyclophosphamide and docetaxel. Residual cancer burden (RCB) with/without tecemotide was defined as primary study endpoint; RCB in the two chemotherapy groups was a key secondary endpoint. RESULTS No significant differences in terms of RCB 0/I (40.1% vs. 37.2%; P = 0.61) or pathologic complete response (pCR) rates (24.3% vs. 25%, P = 0.89) were observed between conventional or reverse chemotherapy sequence. No new safety signals were reported, and upfront docetaxel did not result in decreased rates of treatment delay or discontinuation. CONCLUSION Upfront docetaxel did not improve chemotherapy activity or tolerability; these results suggest that upfront neoadjuvant treatment with anthracyclines remains a valid option.
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Affiliation(s)
- Rupert Bartsch
- Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Georg Pfeiler
- Department of Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Herbert Stoeger
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Angelika Pichler
- Department of Hemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - Vesna Bjelic-Radisic
- Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
- Breast Unit, Helios University Hospital Wuppertal, Wuppertal Germany, University Witten/Herdecke, Wuppertal, Germany
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg, Austria
| | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | | | | | - Andreas L Petzer
- Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern, Elisabethinen, Linz, Austria
| | - Paul Sevelda
- Karl Landsteiner Institute for Gynecologic Oncology and Senology, Vienna, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter C Dubsky
- Department of Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Breastcenter St. Anna, Lucerne, Switzerland
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Raimund Jakesz
- Department of Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria.
| | - Christoph Tinchon
- Department of Hemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | | | - Sophie Frantal
- Statistics Department, Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
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14
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Bergen ES, Binter A, Starzer AM, Heller G, Kiesel B, Tendl-Schulz K, Bago-Horvath Z, Furtner J, Leitner J, Exner R, Fitzal F, Dieckmann K, Widhalm G, Preusser M, Berghoff AS, Bartsch R. Favourable outcome of patients with breast cancer brain metastases treated with dual HER2 blockade of trastuzumab and pertuzumab. Ther Adv Med Oncol 2021; 13:17588359211009002. [PMID: 33995593 PMCID: PMC8072867 DOI: 10.1177/17588359211009002] [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: 12/11/2020] [Accepted: 03/17/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Dual human epidermal growth factor receptor 2 (HER2) blockade with trastuzumab and pertuzumab (TP) is a standard therapy of metastatic and localized HER2-positive breast cancer (BC), but its activity in breast cancer brain metastases (BCBM) is unknown. Methods: Patients with HER2-positive BCBM were identified from the Vienna Brain Metastasis Registry and clinical data including patient characteristics, therapies and overall survival (OS) were obtained. Patients were grouped into ‘TP’, ‘other-HER2-targeted therapy’ and ‘no-HER2-targeted therapy’ according to received first-line systemic therapy after diagnosis of BCBM. Radiological re-assessment of intracranial lesions was performed in patients treated with TP as systemic first-line therapy according to RANO response criteria for brain metastases (BM). Results: A total of 252 HER2-positive BC patients with BM were available for this analysis. Patients treated with TP as systemic first-line therapy after diagnosis of BM had a significantly longer OS compared with treatment with other-HER2-targeted therapy and no-HER2-targeted therapy (44 versus 17 versus 3 months, p < 0.001; log-rank test). Among radiologically re-assessed patients treated with TP as systemic first-line therapy after diagnosis of BM, 5/14 patients (35.7%) had complete intracranial remission (CR), 8/14 patients (57.1%) partial intracranial remission (PR), 1/14 patients (7.1%) stable intracranial disease (SD) and 0/14 patients (0.0%) progressive intracranial disease (PD) as best response resulting in an intracranial objective response rate (iORR) of 92.9% and an intracranial clinical benefit rate (iCBR) of 100.0%. Conclusion: First-line therapy with dual HER2-inhibition of TP after BM diagnosis was associated with the longest median OS times in patients with BCBM.
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Affiliation(s)
| | - Amelie Binter
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Austria
| | | | - Gerwin Heller
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Austria
| | | | | | - Julia Furtner
- Department of Radiology, Medical University of Vienna, Austria
| | | | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Austria
| | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Austria
| | - Karin Dieckmann
- Department of Radiooncology, Medical University of Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Austria
| | - Anna Sophie Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine 1, Medical University of Vienna, Austria
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15
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Wimmer K, Sachet M, Birnleitner H, Exner R, Filipits M, Gnant M, Fitzal F, Oehler R. Differential effects of epirubicin and docetaxel on the immune system in patients with breast cancer (BC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.588] [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: 11/20/2022] Open
Abstract
588 Background: Neoadjuvant chemotherapy (NAC) with epirubicin/cyclophosphamid (EC) followed by docetaxel (D) is currently a standard of care therapy in women with early, high-risk breast cancer (BC). New approaches aim to improve the outcome by combining chemo- with immunotherapy. It is therefore of great interest if chemotherapeutics differ in their effect on the immune system and if some substances are superior combination partners than others. Methods: 79 BC patients, who participated in the ABCSG-34 trial, were included. 39 patients were treated with 6 cycles of EC followed by 6 cycles of D and 40 received the reverse sequence (D→EC). Blood was collected before and after 6 cycles. The plasma levels of a variety of immune mediators were determined by multiplex bead array assay. The response to therapy was measured by Residual Cancer Burden (RCB)-score. A score of ≤1.36 was determined as good response. Lymphocyte activation was assessed after stimulation with phytohaemagglutinin (PHA) by flow cytometric analysis of IFNgamma. Additionally, lymphocytes of 6 healthy probands were stimulated with PHA and treated with E or D. The stimulation was quantified by measuring cluster formation after 5 days. Further, a human BC cell line (SK-BR3) was treated with E or D. The induced cell death was determined morphologically as well as by flow cytometry after staining of phosphatidylserine, Sub-G1 DNA and active caspase-3. Results: The treatment of BC patients with 6 cycles of EC resulted in a decrease of lymphocyte stimulation whereas 6 cycles of D had no effect. The plasma levels of most immune mediators decreased significantly after six cycles EC when compared to baseline. Under the influence of D, the effect was much weaker. The changes of Eotaxin and OPG during the first 6 cycles of D correlated with the RCB-score in the reverse group. A decrease in Eotaxin (p = 0.0136) or in OPG (p = 0.0487) correlated with good response. The in vitro lymphocyte stimulation assay showed that E and D have similar inhibitory effects on lymphocytes.The annexin V/PI analysis confirmed that E more often leads to apoptotic cell death in SK-BR3 cells than D (E:53% vs. D:14%). SK-BR3 cells formed more often polyploid cells when treated with D. This suggests that D induces a regulated form of necrosis whereas E apoptosis. Conclusions: This study is the first to compare the immunomodulatory effect of E and D in BC patients. E inhibits lymphocyte activation in vitro and in vivo and suppresses many soluble immune mediators. This suggests that it is not suited for combination with immunotherapies. D showed a much weaker effect.
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Affiliation(s)
- Kerstin Wimmer
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Monika Sachet
- Department of Surgery - Research Laboratories and Comprehensive Cancer Center, Anna Spiegel Center of Translational Research, Vienna, Austria
| | - Hanna Birnleitner
- Department of Surgery - Research Laboratories and Comprehensive Cancer Center, Anna Spiegel Center of Translational Research, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Rudolf Oehler
- Department of Surgery - Research Laboratories and Comprehensive Cancer Center, Anna Spiegel Center of Translational Research, Vienna, Austria
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16
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Bjelic-Radisic V, Fitzal F, Knauer M, Steger G, Egle D, Greil R, Schrenk P, Balic M, Singer C, Exner R, Soelkner L, Gnant M. Primary surgery versus no surgery in synchronous metastatic breast cancer: patient-reported quality-of-life outcomes of the prospective randomized multicenter ABCSG-28 Posytive Trial. BMC Cancer 2020; 20:392. [PMID: 32375735 PMCID: PMC7204290 DOI: 10.1186/s12885-020-06894-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 08/11/2019] [Accepted: 04/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The ABCSG-28 trial compared primary surgery followed by systemic therapy versus primary systemic therapy without surgery in patients with de novo stage IV BC. The present report describes QoL results of this trial. METHODS Ninety patients with primary operable MBC were randomised to surgery of the primary tumor followed by systemic therapy or to primary systemic therapy without surgery. QoL analyses covering the results at baseline, 6,12,18 and 24 months follow up of 79 (88%) patients, was assessed with the EORTC QLQ-C30 and QLQ-BR23 questionnaires. RESULTS There were no statistically significant differences in any of the scales of the QLQ-C30 and QLQ-BR23 questionnaires between the two groups over the time. Baseline global health status and physical functioning were predictors for OS (patients with a higher score lived longer (p=0.0250, p=0.0225; p=0.0355, p=0.0355)). Global health status, social functioning scale, breast symptoms and future perspective were predictors for longer TTPd (p=0.0244; p=0.0140, p=0.020; p=0.0438, p=0.0123). Patients in both arms reported significant improvement on the emotional functioning scale. Cognitive functioning decreased over time in both groups. Younger women had clinically relevant better physical and sexual functioning scores (p=0.039 and 0.024). CONCLUSION Primary surgery does not improve nor alter QoL of patients with de novo stage IV BC. Global health status and physical functioning were predictors for OS and could be use as additional marker for prediction of OS and TTTd in patients with de novo stage IV BC. TRIAL REGISTRATION The trial is registered on clinicaltrial.gov (NCT01015625, date of registration:18/11/2009).
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Affiliation(s)
- V Bjelic-Radisic
- Breast Unit, University Hospital Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany. .,Department of Gynecology and Obstetrics, Medical University Graz, Graz, Austria.
| | - F Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Knauer
- Breast Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - G Steger
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - D Egle
- Department of Gynecology and Obstetrics, Medical University Innsbruck, Inssbruck, Austria
| | - R Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular cancer Reseasrch, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - P Schrenk
- Department of Surgery, Medical University Linz, Linz, Austria
| | - M Balic
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University Graz, Graz, Austria
| | - Ch Singer
- Department of Gynecology and Obstetrics, Medical University Vienna, Vienna, Austria
| | - R Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - L Soelkner
- Statistics Department, Austrian Breast and Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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17
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Singer CF, Pfeiler G, Hubalek M, Bartsch R, Stöger H, Pichler A, Petru E, Bjelic-Radisic V, Greil R, Rudas M, Maria Tea MK, Wette V, Petzer AL, Sevelda P, Egle D, Dubsky PC, Filipits M, Fitzal F, Exner R, Jakesz R, Balic M, Tinchon C, Bago-Horvath Z, Frantal S, Gnant M. Efficacy and safety of the therapeutic cancer vaccine tecemotide (L-BLP25) in early breast cancer: Results from a prospective, randomised, neoadjuvant phase II study (ABCSG 34). Eur J Cancer 2020; 132:43-52. [PMID: 32325419 DOI: 10.1016/j.ejca.2020.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/14/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immune-based strategies represent a promising approach in breast cancer (BC) treatment. The glycoprotein mucin-1 (MUC-1) is overexpressed in more than 90% of BC patients, and is targeted by the cancer vaccine tecemotide. We have investigated the efficacy and safety of tecemotide when added to neoadjuvant standard-of-care (SoC) treatment in early BC patients. PATIENTS AND METHODS A total of 400 patients with HER2-early BC were recruited into this prospective, multicentre, randomised 2-arm academic phase II trial. Patients received preoperative SoC treatment (chemotherapy or endocrine therapy) with or without tecemotide. Postmenopausal women with oestrogen receptor (ER)+++, or ER++ and Ki67 < 14%, and G1,2 tumours ('luminal A' tumours) received 6 months of letrozole. Postmenopausal patients with triple-negative, ER-/+/++ and Ki67 ≥ 14%, and with G3 tumours, as well as premenopausal patients, received four cycles of epirubicin/cyclophosphamide plus four cycles of docetaxel. Primary end-point was residual cancer burden (RCB; 0/I versus II/III) at surgery. Secondary end-points included pathological complete response (pCR), safety, and quality of life. FINDINGS We observed no significant difference in RCB 0/I rates between patients with (36.4%) and without (31.9%) tecemotide in the overall study population (p = 0.40) nor in endocrine and chemotherapy-treated subgroups (25.0% versus 13.3%, p = 0.17; 39.6% versus 37.8%, p = 0.75, respectively). The addition of tecemotide did not affect overall pCR rates (22.5% versus 17.4%, p = 0.23), MUC-1 expression, or tumour-infiltrating lymphocytes content. Tecemotide did not increase toxicity when compared to SoC therapy alone. INTERPRETATION Neoadjuvant tecemotide is safe, but does not improve RCB or pCR rates in patients receiving standard neoadjuvant therapy.
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Affiliation(s)
- Christian F Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Angelika Pichler
- Department of Hemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal Germany, Germany
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg Cancer Research Institute-CCCIT, Cancer Cluster Salzburg, Salzburg, Austria
| | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, Medical University of Vienna, Vienna, Austria
| | - Muy-Kheng Maria Tea
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Andreas L Petzer
- Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern, Elisabethinen, Linz, Austria
| | - Paul Sevelda
- Karl Landsteiner Institute for Gynecologic Oncology and Senology, Vienna, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter C Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breastcenter St. Anna, Lucerne, Switzerland
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Raimund Jakesz
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Christoph Tinchon
- Department of Hemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - Zsuzsanna Bago-Horvath
- Department of Pathology, Medical University of Vienna, Medical University of Vienna, Vienna, Austria
| | - Sophie Frantal
- Department of Statistics, Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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18
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Marhold M, Ionce LR, Christ A, Aretin MB, Sagaster V, Exner R, Wimmer K, Devyatko Y, Fitzal F, Steger GG. Retrospective single-center outcome analysis of neoadjuvant and palliative treatment with dual trastuzumab and pertuzumab in HER2-positive breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12114] [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: 11/20/2022] Open
Abstract
e12114 Background: Her2-positive (Her2pos) breast cancer (BCa) is the second most lethal subtype of BCa. The treatment of Her2-positive BCa was revolutionized due to the dual use of trastuzumab and pertuzumab (T+P) in recent years both in the neoadjuvant and the palliative setting. Although several years have passed after initial approval of these drugs, single-center outcome data as reported by clinicians is sparse. In this retrospective study, we set to assess outcomes measures at our institution, Austria’s largest academic hospital, for the use of T+P in early and metastasized BCa. Methods: We acquired records on combined pertuzumab and trastuzumab orders from our intramural drug order software (CATO, Cato Research, Durham, NC, USA) for the time period of May 2013 to March 2018. Further, using electronic patient histories, we described both the neoadjuvant and palliative patient groups by assessment of body weight/size, tumor stage, histology including immunohistochemistry (IHC), lines of oncological therapies received, ejection fraction (EF) drops>10%, deaths and most importantly the outcomes measures pathological complete response (pCR, neoadjuvant cohort) rate and progression-free survival (PFS, palliative cohort). Results: 120 breast cancer patients were given dual therapy with T+P. The neoadjuvant cohort contained 63 patients, while the palliative cohort included 57 patients. All patients included were female. Full histology including IHC data was available for 47 of 63 patients in the neoadjuvant cohort and 30 of 57 patients in the palliative cohort. BMI was 25.6 and 23.3, respectively, on average. The mean age was 54 years in the neoadjuvant and 56 years in the palliative cohort. 73.6% (39/53) and 65.9% (29/44) of tumors were ER positive as determined by IHC. While neoadjuvant patients obtained an average of 6.5 cycles, patients within the palliative cohort received a mean of 17.3 cycles of T+P. 0 and 17 deaths were observed in the respective cohorts. Data on pCR and PFS was available for 95.2% and 91.2% of patients, respectively. The pCR rate within the neoadjuvant cohort was 46.7% (28/60), and mean PFS across all treatment lines of the palliative cohort was 10.2 months. Conclusions: We report retrospective single-center outcome data for the combined use of trastuzumab and pertuzumab in both early and metastatic Her2pos BCa in line with previously published data.
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Affiliation(s)
- Maximilian Marhold
- Department of Internal Medicine I, Department of Oncology and Gaston H. Glock Research Center, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Verena Sagaster
- Medical University Vienna, Department for Internal Medicine I, Oncology, Vienna, Austria
| | - Ruth Exner
- Medical University of Vienna, Vienna, Austria
| | - Kerstin Wimmer
- Medical University Vienna, Department for Surgery, Vienna, Austria
| | - Yelena Devyatko
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Guenther G. Steger
- Department of Internal Medicine I, Department of Oncology and Gaston H. Glock Research Center, Medical University of Vienna, Vienna, Austria
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19
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Tendl K, Monschein L, Exner R, Fitzal F, Bergen E, Seifert M, Singer C, Rudas M, Müllauer L, Bago-Horvath Z. Utilization and performance of the Prosigna® breast cancer prognostic gene signature assay at the Medical University of Vienna. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.025] [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: 11/14/2022] Open
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20
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Gnant M, Pfeiler G, Steger GG, Egle D, Greil R, Fitzal F, Wette V, Balic M, Haslbauer F, Melbinger-Zeinitzer E, Bjelic-Radisic V, Jakesz R, Marth C, Sevelda P, Mlineritsch B, Exner R, Fesl C, Frantal S, Singer CF. Adjuvant denosumab in postmenopausal patients with hormone receptor-positive breast cancer (ABCSG-18): disease-free survival results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2019; 20:339-351. [PMID: 30795951 DOI: 10.1016/s1470-2045(18)30862-3] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND In postmenopausal women with hormone receptor-positive, early-stage breast cancer, treatment with adjuvant aromatase inhibitors is the standard of care, but it increases risk for osteoporosis and fractures. Results from the ABCSG-18 trial showed that use of denosumab as an adjuvant to aromatase inhibitor therapy significantly reduced clinical fractures. Disease-free survival outcomes from ABCSG-18 have not yet been reported. METHODS Postmenopausal patients with early, hormone receptor-positive, non-metastatic adenocarcinoma of the breast, who had completed their initial adjuvant treatment pathway (surgery, radiotherapy, or chemotherapy, or a combination) and were receiving adjuvant aromatase inhibitors, were enrolled at 58 trial centres in Austria and Sweden into this prospective, double-blind, placebo-controlled, phase 3 trial. With permuted block randomisation (block sizes 2 and 4, stratified by previous aromatase inhibitor use, total lumbar spine bone mineral density score at baseline, and type of centre), patients were assigned (1:1) to receive subcutaneous denosumab (60 mg) or matching placebo every 6 months during aromatase inhibitor therapy. The primary endpoint (previously reported) was the time to first clinical fracture after randomisation. The secondary endpoint reported here is disease-free survival (defined as time from randomisation to first evidence of local or distant metastasis, contralateral breast cancer, secondary carcinoma, or death from any cause) in the intention-to-treat population. This study is registered with EudraCT (number 2005-005275-15) and ClinicalTrials.gov (number NCT00556374), and is ongoing for long-term follow-up. FINDINGS Between Dec 18, 2006, and July 22, 2013, 3425 eligible patients were enrolled and randomly assigned; 1711 to the denosumab group and 1709 to the placebo group (with five others withdrawing consent). After a median follow-up of 73 months (IQR 58-95), 240 (14·0%) patients in the denosumab and 287 (16·8%) in the placebo group had disease-free survival events. Disease-free survival was significantly improved in the denosumab group versus the placebo group (hazard ratio 0·82, 95% CI 0·69-0·98, Cox p=0·0260; descriptive analysis, without controlling for multiplicity). In the denosumab group, disease-free survival was 89·2% (95% CI 87·6-90·8) at 5 years and 80·6% (78·1-83·1) at 8 years of follow-up, compared with 87·3% (85·7-89·0) at 5 years and 77·5% (74·8-80·2) and 8 years in the placebo group. No independently adjudicated cases of osteonecrosis of the jaw or confirmed atypical femoral fractures were recorded. The total number of adverse events was similar in the denosumab group (1367 [including 521 serious] adverse events) and the placebo group (1339 [515 serious]). The most common serious adverse events were osteoarthritis (62 [3·6%] of 1709 in the denosumab group vs 58 [3·4%] of 1690 in the placebo group), meniscus injury (23 [1·3%] vs 24 [1·4%]), and cataract (16 [0·9%] vs 28 [1·7%]). One (<0·1%) treatment-related death (due to pneumonia, septic kidney failure, and cardiac decompensation) occurred in the denosumab group. INTERPRETATION Denosumab constitutes an effective and safe adjuvant treatment for patients with postmenopausal hormone receptor-positive early breast cancer receiving aromatase inhibitor therapy. FUNDING Amgen.
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Affiliation(s)
- Michael Gnant
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.
| | - Georg Pfeiler
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Department of Gynaecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Günther G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute-Centre for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute, Salzburg, Austria
| | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Breast Health Centre, Hospital of Sisters of Mercy Linz, Linz, Austria
| | | | - Marija Balic
- Department of Oncology, Medical University Graz, Graz, Austria
| | - Ferdinand Haslbauer
- Department of Internal Medicine, Hospital Voecklabruck, Voecklabruck, Austria
| | | | | | - Raimund Jakesz
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Christian Marth
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Paul Sevelda
- Department of Gynaecology, Hospital Hietzing, Vienna, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute-Centre for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Salzburg, Austria
| | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Christian Fesl
- Department of Statistics, Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Sophie Frantal
- Department of Statistics, Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Christian F Singer
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Department of Gynaecology and Obstetrics, Medical University of Vienna, Vienna, Austria
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21
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Strobl SA, Dubsky P, Exner R, Gnant M, Jakesz R, Tausch C, Wette V, Heck D, Luisser I, Bjelic-Radisic V, Schrenk P, Poyssl C, Mathis J, Fitzal F. Abstract P3-03-24: ABCSG 33 - A multi center registry to evaluate the affect of macro metastasis in sentinel lymph node on survival. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-03-24] [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:
Sentinel lymph node dissection identifies nodal positivity in early breast cancer. Trials like the ACOSOG Z0011 trial tried to show that the waiver of axillary dissection in nodal positive breast cancer (BC) has no effect on the oncologic outome, however real world data are rare and the role of adjuvant regional radiotherapy is still disputed in this respect.
Objective:
We initiated a multicenter observational registry to investigate omission of axillary lymph node dissection in nodal positive early BC.
Design and Setting:
The 18 sites participating in Austria and Switzerland included from 2014 to 2017 178 patients in this trail.
Patients:
Women with unilateral invasive lymph node positive BC with one or two sentinel lymph node makrometastases, who did not undergo axillary lymph node dissection were included.
Results:
We had a median follow up time of 3.1 years (range between 0.5 and 10.5 years), the median patient age is 63.6 years (range between 33 – 93 years). In 16.9% women had a G1 Grading, 53.1% had G2 tumor and 29.9% had a G3 tumor. Multifocality was seen in 18.1% of the patients. Luminal A tumors were seen in 16 (8.9%) and Luminal B in 82 (46.1%). Fourteen (7.8%) patients in this cohort had HER2 positive BC. In one (0.5%) local recurrence of the axilla occurred. Three (1.7%) of 178 patients died due to BC recurrence.
Conclusion:
Patients with macro metastasis in the sentinel lymph node, treated with breast conserving surgery and whole breast radiation did not have an increased risk of BC recurrence.
Therefore the authors assume that axillary dissection in patients with early stage BC and macro metastasis is not necessary in this patient cohort.
Citation Format: Strobl SA, Dubsky P, Exner R, Gnant M, Jakesz R, Tausch C, Wette V, Heck D, Luisser I, Bjelic-Radisic V, Schrenk P, Poyssl C, Mathis J, Fitzal F. ABCSG 33 - A multi center registry to evaluate the affect of macro metastasis in sentinel lymph node on survival [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 P3-03-24.
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Affiliation(s)
- SA Strobl
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - P Dubsky
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - R Exner
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - M Gnant
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - R Jakesz
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - C Tausch
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - V Wette
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - D Heck
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - I Luisser
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - V Bjelic-Radisic
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - P Schrenk
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - C Poyssl
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - J Mathis
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
| | - F Fitzal
- Medical University of Vienna, Vienna, Austria; Brust Zentrum Zürich, Zürich, Switzerland; Medical University of Graz, Graz, Austria; General Hospital Linz, Linz, Austria; Brustzentrum Wette, St. Veit an der Glan, Austria; State Hospital Guessing, Guessing, Austria; Barmherzige Schwestern Linz, Linz, Austria; State Hospital Feldkirch, Feldkirch, Austria; State Hospital Dornbirn, Dornbirn, Austria
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Minichsdorfer C, Bergen E, Steger GG, Pfeiler G, Frantal S, Greil R, Fohler H, Egle D, Balic M, Fitzal F, Wette V, Exner R, Bartsch RA, Gnant M. Abstract P6-21-02: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-21-02] [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
This abstract was withdrawn by the authors.
Citation Format: Minichsdorfer C, Bergen E, Steger GG, Pfeiler G, Frantal S, Greil R, Fohler H, Egle D, Balic M, Fitzal F, Wette V, Exner R, Bartsch RA, Gnant M. Withdrawn [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 P6-21-02.
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Affiliation(s)
- C Minichsdorfer
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - E Bergen
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - GG Steger
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - G Pfeiler
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - S Frantal
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - R Greil
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - H Fohler
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - D Egle
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - M Balic
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - F Fitzal
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - V Wette
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - R Exner
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - RA Bartsch
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - M Gnant
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
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23
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Bergen ES, Berghoff AS, Medjedovic M, Rudas M, Fitzal F, Bago-Horvath Z, Dieckmann K, Mader RM, Exner R, Gnant M, Zielinski CC, Steger GG, Preusser M, Bartsch R. Continued Endocrine Therapy Is Associated with Improved Survival in Patients with Breast Cancer Brain Metastases. Clin Cancer Res 2019; 25:2737-2744. [PMID: 30647078 DOI: 10.1158/1078-0432.ccr-18-1968] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/28/2018] [Accepted: 01/11/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Brain metastases (BMs) are a rare but devastating condition in estrogen receptor (ER)-positive metastatic breast cancer (MBC). Although endocrine therapy (ET) is the mainstay of treatment in this disease subtype, only case reports have been published concerning the activity of ET in BMs henceforth. Therefore, we aimed to systematically investigate the impact of ET after diagnosis of BM on outcome and clinical course of disease in patients with ER-positive MBC. EXPERIMENTAL DESIGN Patient characteristics, detailed information about BMs including diagnosis-specific graded prognostic assessment class (DS-GPA), and clinical outcome were obtained by retrospective chart review for all patients treated for ER-positive breast cancer BMs between 1990 and 2017 at an academic care center. Overall survival (OS) was measured as the interval from diagnosis of BM until death or last date of follow-up. RESULTS Overall, 198 patients [female: 195/198 (98.5%); male: 3/198 (1.5%)] with ER-positive breast cancer BMs were available for this analysis. Eighty-eight of 198 patients (44.4%) received ET after diagnosis of BM including aromatase inhibitors (AIs; letrozole, anastrozole, exemestane), tamoxifen, and fulvestrant. Median OS was significantly longer in patients receiving ET after diagnosis of BM compared with patients who did not (15 vs. 4 months, P < 0.001; log-rank test). No significant difference in terms of OS was observed between patients receiving AIs, tamoxifen, or fulvestrant. In patients with concomitant leptomeningeal carcinomatosis (LC), ET prolonged median OS significantly as well (7 vs. 3 months, P = 0.012; log-rank test). In a multivariate analysis including DS-GPA and ET, only treatment with ET after diagnosis of BM (HR, 0.69; 95% confidence interval, 0.48-0.99; P = 0.046) was associated with prognosis (Cox regression model). CONCLUSIONS Continuing ET after BM diagnosis was associated with a significantly prolonged OS in this large single-center cohort. No substantial differences between substances were observed. These findings should be validated in a prospective cohort.
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Affiliation(s)
- Elisabeth S Bergen
- Comprehensive Cancer Center, Vienna, Austria.,Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Comprehensive Cancer Center, Vienna, Austria.,Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Mela Medjedovic
- Comprehensive Cancer Center, Vienna, Austria.,Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Margaretha Rudas
- Comprehensive Cancer Center, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Zsuzsanna Bago-Horvath
- Comprehensive Cancer Center, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center, Vienna, Austria.,Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Robert M Mader
- Comprehensive Cancer Center, Vienna, Austria.,Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph C Zielinski
- Comprehensive Cancer Center, Vienna, Austria.,Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Guenther G Steger
- Comprehensive Cancer Center, Vienna, Austria.,Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Comprehensive Cancer Center, Vienna, Austria.,Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Comprehensive Cancer Center, Vienna, Austria. .,Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
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24
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Bergen E, Berghoff A, Rajky U, Rudas M, Bago-Horvath Z, Exner R, Dieckmann K, Widhalm G, Gnant M, Zielinski C, Steger G, Preusser M, Bartsch R. Androgen receptor expression in breast cancer brain metastases. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy273.367] [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: 11/13/2022] Open
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25
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Gnant M, Pfeiler G, Steger GG, Egle D, Greil R, Fitzal F, Wette V, Balic M, Haslbauer F, Melbinger-Zeinitzer E, Bjelic-Radisic V, Bergh JCS, Jakesz R, Marth C, Sevelda P, Mlineritsch B, Exner R, Fesl C, Frantal S, Singer CF. Adjuvant denosumab in early breast cancer: Disease-free survival analysis of 3,425 postmenopausal patients in the ABCSG-18 trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.500] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna and Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Georg Pfeiler
- Medical University of Vienna, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Vienna, Austria
| | - Guenther G. Steger
- Department of Internal Medicine and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Viktor Wette
- Breast Center, Doctor's Office Wette, St.Veit an Der Glan, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | | | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | | | - Christian Marth
- AGO-A and Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | | | | | - Ruth Exner
- Medical University of Vienna, Vienna, Austria
| | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Sophie Frantal
- Austrian Breast and Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Christian F. Singer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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26
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Singer CF, Rudas M, Fesl C, Steger GG, Pfeiler G, Egle D, Balic M, Petru E, Fitzal F, Greil R, Bjelic-Radisic V, Exner R, Bago-Horvath Z, Filipits M, Tea MKM, Wette V, Petzer AL, Suppan C, Frantal S, Gnant M. Ki67 to predict RCB0/I after neoadjuvant chemotherapy and endocrine therapy in HER2- breast cancer patients from ABCSG 34. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christian F. Singer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Margaretha Rudas
- Department of Pathology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Guenther G. Steger
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Georg Pfeiler
- Medical University of Vienna, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Vienna, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Ruth Exner
- Medical University of Vienna, Vienna, Austria
| | - Zsuzsanna Bago-Horvath
- Clinical Institute for Pathology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Muy-Kheng Maria Tea
- Medical University of Vienna, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Vienna, Austria
| | - Viktor Wette
- Breast Center, Doctor's Office Wette, St.Veit an Der Glan, Austria
| | | | - Christoph Suppan
- Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Sophie Frantal
- Austrian Breast and Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna and Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
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27
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Strobl S, Wimmer K, Exner R, Devyatko Y, Bolliger M, Fitzal F, Gnant M. Adjuvant Bisphosphonate Therapy in Postmenopausal Breast Cancer. Curr Treat Options Oncol 2018. [DOI: 10.1007/s11864-018-0535-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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28
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Wimmer K, Strobl S, Bolliger M, Devyatko Y, Korkmaz B, Exner R, Fitzal F, Gnant M. Optimal duration of adjuvant endocrine therapy: how to apply the newest data. Ther Adv Med Oncol 2017; 9:679-692. [PMID: 29344105 PMCID: PMC5764154 DOI: 10.1177/1758834017732966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/20/2017] [Accepted: 08/23/2017] [Indexed: 12/12/2022] Open
Abstract
Background: The benefit of 5 years of adjuvant endocrine therapy for women with hormone receptor-positive (HR+) breast cancer (BC) is beyond discussion. Nevertheless, the risk of recurrence of luminal BC persists for 15 years or more after diagnosis. Consequently, approaches of extended adjuvant therapy have been investigated in large clinical trials, with the ultimate aim of further reducing the risk of recurrence in patients with HR+ BC. Methods: A review of recently published trial data is presented to provide a solid basis for discussion. A discussion of the side effects of long-term endocrine treatment, multigenetic tests aiming to identify patients at particular risk, and an outlook for further promising targets are additional aims of this review. Conclusion: Extended adjuvant therapy seems beneficial in reducing distant relapse and contralateral BC for a selected group of patients with HR+ BC, particularly if aromatase inhibitors (AIs) are used after initial tamoxifen therapy. However, patients with lower risk of recurrence and initial AI therapy may suffer more from side effects than benefit from extended therapy.
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Affiliation(s)
- Kerstin Wimmer
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Stephanie Strobl
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Bolliger
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Yelena Devyatko
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Belgin Korkmaz
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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29
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Bhangu JS, Exner R, Bachleitner-Hofmann T. Trocar-site evisceration of the vermiform appendix following laparoscopic sigmoid colectomy: A case report. Int J Surg Case Rep 2017; 31:273-275. [PMID: 28208110 PMCID: PMC5310934 DOI: 10.1016/j.ijscr.2017.01.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 12/10/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 11/28/2022] Open
Abstract
Trocar-site evisceration of the vermiform appendix following laparoscopic surgery is a rare complication. A regular intraoperative appearance of the vermiform appendix does not reliably rule out the presence of a diseased appendix. Incidental appendectomy should be considered in all patients undergoing colorectal surgery. The restrictive use of prophylactic drains after colorectal procedures is recommended.
Introduction There is an ongoing debate whether prophylactic drainage or incidental appendectomy should be performed in patients undergoing colorectal surgery. On the other hand, it has been shown that the placement of drains through former trocar sites as well as the use of large (≥10 mm) trocars, incomplete fascial closure or closed laparoscopy technique all predispose for the occurrence of trocar site hernias. Presentation of case We report the case of a 59-year-old male patient who underwent laparoscopic sigmoid colectomy with primary anastomosis for recurrent sigmoid diverticulitis. Preoperative diagnostics revealed no abnormalities other than multiple diverticula in the sigmoid colon. The subsequent surgery was conducted without any complications. Due to inconspicuous intraoperative appearance of the vermiform appendix, no incidental appendectomy was performed. On the 4th postoperative day, the Easy Flow drain − which had been placed prophylactically through the 12 mm trocar site in the right lower abdomen − was removed. Four hours after drain removal, trocar-site evisceration of the vermiform appendix occurred, requiring emergency surgery. Discussion and conclusion The present case is yet another argument for restricting the use of prophylactic drains in colorectal surgery as well as closing port sites of ≥10 mm diameter. Furthermore, incidental appendectomy may be considered since it is able to prevent this type of complication and can be performed with minimal cost and morbidity.
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Affiliation(s)
- Jagdeep Singh Bhangu
- Medical University of Vienna, Department of Surgery, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Ruth Exner
- Medical University of Vienna, Department of Surgery, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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30
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Singer CF, Tan YY, Fitzal F, Steger GG, Egle D, Reiner A, Rudas M, Gruber C, Bartsch R, Fridrik M, Seifert M, Exner R, Balic M, Bago-Horvath Z, Filipits M, Gnant M. Abstract P1-09-10: Pathological complete response to neoadjuvant trastuzumab is dependent on HER2/CEP17 ratio in HER2-amplified early breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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 To evaluate whether pathological complete response to neoadjuvant trastuzumab is dependent on the level of HER2 amplification.
Patients and Methods 114 women with HER2-overexpressing early breast cancer who had received neo-adjuvant trastuzumab in the prospective ABCSG-24 and ABCSG-32 trials, and for whom the HER2/CEP17 ratio was available, were included in this analysis. The ratio was correlated with tumor response as measured by the three most commonly used definitions of pathological complete response: ypT0 ypN0, ypT0/is ypN0, and ypT0/is.
Results In trastuzumab-treated patients, ypT0 pN0 was achieved in 69.0% of patients with a HER2/CEP17 ratio of >6, but only in 30.4% of tumors with a ratio of ≤6 (p=0.001, Chi Square test). When pCR was defined by ypT0/is pN0 or by ypTis, 75.9% and 82.8% of tumors with a high ratio had a complete remission, while only 39.1%, and 38.3% with a low ratio achieved a pCR (p=0.002 and p<0.001, respectively). Logistic regression revealed that tumors with a higher HER2/CEP17 ratio had a significantly higher probability to achieve ypT0 ypN0 (OR: 5.08, 95% CI 1.86-13.90; p=0.002) than tumors with a low ratio, while none of the other clinicopathological parameters was predictive of pCR. The association between high HER2 amplification and pCR was almost exclusively confined to HR positive tumors (62.5% vs. 24.0%, 75.0% vs. 28.0%, and 87.5% vs. 28.0%, for ypT0 ypN0, ypT0/is ypN0, and ypT0/is; p=0.014, p=0.005, and p<0.001), and was largely absent in HR negative tumors.
Conclusion A HER2/CEP17 ratio of >6 in the pre-therapeutic tumor biopsy is associated with a significantly higher pCR rate particularly in HER2 / HR co-positive tumors, and can be used to predict outcome before neoadjuvant trastuzumab is initiated.
Citation Format: Singer CF, Tan YY, Fitzal F, Steger GG, Egle D, Reiner A, Rudas M, Gruber C, Bartsch R, Fridrik M, Seifert M, Exner R, Balic M, Bago-Horvath Z, Filipits M, Gnant M, For the Austrian Breast and Colorectal Cancer Study Group. Pathological complete response to neoadjuvant trastuzumab is dependent on HER2/CEP17 ratio in HER2-amplified early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-10.
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Affiliation(s)
- CF Singer
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - YY Tan
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - F Fitzal
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - GG Steger
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - D Egle
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - A Reiner
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Rudas
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - C Gruber
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Fridrik
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Seifert
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - R Exner
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Balic
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Z Bago-Horvath
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Filipits
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - M Gnant
- Medical University Vienna, Vienna, Austria; Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria; Allgemeines Krankenhaus Linz, Linz, Austria; Medical University of Graz, Graz, Austria; Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
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Singer CF, Tan YY, Fitzal F, Steger GG, Egle D, Reiner A, Rudas M, Moinfar F, Gruber C, Petru E, Bartsch R, Tendl KA, Fuchs D, Seifert M, Exner R, Balic M, Bago-Horvath Z, Filipits M, Gnant M. Pathological Complete Response to Neoadjuvant Trastuzumab Is Dependent on HER2/CEP17 Ratio in HER2-Amplified Early Breast Cancer. Clin Cancer Res 2017; 23:3676-3683. [PMID: 28143867 DOI: 10.1158/1078-0432.ccr-16-2373] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate whether pathologic complete response (pCR) to neoadjuvant trastuzumab is dependent on the level of HER2 amplification.Experimental Design: 114 HER2-overexpressing early breast cancer patients who had received neoadjuvant trastuzumab were included in this study. Absolute HER2 and chromosome 17 centromere (CEP17) were measured by in situ hybridization analysis, and associations were examined between HER2/CEP17 ratio and tumor pCR status (commonly defined by ypT0 ypN0, ypT0/is ypN0, and ypT0/is).Results: In trastuzumab-treated patients, ypT0 ypN0 was achieved in 69.0% of patients with high-level amplification (HER2/CEP17 ratio > 6), but only in 30.4% of tumors with low-level amplification (ratio ≤ 6; P = 0.001). When pCR was defined by ypT0/is ypN0 or ypTis, 75.9% and 82.8% of tumors with high-level amplification had a complete response, whereas only 39.1%, and 38.3% with low-level amplification achieved pCR (P = 0.002 and P < 0.001, respectively). Logistic regression revealed that tumors with high-level amplification had a significantly higher probability achieving ypT0 ypN0 (OR, 5.08; 95% confidence interval, 1.86-13.90; P = 0.002) than tumors with low-level amplification, whereas no other clinicopathologic parameters were predictive of pCR. The association between high-level HER2 amplification and pCR was almost exclusively confined to hormone receptor (HR)-positive tumors (ypT0 ypN0: 62.5% vs. 24.0%, P = 0.014; ypT0/is ypN0: 75.0% vs. 28.0%, P = 0.005; and ypT0/is: 87.5% vs. 28.0%, P < 0.001), and was largely absent in HR-negative tumors.Conclusions: An HER2/CEP17 ratio of >6 in the pretherapeutic tumor biopsy is associated with a significantly higher pCR rate, particularly in HER2/HR copositive tumors, and can be used as a biomarker to predict response before neoadjuvant trastuzumab is initiated. Clin Cancer Res; 23(14); 3676-83. ©2017 AACR.
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Affiliation(s)
- Christian F Singer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria.
| | - Yen Y Tan
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Guenther G Steger
- Department of Internal Medicine 1, Division of Oncology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Angelika Reiner
- Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria
| | - Margaretha Rudas
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Farid Moinfar
- Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria
| | - Christine Gruber
- Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria
| | - Edgar Petru
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Rupert Bartsch
- Department of Internal Medicine 1, Division of Oncology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Kristina A Tendl
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - David Fuchs
- Department of Internal Medicine 3-Hematology and Oncology, Kepler University Hospital, Linz, Austria
| | - Michael Seifert
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Oncology, Medical University of Graz, Graz, Austria
| | | | - Martin Filipits
- Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Exner R, Sachet M, Arnold T, Zinn-Zinnenburg M, Michlmayr A, Dubsky P, Bartsch R, Steger G, Gnant M, Bergmann M, Bachleitner-Hofmann T, Oehler R. Prognostic value of HMGB1 in early breast cancer patients under neoadjuvant chemotherapy. Cancer Med 2016; 5:2350-8. [PMID: 27457217 PMCID: PMC5055166 DOI: 10.1002/cam4.827] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 03/04/2016] [Revised: 06/13/2016] [Accepted: 06/26/2016] [Indexed: 12/16/2022] Open
Abstract
The response to neoadjuvant chemotherapy in breast cancer patients is usually assessed by pCR and RCB score. However, the prognostic value of these parameters is still in discussion. We showed recently that an epirubicin/docetaxel therapy is associated with an increase in the cell death marker high‐mobility group box 1 protein (HMGB1) in the circulation. Here, we investigate whether this increase correlates with the long‐term outcome. Thirty‐six early breast cancer patients under neoadjuvant epirubicin/docetaxel combination chemotherapy were included in this study. To determine the immediate effect of this treatment on HMGB1, we collected blood samples before and 24–96 h after the initial dose. This time course was then compared to the 5‐year follow‐up of the patients. HMGB1 levels varied before chemotherapy between 4.1 and 11.3 ng/mL and reacted differently in response to therapy. Some patients showed an increase while others did not show any changes. Therefore, we subdivided the patient collective into two groups: patients with an at least 1.1 ng/mL increase in HMGB1 and patients with smaller changes. The disease‐free survival was longer in the HMGB1 increase group (56.2 months vs. 46.6 months), but this difference did not reach significance. The overall survival (OS) was significantly better in patients with an increase in HMGB1 (log rank P = 0.021). These data suggest that an immediate increase in HMGB1 levels correlates with improved outcome in early breast cancer patients receiving neoadjuvant chemotherapy, and may be a valuable complementary biomarker for early estimation of prognosis.
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Affiliation(s)
- Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Monika Sachet
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Tobias Arnold
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Mercedes Zinn-Zinnenburg
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Anna Michlmayr
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Peter Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Rupert Bartsch
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Guenther Steger
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Michael Bergmann
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Thomas Bachleitner-Hofmann
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria
| | - Rudolf Oehler
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, A-1090, Austria.
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Bergen ES, Tichy C, Berghoff AS, Rudas M, Dubsky P, Bago-Horvath Z, Mader RM, Exner R, Gnant M, Zielinski CC, Steger GG, Preusser M, Bartsch R. Prognostic impact of breast cancer subtypes in elderly patients. Breast Cancer Res Treat 2016; 157:91-9. [PMID: 27107570 PMCID: PMC4866984 DOI: 10.1007/s10549-016-3787-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 01/09/2016] [Accepted: 04/05/2016] [Indexed: 01/29/2023]
Abstract
We aimed to analyse the impact of breast cancer (BC) subtypes on the clinical course of disease with special emphasis on the occurrence of brain metastases (BM) and outcome in an elderly BC population. A total number of 706 patients ≥65 years receiving treatment for BC from 2007 to 2011 were identified from a BC database. 62 patients diagnosed with DCIS and 73 patients with incomplete datasets were excluded, leaving 571 patients for this analysis. Patient characteristics, biological tumour subtypes, and clinical outcome including overall survival (OS) were obtained by retrospective chart review. 380/571 (66, 5 %) patients aged 65–74 years were grouped among the young-old, 182/571 (31.9 %) patients aged 75–84 years among the old–old, and 29/571 (5.1 %) patients aged ≥85 years among the oldest-old. 392/571 (68.8 %) patients presented with luminal BC, 119/571 (20.8 %) with HER2-positive, and 59/571 (10.3 %) with triple-negative BC (TNBC). At 38 months median follow-up, 115/571 (20.1 %) patients presented with distant recurrence. A higher recurrence rate was observed in the HER2-positive subtype (43/119 (36.1 %)), as compared to TNBC (15/59 (25.4 %)) and luminal BC (57/392 (14.5 %); p < 0.001). BM were detected at a significantly higher rate in HER2-positive BC patients (9/119 (7.6 %)), as compared to TNBC (2/59 (3.4 %)) and luminal BC patients (6/392 (1.5 %); p = 0.003). Diagnosis of metastatic disease (HR 7.7; 95 % CI 5.2–11.4; p < 0.001) as well as development of BM (HR 3.5; 95 % CI 1.9–6.4; p < 0.001) had a significantly negative impact on OS in a time-dependent covariate cox regression model. In contrast to younger BC patients, outcome in this large cohort of elderly patients suggests that HER2-positive disease—not TNBC—featured the most aggressive clinical course with the highest rates of metastatic spread and BM. In-depth analysis regarding a potentially distinct biology of TNBC in elderly is therefore warranted.
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Affiliation(s)
- E S Bergen
- Comprehensive Cancer Center, Vienna, Austria. .,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
| | - C Tichy
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - M Rudas
- Comprehensive Cancer Center, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Z Bago-Horvath
- Comprehensive Cancer Center, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - R M Mader
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - R Exner
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - M Gnant
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - C C Zielinski
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - G G Steger
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Comprehensive Cancer Center, Vienna, Austria. .,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
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Promberger R, Dubsky P, Mittlböck M, Ott J, Singer C, Seemann R, Exner R, Panhofer P, Steger G, Bergen E, Gnant M, Jakesz R, Bago-Horvath Z, Rudas M, Bartsch R. Postoperative CMF Does Not Ameliorate Poor Outcomes in Women With Residual Invasive Breast Cancer After Neoadjuvant Epirubicin/Docetaxel Chemotherapy. Clin Breast Cancer 2015. [DOI: 10.1016/j.clbc.2015.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Exner R, Arnold T, Liang Y, Michlmair A, Zinn-Zinnenburg M, Pluschnig U, Bartsch R, Steger G, Gnant M, Bergmann M, Bachleitner-Hofmann T, Oehler R. 268 Eprirubicin/docetacel induced immunogenic cell death correlates with response to therapy and with extended disease-free survival. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30153-8] [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: 11/30/2022]
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36
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Exner R, Pulverer W, Wolf B, Bergmann M, Weinhausel A, Egger G. 2198 DNA methylation in rectal cancer: A new diagnostic and prognostic biomarker panel. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31117-0] [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: 11/28/2022]
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Abstract
Randomized trials have studied bisphosphonates in the adjuvant setting of early breast cancer to investigate their ability to prevent treatment-induced bone loss. Trial results have also suggested their potential to prevent disease recurrence and metastases. These trials are summarized in this review. A recent patient-level meta-analysis by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) finds convincing evidence that adjuvant antiresorptive treatments provide persistent benefits to breast cancer patients in low-estrogen situations and should be considered an important part of the treatment algorithm.
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Affiliation(s)
- Stephanie Strobl
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Belgin Korkmaz
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Yelena Devyatko
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Michael Schuetz
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Ruth Exner
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Peter C Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Raimund Jakesz
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, A-1090 Vienna, Austria;
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38
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Gnant M, Pfeiler G, Dubsky PC, Hubalek M, Greil R, Jakesz R, Wette V, Balic M, Haslbauer F, Melbinger E, Bjelic-Radisic V, Artner-Matuschek S, Fitzal F, Marth C, Sevelda P, Mlineritsch B, Steger GG, Manfreda D, Exner R, Egle D, Bergh J, Kainberger F, Talbot S, Warner D, Fesl C, Singer CF. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2015; 386:433-43. [PMID: 26040499 DOI: 10.1016/s0140-6736(15)60995-3] [Citation(s) in RCA: 349] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adjuvant endocrine therapy compromises bone health in patients with breast cancer, causing osteopenia, osteoporosis, and fractures. Antiresorptive treatments such as bisphosphonates prevent and counteract these side-effects. In this trial, we aimed to investigate the effects of the anti-RANK ligand antibody denosumab in postmenopausal, aromatase inhibitor-treated patients with early-stage hormone receptor-positive breast cancer. METHODS In this prospective, double-blind, placebo-controlled, phase 3 trial, postmenopausal patients with early hormone receptor-positive breast cancer receiving treatment with aromatase inhibitors were randomly assigned in a 1:1 ratio to receive either denosumab 60 mg or placebo administered subcutaneously every 6 months in 58 trial centres in Austria and Sweden. Patients were assigned by an interactive voice response system. The randomisation schedule used a randomly permuted block design with block sizes 2 and 4, stratified by type of hospital regarding Hologic device for DXA scans, previous aromatase inhibitor use, and baseline bone mineral density. Patients, treating physicians, investigators, data managers, and all study personnel were masked to treatment allocation. The primary endpoint was time from randomisation to first clinical fracture, analysed by intention to treat. As an additional sensitivity analysis, we also analysed the primary endpoint on the per-protocol population. Patients were treated until the prespecified number of 247 first clinical fractures was reached. This trial is ongoing (patients are in follow-up) and is registered with the European Clinical Trials Database, number 2005-005275-15, and with ClinicalTrials.gov, number NCT00556374. FINDINGS Between Dec 18, 2006, and July 22, 2013, 3425 eligible patients were enrolled into the trial, of whom 3420 were randomly assigned to receive denosumab 60 mg (n=1711) or placebo (n=1709) subcutaneously every 6 months. Compared with the placebo group, patients in the denosumab group had a significantly delayed time to first clinical fracture (hazard ratio [HR] 0·50 [95% CI 0·39-0·65], p<0·0001). The overall lower number of fractures in the denosumab group (92) than in the placebo group (176) was similar in all patient subgroups, including in patients with a bone mineral density T-score of -1 or higher at baseline (n=1872, HR 0·44 [95% CI 0·31-0·64], p<0·0001) and in those with a bone mineral density T-score of less than -1 already at baseline (n=1548, HR 0·57 [95% CI 0·40-0·82], p=0·002). The patient incidence of adverse events in the safety analysis set (all patients who received at least one dose of study drug) did not differ between the denosumab group (1366 events, 80%) and the placebo group (1334 events, 79%), nor did the numbers of serious adverse events (521 vs 511 [30% in each group]). The main adverse events were arthralgia and other aromatase-inhibitor related symptoms; no additional toxicity from the study drug was reported. Despite proactive adjudication of every potential osteonecrosis of the jaw by an international expert panel, no cases of osteonecrosis of the jaw were reported. 93 patients (3% of the full analysis set) died during the study, of which one death (in the denosumab group) was thought to be related to the study drug. INTERPRETATION Adjuvant denosumab 60 mg twice per year reduces the risk of clinical fractures in postmenopausal women with breast cancer receiving aromatase inhibitors, and can be administered without added toxicity. Since a main side-effect of adjuvant breast cancer treatment can be substantially reduced by the addition of denosumab, this treatment should be considered for clinical practice. FUNDING Amgen.
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Affiliation(s)
- Michael Gnant
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Georg Pfeiler
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Peter C Dubsky
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Hubalek
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute, Salzburg, Austria
| | - Raimund Jakesz
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Viktor Wette
- Doctor's Office Wette, Breast Center, St Veit an der Glan, Austria
| | - Marija Balic
- Department of Oncology, Medical University of Graz, Graz, Austria
| | | | | | | | | | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breast Health Center, Hospital of Sisters of Mercy Linz, Linz, Austria
| | - Christian Marth
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Paul Sevelda
- Department of Gynecology, Hospital Hietzing, Vienna, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Günther G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Jonas Bergh
- Department of Oncology/Radiumhemmet, Karolinska Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | | | - Christian Fesl
- Department of Statistics, Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Christian F Singer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
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Exner R, Bago-Horvath Z, Bartsch R, Mittlboeck M, Retèl VP, Fitzal F, Rudas M, Singer C, Pfeiler G, Gnant M, Jakesz R, Dubsky P. The multigene signature MammaPrint impacts on multidisciplinary team decisions in ER+, HER2- early breast cancer. Br J Cancer 2014; 111:837-42. [PMID: 25003667 PMCID: PMC4150264 DOI: 10.1038/bjc.2014.339] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/15/2014] [Accepted: 05/26/2014] [Indexed: 12/17/2022] Open
Abstract
Background: Validated multigene signatures (MGS) provide additional prognostic information when evaluating clinical features of ER+, HER2− early breast cancer. We have studied the quantitative and qualitative impact of MGS on multidisciplinary team (MDT) recommendations. Methods: We prospectively recruited 75 ER+, HER2− breast cancer patients. Inclusion was based on biopsy assessment of grade, hormone receptor status, HER2, clinical tumour and nodal status. A fresh tissue sample was sent for MammaPrint (MP), TargetPrint analysis at surgery. Clinical risk was decided by the MDT in the absence of MP results and repeated following the collection of MP results. Decision changes were recorded and a health technology assessment was undertaken to compare cost effectiveness. Results: The majority of patients were assigned low to intermediate clinical risk by the MDT. According to MP, 76% were low risk. A very high correlation between local IHC and the TargetPrint assessment was shown. In over a third of patients, discordance between clinical and molecular risk was observed. Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy. The use of MP was also found to be more cost effective. Conclusions: The multigene signature MP revealed clinical and molecular risk discordance in a third of patients. The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy. The use of MGS is unlikely to have an impact in either clinically low-risk women or in patients with more than one relative indication for chemotherapy.
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Affiliation(s)
- R Exner
- Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Z Bago-Horvath
- Clinical Institute of Pathology, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - R Bartsch
- Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - M Mittlboeck
- Department of Statistics and Intelligent Systems, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - V P Retèl
- Netherlands Cancer Institute, Department of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands
| | - F Fitzal
- Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - M Rudas
- Clinical Institute of Pathology, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - C Singer
- Department of Gynaecology and Obstetrics, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - G Pfeiler
- Department of Gynaecology and Obstetrics, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - M Gnant
- Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - R Jakesz
- Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - P Dubsky
- Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Pfeiler G, Königsberg R, Hadji P, Fitzal F, Maroske M, Dressel-Ban G, Zellinger J, Exner R, Seifert M, Singer C, Gnant M, Dubsky P. Impact of body mass index on estradiol depletion by aromatase inhibitors in postmenopausal women with early breast cancer. Br J Cancer 2013; 109:1522-7. [PMID: 24002592 PMCID: PMC3777005 DOI: 10.1038/bjc.2013.499] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/26/2013] [Accepted: 07/30/2013] [Indexed: 01/08/2023] Open
Abstract
Background: Body mass index (BMI) has an impact on survival outcome in patients treated with aromatase inhibitors (AIs). Obesity is associated with an increased body aromatisation and may be a cause of insufficient estradiol depletion. Methods: Sixty-eight postmenopausal oestrogen receptor-positive patients with early breast cancer were prospectively included in this study. Follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol were analysed immediately in the clinical routine lab and in a dedicated central lab before (T1) and 3 months after start with aromatase inhibitors (T2). Results: A total of 40 patients were normal or overweight (non-obese: BMI 18.5–29.9 kg m−2) and 28 were obese (BMI⩾30 kg m−2). Aromatase inhibitors significantly suppressed estradiol serum levels (T1: 19.5 pg ml−1, T2: 10.5 pg ml−1, P<0.01) and increased FSH serum levels (T1: 70.2 mIU ml−1, T2: 75.7 mIU ml−1, P<0.05). However, after 3 months of AI treatment, estradiol levels of obese patients were nonsignificantly higher compared with non-obese patients (12.5 pg ml−1vs 9.0 pg ml−1, P=0.1). This difference was reflected by significantly lower FSH serum levels in obese compared with non-obese patients (65.5 mIU ml−1vs 84.6 mIU ml−1, P<0.01). The significant effects of BMI on FSH serum levels could be detected both in the routine as well as in the dedicated central lab. Conclusion: Aromatase inhibitors are less efficient at suppressing estradiol serum levels in obese when compared with non-obese women.
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Affiliation(s)
- G Pfeiler
- Division of Gynecology and Gynecological Oncology, Department of OB/GYN, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Pfeiler G, Konigsberg R, Hadji P, Fitzal F, Tea MKM, Vogl S, Berger A, Exner R, Seifert M, Singer CF, Gnant M, Dubsky PC. The impact of estrogen depletion by aromatase inhibitors on adiponectin serum levels in postmenopausal patients with breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e11601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e11601 Background: Adiponectin impacts on breast cancer risk and prognosis. Obesity and insulin resistance are correlated with low adiponectin serum levels, which increase breast cancer risk and lead to a worse outcome regarding breast cancer. Additionally a cross talk between the adiponectin and estrogen signaling system has been suggested. Here we prospectively investigated the impact of estrogen depletion via aromatase inhibitors (AI) on adiponectin serum levels in postmenopausal patients with breast cancer. Methods: 68 postmenopausal ER positive patients with breast cancer, scheduled to receive anastrozole or letrozole as adjuvant endocrine treatment were prospectively included in this study. Serum was taken before (T1) and 3 months after start with aromatase inhibitors (T2). Non-fasting serum levels of adiponectin, FSH, LH, E2, glucose and insulin were analyzed immediately in the clinical routine lab and in a dedicated central lab able to measure E2 in serum at low concentrations with high sensitivity. Results: At baseline, a strong significant negative correlation between adiponectin and body mass index (BMI) as well as a positive correlation between adiponectin and FSH serum levels could be observed (r=-0.43, p=0.01 and r=0.38, p=0.03, respectively). Taking the previously proposed cut off of 15.5μg/ml, patients with low adiponectin serum levels had a significantly higher BMI and significant lower FSH serum levels. No interaction between adiponectin and estradiol serum levels could be detected. As previously shown, AI treatment significantly decreased estradiol serum levels and consequently increased FSH serum levels. However, 3 months of AI treatment did not alter adiponectin, insulin and c-peptide serum levels, respectively. Conclusions: Short term estrogen depletion via aromatase inhibitors does not impact on non-fasting adiponectin, insulin and c-peptide serum levels in postmenopausal patients with breast cancer.
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Affiliation(s)
- Georg Pfeiler
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Robert Konigsberg
- ACR-ITR VIEnna & LBI-ACR VIEnna, Centre for Oncology and Haematology, Kaiser Franz Josef-Spital, Vienna, Austria
| | - Peyman Hadji
- University Hospital of Giessen and Marburg GmbH, Marburg, Marburg, Germany
| | | | - Muy-Kheng Maria Tea
- Department of OB/GYN, Division of Senology, Medical University of Vienna, Vienna, Austria
| | - Sonja Vogl
- Medical University of Vienna, Vienna, Austria
| | | | - Ruth Exner
- Medical University of Vienna, Vienna, Austria
| | - Michael Seifert
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Gnant
- Comprehensive Cancer Center, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Pfeiler G, Königsberg R, Hadji P, Fitzal F, Maroske M, Ban G, Zellinger J, Exner R, Seifert M, Singer C, Gnant M, Dubsky P. Einfluss des Body Mass Index (BMI) auf die Suppression der Östradiol-Spiegel mittels Aromatase-Inhibitoren (AI's) bei postmenopausalen Brustkrebspatientinnen: eine prospektive „Proof of Principle“ Studie. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1336788] [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: 10/27/2022] Open
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Pfeiler G, Königsberg R, Hadji P, Fitzal F, Maroske M, Ban G, Zellinger J, Exner R, Seifert M, Singer C, Gnant M, Dubsky P. Abstract P2-13-01: Impact of Body Mass Index (BMI) on the efficacy of aromatase inhibitors to suppress estradiol serum levels in postmenopausal patients with early breast cancer: a prospective proof of principle. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-13-01] [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: BMI impacts on the efficacy of aromatase inhibitors (AIs) regarding disease outcome in patients with early breast cancer. We hypothesized that this clinical impact of BMI is driven by the inability of AIs to suppress estradiol (E2) serum levels to the same low level in obese compared to non-obese patients.
Methods: 68 postmenopausal ER positive patients with breast cancer, scheduled to receive anastrozole or letrozole as adjuvant endocrine treatment were prospectively included in this study. Serum was taken before (T1) and 3 months after start with aromatase inhibitors (T2). Serum levels of FSH, LH, E2, glucose and insulin were analyzed immediately in the clinical routine lab and in a dedicated central lab able to measure E2 in serum at low concentrations with high sensitivity.
Results: 40 patients were normal - or overweight (non-obese; BMI 18.5–29.9 kg/m2) and 28 patients were obese (BMI ≥ 30 kg/m2). A weak non-significant correlation between BMI and baseline E2 serum levels (r = 0.2, p = 0.2) translated into a strong negative, highly significant correlation between BMI and baseline FSH (r = −0.6, p < 0.01). After 3 months of AI treatment, a moderate correlation between BMI and E2 serum levels (r = 0.35, p = 0.05) and a moderate negative correlation between BMI and FSH (r = −0.34, p = 0.05) could be observed. Aromatase inhibitors significantly suppressed E2 serum levels in non-obese (T1: 18.9 pg/ml, T2: 9.0 pg/ml, p < 0.01) as well as in obese patients (T1: 20.2 pg/ml, T2: 12.5 pg/ml, p < 0.05). In addition an increase in FSH serum levels was observed in obese (T1: 50.0 mIU/ml, T2: 65.5 mIU/ml, p < 0.01) but not in non-obese (T1: 84.0 mIU/ml, T2: 84.6 mIU/ml) patients. However, after 3 months of AI treatment, E2 levels of obese patients were not at the same low level when compared to non-obese patients (E2 obese: 12.5 pg/ml vs. E2 non-obese: 9.0 pg/ml, p = 0.1). This difference translated into significantly lower FSH serum levels in obese compared to non-obese patients (FSH obese: 65.5 mIU/ml vs. FSH: 84.6 mIU/ml, p < 0.01). The significant effects of BMI on FSH serum levels could be detected both in the routine - as well as in the dedicated central lab.
Conclusion: AIs are less efficient at suppressing E2 serum levels in obese when compared to non-obese women. The observed effect may contribute to the survival disadvantage of obese patients in adjuvant AI trials. FSH serum levels should be validated as high sensitive surrogate parameters for estradiol serum level suppression by aromatase inhibitors in postmenopausal patients with breast cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-13-01.
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Affiliation(s)
- G Pfeiler
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - R Königsberg
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - P Hadji
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - F Fitzal
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - M Maroske
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - G Ban
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - J Zellinger
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - R Exner
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - M Seifert
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - C Singer
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - M Gnant
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
| | - P Dubsky
- Medical University of Vienna, Austria; Applied Cancer Research – Institution for Translational Research Vienna (ACR-ITR VIEnna)/CEADDP, Austria; Universityhospital of Giessen and Marburg GmbH, Germany
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Exner R, Sachsenmaier M, Horvath Z, Stift A. Incidental appendectomy--standard or unnecessary additional trauma in surgery for colorectal cancer? A retrospective analysis of histological findings in 380 specimens. Colorectal Dis 2012; 14:1262-6. [PMID: 22230025 DOI: 10.1111/j.1463-1318.2012.02933.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Incidental appendectomy is a frequent but non-standard procedure during surgery for colorectal cancer. Incidental appendectomy during colorectal resections is performed at the discretion of the operating surgeon. METHOD This retrospective study used data from 1352 consecutive patients who underwent surgery for colorectal cancer between 1993 and 2009 at the Medical University of Vienna. The authors evaluated histopathological results of appendices removed incidentally. In addition, complications and costs of the additional intervention were analyzed. RESULTS Appendectomy had been performed in 314 (23.22%) patients because of appendicitis. Incidental appendectomy had been performed in 380 (28.11%) patients: 86 (22.63%) had a histologically completely normal appendix, a pathologic alteration was found in 289 (76.05%) and a neoplasm was found in seven (1.84%). No complications occurred from the additional surgical procedure. The costs and time effort were negligible. CONCLUSION Incidental appendectomy is a safe procedure and can be integrated into surgery for colorectal carcinoma to avoid future complications. Pathological findings of the appendix, including neoplasm, are frequent but the clinical relevance remains questionable.
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Affiliation(s)
- R Exner
- Department of General Surgery, Medical University of Vienna, Vienna, Austria.
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Pfeiler G, Maroske M, Ban G, Exner R, Fitzal F, Fink-Retter A, Seifert M, Panhofer T, Singer C, Gnant M, Dubsky P. Einfluss des Body Mass Index (BMI) auf die Effektivität von Aromatasehemmern bei postmenopausalen Brustkrebspatientinnen unter Berücksichtigung der Serumhormonspiegel - eine prospektive Studie. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1309213] [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: 10/28/2022] Open
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Panhofer P, Ferenc V, Exner R, Gleiss A, Dubsky P, Jakesz R, Gnant M, Fitzal F. 333 Risk Factors for Postoperative Complications After Breast Conserving Therapy in 255 Patients with Breast Cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70399-4] [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: 11/30/2022]
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Exner R, Krois W, Mittlböck M, Dubsky P, Jakesz R, Gnant M, Fitzal F. Objectively measured breast symmetry has no influence on quality of life in breast cancer patients. Eur J Surg Oncol 2012; 38:130-6. [DOI: 10.1016/j.ejso.2011.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/14/2011] [Accepted: 10/20/2011] [Indexed: 11/28/2022] Open
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Armbrust R, Exner R, Doisneau-Sixou S. IMPAKT Meeting 2012 Latest Updates in Breast Cancer Translational Research. Breast Care (Basel) 2012. [DOI: 10.1159/000188331] [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: 11/19/2022] Open
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Exner R, Krois W, Riedl O, Trischer H, Mittlboeck M, Wild T, Jakez R, Gnant M. 86 Oncoplastic surgery but not objectively measured symmetry after breast conserving therapy improves quality of life in breast cancer patients. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70117-8] [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: 11/16/2022] Open
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Blaha P, Exner R, Borgo AD, Bigenzahn S, Panhofer P, Riedl O, Schoppmann S, Bachleitner-Hofmann T, Sporn E, Pluschnig U, Fitzal F, Steger G, Jakesz R, Dubsky P, Gnant M. Is Endocrine Therapy Really Pleasant? Considerations about the Long-Term Use of Antihormonal Therapy and Its Benefit/Side Effect Ratio. ACTA ACUST UNITED AC 2009; 4:155-161. [PMID: 21160541 DOI: 10.1159/000227829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Endocrine therapy has become a key part in the adjuvant treatment of hormone responsive breast cancer. The positive effect on relapse risk reduction is well defined, but therapy is not free from bothersome side effects for which estrogen deprivation accounts to a great extent. Since endocrine therapy is usually prescribed for 5 years or longer to optimally display its protective effect, and because physical strain is missing, good tolerability and safety properties are important, particularly in low-risk patients. While tamoxifen has been the standard adjuvant endocrine treatment with well documented efficiency, it is increasingly replaced by third generation aromatase inhibitors due to their better effectiveness and tolerability. Because tamoxifen holds a risk for life-threatening adverse events such as endometrial cancer, pulmonary embolism, and stroke, its recommended duration of therapy is limited to 5 years, also because extension beyond that time did not produce a measurable advantage. While some side effects are present both with tamoxifen and aromatase inhibitors, differences in side effect profiles are well established. Although side effects of aromatase inhibitor-related therapy usually are mild and common to symptoms of menopause, misconception of the symptoms and their mechanism of action, as well as lack of knowledge about how to handle them, can easily lead to dangerous discontinuation of therapy.
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Affiliation(s)
- Peter Blaha
- Department of Surgery, Medical University of Vienna, Austria
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