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Harbeck N, Fasching PA, Würstlein R, Degenhardt T, Lüftner D, Kates RE, Schumacher J, Räth P, Hoffmann O, Lorenz R, Decker T, Reinisch M, Göhler T, Staib P, Gluz O, Schinköthe T, Schmidt M. Significantly longer time to deterioration of quality of life due to CANKADO PRO-React eHealth support in HR+ HER2- metastatic breast cancer patients receiving palbociclib and endocrine therapy: Primary outcome analysis of the multicenter randomized AGO-B WSG PreCycle trial. Ann Oncol 2023:S0923-7534(23)00684-1. [PMID: 37201751 DOI: 10.1016/j.annonc.2023.05.003] [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: 04/21/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The multicenter, randomized phase IV intergroup AGO-B WSG PreCycle trial (NCT03220178) evaluated the impact of CANKADO-based ePRO (electronic patient-reported outcomes) assessment on quality of life (QoL) in HR+ HER2- locally advanced or metastatic breast cancer (MBC) patients receiving palbociclib (P) and an aromatase inhibitor or P+fulvestrant. CANKADO PRO-React, an EU-registered medical device, is an interactive autonomous application reacting to patient self-reported observations. PATIENTS AND METHODS Between 2017 and 2021, 499 patients (median age 59 years) from 71 centers were randomized (2:1, stratified by therapy line) between an active version of CANKADO PRO-React (CANKADO-active arm) or a version with limited functionality (CANKADO-inform arm). 412 patients (271 CANKADO-active; 141 CANKADO-inform) were available for analysis of the primary endpoint, time to deterioration (TTD) of QoL (10-point drop on FACT-G), using an Aalen-Johansen estimator for cumulative incidence function of TTD DQoL with 95% pointwise confidence intervals (CI). Secondary endpoints included PFS, OS, and DQoL (QoL deterioration). RESULTS In all pts (ITT-ePRO), cumulative incidence of DQoL was significantly more favorable (lower) in the CANKADO-active arm (HR=0.698, 95%CI [0.506 - 0.963]). Among 1stL patients (n=295), the corresponding HR was 0.716 (0.484-1.060; p=0.09), and in 2ndL patients (n=117) it was 0.661 (0.374-1.168; p=0.2). Absolute patient numbers declined in later visits; FACT-G completion rates were 80% and higher until about visit 30; mean FACT-G scores showed steady decline from baseline and an offset in favor of CANKADO-active. No significant differences in clinical outcome were observed between arms: Median PFS (ITT population) was 21.4 (95%CI 19.4-23.7) (CANKADO-active) and 18.7 (15.1-23.5) months (CANKADO-inform); median OS was not reached (CANKADO-active) and 42.6 months (CANKADO-inform). CONCLUSIONS PreCycle is the first multicenter randomized eHealth trial demonstrating a significant benefit for MBC patients receiving oral tumor therapy when using an interactive autonomous patient empowerment application.
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Affiliation(s)
- N Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; West German Study Group, Statistics, Moenchengladbach, Germany.
| | - P A Fasching
- University Hospital Erlangen, Obstetrics and Gynecology, Erlangen, Germany
| | - R Würstlein
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; West German Study Group, Statistics, Moenchengladbach, Germany
| | - T Degenhardt
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; Hausarztpraxis Wolfratshausen, Wolfratshausen, Germany
| | - D Lüftner
- Immanuel Hospital Märkische Schweiz Buckow, Germany; Immanuel Hospital Rüdersdorf and Medical University of Brandenburg Theodor Fontane, Germany
| | - R E Kates
- West German Study Group, Statistics, Moenchengladbach, Germany
| | | | - P Räth
- palleos healthcare GmbH, Wiesbaden, Germany
| | - O Hoffmann
- University Hospital Essen, Breast Center, Essen, Germany
| | - R Lorenz
- Studien GbR Braunschweig, Braunschweig, Germany
| | - T Decker
- Hematology / Oncology, Ravensburg, Germany
| | - M Reinisch
- Breast Center, Kliniken Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - T Göhler
- Oncocenter Dresden, Dresden, Germany
| | - P Staib
- St.-Antonius Hospital gGmbH, Clinic for Hematology and Oncology, Eschweiler, Germany
| | - O Gluz
- West German Study Group, Statistics, Moenchengladbach, Germany
| | - T Schinköthe
- CANKADO Service GmbH, Kirchheim, Germany; Research Center Smart Digital Health, University of the Bundeswehr, Neubiberg, Germany
| | - M Schmidt
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Dall P, Lenzen G, Göhler T, Feisel-Schwickeradi G, Koch T, Heilmann V, Schindler C, Wilke J, Tesch H, Selbach J, Eggert J, Hinke A. Abstract P2-15-02: Trastuzumab treatment of early breast cancer: Long-term results from a prospective observation study, including a large cohort of elderly patients. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-15-02] [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: Trastuzumab (T; Roche) is part of the standard treatment in patients (pts) of any age with early stage, HER2+ breast cancer, in addition to (neo)adjuvant chemotherapy (CT) and locoregional treatment. After its registration in Germany in 2006, this prospective observation study was started in order to assess the generalizability of the results from the randomized studies, specifically with respect to elderly age cohorts.
Methods: 4027 pts were enrolled between 2006 and 2012. 87 were non-eligible due to M1 and/or negative HER2 status. There were no restrictions for recruitment with respect to age or concomitant/sequential adjuvant medication. The long-term relapse/survival status of pts was retrieved by fax forms collected once a year. Safety assessment was limited to the treatment period. Data base cut-off was May 2013.
Results: Among the 3940 evaluable pts, there were 1013 elderly pts (EP) ≥ 65 years (y) of age (26%). This contrasts to the pivotal studies, e.g. with a proportion of only 6% beyond 65 y in the NSABP B-31 and NCCTG N9831 studies. The rate of EP steadily increased during the period from 2006 to 2009, remaining stable thereafter. More than half of the pts had pT≥2, with EP more often presenting with a larger tumor (56% vs. 48%,p<.0001). 52% had a grade 3 tumor. Hormone receptor positivity was recorded in 63%. As to be expected, performance status was more impaired in elderly compared to younger pts (ECOG 0: 53 vs 65%,p<.0001). 94% received CT, 78% as adjuvant, 14% as neoadjuvant treatment (in EP only 8%), while 2% received both modalities. In the vast majority (87%), T was administered sequentially to CT, with no differences among the age cohorts. The proportion without any adjuvant CT was higher in EP (8 vs. 5%). 56% of pts were treated with adjuvant endocrine medication, 78% with irradiation. T treatment was stopped prematurely in only 9% of pts, but more often in EP (11% vs 8%, p = .014).
After a follow-up period of up to a maximum of 8 y, 370 relapses were reported so far. The estimated recurrence-free survival is 94.7% (95% CI: 94-96%), 89.8% (89-91%), and 82.9% (81-85%) after 2, 3 and 5 y, respectively. Numeric results in EP are only slightly lower with 93.9 (92-96%), 89.3% (87-92%), and 81.6% (78-85%), not statistically significant (p = 0.18, HR = 1.17 [95% CI: 0.93 - 1.47]). Adverse effects with respect to cardiac function were reported in overall 153 pts (3.9%), with the majority of these cases of NCI grade 1 (39%) or 2 (38%). 23% of these events were of grade 3/4, but life-threatening in only 2 pts. Thus, the overall incidence of acute grade 3/4 cardiac function toxicity was 0.9%. In the EP subgroup the incidence across all NCI grades was only slightly increased (4.6%), but grade 3/4 cases were more common (1.6%).
Conclusion: Overall, the maturing follow-up data of this observational study confirm the beneficial results from the randomized studies. In addition, the data from more than thousand pts ≥ 65 y of age show that a similar anti-tumor efficiency can be achieved in elderly pts, and suggest that minor age-related differences detected with respect to adjuvant treatment duration, aggressiveness and toxicity do not impair the long-term clinical outcome.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-15-02.
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Affiliation(s)
- P Dall
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - G Lenzen
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - T Göhler
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - G Feisel-Schwickeradi
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - T Koch
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - V Heilmann
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - C Schindler
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - J Wilke
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - H Tesch
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - J Selbach
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - J Eggert
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
| | - A Hinke
- Städtisches Klinikum, Frauenklinik, Lüneburg, Germany; Practice, Osnabrück, Germany; Practice, Dresden, Germany; Klinikum Kassel, Kassel, Germany; Klinikum Nürnberg Nord, Frauenklinik, Nürnberg, Germany; Practice, Günzburg, Germany; Practice, Leipzig, Germany; Practice, Fürth, Germany; Onkologie Bethanien, Frankfurt, Germany; Practice, Duisburg, Germany; Practice, Moers, Germany; WiSP Research Institute, Langenfeld, Germany
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