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Tolmeijer SH, van Wilpe S, Geerlings MJ, von Rhein D, Smilde TJ, Kloots ISH, Westdorp H, Coskuntürk M, Oving IM, van Ipenburg JA, van der Heijden AG, Hofste T, Weiss MM, Schalken JA, Gerritsen WR, Ligtenberg MJL, Mehra N. Early On-treatment Circulating Tumor DNA Measurements and Response to Immune Checkpoint Inhibitors in Advanced Urothelial Cancer. Eur Urol Oncol 2024; 7:282-291. [PMID: 37673768 DOI: 10.1016/j.euo.2023.08.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) can induce durable disease control in metastatic urothelial cancer (mUC), but only 20-25% of patients respond. Early identification of a nondurable response will improve management strategies. OBJECTIVE To investigate whether on-treatment circulating tumor DNA (ctDNA) measurements can predict ICI responsiveness in mUC patients. DESIGN, SETTING, AND PARTICIPANTS This study consists of a discovery cohort of 40 mUC patients and a prospective multicenter validation cohort of 16 mUC patients. Plasma cell-free DNA was collected at baseline and after 3 and 6 wk on ICIs. The ctDNA levels were calculated from targeted sequencing. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcome measurements were progression-free survival (PFS), overall survival (OS), and nondurable response (PFS ≤6 mo). Relationships with ctDNA were assessed using Cox regression. Changes in ctDNA level at 3 and 6 wk were categorized by an increase or decrease relative to baseline. RESULTS AND LIMITATIONS In the discovery cohort, ctDNA was detected in 37/40 (93%) of patients at baseline. A ctDNA increase was observed in 12/15 (80%) and ten of 12 (83%) patients with a nondurable response at 3 and 6 wk, respectively. Of patients with a durable response (PFS >6 mo), 94% showed a decrease. A ctDNA increase at 3 wk was associated with shorter PFS (hazard ratio [HR] 7.8, 95% confidence interval [CI] 3.1-19.5) and OS (HR 8.0, 95% CI 3.0-21.0), independent of clinical prognostic variables. Similar results were observed at 6 wk. The 3-wk association with PFS was validated in a prospective cohort (HR 7.5, 95% CI 1.3-42.6). Limitations include the limited number of patients. CONCLUSIONS Early changes in ctDNA levels are strongly linked to the duration of ICI benefit in mUC and may contribute to timely therapy modifications. PATIENT SUMMARY Benefit from immunotherapy can be predicted after only 3 wk of treatment by investigating cancer DNA in blood. This could help in timely therapy changes for urothelial cancer patients with limited benefit from immunotherapy.
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Affiliation(s)
- Sofie H Tolmeijer
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sandra van Wilpe
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maartje J Geerlings
- Department of Human Genetics, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel von Rhein
- Department of Human Genetics, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Iris S H Kloots
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harm Westdorp
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mustafa Coskuntürk
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irma M Oving
- Department of Medical Oncology, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Jolique A van Ipenburg
- Department of Pathology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antoine G van der Heijden
- Department of Urology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom Hofste
- Department of Human Genetics, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan M Weiss
- Department of Human Genetics, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jack A Schalken
- Department of Urology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolijn J L Ligtenberg
- Department of Human Genetics, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Pathology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands.
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Haaksman M, Ham L, Brom L, Baars A, van Basten JP, van den Borne BEEM, Hendriks MP, de Jong WK, van Laarhoven HWM, van Lindert ASR, Mandigers CMPW, van der Padt-Pruijsten A, Smilde TJ, van Zuylen LC, van Vliet LM, Raijmakers NJH. Open communication between patients and relatives about illness & death in advanced cancer-results of the eQuiPe Study. Support Care Cancer 2024; 32:214. [PMID: 38446248 PMCID: PMC10917842 DOI: 10.1007/s00520-024-08379-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To assess the degree of openness of communication about illness and death between patients with advanced cancer and their relatives during the last three months of the patient's life, and its association with relatives' characteristics and bereavement distress. METHODS We used data from bereaved relatives of patients with advanced cancer from the prospective, longitudinal, multicenter, observational eQuipe study. Univariate and multivariable linear regression analyses were used to assess the association between the degree of openness of communication (measured using the validated Caregivers' Communication with patients about Illness and Death scale), the a priori defined characteristics of the relatives, and the degree of bereavement distress (measured using the Impact of Event Scale). RESULTS A total of 160 bereaved relatives were included in the analysis. The average degree of open communication about illness and death between patients with advanced cancer and their relatives was 3.86 on a scale of 1 to 5 (SE=0.08). A higher degree of open communication was associated with a lower degree of bereavement distress (p=0.003). No associations were found between the degree of open communication and the relatives' age (p=0.745), gender (p=0.196), level of education (p>0.773), (religious) worldview (p=0.435), type of relationship with the patient (p>0.548), or level of emotional functioning before the patient's death (p=0.075). CONCLUSIONS Open communication about illness and death between patients and relatives seems to be important, as it is associated with a lower degree of bereavement distress. Healthcare professionals can play an important role in encouraging the dialogue. However, it is important to keep in mind that some people not feel comfortable talking about illness and death.
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Affiliation(s)
- Michelle Haaksman
- Department of Health, Medical and Neuropsychology, University of Leiden, Leiden, the Netherlands.
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, the Netherlands.
| | - Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Linda Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, the Netherlands
| | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, the Netherlands
| | | | | | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Center, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne S R van Lindert
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Lia C van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Center, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Liesbeth M van Vliet
- Department of Health, Medical and Neuropsychology, University of Leiden, Leiden, the Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, the Netherlands
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Ham L, Fransen HP, Raijmakers NJH, van den Beuken-van Everdingen MHJ, van den Borne B, Creemers GJ, de Graeff A, Hendriks MP, de Jong WK, van Laarhoven H, van Leeuwen L, van der Padt-Pruijsten A, Smilde TJ, Stellingwerf M, van Zuylen L, van de Poll-Franse LV. Trajectories of emotional functioning and experienced care of relatives in the last year of life of patients with advanced cancer: A longitudinal analysis of the eQuiPe study. Psychooncology 2023; 32:1858-1866. [PMID: 37882097 DOI: 10.1002/pon.6233] [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: 07/08/2023] [Revised: 09/30/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Advanced cancer has a major impact on both patients and their relatives. To allow for personalized support, it is important to recognize which relatives will experience a decline in emotional functioning during the patient's last year of life, when this decline will occur, and what factors are associated with it. This study aimed to examine the trajectory of emotional functioning of relatives during that time and the characteristics associated with changes in this trajectory. METHODS A prospective, longitudinal, multicenter, observational study in patients with advanced cancer and their relatives was conducted (eQuiPe). We analyzed relatives' changes in emotional functioning in the patient's last year using the EORTC QLQ-C30 and assessed associations with sociodemographic and care characteristics using multivariable mixed-effects analysis. RESULTS 409 relatives completed ≥1 questionnaires during the patient's last year of life. Mean age was 64 years, 61% were female and 75% were the patient's partner. During this year, mean emotional functioning declined significantly over time from 73.9 to 64.6 (p = 0.023, effect size = 0.43). The type of relationship between relatives and patients (p = 0.002), patient' sleep problems (p = 0.033), and continuity of care (p = 0.002) were significantly associated with changes in emotional functioning. CONCLUSIONS Relatives' emotional functioning declined during the patient's last year of life. Support for them, especially partners and relatives of patients with sleep problems, is important. Relatives who experienced more continuity of care had a less steep decline in emotional functioning.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Marieke H J van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Ben van den Borne
- Department of Pulmonology, Catharina Hospital, Eindhoven, The Netherlands
| | - Geert Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Hanneke van Laarhoven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Lobke van Leeuwen
- Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | | | - Tineke J Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Margriet Stellingwerf
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lia van Zuylen
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Schröder CP, van Leeuwen-Stok E, Cardoso F, Linderholm B, Poncet C, Wolff AC, Bjelic-Radisic V, Werutsky G, Abreu MH, Bozovic-Spasojevic I, den Hoed I, Honkoop AH, Los M, Leone JP, Russell NS, Smilde TJ, van der Velden AWG, Van Poznak C, Vleugel MM, Yung RL, Coens C, Giordano SH, Ruddy KJ. Quality of Life in Male Breast Cancer: Prospective Study of the International Male Breast Cancer Program (EORTC10085/TBCRC029/BIG2-07/NABCG). Oncologist 2023; 28:e877-e883. [PMID: 37310797 PMCID: PMC10546813 DOI: 10.1093/oncolo/oyad152] [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: 08/29/2022] [Accepted: 04/22/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Prospective data about quality of life (QoL) in men with breast cancer (BC) are lacking. A prospective registry (EORTC10085) of men with all BC stages, including a QoL correlative study, was performed as part of the International Male Breast Cancer Program. METHODS Questionnaires at BC diagnosis included the EORTC QLQ-C30 and BR23 (BC specific module), adapted for men. High functioning and global health/QoL scores indicate high functioning levels/high QoL; high symptom-focused measures scores indicate high symptoms/problems levels. EORTC reference data for healthy men and women with BC were used for comparisons. RESULTS Of 422 men consenting to participate, 363 were evaluable. Median age was 67 years, and median time between diagnosis and survey was 1.1 months. A total of 114 men (45%) had node-positive early disease, and 28 (8%) had advanced disease. Baseline mean global health status score was 73 (SD: 21), better than in female BC reference data (62, SD: 25). Common symptoms in male BC were fatigue (22, SD: 24), insomnia (21, SD: 28), and pain (16, SD: 23), for which women's mean scores indicated more burdensome symptoms at 33 (SD: 26), 30 (SD: 32), and 29 (SD: 29). Men's mean sexual activity score was 31 (SD: 26), with less sexual activity in older patients or advanced disease. CONCLUSIONS QoL and symptom burden in male BC patients appears no worse (and possibly better) than that in female patients. Future analyses on impact of treatment on symptoms and QoL over time, may support tailoring of male BC management.
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Affiliation(s)
- Carolien P Schröder
- Department Medical Oncology, Netherlands Cancer Institute Amsterdam and University Medical Center Groningen, The Netherlands
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Barbro Linderholm
- Department of Oncologym, Sahlgrenska University Hospital, Gothenburg, Sweden and Swedish Association of Breast Oncologists (SABO), Sweden
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Antonio C Wolff
- Department of Medical Oncology, Johns Hopkins, Baltimore, MD, USA
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Clinic, Wuppertal, University Witten/Herdecke, Germany
| | | | - Miguel H Abreu
- Department of Medical Oncology, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | | | - Irma den Hoed
- Department of Medical Oncology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Aafke H Honkoop
- Department of Medical Oncology, Isala, Zwolle, The Netherlands
| | - Maartje Los
- Department of Medical Oncology, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Jose P Leone
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Nicola S Russell
- Department of Radiotherapy, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Ziekenhuis’s Hertogenbosch, The Netherlands
| | | | | | - Marije M Vleugel
- Department of Medical Oncology, Waterlandziekenhuis, Purmerend, The Netherlands
| | - Rachel L Yung
- Department of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Sharon H Giordano
- Department of Health Services Research and Department of Breast Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Bosch D, Kuppen MCP, Tascilar M, Smilde TJ, Mulders PFA, Uyl-de Groot CA, van Oort IM. Reliability and Efficiency of the CAPRI-3 Metastatic Prostate Cancer Registry Driven by Artificial Intelligence. Cancers (Basel) 2023; 15:3808. [PMID: 37568624 PMCID: PMC10417512 DOI: 10.3390/cancers15153808] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Manual data collection is still the gold standard for disease-specific patient registries. However, CAPRI-3 uses text mining (an artificial intelligence (AI) technology) for patient identification and data collection. The aim of this study is to demonstrate the reliability and efficiency of this AI-driven approach. METHODS CAPRI-3 is an observational retrospective multicenter cohort registry on metastatic prostate cancer. We tested the patient-identification algorithm and automated data extraction through manual validation of the same patients in two pilots in 2019 and 2022. RESULTS Pilot one identified 2030 patients and pilot two 9464 patients. The negative predictive value of the algorithm was maximized to prevent false exclusions and reached 94.8%. The completeness and accuracy of the automated data extraction were 92.3% or higher, except for date fields and inaccessible data (images/pdf) (10-88.9%). Additional manual quality control took over 3 h less time per patient than the original fully manual CAPRI registry (105 vs. 300 min). CONCLUSIONS The CAPRI-3 patient-identification algorithm is a sound replacement for excluding ineligible candidates. The AI-driven data extraction is largely accurate and complete, but manual quality control is needed for less reliable and inaccessible data. Overall, the AI-driven approach of the CAPRI-3 registry is reliable and timesaving.
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Affiliation(s)
- Dianne Bosch
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands (I.M.v.O.)
| | - Malou C. P. Kuppen
- Department of Radiotherapy, Maastro Clinic, 6229 ET Maastricht, The Netherlands
| | - Metin Tascilar
- Department of Medical Oncology, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands;
| | - Peter F. A. Mulders
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands (I.M.v.O.)
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
| | - Inge M. van Oort
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands (I.M.v.O.)
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van Hoogstraten LMC, Man CCO, Witjes JA, Meijer RP, Mulder SF, Smilde TJ, Ripping TM, Kiemeney LA, Aben KKH. Low adherence to recommended use of neoadjuvant chemotherapy for muscle-invasive bladder cancer. World J Urol 2023; 41:1837-1845. [PMID: 37258902 PMCID: PMC10231297 DOI: 10.1007/s00345-023-04443-7] [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: 11/30/2022] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE To evaluate guideline adherence and variation in the recommended use of neoadjuvant chemotherapy (NAC) and the effects of this variation on survival in patients with non-metastatic muscle-invasive bladder cancer (MIBC). PATIENTS AND METHODS In this nationwide, Netherlands Cancer Registry-based study, we identified 1025 patients newly diagnosed with non-metastatic MIBC between November 2017 and November 2019 who underwent radical cystectomy. Patients with ECOG performance status 0-1 and creatinine clearance ≥ 50 mL/min/1.73 m2 were considered NAC-eligible. Interhospital variation was assessed using case-mix adjusted multilevel analysis. A Cox proportional hazards model was used to evaluate the association between hospital specific probability of using NAC and survival. All analyses were stratified by disease stage (cT2 versus cT3-4a). RESULTS In total, of 809 NAC-eligible patients, only 34% (n = 277) received NAC. Guideline adherence for NAC in cT2 was 26% versus 55% in cT3-4a disease. Interhospital variation was 7-57% and 31-62%, respectively. A higher hospital specific probability of NAC might be associated with a better survival, but results were not statistically significant (HRcT2 = 0.59, 95% CI 0.33-1.05 and HRcT3-4a = 0.71, 95% CI 0.25-2.04). CONCLUSION Guideline adherence regarding NAC use is low and interhospital variation is large, especially for patients with cT2-disease. Although not significant, our data suggest that survival of patients diagnosed in hospitals more inclined to give NAC might be better. Further research is warranted to elucidate the underlying mechanism. As literature clearly shows the potential survival benefit of NAC in patients with cT3-4a disease, better guideline adherence might be pursued.
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Affiliation(s)
- Lisa M C van Hoogstraten
- Netherlands Comprehensive Cancer Organisation, PO Box 1281, 6501 BG, Nijmegen, The Netherlands.
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Calvin C O Man
- Netherlands Comprehensive Cancer Organisation, PO Box 1281, 6501 BG, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sasja F Mulder
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Theodora M Ripping
- Netherlands Comprehensive Cancer Organisation, PO Box 1281, 6501 BG, Nijmegen, The Netherlands
| | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Katja K H Aben
- Netherlands Comprehensive Cancer Organisation, PO Box 1281, 6501 BG, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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van Hoogstraten LM, Witjes JA, Meijer RP, Ripping TM, Kiemeney LA, Aben KK, de Reijke TM, Goossens‐Laan CA, Hulshof MC, van Leenders GJ, Leliveld AM, Mulder SF, Noteboom JL, Oddens JR, Smilde TJ, Venderbosch GW, van der Heijden AG, van der Heijden MS, van Moorselaar RJ, van Rhijn BW, van Roermund JG, Wijsman BP. Non-metastatic muscle-invasive bladder cancer: the role of age in receiving treatment with curative intent. BJU Int 2022; 130:764-775. [PMID: 35064953 PMCID: PMC9790563 DOI: 10.1111/bju.15697] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/26/2021] [Accepted: 01/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate which patient and tumour characteristics are associated with remaining untreated in patients with potentially curable, non-metastatic muscle-invasive bladder cancer (MIBC), and to compare survival of untreated vs treated patients with similar characteristics. PATIENTS AND METHODS For this cohort study, 15 047 patients diagnosed with cT2-T4aN0/xM0/x urothelial MIBC between 2005 and 2019 were identified in the Netherlands Cancer Registry. Factors associated with remaining untreated were identified using logistic regression analyses. Interhospital variation was assessed using multilevel analysis. Using a propensity score, the median overall survival (mOS) of untreated and treated patients was evaluated. Analyses were stratified by age (<75 vs ≥75 years). RESULTS One-third of patients aged ≥75 years remained untreated; increasing age, worse performance status, worse renal function, cT4a stage and previous radiotherapy in the abdomen/pelvic area increased the odds of remaining untreated. One in 10 patients aged <75 years remained untreated; significant associations were only found for performance status, renal function and cT4a stage. Interhospital variation for remaining untreated was largest for patients aged ≥75 years, ranging from 37% to 69% (case-mix-adjusted). Irrespective of age, mOS was significantly worse for untreated patients: 6.4 months (95% confidence interval [CI] 5.1-7.3) vs 16.0 months (95% CI 13.5-19.1) for treated patients. CONCLUSION On average, one in five patients with non-metastatic MIBC remained untreated. Untreated patients were generally older and had a more unfavourable prognostic profile. Untreated patients had significantly worse overall survival, regardless of age. Age alone should therefore not affect treatment decision-making. Considering the large interhospital variation, a proportion of untreated patients might be wrongfully denied life-prolonging treatment.
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Affiliation(s)
- Lisa M.C. van Hoogstraten
- Netherlands Comprehensive Cancer OrganizationUtrechtthe Netherlands,Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenthe Netherlands
| | - J. Alfred Witjes
- Department of UrologyRadboud University Medical CentreNijmegenthe Netherlands
| | - Richard P. Meijer
- Department of Oncological UrologyUniversity Medical Centre UtrechtUtrechtthe Netherlands
| | | | | | - Lambertus A. Kiemeney
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenthe Netherlands,Department of UrologyRadboud University Medical CentreNijmegenthe Netherlands
| | - Katja K.H. Aben
- Netherlands Comprehensive Cancer OrganizationUtrechtthe Netherlands,Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenthe Netherlands
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Burghout C, Nahar-van Venrooij LMW, Bolt SR, Smilde TJ, Wouters EJM. Benefits of Structured Advance Care Plan in end-of-Life Care Planning among Older Oncology Patients: A Retrospective Pilot Study. J Palliat Care 2022; 38:30-40. [PMID: 36039518 DOI: 10.1177/08258597221119660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: Studies suggest that advance care planning (ACP) results in improved quality of life and reduced healthcare consumption. We assessed how the use of a structured advance care planning tool (ACPT) in oncology patients relates to their healthcare consumption before death, and to the match between preferred and actual place of death. Methods: We performed a pilot study at a teaching hospital in the Netherlands. Endpoints were 1) healthcare consumption at three and one month(s) before death, and 2) the match between preferred and actual place of death. Results: The study included 75 patients without an ACPT (group 1) and 59 patients with an ACPT (group 2) of whom the preferred place of care or death were documented at least three months before death in 15 patients (subgroup 2b). Compared to group 1, patients in group 2 had significantly more healthcare consumption. However, compared to group 1, patients in subgroup 2b underwent significantly less diagnostic (33.3% (n = 5) versus 69.3% (n = 52), p < 0.05) and laboratory tests (33.3% (n = 5) versus 62.7% (n = 47), p < 0.05) one month before death. Patients in subgroup 2b died at their preferred place more often (76.9%, n = 10) compared to patients in group 1 (58.3%, n = 7) (NS), which meant more deaths at home and less in-hospital-deaths. Conclusions: The results suggest that timely documentation of the preferred place of care or death in a structured ACPT may result in less healthcare consumption and a better match between the preferred and actual place of death.
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Affiliation(s)
- Carolien Burghout
- Department of hemato-oncology, 10233Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands.,Jeroen Bosch Academy Research, 10233Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands.,Department of Tranzo, 120694Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands
| | | | - Sascha R Bolt
- Department of Tranzo, 120694Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands
| | - Tineke J Smilde
- Department of hemato-oncology, 10233Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands
| | - Eveline J M Wouters
- Department of Tranzo, 120694Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands.,3170Fontys University of Applied Science, School For Allied Health Professionals, Eindhoven, Noord-Brabant, Netherlands
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9
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van Hoogstraten LM, Kiemeney LA, Meijer RP, van Leenders GJ, Vanneste BG, Incrocci L, Smilde TJ, Siesling S, Witjes JA, Aben KK. The impact of the COVID-19 pandemic on bladder cancer care in the Netherlands. Bladder Cancer 2022. [DOI: 10.3233/blc-211608] [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: 11/15/2022]
Abstract
BACKGROUND: The COVID-19 pandemic has disrupted regular health care with potential consequences for non-COVID diseases like cancer. To ensure continuity of oncological care, guidelines were temporarily adapted. OBJECTIVE: To evaluate the impact of the COVID-19 outbreak on bladder cancer care in the Netherlands. METHODS: The number of bladder cancer (BC) diagnoses per month during 2020-2021 was compared to 2018-2019 based on preliminary data from the Netherlands Cancer Registry (NCR). Additionally, detailed data were retrieved from the NCR for the cohort diagnosed between March 1st-May 31st 2020 (first COVID wave) and 2018-2019 (reference cohort). BC diagnoses, changes in age and stage at diagnosis, and time to first-line treatment were compared between both periods. Changes in treatment were evaluated using logistic regression. RESULTS: During the first COVID wave (week 9–22), the number of BC diagnoses decreased by 14%, corresponding with approximately 300 diagnoses, but increased again in the second half of 2020. The decline was most pronounced from week 13 onwards in patients≥70 years and patients with non-muscle invasive BC. Patients with muscle-invasive disease were less likely to undergo a radical cystectomy (RC) in week 17–22 (OR = 0.62, 95% CI = 0.40–0.97). Shortly after the start of the outbreak, use of neoadjuvant chemotherapy decreased from 34% to 25% but this (non-significant) effect disappeared at the end of April. During the first wave, 5% more RCs were performed compared to previous years. Time from diagnosis to RC became 6 days shorter. Overall, a 7% reduction in RCs was observed in 2020. CONCLUSIONS: The number of BC diagnoses decreased steeply by 14% during the first COVID wave but increased again to pre-COVID levels by the end of 2020 (i.e. 600 diagnoses/month). Treatment-related changes remained limited and followed the adapted guidelines. Surgical volume was not compromised during the first wave. Altogether, the impact of the first COVID-19 outbreak on bladder cancer care in the Netherlands appears to be less pronounced than was reported for other solid tumors, both in the Netherlands and abroad. However, its impact on bladder cancer stage shift and long-term outcomes, as well as later pandemic waves remain so far unexamined.
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Affiliation(s)
- Lisa M.C. van Hoogstraten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Lambertus A. Kiemeney
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Richard P. Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ben G.L. Vanneste
- Department of Radiation Oncology, MAASTRO-clinic, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MCCancer Institute, Rotterdam, the Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Katja K.H. Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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10
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Damen A, Raijmakers NJH, van Roij J, Visser A, Beuken-Everdingen MVD, Kuip E, van Laarhoven HWM, van Leeuwen-Snoeks L, van der Padt-Pruijsten A, Smilde TJ, Leget C, Fitchett G. Spiritual Well-Being and Associated Factors in Dutch Patients With Advanced Cancer. J Pain Symptom Manage 2022; 63:404-414. [PMID: 34656652 DOI: 10.1016/j.jpainsymman.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT Palliative care aims to support patients' spiritual needs with the intention of promoting their spiritual well-being (SWB), an important dimension of quality of life. SWB is one of the less-studied dimensions of QoL, particularly in a secular country such as the Netherlands. OBJECTIVES In this study we aimed to get a better understanding of SWB in Dutch patients with advanced cancer. We therefore examined its prominence and associated factors. METHODS We used the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), which included 1,103 patients with advanced cancer. In addition to sociodemographic and religious/spiritual characteristics, study measures comprised the SWB subscales Meaning, Peace, and Faith of the revised FACIT-Sp-12, spiritual problems and needs (PNPCsv), quality of life (EORTC-QLQ-C30) and satisfaction with healthcare professionals' interpersonal skills (INPATSAT-32). RESULTS On average, patients experienced quite a bit of Meaning (8.9, SD 2.3), a little bit to somewhat Peace (6.8, SD 2.7), and very low levels of Faith (2.9, SD 3.7). Two-thirds (71%) of patients reported one or more spiritual problems, for which the majority (54%) wanted to receive attention. In the final multivariable models, only a few factors were associated with SWB, such as greater spiritual needs with lower levels of Meaning and Peace. CONCLUSION Dutch patients with advanced cancer experience medium to low levels of Meaning, Peace, and Faith. More attention for their SWB is warranted.
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Affiliation(s)
- Annelieke Damen
- Netherlands Comprehensive Cancer Organisation (A.D., N.J.H.R.), Utrecht, The Netherlands.
| | - Natasja J H Raijmakers
- Netherlands Comprehensive Cancer Organisation (A.D., N.J.H.R.), Utrecht, The Netherlands; Netherlands Association for Palliative Care (N.J.H.R.), Utrecht, The Netherlands
| | - Janneke van Roij
- Netherlands Comprehensive Cancer Organization (IKNL) (J.V.R.), Department of Research & Development, Utrecht, The Netherlands; CoRPS - Center of Research on Psychology in Somatic Diseases (J.V.R.), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Netherlands Association for Palliative Care (PZNL) (J.V.R.), Utrecht, The Netherlands; Libra Rehabilitation and Audiology (J.V.R.), Tilburg, The Netherlands
| | - Anja Visser
- Faculty of Theology and Religious Studies (A.V.), University of Groningen, Groningen, The Netherlands
| | | | - Eveline Kuip
- Department of Medical Oncology and Anesthesiology (E.K.), Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology (H.W.M.L.), Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Tineke J Smilde
- Department of Oncology (T.J.S.), Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Carlo Leget
- Department of Care Ethics (C.L.), University of Humanistic Studies, Utrecht, The Netherlands
| | - George Fitchett
- Department of Religion (G.F.), Health and Human Values, Rush University Medical Center, Chicago, IL
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11
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Boerrigter E, Benoist GE, van Oort IM, Verhaegh GW, de Haan AFJ, van Hooij O, Groen L, Smit F, Oving IM, de Mol P, Smilde TJ, Somford DM, Hamberg P, Dezentjé VO, Mehra N, van Erp NP, Schalken JA. RNA Biomarkers as a Response Measure for Survival in Patients with Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2021; 13:6279. [PMID: 34944897 PMCID: PMC8699291 DOI: 10.3390/cancers13246279] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 01/01/2023] Open
Abstract
Treatment evaluation in metastatic castration-resistant prostate cancer is challenging. There is an urgent need for biomarkers to discriminate short-term survivors from long-term survivors, shortly after treatment initiation. Thereto, the added value of early RNA biomarkers on predicting progression-free survival (PFS) and overall survival (OS) were explored. The RNA biomarkers: KLK3 mRNA, miR-375, miR-3687, and NAALADL2-AS2 were measured in 93 patients with mCRPC, before and 1 month after start of first-line abiraterone acetate or enzalutamide treatment, in two prospective clinical trials. The added value of the biomarkers to standard clinical parameters in predicting PFS and OS was tested by Harell's C-index. To test whether the biomarkers were independent markers of PFS and OS, multivariate Cox regression was used. The best prediction model for PFS and OS was formed by adding miR-375 and KLK3 (at baseline and 1 month) to standard clinical parameters. Baseline miR-375 and detectable KLK3 after 1 month of therapy were independently related to shorter PFS, which was not observed for OS. In conclusion, the addition of KLK3 and miR-375 (at baseline and 1 month) to standard clinical parameters resulted in the best prediction model for survival assessment.
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Affiliation(s)
- Emmy Boerrigter
- Radboud University Medical Center, Department of Pharmacy, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands; (E.B.); (G.E.B.)
| | - Guillemette E. Benoist
- Radboud University Medical Center, Department of Pharmacy, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands; (E.B.); (G.E.B.)
| | - Inge M. van Oort
- Radboud University Medical Center, Department of Urology, Radboud Institute for Molecular Life Sciences, 6525 GA Nijmegen, The Netherlands; (I.M.v.O.); (G.W.V.); (O.v.H.); (L.G.); (J.A.S.)
| | - Gerald W. Verhaegh
- Radboud University Medical Center, Department of Urology, Radboud Institute for Molecular Life Sciences, 6525 GA Nijmegen, The Netherlands; (I.M.v.O.); (G.W.V.); (O.v.H.); (L.G.); (J.A.S.)
| | - Anton F. J. de Haan
- Radboud University Medical Center, Department for Health Evidence, Biostatistics, 6525 GA Nijmegen, The Netherlands;
| | - Onno van Hooij
- Radboud University Medical Center, Department of Urology, Radboud Institute for Molecular Life Sciences, 6525 GA Nijmegen, The Netherlands; (I.M.v.O.); (G.W.V.); (O.v.H.); (L.G.); (J.A.S.)
| | - Levi Groen
- Radboud University Medical Center, Department of Urology, Radboud Institute for Molecular Life Sciences, 6525 GA Nijmegen, The Netherlands; (I.M.v.O.); (G.W.V.); (O.v.H.); (L.G.); (J.A.S.)
| | - Frank Smit
- MDxHealth, 6534 AT Nijmegen, The Netherlands;
| | - Irma M. Oving
- Department of Medical Oncology, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands;
| | - Pieter de Mol
- Department of Medical Oncology, Gelderse Vallei Hospital, 6716 RP Ede, The Netherlands;
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 5223 GZ ’s-Hertogenbosch, The Netherlands;
| | - Diederik M. Somford
- Department of Urology, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands;
| | - Paul Hamberg
- Department of Medical Oncology, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands;
| | - Vincent O. Dezentjé
- Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Niven Mehra
- Radboud University Medical Center, Department of Medical Oncology, 6525 GA Nijmegen, The Netherlands;
| | - Nielka P. van Erp
- Radboud University Medical Center, Department of Pharmacy, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands; (E.B.); (G.E.B.)
| | - Jack A. Schalken
- Radboud University Medical Center, Department of Urology, Radboud Institute for Molecular Life Sciences, 6525 GA Nijmegen, The Netherlands; (I.M.v.O.); (G.W.V.); (O.v.H.); (L.G.); (J.A.S.)
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12
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Westgeest HM, Kuppen MCP, van den Eertwegh FAJM, van Oort IM, Coenen JLLM, van Moorselaar JRJA, Aben KKH, Bergman AM, Huinink DTB, van den Bosch J, Hendriks MP, Lampe MI, Lavalaye J, Mehra N, Smilde TJ, Somford RDM, Tick L, Weijl NI, van de Wouw YAJ, Gerritsen WR, Groot CAUD. High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry. J Palliat Med 2021; 24:1789-1797. [PMID: 34415798 DOI: 10.1089/jpm.2020.0800] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Intensive end-of-life care (i.e., the overuse of treatments and hospital resources in the last months of life), is undesirable since it has a minimal clinical benefit with a substantial financial burden. The aim was to investigate the care in the last three months of life (end-of-life [EOL]) in castration-resistant prostate cancer (CRPC). Methods: Castration-resistant prostate cancer registry (CAPRI) is an investigator-initiated, observational multicenter cohort study in 20 hospitals retrospectively including patients diagnosed with CRPC between 2010 and 2016. High-intensity care was defined as the initiation of life-prolonging drugs (LPDs) in the last month, continuation of LPD in last 14 days, >1 admission, admission duration ≥14 days, and/or intensive care admission in last three months of life. Descriptive and binary logistic regression analyses were performed. Results: High-intensity care was experienced by 41% of 2429 patients in the EOL period. Multivariable analysis showed that age (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), performance status (OR 0.57, 95% CI 0.33-0.97), time from CRPC to EOL (OR 0.98, 95% CI 0.97-0.98), referral to a medical oncologist (OR 1.99, 95% CI 1.55-2.55), prior LPD treatment (>1 line OR 1.72, 95% CI 1.31-2.28), and opioid use (OR 1.45, 95% CI 1.08-1.95) were significantly associated with high-intensity care. Conclusions: High-intensity care in EOL is not easily justifiable due to high economic cost and little effect on life span, but further research is awaited to give insight in the effect on patients' and their caregivers' quality of life.
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Affiliation(s)
- Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands
| | - Malou C P Kuppen
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| | - Fons A J M van den Eertwegh
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Katja K H Aben
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.,Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Andre M Bergman
- Division of Medical Oncology, the Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | - Joan van den Bosch
- Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Mathijs P Hendriks
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | - Menuhin I Lampe
- Department of Urology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tineke J Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Rik D M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Lidwine Tick
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, the Netherlands
| | - Nir I Weijl
- Department of Internal Medicine, MCH-Bronovo Hospital, 's-Gravenhage, the Netherlands
| | - Yes A J van de Wouw
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carin A Uyl-de Groot
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
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13
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Boerrigter E, Benoist GE, van Oort IM, Verhaegh GW, van Hooij O, Groen L, Smit F, Oving IM, de Mol P, Smilde TJ, Somford DM, Mehra N, Schalken JA, van Erp NP. Liquid biopsy reveals KLK3 mRNA as a prognostic marker for progression free survival in patients with metastatic castration-resistant prostate cancer undergoing first-line abiraterone acetate and prednisone treatment. Mol Oncol 2021; 15:2453-2465. [PMID: 33650292 PMCID: PMC8410566 DOI: 10.1002/1878-0261.12933] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/13/2020] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022] Open
Abstract
Circulating RNAs extracted from liquid biopsies represent a promising source of cancer‐ and therapy‐related biomarkers. We screened whole blood from patients with metastatic castration‐resistant prostate cancer (mCRPC) following their first‐line treatment with abiraterone acetate and prednisone (AA‐P) to identify circulating RNAs that may correlate with progression‐free survival (PFS). In a prospective multicenter observational study, 53 patients with mCRPC were included after they started first‐line AA‐P treatment. Blood was drawn at baseline, 1, 3, and 6 months after treatment initiation. The levels of predefined circulating RNAs earlier identified as being upregulated in patients with mCRPC (e.g., microRNAs, long noncoding RNAs, and mRNAs), were analyzed. Uni‐ and multivariable Cox regression and Kaplan–Meier analyses were used to analyze the prognostic value of the various circulating RNAs for PFS along treatment. Detectable levels of kallikrein‐related peptidase 3 (KLK3) mRNA at baseline were demonstrated to be an independent prognostic marker for PFS (201 vs 501 days, P = 0.00054). Three months after AA‐P treatment initiation, KLK3 could not be detected in the blood of responding patients, but was still detectable in 56% of the patients with early progression. Our study confirmed that KLK3 mRNA detection in whole blood is an independent prognostic marker in mCRPC patients receiving AA‐P treatment. Furthermore, the levels of circulating KLK3 mRNA in patients receiving AA‐P treatment might reflect treatment response or early signs of progression.
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Affiliation(s)
- Emmy Boerrigter
- Department of PharmacyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Guillemette E. Benoist
- Department of PharmacyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Inge M. van Oort
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | - Gerald W. Verhaegh
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | - Onno van Hooij
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | - Levi Groen
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | | | - Irma M. Oving
- Department of Medical OncologyZiekenhuisgroep TwenteAlmelothe Netherlands
| | - Pieter de Mol
- Department of Medical OncologyGelderse Vallei HospitalEdethe Netherlands
| | - Tineke J. Smilde
- Department of Medical OncologyJeroen Bosch Hospital‘s Hertogenboschthe Netherlands
| | | | - Niven Mehra
- Deparment of Medical OncologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Jack A. Schalken
- Department of UrologyRadboud University Medical CenterRadboud Institute for Molecular Life SciencesNijmegenthe Netherlands
| | - Nielka P. van Erp
- Department of PharmacyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
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14
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Kroon LL, van Roij J, Korfage IJ, Reyners AKL, van den Beuken-van Everdingen MHJ, den Boer MO, Creemers GJ, de Graeff A, Hendiks MP, Hunting JCB, de Jong WK, Kuip EJM, van Laarhoven HWM, van Leeuwen L, van Lindert ASR, Mandigers CMPW, Nieboer P, van der Padt-Pruijsten A, Smilde TJ, Sommeijer DW, Thijs MF, Tiemessen MA, Vos AH, Vreugdenhil A, Werner PT, van Zuylen L, van de Poll-Franse LV, Raijmakers NJH. Perceptions of involvement in advance care planning and emotional functioning in patients with advanced cancer. J Cancer Surviv 2021; 15:380-385. [PMID: 33840000 PMCID: PMC8134301 DOI: 10.1007/s11764-021-01020-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/06/2021] [Indexed: 01/03/2023]
Abstract
Purpose Advance Care Planning (ACP) is positively associated with the quality of care, but its impact on emotional functioning is ambiguous. This study investigated the association between perceptions of ACP involvement and emotional functioning in patients with advanced cancer. Methods This study analyzed baseline data of 1,001 patients of the eQuiPe study, a prospective, longitudinal, multicenter, observational study on quality of care and quality of life in patients with advanced cancer in the Netherlands. Patients with metastatic solid cancer were asked to participate between November 2017 and January 2020. Patients’ perceptions of ACP involvement were measured by three self-administered statements. Emotional functioning was measured by the EORTC-QLQ-C30. A linear multivariable regression analysis was performed while taking gender, age, migrant background, education, marital status, and symptom burden into account. Results The majority of patients (87%) reported that they were as much involved as they wanted to be in decisions about their future medical treatment and care. Most patients felt that their relatives (81%) and physicians (75%) were familiar with their preferences for future medical treatment and care. A positive association was found between patients’ perceptions of ACP involvement and their emotional functioning (b=0.162, p<0.001, 95%CI[0.095;0.229]) while controlling for relevant confounders. Conclusions Perceptions of involvement in ACP are positively associated with emotional functioning in patients with advanced cancer. Future studies are needed to further investigate the effect of ACP on emotional functioning. Trial registration number NTR6584 Date of registration: 30 June 2017 Implications for Cancer Survivors Patients’ emotional functioning might improve from routine discussions regarding goals of future care. Therefore, integration of ACP into palliative might be promising.
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Affiliation(s)
- Lente L Kroon
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands.,University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Janneke van Roij
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands.,Department of Psychology, Pantein, Boxmeer, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - An K L Reyners
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Marien O den Boer
- Department of Medical Oncology, Laurentius Hospital, Roermond, The Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathijs P Hendiks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Jarmo C B Hunting
- Department of Medical Oncology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Evelien J M Kuip
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Lobke van Leeuwen
- Department of Medical Oncology, Diakonessenhuis, Utrecht, The Netherlands
| | - Anne S R van Lindert
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Peter Nieboer
- Department of Medical Oncology, Wilhelmina Hospital Assen, Assen, The Netherlands
| | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Dirkje W Sommeijer
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, FlevoHospital, Almere, The Netherlands
| | - Martine F Thijs
- Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands
| | | | - Allert H Vos
- Department of Medical Oncology, Bernhoven Hospital, Uden, The Netherlands
| | - Art Vreugdenhil
- Department of Medical Oncology, Maxima Medical Center, Eindhoven, The Netherlands
| | - Philo T Werner
- Department of Medical Oncology, VieCuri Medical Center, Venlo, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands.,Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands. .,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands.
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Piccart M, van 't Veer LJ, Poncet C, Lopes Cardozo JMN, Delaloge S, Pierga JY, Vuylsteke P, Brain E, Vrijaldenhoven S, Neijenhuis PA, Causeret S, Smilde TJ, Viale G, Glas AM, Delorenzi M, Sotiriou C, Rubio IT, Kümmel S, Zoppoli G, Thompson AM, Matos E, Zaman K, Hilbers F, Fumagalli D, Ravdin P, Knox S, Tryfonidis K, Peric A, Meulemans B, Bogaerts J, Cardoso F, Rutgers EJT. 70-gene signature as an aid for treatment decisions in early breast cancer: updated results of the phase 3 randomised MINDACT trial with an exploratory analysis by age. Lancet Oncol 2021; 22:476-488. [PMID: 33721561 DOI: 10.1016/s1470-2045(21)00007-3] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The MINDACT trial showed excellent 5-year distant metastasis-free survival of 94·7% (95% CI 92·5-96·2) in patients with breast cancer of high clinical and low genomic risk who did not receive chemotherapy. We present long-term follow-up results together with an exploratory analysis by age. METHODS MINDACT was a multicentre, randomised, phase 3 trial done in 112 academic and community hospitals in nine European countries. Patients aged 18-70 years, with histologically confirmed primary invasive breast cancer (stage T1, T2, or operable T3) with up to three positive lymph nodes, no distant metastases, and a WHO performance status of 0-1 were enrolled and their genomic risk (using the MammaPrint 70-gene signature) and clinical risk (using a modified version of Adjuvant! Online) were determined. Patients with low clinical and low genomic risk results did not receive chemotherapy, and patients with high clinical and high genomic risk did receive chemotherapy (mostly anthracycline-based or taxane-based, or a combination thereof). Patients with discordant risk results (ie, patients with high clinical risk but low genomic risk, and those with low clinical risk but high genomic risk) were randomly assigned (1:1) to receive chemotherapy or not based on either the clinical risk or the genomic risk. Randomisation was done centrally and used a minimisation technique that was stratified by institution, risk group, and clinical-pathological characteristics. Treatment allocation was not masked. The primary endpoint was to test whether the distant metastasis-free survival rate at 5 years in patients with high clinical risk and low genomic risk not receiving chemotherapy had a lower boundary of the 95% CI above the predefined non-inferiority boundary of 92%. In the primary test population of patients with high clinical risk and low genomic risk who adhered to the treatment allocation of no chemotherapy and had no change in risk post-enrolment. Here, we present updated follow-up as well as an exploratory analysis of a potential age effect (≤50 years vs >50 years) and an analysis by nodal status for patients with hormone receptor-positive and HER2-negative disease. These analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT00433589, and the European Clinical Trials database, EudraCT2005-002625-31. Recruitment is complete and further long-term follow-up is ongoing. FINDINGS Between Feb 8, 2007, and July 11, 2011, 6693 patients were enrolled. On Feb 26, 2020, median follow-up was 8·7 years (IQR 7·8-9·7). The updated 5-year distant metastasis-free survival rate for patients with high clinical risk and low genomic risk receiving no chemotherapy (primary test population, n=644) was 95·1% (95% CI 93·1-96·6), which is above the predefined non-inferiority boundary of 92%, supporting the previous analysis and proving MINDACT as a positive de-escalation trial. Patients with high clinical risk and low genomic risk were randomly assigned to receive chemotherapy (n=749) or not (n=748); this was the intention-to-treat population. The 8-year estimates for distant metastasis-free survival in the intention-to-treat population were 92·0% (95% CI 89·6-93·8) for chemotherapy versus 89·4% (86·8-91·5) for no chemotherapy (hazard ratio 0·66; 95% CI 0·48-0·92). An exploratory analysis confined to the subset of patients with hormone receptor-positive, HER2-negative disease (1358 [90.7%] of 1497 randomly assigned patients, of whom 676 received chemotherapy and 682 did not) shows different effects of chemotherapy administration on 8-year distant metastasis-free survival according to age: 93·6% (95% CI 89·3-96·3) with chemotherapy versus 88·6% (83·5-92·3) without chemotherapy in 464 women aged 50 years or younger (absolute difference 5·0 percentage points [SE 2·8, 95% CI -0·5 to 10·4]) and 90·2% (86·8-92·7) versus 90·0% (86·6-92·6) in 894 women older than 50 years (absolute difference 0·2 percentage points [2·1, -4·0 to 4·4]). The 8-year distant metastasis-free survival in the exploratory analysis by nodal status in these patients was 91·7% (95% CI 88·1-94·3) with chemotherapy and 89·2% (85·2-92·2) without chemotherapy in 699 node-negative patients (absolute difference 2·5 percentage points [SE 2·3, 95% CI -2·1 to 7·2]) and 91·2% (87·2-94·0) versus 89·9% (85·8-92·8) for 658 patients with one to three positive nodes (absolute difference 1·3 percentage points [2·4, -3·5 to 6·1]). INTERPRETATION With a more mature follow-up approaching 9 years, the 70-gene signature shows an intact ability of identifying among women with high clinical risk, a subgroup, namely patients with a low genomic risk, with an excellent distant metastasis-free survival when treated with endocrine therapy alone. For these women the magnitude of the benefit from adding chemotherapy to endocrine therapy remains small (2·6 percentage points) and is not enhanced by nodal positivity. However, in an underpowered exploratory analysis this benefit appears to be age-dependent, as it is only seen in women younger than 50 years where it reaches a clinically relevant threshold of 5 percentage points. Although, possibly due to chemotherapy-induced ovarian function suppression, it should be part of informed, shared decision making. Further study is needed in younger women, who might need reinforced endocrine therapy to forego chemotherapy. FUNDING European Commission Sixth Framework Programme.
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Affiliation(s)
- Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Laura J van 't Veer
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | | | | | - Jean-Yves Pierga
- Institut Curie, Paris & Saint-Cloud, Université de Paris, Paris, France
| | | | - Etienne Brain
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France
| | | | | | | | | | - Giuseppe Viale
- University of Milan, Milan, Italy; European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mauro Delorenzi
- Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland
| | - Christos Sotiriou
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Gabriele Zoppoli
- Gruppo Oncologico Italiano di Ricerca Clinica, Università degli Studi di Genova and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Khalil Zaman
- Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | | | - Peter Ravdin
- University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Susan Knox
- Europa Donna-European Breast Cancer Coalition, Milan, Italy
| | | | - Aleksandra Peric
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Bart Meulemans
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Jan Bogaerts
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Fatima Cardoso
- Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
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16
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Blok JM, Groot HJ, Huele EH, de Wit R, Horenblas S, Nuver J, Groenewegen G, Bosch JR, Witjes JA, Tromp JM, de Brouwer PJ, van den Berg HA, Vanneste BG, Smilde TJ, Aarts MJ, Gietema JA, Meijer RP, Schaapveld M. Dose-Dependent Effect of Platinum-Based Chemotherapy on the Risk of Metachronous Contralateral Testicular Cancer. J Clin Oncol 2021; 39:319-327. [DOI: 10.1200/jco.20.02352] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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
PURPOSE Patients with testicular germ cell tumor (TGCT) are at increased risk of developing a contralateral TGCT (CTGCT). Although some studies suggest that prior treatment with platinum-based chemotherapy affects CTGCT risk, a relationship between CTGCT risk and platinum dose has not previously been assessed. We analyzed the association between the number of platinum-based chemotherapy cycles and CTGCT risk. PATIENTS AND METHODS The risk of developing a metachronous CTGCT was evaluated in a nationwide cohort of 4,755 patients diagnosed with primary TGCT in the Netherlands between 1989 and 2007. Standardized incidence ratios were computed to compare CTGCT incidence with expected TGCT on the basis of TGCT incidence in the general population. The cumulative incidence of CTGCT was estimated in the presence of death as competing risk. The effect of treatment with platinum-based chemotherapy on CTGCT risk was assessed using multivariable Cox proportional hazards regression models. RESULTS CTGCT was diagnosed in 136 patients (standardized incidence ratio, 14.6; 95% CI, 12.2 to 17.2). The cumulative incidence increased up to 20 years after primary diagnosis, reaching 3.4% (95% CI, 2.8% to 4.0%) after 20 years of follow up. The risk of developing a CTGCT decreased with age (hazard ratio [HR], 0.93; 95% CI, 0.90 to 0.96), was lower after nonseminomatous germ cell tumor (HR, 0.58; 95% CI, 0.35 to 0.96) and decreased with every additional cycle of chemotherapy (HRper cycle, 0.74; 95% CI, 0.64 to 0.85). CONCLUSION Approximately one in every 30 survivors of TGCT will develop a CTGCT, with CTGCT incidence increasing up to 20 years after a primary TGCT. Treatment with platinum-based chemotherapy shows a dose-dependent inverse association with CTGCT risk.
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Affiliation(s)
- Joost M. Blok
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Harmke J. Groot
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Eline H. Huele
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus University Hospital, Rotterdam, the Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerard Groenewegen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J.L.H. Ruud Bosch
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jacqueline M. Tromp
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Peter J.M. de Brouwer
- Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands
| | | | - Ben G.L. Vanneste
- Department of Radiation Oncology, MAASTRO-clinic, Maastricht, the Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
| | - Maureen J.B. Aarts
- Department of Medical Oncology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard P. Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael Schaapveld
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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17
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Richters A, Mehra N, Meijer RP, Boormans JL, van der Heijden AG, Smilde TJ, van der Heijden MS, Kiemeney LA, Aben KK. Utilization of systemic treatment for metastatic bladder cancer in everyday practice: Results of a nation-wide population-based cohort study. Cancer Treat Res Commun 2020; 25:100266. [PMID: 33316557 DOI: 10.1016/j.ctarc.2020.100266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND With the introduction of new therapeutic options, the landscape of metastatic bladder cancer (mBC) management is shifting. We describe current clinical practice and outcomes of mBC patients as a benchmark for translation of developments into clinical practice in the near future. PATIENTS AND METHODS Nation-wide population-based cohort study including all patients diagnosed with synchronous metastatic bladder cancer in the Netherlands in 2016-2017, identified through the Netherlands Cancer Registry (NCR). Clinical data on patient and disease characteristics, treatments and survival from the NCR were supplemented with specific information from electronic health records and descriptively analyzed. This study was part of the Prospective Bladder Cancer Infrastructure. RESULTS Synchronous metastatic bladder cancer was diagnosed in 636 patients in the Netherlands in 2016 and 2017. 35% (221 patients) received systemic treatment, of whom 88 received multiple treatment lines. Most common first-line regimen was carboplatin-based chemotherapy (49%), followed by cisplatin-based chemotherapy (41%) and immunotherapy (8%). Factors associated with systemic treatment were: young age, <2 comorbidities, adequate renal function and performance-status (WHO-0-1/Karnofsky-80-100), urothelial carcinoma and lymph node only metastases. Median overall survival was 4.4 months for the total cohort, and 12.3, 12.9 and 11.1 months for patients treated with first-line immunotherapy, cisplatin-based and carboplatin-based chemotherapy, respectively. CONCLUSIONS Many mBC patients received no systemic treatment or received carboplatin-based chemotherapy, partly because of cisplatin-ineligibility. Observed survival corresponded relatively well with rates reported from trials among chemotherapy-treated patients. These data can serve as a benchmark for future studies evaluating the application of immunotherapy outside a trial setting.
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Affiliation(s)
- Anke Richters
- The Netherlands Comprehensive Cancer Organisation, Department of Research and Development, Utrecht, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - Niven Mehra
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
| | - Richard P Meijer
- University Medical Center Utrecht, Department of Oncological Urology, Utrecht, The Netherlands
| | - Joost L Boormans
- Erasmus MC Cancer Institute, Department of Urology, Rotterdam, The Netherlands
| | | | - Tineke J Smilde
- Jeroen Bosch Hospital, Department of Internal Medicine, 's Hertogenbosch, The Netherlands
| | | | - Lambertus A Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Katja K Aben
- The Netherlands Comprehensive Cancer Organisation, Department of Research and Development, Utrecht, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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18
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Pouwels XGLV, Ramaekers BLT, Geurts SME, Erdkamp F, Vriens BEPJ, Aaldering KNA, van de Wouw AJ, Dercksen MW, Smilde TJ, Peters NAJB, van Riel JMGH, Pepels MJ, Heijnen-Mommers J, Tjan-Heijnen VCG, de Boer M, Joore MA. An economic evaluation of eribulin for advanced breast cancer treatment based on the Southeast Netherlands advanced breast cancer registry. Acta Oncol 2020; 59:1123-1130. [PMID: 32544366 DOI: 10.1080/0284186x.2020.1775289] [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: 10/24/2022]
Abstract
Background: In 2013, eribulin was reimbursed under a coverage with evidence development (CED) as third or later chemotherapy line for advanced breast cancer (ABC) patients in the Netherlands because of uncertain cost effectiveness. In 2016, the final decision of reimbursing eribulin was taken without considering the evidence collected during CED research. We analysed the cost effectiveness of eribulin versus non-eribulin chemotherapy, using real-world data.Methods: A three health states (progression-free, progressed disease, dead) partitioned survival model was developed. The SOuth East Netherlands Advanced BREast Cancer (SONABRE) registry informed the effectiveness and costs inputs. Health state utility values were obtained from the literature. Incremental cost-effectiveness ratio (ICER) between the eribulin and matched non-eribulin chemotherapy was estimated. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed. The financial risk (i.e., the expected value of perfect information (EVPI) plus the expected monetary loss (eML) associated with reimbursing eribulin) and budget impact associated with reimbursing eribulin were calculated.Results: Eribulin led to higher health benefits (0.07 quality-adjusted life year (QALY)) and costs (€15,321) compared with non-eribulin chemotherapy. This resulted in an ICER of €220,608. At a €80,000 per QALY threshold, the risk of reimbursing eribulin was €9,791 per patient (EVPI €13, eML €9,778). Scaled up to the Dutch population, the estimated annual budget impact was €1.9 million and the annual risk of reimbursing eribulin was €2.7 million.Conclusion: From a Dutch societal perspective, eribulin is not cost effective when considering its list price as third and later chemotherapy line for ABC patients.
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Affiliation(s)
- Xavier G. L. V. Pouwels
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Bram L. T. Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Sandra M. E. Geurts
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Frans Erdkamp
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | | | | | | | - M. W. Dercksen
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Tineke J. Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Hertogenbosch, The Netherlands
| | | | - J. M. G. H. van Riel
- Department of Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Manon J. Pepels
- Department of Internal Medicine, Elkerliek Hospital, Helmond, The Netherlands
| | - Jose Heijnen-Mommers
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Vivianne C. G. Tjan-Heijnen
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Maaike de Boer
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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19
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Boerrigter E, Benoist GE, van Oort IM, Verhaegh GW, van Hooij O, Groen L, Smit F, Oving IM, de Mol P, Smilde TJ, Somford DM, Mehra N, Schalken JA, van Erp NP. Abstract 1413: Exploring the prognostic value of microRNAs and drug exposure in patients with metastatic castration resistant prostate cancer treated with abiraterone: a prospective observational study. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1413] [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 Abiraterone acetate is registered for treatment of metastatic prostate cancer, including those with castration-resistant disease (mCRPC). Although it improves overall survival and progression free survival (PFS), treatment response differs between patients. Biomarkers to predict treatment response are lacking. Liquid biopsies containing microRNAs (miRNAs) are a promising source of prognostic biomarkers in mCRPC patients. Furthermore, the exposure to abiraterone in plasma is highly variable and subtherapeutic exposure might contribute to the variability in response to therapy. We explored the prognostic value of microRNAs and drug exposure in mCRPC patients treated with abiraterone.
Methods In a prospective multi-center observational study, 53 patients with mCRPC were included who started pre-chemotherapy abiraterone treatment. Blood was drawn at baseline, 1, 3 and 6 months after start of treatment. The following predefined miRNAs were selected; miR-21, miR-141, miR-200a, miR-200c, miR-375, miR-3687 and abiraterone concentrations were measured. MiRNA-levels in 30 healthy individuals served as controls. Relative miRNA-levels were calculated by the ΔΔCt method. If the geometric mean of a miRNA was more than 2-fold higher in patients versus healthy controls, they were included for survival analysis. Ctrough levels after 1, 3 and 6 months of therapy were measured. The average Ctrough level per patient was used for further analysis. The prognostic value of miRNAs and drug exposure for PFS (radiographic, biochemical or clinical progression) was analyzed with Kaplan-Meier (KM) analysis and tested with a log-rank test. Cut-off values for miRNAs in KM analysis were calculated using maximally selected rank statistics and for the relation with abiraterone Ctrough the earlier defined threshold of 8.4ng/ml was used.
Results Of the miRNAs analyzed, miR-375 was more than 2-fold higher in mCRPC patients versus healthy controls. Patients with more than 2.16 fold higher miR-375 compared to healthy controls showed a trend towards shorter PFS, median 352 vs. 456 days (p=0.076). No PFS benefit was shown for patients with a mean abiraterone Ctrough concentration ≥8.4ng/ml compared to patients below this threshold, median 411 vs. 409 days (p=0.81).
Conclusion High levels of miR-375 might be a prognostic biomarker for PFS in patients with mCRPC treated with abiraterone. The prognostic value of this miRNA should be further explored in a larger cohort of patients. Additionally, the functionality of miR-375 should be further elucidated. The beneficial effect of higher abiraterone exposure levels could not be confirmed in this study for this patient population.
Citation Format: Emmy Boerrigter, Guillemette E. Benoist, Inge M. van Oort, Gerald W. Verhaegh, Onno van Hooij, Levi Groen, Frank Smit, Irma M. Oving, Pieter de Mol, Tineke J. Smilde, Diederik M. Somford, Niven Mehra, Jack A. Schalken, Nielka P. van Erp. Exploring the prognostic value of microRNAs and drug exposure in patients with metastatic castration resistant prostate cancer treated with abiraterone: a prospective observational study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1413.
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Delaloge S, Piccart M, Rutgers E, Litière S, van 't Veer LJ, van den Berkmortel F, Brain E, Dudek-Peric A, Gil-Gil M, Gomez P, Hilbers FS, Khalil Z, Knox S, Kuemmel S, Kunz G, Lesur A, Pierga JY, Ravdin P, Rubio IT, Saghatchian M, Smilde TJ, Thompson AM, Viale G, Zoppoli G, Vuylsteke P, Tryfonidis K, Poncet C, Bogaerts J, Cardoso F. Standard Anthracycline Based Versus Docetaxel-Capecitabine in Early High Clinical and/or Genomic Risk Breast Cancer in the EORTC 10041/BIG 3-04 MINDACT Phase III Trial. J Clin Oncol 2020; 38:1186-1197. [PMID: 32083990 DOI: 10.1200/jco.19.01371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE MINDACT demonstrated that 46% of patients with early breast cancer at high clinical but low genomic risk on the basis of MammaPrint may safely avoid adjuvant chemotherapy. A second random assignment (R-C) compared docetaxel-capecitabine with an anthracycline-based regimen. PATIENTS AND METHODS R-C randomly assigned patients 1:1 between standard anthracycline-based regimens, with or without taxanes (control) and experimental docetaxel 75 mg/m2 intravenously plus oral capecitabine 825 mg/m2 two times per day for 14 days (DC) every 3 weeks for 6 cycles. The primary end point was disease-free survival (DFS). Secondary end points included overall survival and safety. RESULTS Of 2,832 patients, 1,301 (45%) were randomly assigned, and 97% complied with R-C assignment. In the control arm, 29.6% only received taxanes (0.5% of N0 patients). DFS events (n = 148) were much less than required (n = 422) as a result of a lower-than-expected accrual and event rate. At 5 years of median follow-up, DFS was not different between DC (n = 652) and control (n = 649; 90.7% [95% CI, 88% to 92.8%] v 88.8% [95% CI, 85.9% to 91.1%]; hazard ratio [HR], 0.83 [95% CI, 0.60 to 1.15]; P = .26). Overall survival (HR, 0.91 [95% CI, 0.54 to 1.53]) and DFS in the clinical high and genomic high-risk subgroup (86.1% v 88.1%; HR, 0.83 [95% CI, 0.58 to 1.21]) were similar in both arms. DC led to more grade 1 neuropathy (27.1% v 11.2%) and more grade 2 hand/foot syndrome (28.5% v 3.3%) and diarrhea (13.7% v 5.8%). Serious cardiac events occurred in 9 patients (control, n = 4; DC, n = 5). Fifty-three patients developed second cancers (control, n = 32; DC, n = 21; leukemia: 2 v 1). Five treatment-related deaths occurred (control, 2 [0.3%]; DC, 3 [0.5%]). CONCLUSION Although underpowered, this second randomization in MINDACT did not show any improvement in outcome or safety with the use of DC compared with anthracycline-based chemotherapy.
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Affiliation(s)
- Suzette Delaloge
- Gustave Roussy, Villejuif, France.,Unicancer Breast Group, Paris, France
| | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Emiel Rutgers
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Saskia Litière
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Laura J van 't Veer
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | | | - Etienne Brain
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France
| | | | - Miguel Gil-Gil
- Institut Catala D'Oncologia-Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet, Barcelona, Spain
| | | | | | - Zaman Khalil
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Susan Knox
- Europa Donna-The European Breast Cancer Coalition, Milan, Italy
| | - Sherko Kuemmel
- Breast Unit Kliniken Essen-Mitte, Westdeutsche Studiengruppe, Mönchengladbach, Germany
| | | | - Anne Lesur
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Jean-Yves Pierga
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France.,Institut Curie Paris Sciences et Lettres, Université de Paris, Paris, France
| | - Peter Ravdin
- The University of Texas Health Sciences Center, San Antonio, TX
| | - Isabel T Rubio
- Clinica Universidad de Navarra-Site Madrid, Madrid, Spain
| | | | | | | | - Giuseppe Viale
- University of Milan and European Institute of Oncology-Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gabriele Zoppoli
- University of Genoa and Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Peter Vuylsteke
- Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | | | - Coralie Poncet
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Jan Bogaerts
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Fatima Cardoso
- Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
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21
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Kuppen MCP, Westgeest HM, van den Eertwegh AJM, Coenen JLLM, van Moorselaar RJA, van den Berg P, Geenen MM, Mehra N, Hendriks MP, Lampe MI, van de Luijtgaarden ACM, Peters FPJ, Roeleveld TA, Smilde TJ, de Wit R, van Oort IM, Gerritsen WR, Uyl-de Groot CA. Health-related Quality of Life and Pain in a Real-world Castration-resistant Prostate Cancer Population: Results From the PRO-CAPRI Study in the Netherlands. Clin Genitourin Cancer 2019; 18:e233-e253. [PMID: 31883940 DOI: 10.1016/j.clgc.2019.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to determine generic, cancer-specific, and prostate cancer-specific health-related quality of life (HRQoL), pain and changes over time in patients with metastatic castration-resistant prostate cancer (mCRPC) in daily practice. PATIENTS AND METHODS PRO-CAPRI is an observational, prospective study in 10 hospitals in the Netherlands. Patients with mCRPC completed the EQ-5D, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Brief Pain Inventory-Short Form (BPI-SF) every 3 months and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Prostate Cancer Module (EORTC QLQ-PR25) every 6 months for a maximum of 2 years. Subgroups were identified based on chemotherapy pretreatment. Outcomes were generic, cancer-specific, and prostate cancer-specific HRQoL and self-reported pain. Descriptive statistics were performed including changes over time and minimal important differences (MID) between subgroups. RESULTS In total, 151 included patients answered 873 questionnaires. The median follow-up from the start of the study was 19.5 months, and 84% were treated with at least 1 life-prolonging agent. Overall, patients were in good clinical condition (Eatern Cooperative Oncology Group performance status 0-1 in 78%) with normal baseline hemoglobin, lactate dehydrogenase, and alkaline phosphatase. At inclusion, generic HRQoL was high with a mean EQ visual analog score of 73.2 out of 100. The lowest scores were reported on role and physical functioning (mean scores of 69 and 76 of 100, respectively), and fatigue, pain, and insomnia were the most impaired domains. These domains deteriorated in > 50% of patients. CONCLUSION Although most patients were treated with new treatments during follow-up, mCRPC has a negative impact on HRQoL with deterioration in all domains over time, especially role and physical functioning. These domains need specific attention during follow-up to maintain HRQoL as long as possible by timely start of adequate supportive care management.
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Affiliation(s)
- Malou C P Kuppen
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands
| | | | | | | | - Pieter van den Berg
- Department of Internal Medicine, TerGooi Ziekenhuizen, Hilversum, the Netherlands
| | - Maud M Geenen
- Department of Internal Medicine, OLVG, Amsterdam, the Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathijs P Hendriks
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | - Menuhin I Lampe
- Department of Urology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Addy C M van de Luijtgaarden
- Department of Internal Medicine, Reinier de Graaf Gasthuis and Reineir Haga Prostate Cancer Center, Delft, the Netherlands
| | - Frank P J Peters
- Department of Internal Medicine, Zuyderland Medical Center, Heerlen-Sittard-Geleen, the Netherlands
| | - Ton A Roeleveld
- Department of Urology, Northwest Clinics, Alkmaar, the Netherlands
| | - Tineke J Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC Daniel den Hoed Cancer Center, Rotterdam, the Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carin A Uyl-de Groot
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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22
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Groot HJ, van Leeuwen FE, Lubberts S, Horenblas S, de Wit R, Witjes JA, Groenewegen G, Poortmans PM, Hulshof MCCM, Meijer OWM, de Jong IJ, van den Berg HA, Smilde TJ, Vanneste BGL, Aarts MJB, Jóźwiak K, van den Belt-Dusebout AW, Gietema JA, Schaapveld M. Platinum exposure and cause-specific mortality among patients with testicular cancer. Cancer 2019; 126:628-639. [PMID: 31730712 PMCID: PMC7004069 DOI: 10.1002/cncr.32538] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 03/24/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/06/2022]
Abstract
Background Although testicular cancer (TC) treatment has been associated with severe late morbidities, including second malignant neoplasms (SMNs) and ischemic heart disease (IHD), cause‐specific excess mortality has been rarely studied among patients treated in the platinum era. Methods In a large, multicenter cohort including 6042 patients with TC treated between 1976 and 2006, cause‐specific mortality was compared with general population mortality rates. Associations with treatment were assessed with proportional hazards analysis. Results With a median follow‐up of 17.6 years, 800 patients died; 40.3% of these patients died because of TC. The cumulative mortality was 9.6% (95% confidence interval [CI], 8.5%‐10.7%) 25 years after TC treatment. In comparison with general population mortality rates, patients with nonseminoma experienced 2.0 to 11.6 times elevated mortality from lung, stomach, pancreatic, rectal, and kidney cancers, soft‐tissue sarcomas, and leukemia; 1.9‐fold increased mortality (95% CI, 1.3‐2.8) from IHD; and 3.9‐fold increased mortality (95% CI, 1.5‐8.4) from pneumonia. Seminoma patients experienced 2.5 to 4.6 times increased mortality from stomach, pancreatic, bladder cancer and leukemia. Radiotherapy and chemotherapy were associated with 2.1 (95% CI, 1.8‐2.5) and 2.5 times higher SMN mortality (95% CI, 2.0‐3.1), respectively, in comparison with the general population. In a multivariable analysis, patients treated with platinum‐containing chemotherapy had a 2.5‐fold increased hazard ratio (HR; 95% CI, 1.8‐3.5) for SMN mortality in comparison with patients without platinum‐containing chemotherapy. The HR for SMN mortality increased 0.29 (95% CI, 0.19‐0.39) per 100 mg/m2 platinum dose administered (Ptrend < .001). IHD mortality was increased 2.1‐fold (95% CI, 1.5‐4.2) after platinum‐containing chemotherapy in comparison with patients without platinum exposure. Conclusions Platinum‐containing chemotherapy is associated with a dose‐dependent increase in the risk of SMN mortality. Platinum‐containing chemotherapy is associated with a dose‐dependent increase in the risk of cancer mortality among patients with testicular cancer. Patients with testicular cancer experience increased mortality from second malignancies as well as causes other than cancer, particularly ischemic heart diseases.
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Affiliation(s)
- Harmke J Groot
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Simon Horenblas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerard Groenewegen
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Philip M Poortmans
- Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, the Netherlands.,Department of Radiation Oncology, Curie Institute, Paris, France
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands
| | - Otto W M Meijer
- Department of Radiation Oncology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Igle J de Jong
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Ben G L Vanneste
- Department of Radiotherapy, Maastro Clinic, Maastricht, the Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Katarzyna Jóźwiak
- Department of Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany
| | | | - Jourik A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Michael Schaapveld
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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23
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Groot HJ, Lubberts S, de Wit R, Witjes JA, Kerst JM, de Jong IJ, Groenewegen G, van den Eertwegh AJ, Poortmans PM, Klümpen HJ, van den Berg HA, Smilde TJ, Vanneste BG, Aarts MJ, Incrocci L, van den Bergh AC, Jóźwiak K, van den Belt-Dusebout AW, Horenblas S, Gietema JA, van Leeuwen FE, Schaapveld M. Risk of Solid Cancer After Treatment of Testicular Germ Cell Cancer in the Platinum Era. J Clin Oncol 2018; 36:2504-2513. [DOI: 10.1200/jco.2017.77.4174] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Testicular cancer (TC) treatment increases risk of subsequent malignant neoplasms (SMNs). It is unknown whether changes in TC treatment over time have affected SMN risk. Methods Solid SMN risk was evaluated in a multicenter cohort comprising 5,848 1-year survivors treated for TC before age 50 years between 1976 and 2007. SMN incidence was compared with cancer incidence in the general population. Treatment-specific risks were assessed using multivariable regression in a case-cohort design. Results After a median follow-up of 14.1 years, 350 solid SMNs were observed, translating into a 1.8-fold (95% CI, 1.6-2.0) increased risk compared with general population rates. Solid SMN risk was increased in patients with seminoma and those with nonseminoma (standardized incidence ratio, 1.52 and 2.21, respectively). Patients with nonseminoma experienced increased risk of SMNs of the thyroid, lung, stomach, pancreas, colon, and bladder and of melanoma and soft tissue sarcoma, whereas those with seminoma experienced increased risk of SMNs of the small intestine, pancreas, and urinary bladder. The 25-year cumulative incidence of solid SMNs was 10.3% (95% CI, 9.0% to 11.6%). In multivariable analysis, platinum-based chemotherapy was associated with increased risk of a solid SMN (hazard ratio [HR], 2.40; 95% CI, 1.58 to 3.62), colorectal SMN (HR, 3.85; 95% CI, 1.67 to 8.92), and noncolorectal GI SMN (HR, 5.00; 95% CI, 2.28 to 10.95). Receipt of platinum 400 to 499 and ≥ 500 mg/m2 increased solid SMN risk compared with surgery only (HR, 2.43; 95% CI, 1.40 to 4.23 and HR, 2.42; 95% CI, 1.50 to 3.90, respectively), whereas risk was not significantly increased with lower doses (HR, 1.75; 95% CI, 0.90 to 3.43). The HR of a GI SMN increased by 53% (95% CI, 26% to 80%) per 100 mg/m2 of platinum-containing chemotherapy. The HR of an infradiaphragmatic SMN increased by 8% per Gray of radiation dose administered (95% CI, 6% to 9%; P < .001). Conclusion Radiotherapy and platinum-containing chemotherapy are associated with increased solid SMN risk, specifically with GI SMNs.
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Affiliation(s)
- Harmke J. Groot
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Sjoukje Lubberts
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Ronald de Wit
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Johannes A. Witjes
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Jan Martijn Kerst
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Igle J. de Jong
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Gerard Groenewegen
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Alfons J.M. van den Eertwegh
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Philip M. Poortmans
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Heinz-Josef Klümpen
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Hetty A. van den Berg
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Tineke J. Smilde
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Ben G.L. Vanneste
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Maureen J. Aarts
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Luca Incrocci
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Alfons C.M. van den Bergh
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Katarzyna Jóźwiak
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Alexandra W. van den Belt-Dusebout
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Simon Horenblas
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Jourik A. Gietema
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Flora E. van Leeuwen
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Michael Schaapveld
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
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Giordano SH, Schröder CP, Poncet C, van Leeuwen-Stok E, Linderholm B, Abreu MH, Rubio I, Van Poznak C, Morganstern D, Cameron D, Vleugel MM, Smilde TJ, Bozovic-Spasojevic I, Korde L, Russell NS, den Hoed IDM, Honkoop AH, van der Velden AWG, van 't Riet M, Dijkstra N, Bogler O, Goulioti T, Hilsenbeck S, Ruddy KJ, Wolff A, van Deurzen CHM, Martens J, Bartlett JMS, Aalders K, Tryfonidis K, Cardoso F. Abstract P5-23-01: Clinical and biological characterization of male breast cancer (BC) EORTC 10085/TBCRC 029/BOOG 2013-02/BIG 2-07: Baseline results from the prospective registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-23-01] [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: Through the International Male Breast Cancer Program, a prospective registry for male BC was created with the goals of evaluating 1) the clinical and biological features of this disease and 2) assessing feasibility of a prospective therapeutic clinical trial.
METHODS: All men, with any stage histologically proven invasive breast cancer, age 3 18 years, and newly presenting at the participating institutions (within 3 months prior) were eligible. Patients were enrolled for 30 months after activation of the first center, through February 2017. Per the study design, if <100 men enrolled, the study would be considered a failure and therapeutic trials would not be pursued through this network. Epidemiologic data, staging, pathologic features, and BRCA status were collected. Treatment and outcome data collection is ongoing. Optional collection of FFPE tumor samples, blood, and QOL were performed in the US, the Netherlands, and Latin America. Clinical database lock for this report was May 30, 2017. We currently report patient and disease characteristics and will update with patterns of treatment for the presentation. Outcomes and biological samples will be analyzed in the future.
RESULTS: 557 patients were enrolled: 75% in Europe, 20% in United States, 5% in other countries. 6.3% of patients had missing forms. Median age was 67 years (range 26-92). 93% were diagnosed 2010-2017. Among patients with complete data, 79% presented with a breast mass. 88% were M0 and 12% M1. Among M0 patients: 47%, 39%, 2%, and 11% had T1, T2, T3, and T4 disease respectively; 52% were N0. Overall, 98% had ER+ disease and 11% had HER2+ cancer. 14% had grade 1, 56% had grade 2, and 30% had grade 3 tumors. Among 112 men who underwent BRCA1 testing, 1 was positive. Among 118 men who had BRCA2 testing, 18 (15%) were positive. 21% of men had prior or concurrent malignancies, with the following most common sites: prostate, non-melanoma skin, colorectal, and melanoma. The prevalence of previously identified possible risk factors for male breast cancer were: overweight/obesity (72%), former/current smoker (51%), current alcohol 31 drink daily (41%), family history of breast cancer (35%), gynecomastia (16%), history radiation exposure (8%), use of anti-androgens (1%), and use of estrogens (1%).
CONCLUSION: Through an international collaborative effort, we were able to prospectively accrue 557 patients to a male breast cancer registry. These results demonstrate feasibility of pursuing a therapeutic clinical trial in men with breast cancer. In addition, this study shows the relatively low uptake of BRCA testing, high rates of concurrent/prior malignancy, and the rates of potentially modifiable risk factors in this patient population.
Funding from Breast Cancer Research Foundation, Susan G. Komen, Dutch Pink Ribbon Foundation, Swedish Breast Cancer Association (BRO) and EBCC Council.
Citation Format: Giordano SH, Schröder CP, Poncet C, van Leeuwen-Stok E, Linderholm B, Abreu MH, Rubio I, Van Poznak C, Morganstern D, Cameron D, Vleugel MM, Smilde TJ, Bozovic-Spasojevic I, Korde L, Russell NS, den Hoed IDM, Honkoop AH, van der Velden AWG, van 't Riet M, Dijkstra N, Bogler O, Goulioti T, Hilsenbeck S, Ruddy KJ, Wolff A, van Deurzen CHM, Martens J, Bartlett JMS, Aalders K, Tryfonidis K, Cardoso F. Clinical and biological characterization of male breast cancer (BC) EORTC 10085/TBCRC 029/BOOG 2013-02/BIG 2-07: Baseline results from the prospective registry [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-23-01.
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Affiliation(s)
- SH Giordano
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - CP Schröder
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - C Poncet
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - E van Leeuwen-Stok
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - B Linderholm
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - MH Abreu
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - I Rubio
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - C Van Poznak
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - D Morganstern
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - D Cameron
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - MM Vleugel
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - TJ Smilde
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - I Bozovic-Spasojevic
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - L Korde
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - NS Russell
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - IDM den Hoed
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - AH Honkoop
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - AWG van der Velden
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - M van 't Riet
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - N Dijkstra
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - O Bogler
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - T Goulioti
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - S Hilsenbeck
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - KJ Ruddy
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - A Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - CHM van Deurzen
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - J Martens
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - JMS Bartlett
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - K Aalders
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - K Tryfonidis
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - F Cardoso
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
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Benoist GE, van der Meulen E, Lubberman FJE, Gerritsen WR, Smilde TJ, Schalken JA, Beumer JH, Burger DM, van Erp NP. Analytical challenges in quantifying abiraterone with LC-MS/MS in human plasma. Biomed Chromatogr 2017; 31:10.1002/bmc.3986. [PMID: 28370076 PMCID: PMC6114173 DOI: 10.1002/bmc.3986] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 11/09/2022]
Abstract
A method was developed and validated to quantify abiraterone in human plasma. During assay development, several analytical challenges were encountered: limited stability in patient samples, adsorption to glass, coelution with metabolites and carry-over issues. Limited stability (2 h) was found for abiraterone in fresh plasma as well as whole blood at ambient temperature. When kept at 2-8°C, abiraterone in plasma was stable for 24 h and in whole blood for 8 h. Adsorption of abiraterone to glass materials was addressed by using polypropylene throughout the method. Carry-over was reduced to acceptable limits by incorporating a third mobile phase into the gradient. The chromatographic separation of abiraterone with its multiple metabolites was addressed by using a longer analytical column and adjusting the gradient. Abiraterone was extracted by protein precipitation, separated on a C18 column with gradient elution and analyzed with tandem quadrupole mass spectrometry in positive ion mode. A stable deuterated isotope was used as the internal standard. The assay ranges from 1 to 500 ng/mL. Within- and-between-day precisions and accuracies were below 13.4% and within 95-102%. This bioanalytical method was successfully validated and applied to determine plasma concentrations of abiraterone in clinical studies and in regular patient care for patients with metastatic castration-resistant prostate cancer.
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Affiliation(s)
| | - Eric van der Meulen
- Department of Pharmacy, Radboud university medical center, Nijmegen, Netherlands
| | | | - Winald R. Gerritsen
- Department of Medical Oncology, Radboud university medical center, Nijmegen, Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Jack A. Schalken
- Department of Urology, Radboud university medical center, Nijmegen, Netherlands
| | - Jan H. Beumer
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, United States of America
| | - David M. Burger
- Department of Pharmacy, Radboud university medical center, Nijmegen, Netherlands
| | - Nielka P. van Erp
- Department of Pharmacy, Radboud university medical center, Nijmegen, Netherlands
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26
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Oostendorp LJM, Ottevanger PB, Donders ART, van de Wouw AJ, Schoenaker IJH, Smilde TJ, van der Graaf WTA, Stalmeier PFM. Decision aids for second-line palliative chemotherapy: a randomised phase II multicentre trial. BMC Med Inform Decis Mak 2017; 17:130. [PMID: 28859646 PMCID: PMC5580234 DOI: 10.1186/s12911-017-0529-y] [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: 01/25/2017] [Accepted: 08/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing recognition of the delicate balance between the modest benefits of palliative chemotherapy and the burden of treatment. Decision aids (DAs) can potentially help patients with advanced cancer with these difficult treatment decisions, but providing detailed information could have an adverse impact on patients' well-being. The objective of this randomised phase II study was to evaluate the safety and efficacy of DAs for patients with advanced cancer considering second-line chemotherapy. METHODS Patients with advanced breast or colorectal cancer considering second-line treatment were randomly assigned to usual care (control group) or usual care plus a DA (intervention group) in a 1:2 ratio. A nurse offered a DA with information on adverse events, tumour response and survival. Outcome measures included patient-reported well-being (primary outcome: anxiety) and quality of the decision-making process and the resulting choice. RESULTS Of 128 patients randomised, 45 were assigned to the control group and 83 to the intervention group. Median age was 62 years (range 32-81), 63% were female, and 73% had colorectal cancer. The large majority of patients preferred treatment with chemotherapy (87%) and subsequently commenced treatment with chemotherapy (86%). No adverse impact on patients' well-being was found and nurses reported that consultations in which the DAs were offered went well. Being offered the DA was associated with stronger treatment preferences (3.0 vs. 2.5; p=0.030) and increased subjective knowledge (6.7 vs. 6.3; p=0.022). Objective knowledge, risk perception and perceived involvement were comparable between the groups. CONCLUSIONS DAs containing detailed risk information on second-line palliative treatment could be delivered to patients with advanced cancer without having an adverse impact on patient well-being. Surprisingly, the DAs only marginally improved the quality of the decision-making process. The effectiveness of DAs for palliative treatment decisions needs further exploration. TRIAL REGISTRATION Netherlands Trial Registry (NTR): NTR1113 (registered on 2 November 2007).
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Affiliation(s)
| | | | | | - Agnes J van de Wouw
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
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27
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Aarts MJ, Vriens BE, de Boer M, Peters FP, Mandigers CM, Dercksen MW, Stouthard JM, Tol J, van Warmerdam LJ, van de Wouw AJ, Jacobs EM, van der Rijt CCD, Smilde TJ, van der Velden AW, Peer N, Tjan-Heijnen VCG. Neutrophil Recovery in Breast Cancer Patients Receiving Docetaxel-Containing Chemotherapy with and without Granulocyte Colony-Stimulating Factor Prophylaxis. Oncology 2017; 93:323-328. [PMID: 28848182 DOI: 10.1159/000479067] [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: 03/14/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The primary outcome of the current study is, whether there is a protective effect of prior chemotherapy or of prior granulocyte colony-stimulating factor (G-CSF) on the next cycle blood cell counts. METHODS Hematologic toxicity was evaluated, based on a randomized phase III study in breast cancer patients (n = 167) with >20% risk of febrile neutropenia. The primary endpoint was the nadir blood cell counts for patients treated with G-CSF given during all 6 chemotherapy cycles or limited to the first 2 chemotherapy cycles only. RESULTS For the present analyses, 47 patients were eligible. In the G-CSF 1-6 arm, the median white blood cell count (WBC) and absolute neutrophil count (ANC) nadir slowly decreased from 10.8 × 109/L in cycle 1 to 7.5 × 109/L in cycle 6 and from 7.1 × 109/L to 5.5 × 109/L, respectively. The median WBC nadir in the G-CSF 1-2 arm decreased from 1.2 × 109/L in cycle 3 to 0.9 × 109/L in cycle 6 and the ANC nadir showed a grade 4 neutropenia of 0.1 × 109/L in cycles 3-6. All patients had ANC recovery to normal levels (≥1.5 × 109/L) without delay on day 1 of the next cycle. CONCLUSION We conclude that there is no protective effect of prior G-CSF or prior chemotherapy use on nadir blood cell counts in subsequent cycles.
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Affiliation(s)
- Maureen J Aarts
- Department of Medical Oncology, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
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28
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Vriens BEPJ, Vriens IJH, Aarts MJB, van Gastel SM, van den Berkmortel FWPJ, Smilde TJ, van Warmerdam LJC, van Spronsen DJ, Peer PGM, de Boer M, Tjan-Heijnen VCG. Improved survival for sequentially as opposed to concurrently delivered neoadjuvant chemotherapy in non-metastatic breast cancer. Breast Cancer Res Treat 2017; 165:593-600. [PMID: 28674765 PMCID: PMC5602024 DOI: 10.1007/s10549-017-4364-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/27/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The INTENS study was designed to determine whether delivering neoadjuvant chemotherapy at a higher dose in a shorter period of time improves outcome of breast cancer patients. METHODS Women with newly diagnosed breast cancer were randomly assigned to neoadjuvant chemotherapy consisting of four cycles of doxorubicin and cyclophosphamide followed by four cycles of docetaxel (AC 60/600-T 100 mg/m2) or six cycles of TAC as triplet chemotherapy (75/50/500 mg/m2) every 3 weeks. The primary outcome was the pathologic complete response (pCR), with disease-free and overall survival as secondary endpoints. RESULTS In total, 201 patients were included. The pCR rates were 28% for patients treated with AC-T and 19% for patients treated with TAC, with an odds ratio of 1.60 (95% CI 0.90-3.21). With a median follow-up of 6 years (range 0.04-8.41 years), the five-year disease-free survival was 81% for patients treated with sequentially AC-T and 71% for patients treated with concurrent triplet TAC chemotherapy with a stratified hazard ratio (HR) of 0.50 (95% CI 0.29-0.86). Five-year overall survival was 84% versus 76%, respectively, with a stratified HR of 0.55 (95% CI 0.29-1.03). CONCLUSIONS No differences were observed between the two treatment arms with respect to pCR rate, but the sequentially delivered chemotherapy outperformed the triplet combination chemotherapy in terms of survival, despite a lower cumulative dose per agent. GOV nr NCT00314977.
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Affiliation(s)
- B E P J Vriens
- Division of Medical Oncology, Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - I J H Vriens
- Division of Medical Oncology, Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - M J B Aarts
- Division of Medical Oncology, Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - S M van Gastel
- Comprehensive Cancer Centre the Netherlands, Nijmegen, The Netherlands
| | | | - T J Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - L J C van Warmerdam
- Department of Internal Medicine, Catharina-Hospital, Eindhoven, The Netherlands
| | - D J van Spronsen
- Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - P G M Peer
- Biostatistics, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - M de Boer
- Division of Medical Oncology, Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - V C G Tjan-Heijnen
- Division of Medical Oncology, Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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29
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Cardoso F, Piccart M, Rutgers E, Slaets L, van 't Veer L, Viale G, Pierga JY, Brain E, Causeret S, Golfinopoulos V, Goulioti T, Knox S, Matos E, Neijenhuis P, Nitz U, Passalacqua R, Rubio IT, Saghatchian M, Smilde TJ, Sotiriou C, Stork L, Straehle C, Thomas G, Thompson A, Vrijaldenhoven S, Vuylsteke P, Tryfonidis K, Bogaerts J, Delaloge S. Abstract P5-14-01: Chemotherapy randomization of the EORTC 10041/ BIG 3-04 MINDACT (microarray in node-negative and 1 to 3 positive lymph node disease may avoid chemotherapy) trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-14-01] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- F Cardoso
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - M Piccart
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - E Rutgers
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - L Slaets
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - L van 't Veer
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - G Viale
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - J-Y Pierga
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - E Brain
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Causeret
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - V Golfinopoulos
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - T Goulioti
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Knox
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - E Matos
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - P Neijenhuis
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - U Nitz
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - R Passalacqua
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - IT Rubio
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - M Saghatchian
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - TJ Smilde
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - C Sotiriou
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - L Stork
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - C Straehle
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - G Thomas
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - A Thompson
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Vrijaldenhoven
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - P Vuylsteke
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - K Tryfonidis
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - J Bogaerts
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Delaloge
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
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van Wissen S, Smilde TJ, de Groot E, Hutten BA, Kastelein JJP, Stalenhoef AFH. The significance of femoral intima-media thickness and plaque scoring in the Atorvastatin versus Simvastatin on Atherosclerosis Progression (ASAP) study. ACTA ACUST UNITED AC 2016; 10:451-5. [PMID: 14671468 DOI: 10.1097/01.hjr.0000103277.02552.1e] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Measurement of intima-media thickness (IMT) is a well established surrogate marker for cardiovascular endpoints. We studied the long-term effects of statins on femoral IMT and plaque scoring in the Atorvastatin versus Simvastatin on Atherosclerosis Progression (ASAP) study. METHODS AND RESULTS Three hundred and twenty-five patients with familial hypercholesterolaemia were randomized to either atorvastatin 80 mg/day or simvastatin 40 mg/day. IMT was measured at baseline and at 2 years. At baseline, femoral IMT was 1.69 mm in the atorvastatin group and 1.61 mm in the simvastatin group; at 2 years, IMT increased by 0.06 mm (P=0.24) and 0.15 mm (P=0.012), respectively. No significant differences were obvious between these two treatment arms (P=0.26). Femoral plaques were present in 64.7% in the atorvastatin group and 56.1% in the simvastatin group at baseline; after 2 years, these proportions rose to 66.0% (P=0.47) and 67.3% (P=0.02), respectively (P=0.87 between treatment arms). Carotid plaques were present in 6.3% versus 4.9%; after 2 years, these percentages were 5.0% (P=0.48) versus 5.5% (P=0.71), respectively (P=0.90 between treatment arms). CONCLUSION Our study indicates increased efficacy of atorvastatin 80 mg in retarding progression of atherosclerosis in the femoral artery compared with simvastatin 40 mg. Interestingly, in the carotid arteries these statins influenced IMT to a greater extent, whereas in the femoral artery the effects were more pronounced on plaque frequency. These findings underscore the generalized effects of lipid lowering on atherosclerosis.
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Affiliation(s)
- Sanne van Wissen
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
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31
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Cardoso F, van't Veer LJ, Bogaerts J, Slaets L, Viale G, Delaloge S, Pierga JY, Brain E, Causeret S, DeLorenzi M, Glas AM, Golfinopoulos V, Goulioti T, Knox S, Matos E, Meulemans B, Neijenhuis PA, Nitz U, Passalacqua R, Ravdin P, Rubio IT, Saghatchian M, Smilde TJ, Sotiriou C, Stork L, Straehle C, Thomas G, Thompson AM, van der Hoeven JM, Vuylsteke P, Bernards R, Tryfonidis K, Rutgers E, Piccart M. 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. N Engl J Med 2016; 375:717-29. [PMID: 27557300 DOI: 10.1056/nejmoa1602253] [Citation(s) in RCA: 1143] [Impact Index Per Article: 142.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy. METHODS In this randomized, phase 3 study, we enrolled 6693 women with early-stage breast cancer and determined their genomic risk (using the 70-gene signature) and their clinical risk (using a modified version of Adjuvant! Online). Women at low clinical and genomic risk did not receive chemotherapy, whereas those at high clinical and genomic risk did receive such therapy. In patients with discordant risk results, either the genomic risk or the clinical risk was used to determine the use of chemotherapy. The primary goal was to assess whether, among patients with high-risk clinical features and a low-risk gene-expression profile who did not receive chemotherapy, the lower boundary of the 95% confidence interval for the rate of 5-year survival without distant metastasis would be 92% (i.e., the noninferiority boundary) or higher. RESULTS A total of 1550 patients (23.2%) were deemed to be at high clinical risk and low genomic risk. At 5 years, the rate of survival without distant metastasis in this group was 94.7% (95% confidence interval, 92.5 to 96.2) among those not receiving chemotherapy. The absolute difference in this survival rate between these patients and those who received chemotherapy was 1.5 percentage points, with the rate being lower without chemotherapy. Similar rates of survival without distant metastasis were reported in the subgroup of patients who had estrogen-receptor-positive, human epidermal growth factor receptor 2-negative, and either node-negative or node-positive disease. CONCLUSIONS Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy. (Funded by the European Commission Sixth Framework Program and others; ClinicalTrials.gov number, NCT00433589; EudraCT number, 2005-002625-31.).
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Affiliation(s)
- Fatima Cardoso
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Laura J van't Veer
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Jan Bogaerts
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Leen Slaets
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Giuseppe Viale
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Suzette Delaloge
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Jean-Yves Pierga
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Etienne Brain
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Sylvain Causeret
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Mauro DeLorenzi
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Annuska M Glas
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Vassilis Golfinopoulos
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Theodora Goulioti
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Susan Knox
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Erika Matos
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Bart Meulemans
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Peter A Neijenhuis
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Ulrike Nitz
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Rodolfo Passalacqua
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Peter Ravdin
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Isabel T Rubio
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Mahasti Saghatchian
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Tineke J Smilde
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Christos Sotiriou
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Lisette Stork
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Carolyn Straehle
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Geraldine Thomas
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Alastair M Thompson
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Jacobus M van der Hoeven
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Peter Vuylsteke
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - René Bernards
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Konstantinos Tryfonidis
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Emiel Rutgers
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Martine Piccart
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
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Lobbezoo DJA, Truin W, Voogd AC, Roumen RMH, Vreudgenhil G, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, van Kampen RJW, van Riel JMGH, Peters NAJB, Peer PGM, Tjan-Heijnen VCG. Abstract P1-13-06: Does histological subtype play a role in treatment decision-making for hormone receptor positive metastatic breast cancer? A study of the Southeast Netherlands breast cancer consortium. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-13-06] [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
Introduction
Breast cancer is a heterogeneous disease with distinct biological subtypes. Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) are the two most frequent histological breast cancer subtypes. With this study, we aimed to provide insight into the role of histological subtype on the characteristics, choices with respect to systemic therapy in daily practice and outcome of patients with metastatic breast cancer.
Patients and methods
We analyzed 815 patients diagnosed with metastatic breast cancer in eight hospitals between 2007 and 2009. All hormone receptor (HR) positive patients with either IDC or (mixed) ILC were included. Patient and tumor characteristics, outcomes and treatment data were collected. Survival curves and time to first palliative systemic therapy (either chemotherapy or endocrine therapy) were estimated using the Kaplan-Meier method and compared using log-rank tests. To explore the association of palliative systemic therapy with the survival of patients with metastatic breast cancer a Cox proportional hazards model was performed with palliative chemotherapy and endocrine therapy as a time-dependent covariates.
Results
A total of 568 patients with HR-positive tumors were included; 437 with IDC and 131 with (mixed) ILC. Patients with ILC were older at diagnosis of primary breast cancer, had larger primary tumors and more node-positive disease compared with IDC. Median survival was not different between the subtypes (29 months for ILC and 25 months for IDC, P=0.53).
One year after diagnosis of metastatic breast cancer, less patients with HR-positive ILC received chemotherapy (33% of patients with ILC and 47% of patients with IDC) and their time to first palliative chemotherapy was significantly longer compared with HR-positive IDC (P=0.001). Time to first palliative endocrine therapy was significantly shorter for ILC compared with IDC (P=0.0001).
In multivariable analysis for patients with ILC with palliative endocrine therapy and palliative chemotherapy as time-dependent covariates, palliative chemotherapy as first given systemic therapy was associated with an unfavorable outcome (hazard ratio 2.8, 95% CI 1.7-4.6, P<.0001) compared to no palliative chemotherapy and treatment with palliative endocrine therapy as first given systemic therapy was associated with a favorable outcome (hazard ratio 0.4, 95% CI 0.2-0.8, P=0.005). In multivariable analysis for patients with IDC, treatment with palliative chemotherapy as first given systemic therapy was also associated with unfavorable outcome (hazard ratio 2.1, 95% CI 1.6-2.7. P<.0001), whereas treatment with palliative endocrine therapy as first given systemic therapy was not associated with outcome for patients with IDC (hazard ratio 0.9, 95% CI 0.6-1.2, P=0.4).
Conclusion
There was no difference in survival of metastatic breast cancer patients with HR-positive ILC compared with those with IDC. This similar outcome was achieved with different treatment strategies, in which patients with ILC were more likely to receive endocrine therapy and less likely to receive chemotherapy.
Citation Format: Lobbezoo DJA, Truin W, Voogd AC, Roumen RMH, Vreudgenhil G, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, van Kampen RJW, van Riel JMGH, Peters NAJB, Peer PGM, Tjan-Heijnen VCG. Does histological subtype play a role in treatment decision-making for hormone receptor positive metastatic breast cancer? A study of the Southeast Netherlands breast cancer consortium. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-13-06.
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Affiliation(s)
- DJA Lobbezoo
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - W Truin
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - AC Voogd
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - RMH Roumen
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - G Vreudgenhil
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - MW Dercksen
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - F van den Berkmortel
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - TJ Smilde
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - AJ van de Wouw
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - RJW van Kampen
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - JMGH van Riel
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - NAJB Peters
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - PGM Peer
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
| | - VCG Tjan-Heijnen
- Maastricht University Medical Center; Máxima Medical Center; Orbis-Atrium Heerlen; Jeroen Bosch Hospital; VieCuri Medical Center; Orbis-Atrium Sittard; Sint Elisabeth Hospital; St Jans Hospital; Radboud University Medical Center
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Vriens BEPJ, de Vries B, Lobbes MBI, van Gastel SM, van den Berkmortel FWPJ, Smilde TJ, van Warmerdam LJC, de Boer M, van Spronsen DJ, Smidt ML, Peer PGM, Aarts MJ, Tjan-Heijnen VCG. Ultrasound is at least as good as magnetic resonance imaging in predicting tumour size post-neoadjuvant chemotherapy in breast cancer. Eur J Cancer 2015; 52:67-76. [PMID: 26650831 DOI: 10.1016/j.ejca.2015.10.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/30/2015] [Accepted: 10/15/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the accuracy of clinical imaging of the primary breast tumour post-neoadjuvant chemotherapy (NAC) related to the post-neoadjuvant histological tumour size (gold standard) and whether this varies with breast cancer subtype. In this study, results of both magnetic resonance imaging (MRI) and ultrasound (US) were reported. METHODS Patients with invasive breast cancer were enrolled in the INTENS study between 2006 and 2009. We included 182 patients, of whom data were available for post-NAC MRI (n=155), US (n=123), and histopathological tumour size. RESULTS MRI estimated residual tumour size with <10-mm discordance in 54% of patients, overestimated size in 28% and underestimated size in 18% of patients. With US, this was 63%, 20% and 17%, respectively. The negative predictive value in hormone receptor-positive tumours for both MRI and US was low, 26% and 33%, respectively. The median deviation in clinical tumour size as percentage of pathological tumour was 63% (P25=26, P75=100) and 49% (P25=22, P75=100) for MRI and US, respectively (P=0.06). CONCLUSIONS In this study, US was at least as good as breast MRI in providing information on residual tumour size post-neoadjuvant chemotherapy. However, both modalities suffered from a substantial percentage of over- and underestimation of tumour size and in addition both showed a low negative predictive value of pathologic complete remission (Gov nr: NCT00314977).
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Affiliation(s)
- Birgit E P J Vriens
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bart de Vries
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Tineke J Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | | | - Maaike de Boer
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Petronella G M Peer
- Biostatistics, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Maureen J Aarts
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Lobbezoo DJA, van Kampen RJW, Voogd AC, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, Peters FPJ, van Riel JMGH, Peters NAJB, de Boer M, Peer PGM, Tjan-Heijnen VCG. In real life, one-quarter of patients with hormone receptor-positive metastatic breast cancer receive chemotherapy as initial palliative therapy: a study of the Southeast Netherlands Breast Cancer Consortium. Ann Oncol 2015; 27:256-62. [PMID: 26578730 DOI: 10.1093/annonc/mdv544] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [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: 05/24/2015] [Accepted: 10/26/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of this study was to present initial systemic treatment choices and the outcome of hormone receptor-positive (HR+) metastatic breast cancer. PATIENTS AND METHODS All the 815 consecutive patients diagnosed with metastatic breast cancer in 2007-2009 in eight participating hospitals were identified. From the 611 patients with HR+ disease, a total of 520 patients with HER2-negative (HER2-) breast cancer were included. Initial palliative systemic treatment was registered. Progression-free survival (PFS) and overall survival (OS) per initial palliative systemic therapy were obtained using the Kaplan-Meier method and compared using the log-rank test. RESULTS From the total of 520 patients with HR+/HER2- metastatic breast cancer, 482 patients (93%) received any palliative systemic therapy. Patients that received initial chemotherapy (n = 116) were significantly younger, had less comorbidity, had received more prior adjuvant systemic therapy and were less likely to have bone metastasis only compared with patients that received initial endocrine therapy (n = 366). Median PFS of initial palliative chemotherapy was 5.3 months [95% confidence interval (CI) 4.2-6.2] and of initial endocrine therapy 13.3 months (95% CI 11.3-15.5), with a median OS of 16.1 and 36.9 months, respectively. Initial chemotherapy was also associated with worse outcome in terms of PFS and OS after adjustment for prognostic factors. CONCLUSIONS A high percentage of patients with HR+ disease received initial palliative chemotherapy, which was associated with worse outcome, even after adjustment of relevant prognostic factors.
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Affiliation(s)
- D J A Lobbezoo
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht Department of Internal Medicine, Máxima Medical Center, Veldhoven
| | - R J W van Kampen
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | - A C Voogd
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht Netherlands Comprehensive Cancer Organisation, Utrecht
| | - M W Dercksen
- Department of Internal Medicine, Máxima Medical Center, Veldhoven
| | | | - T J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch
| | - A J van de Wouw
- Department of Internal Medicine, VieCuri Medical Center, Venlo
| | - F P J Peters
- Department of Internal Medicine, Atrium-Orbis Sittard, Sittard
| | | | - N A J B Peters
- Department of Internal Medicine, St Jans Hospital, Weert
| | - M de Boer
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | - P G M Peer
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - V C G Tjan-Heijnen
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
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Lobbezoo DJA, van Kampen RJW, Voogd AC, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, Peters FPJ, van Riel JMGH, Peters NAJB, de Boer M, Peer PGM, Tjan-Heijnen VCG. Prognosis of metastatic breast cancer: are there differences between patients with de novo and recurrent metastatic breast cancer? Br J Cancer 2015; 112:1445-51. [PMID: 25880008 PMCID: PMC4453676 DOI: 10.1038/bjc.2015.127] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [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: 01/09/2015] [Revised: 03/01/2015] [Accepted: 03/09/2015] [Indexed: 12/18/2022] Open
Abstract
Background: We aimed to determine the prognostic impact of time between primary breast cancer and diagnosis of distant metastasis (metastatic-free interval, MFI) on the survival of metastatic breast cancer patients. Methods: Consecutive patients diagnosed with metastatic breast cancer in 2007–2009 in eight hospitals in the Southeast of the Netherlands were included and categorised based on MFI. Survival curves were estimated using the Kaplan–Meier method. Cox proportional hazards model was used to determine the prognostic impact of de novo metastatic breast cancer vs recurrent metastatic breast cancer (MFI ⩽24 months and >24 months), adjusted for age, hormone receptor and HER2 status, initial site of metastasis and use of prior (neo)adjuvant systemic therapy. Results: Eight hundred and fifteen patients were included and divided in three subgroups based on MFI; 154 patients with de novo metastatic breast cancer, 176 patients with MFI <24 months and 485 patients with MFI >24 months. Patients with de novo metastatic breast cancer had a prolonged survival compared with patients with recurrent metastatic breast cancer with MFI <24 months (median 29.4 vs 9.1 months, P<0.0001), but no difference in survival compared with patients with recurrent metastatic breast cancer with MFI >24 months (median, 29.4 vs 27.9 months, P=0.73). Adjusting for other prognostic factors, patients with MFI <24 months had increased mortality risk (hazard ratio 1.97, 95% CI 1.49–2.60, P<0.0001) compared with patients with de novo metastatic breast cancer. When comparing recurrent metastatic breast cancer with MFI >24 months with de novo metastatic breast cancer no significant difference in mortality risk was found. The association between MFI and survival was seen irrespective of use of (neo)adjuvant systemic therapy. Conclusion: Patients with de novo metastatic breast cancer had a significantly better outcome when compared with patients with MFI <24 months, irrespective of the use of prior adjuvant systemic therapy in the latter group. However, compared with patients with MFI >24 months, patients with de novo metastatic breast cancer had similar outcome.
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Affiliation(s)
- D J A Lobbezoo
- 1] GROW- School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands [2] Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands
| | - R J W van Kampen
- GROW- School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A C Voogd
- 1] GROW- School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands [2] Department of Research, Comprehensive Cancer Centre, Eindhoven, The Netherlands
| | - M W Dercksen
- Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands
| | - F van den Berkmortel
- Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands
| | - T J Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - A J van de Wouw
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - F P J Peters
- Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands
| | - J M G H van Riel
- Department of Internal Medicine, St Elisabeth Hospital, Tilburg, The Netherlands
| | - N A J B Peters
- Department of Internal Medicine, St Jans Hospital, Weert, The Netherlands
| | - M de Boer
- GROW- School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P G M Peer
- Department for Health Evidence, Radboud university medical centre, Nijmegen, The Netherlands
| | - V C G Tjan-Heijnen
- GROW- School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Peters MEWJ, Goedendorp MM, Verhagen SAHHVM, Smilde TJ, Bleijenberg G, van der Graaf WTA. A prospective analysis on fatigue and experienced burden in informal caregivers of cancer patients during cancer treatment in the palliative phase. Acta Oncol 2015; 54:500-6. [PMID: 25291079 DOI: 10.3109/0284186x.2014.953254] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although fatigue is the most frequently occurring symptom in patients with cancer, hardly anything is known about fatigue of their informal caregivers and the impact fatigue might have on perceived burden with providing care. We investigated the presence of fatigue in caregivers, its course and the relation of fatigue severity between caregivers and patients. Furthermore, we explored in caregivers whether fatigue severity was correlated to experienced burden. MATERIAL AND METHODS Informal caregivers and patients on cancer treatment in the palliative phase completed questionnaires at baseline and follow-up (6 months later). To measure fatigue severity, both groups completed the Checklist Individual Strength. Additionally, caregivers completed the Caregivers Strain Index to assess experienced burden with providing care. Descriptive analyses, paired t-tests, χ(2)-tests, Pearson's correlations and regression analysis were performed. RESULTS At baseline 111 couples (patients and caregivers) participated, at follow-up 75 couples. At both time points 23% of caregivers were severely fatigued. There was no significant correlation between patients and caregivers on fatigue. Higher fatigue in both patients and caregivers was correlated with higher burden in caregivers and over 30% of burden could be explained by fatigue. CONCLUSION Almost a quarter of caregivers of patients on active palliative treatment were severely fatigued, which figure remained stable over time. Fatigue in both patients and caregivers was related to caregivers' burden. This observation should be taken into account with the growing demand on caregivers and the increase in cancer treatment options in the palliative setting.
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Affiliation(s)
- Marlies E W J Peters
- Radboud university medical center, Department of Medical Oncology (452) , Nijmegen , The Netherlands
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Tjan-Heijnen VCG, Lobbezoo DJA, van Kampen RJW, Voogd AC, Dercksen M, van den Berkmortel F, Smilde TJ, van de Wouw AJ, Peters FPJ, van Riel JMGH, Peters NAJB, de Boer M, Peer PGM. Abstract P3-13-11: Unexpected large treatment and outcome variations in metastatic breast cancer: Results of a hormone receptor positive cohort study in the Netherlands. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-13-11] [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
Introduction
Treatment of patients with metastatic breast cancer (MBC) generally has a palliative intent. The systemic treatment approach is based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. However, with a variety of available agents and major changes in adjuvant breast cancer treatment, treatment decisions in MBC are complex. The objective of this study was to present treatment patterns of HR positive metastatic breast cancer patients, categorized by HER2 status.
Patients and methods
All patients diagnosed with HR positive MBC between 2007 and 2009 (irrespective of date of primary diagnosis) in eight participating hospitals in the South-East part of the Netherlands were included and all medical charts were reviewed. Patient and tumor characteristics as well as treatments and outcomes were collected. Survival was estimated using the Kaplan-Meier method.
Results
A total of 611 patients had HR positive MBC; 529 of these (86.6%) had a negative HER2 status. Median survival after diagnosis of distant metastases was 22.1 months for the HR+/HER2-subtype and 32.9 months for the HR+/HER2+ subtype.
In the HR+/HER2- subgroup 7% of patients did not receive any palliative systemic treatment and in the HR+/HER2+ subgroup 8.5% of patients did not receive any palliative systemic treatment.
In the HR+/HER2- subgroup, first given palliative systemic treatment was chemotherapy in 22% and endocrine therapy in 71% of patients. Of the patients starting with chemotherapy, 15% had bone metastases only, 37% had visceral metastases and 39% had multiple metastatic sites compared to 49%, 20% and 25% respectively for those starting with endocrine treatment. Of the patients starting with chemotherapy, 38% had progressive disease during or after this line of treatment and 62% had either response or stable disease.
In the HR+/HER2+ subgroup, 59.8% of patients received chemotherapy as first palliative systemic treatment (in two thirds of these patients targeted therapy was added to the chemotherapy) and 31.7% received endocrine therapy with or without trastuzumab. Of the patients starting with chemotherapy (+/- targeted therapy) 20% had bone metastases only, 39% visceral metastases and 37% had multiple metastatic sites versus respectively 23%, 31% and 35% for the patients starting with endocrine therapy. Of the patients starting with chemotherapy (+/- targeted therapy), 17% had progressive disease during or after this line of treatment and 83% had either response or stable disease.
Conclusion
A considerable proportion of HR+ MBC patients received chemotherapy as first given treatment despite HR positive status and presence of bone metastases only or limited visceral metastases, which is more than expected based on current treatment guidelines. Daily-practice monitoring of MBC, as we have reported here, may improve future treatment decision-making.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-13-11.
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Affiliation(s)
- VCG Tjan-Heijnen
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - DJA Lobbezoo
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - RJW van Kampen
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - AC Voogd
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - M Dercksen
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - F van den Berkmortel
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - TJ Smilde
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - AJ van de Wouw
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - FPJ Peters
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - JMGH van Riel
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - NAJB Peters
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - M de Boer
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - PGM Peer
- Maastricht University Medical Center, Maastricht, Netherlands; Máxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; VieCuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; Sint Elisabeth Hospital, Tilburg, Netherlands; Sint Jans Hospital, Weert, Netherlands; Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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Aarts MJ, Grutters JP, Peters FP, Mandigers CM, Dercksen MW, Stouthard JM, Nortier HJ, van Laarhoven HW, van Warmerdam LJ, van de Wouw AJ, Jacobs EM, Mattijssen V, van der Rijt CC, Smilde TJ, van der Velden AW, Temizkan M, Batman E, Muller EW, van Gastel SM, Joore MA, Borm GF, Tjan-Heijnen VC. Cost effectiveness of primary pegfilgrastim prophylaxis in patients with breast cancer at risk of febrile neutropenia. J Clin Oncol 2013; 31:4283-9. [PMID: 24166522 DOI: 10.1200/jco.2012.48.3644] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Guidelines advise primary granulocyte colony-stimulating factor (G-CSF) prophylaxis during chemotherapy if risk of febrile neutropenia (FN) is more than 20%, but this comes with considerable costs. We investigated the incremental costs and effects between two treatment strategies of primary pegfilgrastim prophylaxis. METHODS Our economic evaluation used a health care perspective and was based on a randomized study in patients with breast cancer with increased risk of FN, comparing primary G-CSF prophylaxis throughout all chemotherapy cycles (G-CSF 1-6 cycles) with prophylaxis during the first two cycles only (G-CSF 1-2 cycles). Primary outcome was cost effectiveness expressed as costs per patient with episodes of FN prevented. RESULTS The incidence of FN increased from 10% in the G-CSF 1 to 6 cycles study arm (eight of 84 patients) to 36% in the G-CSF 1 to 2 cycles study arm (30 of 83 patients), whereas the mean total costs decreased from € 20,658 (95% CI, € 20,049 to € 21,247) to € 17,168 (95% CI € 16,239 to € 18,029) per patient, respectively. Chemotherapy and G-CSF determined 80% of the total costs. As expected, FN-related costs were higher in the G-CSF 1 to 2 cycles arm. The incremental cost effectiveness ratio for the G-CSF 1 to 6 cycles arm compared with the G-CSF 1 to 2 cycles arm was € 13,112 per patient with episodes of FN prevented. CONCLUSION We conclude that G-CSF prophylaxis throughout all chemotherapy cycles is more effective, but more costly, compared with prophylaxis limited to the first two cycles. Whether G-CSF prophylaxis throughout all chemotherapy cycles is considered cost effective depends on the willingness to pay per patient with episodes of FN prevented.
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Affiliation(s)
- Maureen J Aarts
- Maureen J. Aarts, Vivianne C. Tjan-Heijnen, Janneke P. Grutters, Manuela A. Joore, Maastricht University Medical Center, Maastricht; Frank P. Peters, Orbis Medical Centre, Sittard; Caroline M. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; M. Wouter Dercksen, Maxima Medical Center, Veldhoven; Jacqueline M. Stouthard, Maasstad Medical Center, Rotterdam; Hans J. Nortier, Leiden University Medical Center, Leiden; Hanneke W. van Laarhoven, George F. Borm, Radboud University Nijmegen Medical Centre, Nijmegen; Laurence J. van Warmerdam, Catharina Hospital, Eindhoven; Agnes J. van de Wouw, VieCuri Medical Center, Venlo; Esther M. Jacobs, Elkerliek Hospital, Helmond; Vera Mattijssen, Rijnstate Hospital, Arnhem; Carin C. van der Rijt, Erasmus Medical Center Daniel den Hoed Cancer Center, Rotterdam; Tineke J. Smilde, Jeroen Bosch Hospital, 's-Hertogenbosch; Annette W. van der Velden, Martini Hospital, Groningen; Mehmet Temizkan, Hospital St Jansdal, Harderwijk; Erdogan Batman, Diaconessenhuis Leiden, Leiden; Erik W. Muller, Slingeland Hospital, Doetinchem; Saskia M. van Gastel, Comprehensive Cancer Center East, Nijmegen the Netherlands
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Lobbezoo DJA, van Kampen RJW, Voogd AC, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, Peters FPJ, van Riel JMGH, Peters NAJB, de Boer M, Borm GF, Tjan-Heijnen VCG. Prognosis of metastatic breast cancer subtypes: the hormone receptor/HER2-positive subtype is associated with the most favorable outcome. Breast Cancer Res Treat 2013; 141:507-14. [PMID: 24104881 DOI: 10.1007/s10549-013-2711-y] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [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: 09/18/2013] [Accepted: 09/24/2013] [Indexed: 12/25/2022]
Abstract
Contrary to the situation in early breast cancer, little is known about the prognostic relevance of the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) in metastatic breast cancer. The objectives of this study were to present survival estimates and to determine the prognostic impact of breast cancer subtypes based on HR and HER2 status in a recent cohort of metastatic breast cancer patients, which is representative of current clinical practice. Patients diagnosed with metastatic breast cancer between 2007 and 2009 were included. Information regarding patient and tumor characteristics and treatment was collected. Patients were categorized in four subtypes based on the HR and HER2 status of the primary tumor: HR positive (+)/HER2 negative (-), HR+/HER2+, HR-/HER2+ and triple negative (TN). Survival was estimated using the Kaplan-Meier method. Cox proportional hazards model was used to determine the prognostic impact of breast cancer subtype, adjusted for possible confounders. Median follow-up was 21.8 months for the 815 metastatic breast cancer patients included; 66 % of patients had the HR+/HER2- subtype, 8 % the HR-/HER2+ subtype, 15 % the TN subtype and 11 % the HR+/HER2+ subtype. The longest survival was observed for the HR+/HER2+ subtype (median 34.4 months), compared to 24.8 months for the HR+/HER2- subtype, 19.8 months for the HR-/HER2+ subtype and 8.8 months for the TN subtype (P < 0.0001). In the multivariate analysis, subtype was an independent prognostic factor, as were initial site of metastases and metastatic-free interval. The HR+/HER2+ subtype was associated with the longest survival after diagnosis of distant metastases.
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Affiliation(s)
- Dorien J A Lobbezoo
- Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
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Aarts MJ, Peters FP, Mandigers CM, Dercksen MW, Stouthard JM, Nortier HJ, van Laarhoven HW, van Warmerdam LJ, van de Wouw AJ, Jacobs EM, Mattijssen V, van der Rijt CC, Smilde TJ, van der Velden AW, Temizkan M, Batman E, Muller EW, van Gastel SM, Borm GF, Tjan-Heijnen VCG. Primary granulocyte colony-stimulating factor prophylaxis during the first two cycles only or throughout all chemotherapy cycles in patients with breast cancer at risk for febrile neutropenia. J Clin Oncol 2013; 31:4290-6. [PMID: 23630211 DOI: 10.1200/jco.2012.44.6229] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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
PURPOSE Early breast cancer is commonly treated with anthracyclines and taxanes. However, combining these drugs increases the risk of myelotoxicity and may require granulocyte colony-stimulating factor (G-CSF) support. The highest incidence of febrile neutropenia (FN) and largest benefit of G-CSF during the first cycles of chemotherapy lead to questions about the effectiveness of continued use of G-CSF throughout later cycles of chemotherapy. PATIENTS AND METHODS In a multicenter study, patients with breast cancer who were considered fit enough to receive 3-weekly polychemotherapy, but also had > 20% risk for FN, were randomly assigned to primary G-CSF prophylaxis during the first two chemotherapy cycles only (experimental arm) or to primary G-CSF prophylaxis throughout all chemotherapy cycles (standard arm). The noninferiority hypothesis was that the incidence of FN would be maximally 7.5% higher in the experimental compared with the standard arm. RESULTS After inclusion of 167 eligible patients, the independent data monitoring committee advised premature study closure. Of 84 patients randomly assigned to G-CSF throughout all chemotherapy cycles, eight (10%) experienced an episode of FN. In contrast, of 83 patients randomly assigned to G-CSF during the first two cycles only, 30 (36%) had an FN episode (95% CI, 0.13 to 0.54), with a peak incidence of 24% in the third cycle (ie, first cycle without G-CSF prophylaxis). CONCLUSION In patients with early breast cancer at high risk for FN, continued use of primary G-CSF prophylaxis during all chemotherapy cycles is of clinical relevance and thus cannot be abandoned.
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Affiliation(s)
- Maureen J Aarts
- Maureen J. Aarts and Vivianne C.G. Tjan-Heijnen, Maastricht University Medical Center, Maastricht; Frank P. Peters, Orbis Medical Center, Sittard-Geleen; Caroline M. Mandigers, Canisius Wilhelmina Hospital; Hanneke W. van Laarhoven and George F. Borm, Radboud University Nijmegen Medical Center; Saskia M. van Gastel; Comprehensive Cancer Centre East; George F. Borm, Nijmegen I, Nijmegen; M. Wouter Dercksen, Maxima Medical Center, Veldhoven; Laurence J. van Warmerdam, Catharina Hospital, Eindhoven; Jacqueline M. Stouthard, Maasstad Medical Center; Carin C. van der Rijt, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam; Hans J. Nortier, Leiden University Medical Center; Erdogan Batman, Diaconessenhuis Leiden, Leiden; Agnes J. van de Wouw, VieCuri Medical Center, Venlo; Esther M. Jacobs, Elkerliek Hospital, Helmond; Vera Mattijssen, Rijnstate Hospital, Arnhem; Tineke J. Smilde, Jeroen Bosch Hospital, 's-Hertogenbosch; Annette W. van der Velden, Martini Hospital, Groningen; Mehmet Temizkan, Hospital St Jansdal, Harderwijk; and Erik W. Muller, Slingeland Hospital, Doetinchem, the Netherlands
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Thong MSY, Mols F, Wang XS, Lemmens VEPP, Smilde TJ, van de Poll-Franse LV. Quantifying fatigue in (long-term) colorectal cancer survivors: a study from the population-based patient reported outcomes following initial treatment and long term evaluation of survivorship registry. Eur J Cancer 2013; 49:1957-66. [PMID: 23453750 DOI: 10.1016/j.ejca.2013.01.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/15/2013] [Accepted: 01/17/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few studies specifically focus on fatigue of (long-term) colorectal cancer (CRC) survivors or compare fatigue levels with a normative population. Association between surviving multiple primary cancers and fatigue is also explored. METHODS Survivors diagnosed from 1998 to 2009 were identified from the Eindhoven Cancer Registry. In total, 3739 (79%) respondents and an age- and gender-matched normative population (n=338) completed questionnaires on fatigue and psychological distress. RESULTS More survivors reported feeling fatigued than the normative population (39% versus 22%, p<0.0001). Short-term survivors (<5 years post-diagnosis) had the highest mean fatigue scores compared with long-term survivors (≥5 years post-diagnosis) or the normative population (21±7 versus 20±7 versus 18±5, p<0.0001, respectively). Having primary cancers prior to CRC was associated with more fatigue. Surgery+chemoradiation was independently associated with fatigue (odds ratio (OR): 1.63, 95% confidence interval (CI): 1.17-2.29, p=0.004) as were anxiety (OR: 1.16, 95% CI: 1.12-1.19, p<0.0001) and depressive symptoms (OR: 1.38, 95% CI: 1.33-1.43, p<0.0001). CONCLUSIONS Fatigue is a significant problem, especially for short-term CRC survivors. The association between chemoradiation and fatigue suggests that patients could benefit from better information on treatment side-effects. When treating fatigue, clinical care should also focus on survivors' psychological needs, especially survivors of multiple primary cancers.
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Affiliation(s)
- Melissa S Y Thong
- CoRPS, Dept. of Medical and Clinical Psychology, Tilburg University, The Netherlands; Comprehensive Cancer Centre South (CCCS), Eindhoven Cancer Registry, Eindhoven, The Netherlands.
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Husson O, Thong MSY, Mols F, Smilde TJ, Creemers GJ, van de Poll-Franse LV. Information provision and patient reported outcomes in patients with metastasized colorectal cancer: results from the PROFILES registry. J Palliat Med 2013; 16:281-8. [PMID: 23437833 PMCID: PMC3583247 DOI: 10.1089/jpm.2012.0430] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients with metastasized colorectal cancer (mCRC) have different information needs compared with patients with nonmetastatic colorectal cancer (CRC). Appropriate information provision leads to better patient reported outcomes for patients with nonmetastatic disease. OBJECTIVE To measure the perceived level of, and satisfaction with, information received by patients with mCRC as compared with those with nonmetastatic (stage I,II,III) CRC. Also, associations of information provision with health status, anxiety, depression, and illness perceptions were investigated. METHODS A cross-sectional population-based survey was conducted. All CRC patients diagnosed between 2002 and 2007 according to the Eindhoven Cancer Registry (ECR) were selected. Response rate was 75% (n=1159, of which 139 had mCRC). Participants completed questionnaires on information provision (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-INFO25), health status (Short Form-36), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), and illness perceptions (Brief Illness Perception Questionnaire [B-IPQ]). RESULTS The perceived receipt of information was quite comparable between CRC patients with and without mCRC. Only perceived receipt of treatment information was higher for patients with mCRC (45 versus 37; p<0.01). Sixty percent of the patients with mCRC were satisfied with the amount of received information and almost 30% wanted to receive more information. The perceived receipt of more disease information and information about other services was associated with worse health outcomes, whereas satisfaction with the received information was not associated with health outcomes. CONCLUSION The findings of this study indicate that some improvements can be made in the provision of information to patients with mCRC. Adequate assessment of information needs of mCRC patients, as well as appropriate responses to these needs by providing the information in an appropriate way could possibly lead to improvements in patient satisfaction.
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Affiliation(s)
- Olga Husson
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands.
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Tjan-Heijnen VCG, Lobbezoo DJA, van Kampen RJW, Voogd AC, Dercksen MW, van den Berkmortel F, Smilde TJ, van de Wouw AJ, Peters FPJ, van Riel JMGH, Peters NAJB, Borm GF. Abstract P6-07-32: Prognosis of metastatic breast cancer subtypes: the hormone receptor/HER2 positive subtype is associated with the most favorable outcome. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-07-32] [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: In early breast cancer the different subtypes and their prognostic relevance are well known, contrary to the knowledge on prognostic relevance of subtypes in metastatic breast cancer. This study presents survival estimates after diagnosis of distant metastases of breast cancer subtypes in a recent cohort in which the treatment is representative of current clinical practice.
Patients and methods: All patients diagnosed with metastatic breast cancer in one of eight participating hospitals in the South-East part of the Netherlands between 2007–2009 were included and all medical charts were reviewed. Patients were categorized in 4 subtypes based on the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status of the primary tumor; HR positive/HER2 negative, HR positive/HER2 positive, HR negative/HER2 positive and triple negative (TN). Metastatic survival was estimated using the Kaplan-Meier product-limit method. Cox proportional hazards model was used to determine the prognostic impact of breast cancer subtype, adjusted for possible confounders.
Results: A total of 815 patients were included; the HR+/HER2− subtype comprising 66%, the HR−/HER2+ subtype 8%, the TN subtype 15% and the HR+/HER2+ subtype 11% of patients. The four subtypes were associated with different metastatic survival times; the HR+/HER2+ subtype was associated with the best metastatic survival (median, 32.9 months), compared to 22.1 months for the HR+/HER2− subtype, 19.5 months for the HR−/HER2+ subtype and 7.7 months for the TN subtype. Aside from subtype, other prognostic factors of metastatic survival were site of metastases and metastatic-free interval.
Conclusion: Of the four subtypes, the HR+/HER2+ subtype was associated with the most favorable outcome, in terms of metastatic survival.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-32.
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Affiliation(s)
- VCG Tjan-Heijnen
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - DJA Lobbezoo
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - RJW van Kampen
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - AC Voogd
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - MW Dercksen
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - F van den Berkmortel
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - TJ Smilde
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - AJ van de Wouw
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - FPJ Peters
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - JMGH van Riel
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - NAJB Peters
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - GF Borm
- Maastricht University Medical Center, Maastricht, Netherlands; Maxima Medical Center, Eindhoven, Netherlands; Atrium Medical Center Parkstad, Heerlen, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Viecuri Medical Center, Venlo, Netherlands; Orbis Medical Center, Sittard, Netherlands; St Elisabeth Hospital, Tilburg, Netherlands; St Jans Hospital, Weert, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
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Tjan-Heijnen VCG, Vriens BE, de Vries B, van Gastel SM, Wals J, Smilde TJ, van Warmerdam LJ, van Laarhoven HW, van Spronsen DJ, Borm GF. Abstract P1-14-07: Neoadjuvant chemotherapy and pathologic complete response in relation to the clinical response, results from a phase III study (INTENS) of the Dutch breast cancer trialists' group (BOOG). Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-14-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Taxanes have an established role as (neo-)adjuvant treatment of breast cancer. In the present study, we compared 4 AC–4 T with 6 cycles of TAC in the neoadjuvant setting (A = adriamycine, C = cyclophosphamide, T = docetaxel). Previously, we reported that AC-T resulted in a trend for improved outcome (odds ratio of the pathologic complete response (pCR) of the breast 1.60; 95% CI 0.90–3.21). This present analysis focuses on the results of treatment and pCR in the breast in relation to clinical response.
Methods Women with breast cancer, eligible for neoadjuvant chemotherapy, were randomized to AC (60/600 mg/m2 q3wk × 4 cycles) followed by T (100 mg/m2 q3wk × 4 cycles), or to TAC (75/50/500 mg/m2 q3wk × 6 cycles). If indicated, trastuzumab and/or endocrine therapy were given as adjuvant treatment. Physical examination, ultrasound of breast and axillary lymph nodes and breast MRI were performed before start of chemotherapy, halfway and after completion of chemotherapy. These results together determined the clinical response (c) halfway and after chemotherapy. The clinical response was classified as cCR (complete response), cPR (partial response), cSD (stable disease) or cPD (progressive disease). pCR was defined as no invasive tumor in the breast at surgery.
Results In total, 201 patients (n = 100 AC-T, n=101 TAC) were enrolled between February 2006 and April 2009. Baseline characteristics (AC-T/TAC) were well balanced. The clinical overall response rate (cCR and cPR) to 4 AC was comparable to that seen with 3 cycles TAC (48% versus 54%). Also, the clinical overall response rate to 8 AC-T was comparable to that seen with 6 TAC (81% versus 72%). In the AC-T arm, a third of the patients with cSD halfway reached a cCR or cPR after 8 cycles, whereas in the TAC arm only 18% of patients with cSD halfway reached a cCR or cPR after chemotherapy. In the sequential AC-T arm, 16% of the patients with cSD halfway reached a pCR after switching to docetaxel monotherapy. In contrast, in the TAC arm cSD halfway rarely resulted in pCR after 6 cycles. Patients with a cCR after chemotherapy had a pCR in 58% and 49% of cases, respectively. For patients with cPR these rates were 29% and 18%, respectively, and for patients with cSD 6% and 0%, respectively.
Conclusion: Clinical response rates are related to pCR rates. The meaning of cSD halfway should be differently interpreted for sequential versus concurrent chemotherapy. In concurrent chemotherapy schedules, a switch to a non-cross resistant drug may be worthwhile. Early clinical response may be used as a decision aid during neoadjuvant chemotherapy to recognize non-responders.
Support: Unrestricted grants from sanofi-aventis NL BV and Amgen BV. Dutch breast cancer trialists' group (BOOG).
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-14-07.
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Affiliation(s)
- VCG Tjan-Heijnen
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - BE Vriens
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - B de Vries
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - SM van Gastel
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - J Wals
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - TJ Smilde
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - LJ van Warmerdam
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - HW van Laarhoven
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - DJ van Spronsen
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - GF Borm
- Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
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Vriens BE, Van DVKK, Boetes C, van GSM, Wals J, Smilde TJ, van WLJ, van LHW, van SDJ, Borm GF, Tjan-Heijnen VC. P3-14-02: Sequential Versus Upfront Intensified Neoadjuvant Chemotherapy in Patients with Large Resectable or Locally Advanced Breast Cancer (INTENS), Toxicity Results from a Phase III Study of the Dutch Breast Cancer Trialists' Group (BOOG). Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-14-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Taxanes have an established role as (neo-)adjuvant treatment of breast cancer. In the present study, we compared 4 AC - 4 T with 6 cycles of TAC in the neo-adjuvant setting (A=adriamycine, C=cyclophosphamide, T=docetaxel). Previously, we reported that AC-T resulted in a trend for improved outcome (odds ratio pCR of the breast 1.61; 95% CI 0.79−3.33). Now we report the safety data.
Methods Women presenting with breast cancer, cT2≥3cm, cT3, cT4 and/or cN+, with measurable disease and no prior treatment, age ≥18 and ≤70 years and Karnofsky Score ≥70% were eligible. Patients were randomized to AC (60/600 mg/m2 q3wk x 4 cycles) followed by T (100 mg/m2 q3wk x 4 cycles) without primary G-CSF prophylaxis, or to TAC (75/50/500 mg/m2 q3wk x 6 cycles) with primary G-CSF prophylaxis. If indicated, trastuzumab and/or endocrine therapy were given as adjuvant treatment. This present analysis focuses on the toxicity profile of the two treatment arms.
Results In total, 201 patients (n=100 AC-T, n=101 TAC) were included between February 2006 and April 2009. Baseline characteristics (AC-T/TAC) were well balanced. Patients in the AC-T arm had more frequently grade 3 / 4 toxicities as compared to the TAC arm, respectively in 57% and 28% (p=0.001). Grade 3 / 4 neutropenia without fever was more frequently reported with AC-T (35% vs. 4%; p=0.001). Grade 3 / 4 febrile neutropenia was also more frequent with AC-T (17% versus 5%; p=0.0062) and significantly increased during docetaxel treatment after AC. Notably, diarrhea was also more frequently seen in the AC-T arm (4% versus 0%, p=0.0423). Other grade 3 / 4 toxicities more frequently reported in the AC-T arm were neuropathy - sensory (5% vs. 0%; p=0.229) and pain other than muscle or bone pain (4% vs. 0%; p=0.0423). There were no grade 3 / 4 toxicities more frequently observed in the TAC arm.
Conclusion In the comparison of two taxane-anthracycline-cyclophosphamide regimens in the neo-adjuvant setting, it is observed that the sequential approach with a lower cumulative dose tends to have a slightly better efficacy outcome, but at the cost of increased grade 3 / 4 toxicity. However, considering the use of primary G-CSF prophylaxis in the TAC arm, and the fact that the incidence of febrile neutropenia was higher during taxane containing chemotherapy in the AC-T arm, the difference might (partly) disappear if primary G-CSF prophylaxis would be used in the sequential arm. Primary G-CSF prophylaxis may be considered during docetaxel if used sequentially after anthracycline-containing chemotherapy.
Support: Unrestricted grants from sanofi-aventis NL BV and Amgen BV.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-14-02.
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Affiliation(s)
- BE Vriens
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - de Vijver KK Van
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - C Boetes
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Gastel SM van
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - J Wals
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - TJ Smilde
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Warmerdam LJ van
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Laarhoven HW van
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Spronsen DJ van
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - GF Borm
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - VC Tjan-Heijnen
- 1Maastricht University Medical Centre, Maastricht, Netherlands; Comprehensive Cancer Centre the Netherlands, Nijmegen, Netherlands; Atrium Medical Centre, Heerlen, Netherlands; Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands; Catharina-Hospital, Eindhoven, Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
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Schellekens AFA, Mulder SF, van Eijndhoven PFP, Smilde TJ, van Herpen CML. Psychotic symptoms in the course of sunitinib treatment for advanced renal cell cancer. Two cases. Gen Hosp Psychiatry 2011; 33:83.e1-3. [PMID: 21353137 DOI: 10.1016/j.genhosppsych.2010.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/18/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Arnt F A Schellekens
- Department of Psychiatry (961), Radboud University Nijmegen Medical Centre, P.O. Box 9100 HB, Nijmegen, The Netherlands.
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Bleeker-Rovers CP, Vos FJ, de Kleijn EMHA, Mudde AH, Dofferhoff TSM, Richter C, Smilde TJ, Krabbe PFM, Oyen WJG, van der Meer JWM. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine (Baltimore) 2007; 86:26-38. [PMID: 17220753 DOI: 10.1097/md.0b013e31802fe858] [Citation(s) in RCA: 224] [Impact Index Per Article: 13.2] [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: 12/13/2022] Open
Abstract
We conducted a prospective study to update our knowledge of fever of unknown origin (FUO) and to explore the utility of a structured diagnostic protocol. From December 2003 to July 2005, 73 patients with FUO were recruited from 1 university hospital (n = 40) and 5 community hospitals (n = 33) in the same region in The Netherlands. FUO was defined as a febrile illness of >3 weeks' duration, a temperature of >38.3 degrees C on several occasions, without a diagnosis after standardized history-taking, physical examination, and certain obligatory investigations. Immunocompromised patients were excluded. A structured diagnostic protocol was used. Patients from the university hospital were characterized by more secondary referrals and a higher percentage of periodic fever than those referred to community hospitals. Infection was the cause in 16%, a neoplasm in 7%, noninfectious inflammatory diseases in 22%, miscellaneous causes in 4%, and in 51%, the cause of fever was not found (no differences between university and community hospitals). There were no differences regarding the number and type of investigations between university and community hospitals. Significant predictors for reaching a diagnosis included continuous fever; fever present for <180 days; elevated erythrocyte sedimentation rate, C-reactive protein, or lactate dehydrogenase; leukopenia; thrombocytosis; abnormal chest computed tomography (CT); and abnormal F-fluorodeoxyglucose positron emission tomography (FDG-PET). For future FUO studies, inclusion of outpatients and the use of a set of obligated investigations instead of a time-related criterion are recommended. Except for tests from the obligatory part of our protocol and cryoglobulins in an early stage, followed by FDG-PET, and in a later stage by abdominal and chest CT, temporal artery biopsy in patients aged 55 years or older, and possibly bone marrow biopsy, other tests should not be used as screening investigations.
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Affiliation(s)
- Chantal P Bleeker-Rovers
- From Department of Internal Medicine (CPBR, FJV, JWMvdM), Department of Nuclear Medicine (CPBR, WJGO), and Department of Medical Technology Assessment (PFMK), Radboud University Nijmegen Medical Centre, Nijmegen; Nijmegen University Centre for Infectious Diseases (CPBR, FJV, WJGO, JWMvdM), Nijmegen; Division of Medical Oncology (EMHAdK), Department of Internal Medicine, University Medical Centre Nijmegen; Department of Internal Medicine (AHM), Slingeland Hospital, Doetinchem; Department of Internal Medicine (TSMD), Canisius-Wilhelmina Hospital, Nijmegen; Department of Internal Medicine (CR), Rijnstate Hospital, Arnhem; and Department of Internal Medicine (TJS), Jeroen Bosch Hospital, 's-Hertogenbosch; The Netherlands
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Denissen NHAM, van Spronsen DJ, Smilde TJ, De Mulder PHM. Leptomeningeal carcinomatosis in relapsed non-seminoma testis: a 1-year complete remission with high-dose chemotherapy. Anticancer Drugs 2005; 16:897-9. [PMID: 16096440 DOI: 10.1097/01.cad.0000172836.67766.23] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 1-year complete remission could be achieved with high-dose systemic chemotherapy in a 33-year-old patient with relapsed germ cell tumor presenting with leptomeningeal carcinomatosis (LC). Although LC in general has a very poor prognosis for patients with chemosensitive malignancies, systemic chemotherapy should be considered.
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Affiliation(s)
- N H A M Denissen
- Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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van Wissen S, Smilde TJ, Trip MD, Stalenhoef AFH, Kastelein JJP. Long-term safety and efficacy of high-dose atorvastatin treatment in patients with familial hypercholesterolemia. Am J Cardiol 2005; 95:264-6. [PMID: 15642565 DOI: 10.1016/j.amjcard.2004.09.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [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] [Received: 05/06/2004] [Revised: 09/07/2004] [Accepted: 09/07/2004] [Indexed: 10/26/2022]
Abstract
In the 2-year Atorvastatin versus Simvastatin on Atherosclerosis Progression extension study, patients with familial hypercholesterolemia who continued to take atorvastatin 80 mg for an additional 2 years had complete arrest of the progression of mean carotid intima-media thickness (0.89 mm at the start vs 0.90 mm at the end of the study, p = 0.58). In contrast, patients previously taking simvastatin 40 mg had significant regression of intima-media thickness (0.95 mm at the start vs 0.92 mm at the end of the study, p = 0.01). Therefore, both placebo- and statin-treated patients with familial hypercholesterolemia are best treated with high-dose atorvastatin, a therapeutic regimen that induces atherosclerosis regression and is safe and well tolerated over a 4-year period.
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Affiliation(s)
- Sanne van Wissen
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam,The Netherlands.
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van Tits LJH, Smilde TJ, van Wissen S, de Graaf J, Kastelein JJP, Stalenhoef AFH. Effects of atorvastatin and simvastatin on low-density lipoprotein subfraction profile, low-density lipoprotein oxidizability, and antibodies to oxidized low-density lipoprotein in relation to carotid intima media thickness in familial hypercholesterolemia. J Investig Med 2004; 52:177-84. [PMID: 15222407 DOI: 10.1136/jim-52-03-32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about the effects of statins on the quality of circulating low-density lipoprotein (LDL) in relation to atherosclerosis progression. METHODS In a double-blind, randomized trial of 325 patients with familial hypercholesterolemia (FH), we assessed the effects of high-dose atorvastatin (80 mg) and conventional-dose simvastatin (40 mg) on LDL subfraction profile (n = 289), LDL oxidizability (n = 121), and circulating autoantibodies to oxidized LDL (n = 220). Progression of atherosclerosis was measured by carotid intima media thickness (IMT) (n = 325). RESULTS At baseline, the patients showed an intermediate LDL subfraction profile composed of three LDL subfractions (LDL1, LDL2, LDL3), with LDL2 as the predominant subfraction. A strong negative correlation was found between plasma triglycerides and the LDL subfraction profile (r = -.64, p = .000). Both plasma levels of triglycerides and small dense LDL3 correlated weakly with baseline IMT (r = .11, p = .04 and r = .15, p = .01, respectively; n = 289). No association was found between baseline IMT and oxidation parameters or circulating antibodies to oxidized LDL. Atorvastatin reduced triglycerides, LDL cholesterol, and all LDL subfractions to a greater extent than did simvastatin and led to regression of carotid IMT. However, LDL subfraction pattern and plasma levels of autoantibodies to oxidized LDL remained unchanged in both treatment groups, and LDL oxidizability increased minimally to a similar extent in both groups. Significant treatment differences were found for the rate of in vitro oxidation of LDL and the amount of dienes formed during in vitro oxidation of LDL, which both decreased more following atorvastatin than after simvastatin. CONCLUSION Change of IMT after statin treatment was associated with baseline IMT (r = .41), LDL cholesterol (r = -.20), and the amount of dienes formed during in vitro oxidation of LOL (r = .28) but not with plasma levels of antibodies to oxidized LDL, in vitro LDL oxidizability, and LDL subfraction profile.
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Affiliation(s)
- Lambertus J H van Tits
- Department of Medicine, Division of General Internal Medicine, University Medical Center Nijmegen, Nijmegen, The Netherlands.
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