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Leinert E, Lukac S, Schwentner L, Coenen A, Fink V, Veselinovic K, Dayan D, Janni W, Friedl TWP. The use of axillary ultrasound (AUS) to assess the nodal status after neoadjuvant chemotherapy (NACT) in primary breast cancer patients. Surg Oncol 2024; 52:102016. [PMID: 38056112 DOI: 10.1016/j.suronc.2023.102016] [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: 06/06/2023] [Revised: 11/02/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Axillary Ultrasound (AUS) is standard for pre-therapeutic axillary staging in early breast cancer patients. 35-75 % of the breast cancer (BC) patients with positive axillary lymph nodes receiving neoadjuvant chemotherapy (NACT) convert to pathological node negative. For those patients, axillary surgery after NACT could be de-escalated, if an accurate prediction of the pathologic nodal status following NACT was possible. This study aims to answer the question, whether AUS can be used as a reliable diagnostic tool for restaging of axillary nodal status after NACT. PATIENTS AND METHODS We collected data of 96 patients with nodal positive primary breast cancer who received NACT between 2009 and 2015 at the Breast Cancer Center of the University Hospital Ulm. Patients were classified as node negative or positive by AUS after NACT (ycN + or ycN0) and the results were compared to the pathological result obtained after axillary lymph node dissection (ypN + vs ypN0) in all patients. RESULTS 58.3 % of the patients had pathological complete remission of axillary lymph nodes after NACT (ypN0). The sensitivity and specificity of AUS were 57.5 % and 78.6 %, respectively. The FNR was 42.5 %. The Positive and Negative Predictive Values (PPV and NPV) were 65.7 % and 72.1 %, respectively. The accuracy of AUS was 69.8 % and not associated with any of the investigated clinico-pathological parameters. CONCLUSION AUS alone is not accurate enough to replace surgical restaging of the axilla after NACT in initially node positive breast cancer patients.
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Affiliation(s)
- Elena Leinert
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany.
| | - Stefan Lukac
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Antonia Coenen
- Department of Internal Medicine, Krankenhaus der Augustinerinnen, Cologne, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | | | - Davut Dayan
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
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Kersten J, Fink V, Kersten M, May L, Nunn S, Tadic M, Huober J, Bekes I, Radermacher M, Hombach V, Rottbauer W, Buckert D. CMR reveals myocardial damage from cardiotoxic oncologic therapies in breast cancer patients. Int J Cardiovasc Imaging 2024; 40:225-235. [PMID: 38001273 PMCID: PMC10884136 DOI: 10.1007/s10554-023-02996-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Breast cancer is a common and increasingly treatable disease. However, survivors have a significantly elevated risk of cardiac events afterwards. This study aimed to characterise cardiac changes during cardiotoxic cancer therapy using cardiovascular magnetic resonance (CMR) imaging. METHODS This study involved 34 patients with histologically proven breast cancer and planned cardiotoxic therapy. All patients underwent CMR before starting therapy, and 6 and 12 months thereafter. The CMR protocol included volumetric and functional analyses, parametric mapping, and deformation analysis using feature tracking. As the control group, 10 healthy female volunteers were scanned using the same protocol. RESULTS With therapy, there was a significant reduction of left ventricular and right ventricular ejection fractions (both p < 0.05) without reaching pathologic values. Left ventricular radial (p = 0.008), circumferential (p = 0.010), and longitudinal strain (p = 0.036) were also reduced at follow-up. In the parametric mapping, there was a significant increase in native T1 time (start: 1037 ± 41 ms vs. 6 months: 1068 ± 51 ms vs. 12 months: 1017 ± 57 ms, p < 0.001) and T2 time (start: 55 ± 4 ms vs. 6 months: 59 ± 3 ms vs. 12 months: 57 ± 3 ms, p = 0.001), with unchanged extracellular volume and relative late gadolinium enhancement. Twelve months after cancer diagnosis, the breast cancer patients exhibited significant impairments in left ventricular global radial (p = 0.001), circumferential (p = 0.001), and longitudinal strain (p = 0.002) and T2 time (p = 0.008) compared to the healthy controls. DISCUSSION Breast cancer patients receiving cardiotoxic chemotherapy show persistent deterioration in left ventricular strain values. This is accompanied by inflammatory changes in non-invasive tissue characterisation. Larger studies with longer follow-up periods are needed to identify patients at risk and establish preventive and therapeutic approaches.
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Affiliation(s)
- Johannes Kersten
- Department for Internal Medicine II, University Hospital Ulm, Ulm, Germany.
| | - Visnja Fink
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Maria Kersten
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Lisa May
- Department for Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Samuel Nunn
- Department for Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Marijana Tadic
- Department for Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Jens Huober
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
- Cantonal Hospital, Department of Medical Oncology and Breast Center, St. Gallen, Switzerland
| | - Inga Bekes
- Cantonal Hospital, Department of Medical Oncology and Breast Center, St. Gallen, Switzerland
| | | | - Vinzenz Hombach
- Department for Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department for Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Dominik Buckert
- Department for Internal Medicine II, University Hospital Ulm, Ulm, Germany
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Dayan D, Lukac S, Rack B, Ebner F, Fink V, Leinert E, Veselinovic K, Schütze S, El Taie Z, Janni W, Friedl TWP. Effect of histological breast cancer subtypes invasive lobular versus non-special type on survival in early intermediate-to-high-risk breast carcinoma: results from the SUCCESS trials. Breast Cancer Res 2023; 25:153. [PMID: 38098086 PMCID: PMC10722735 DOI: 10.1186/s13058-023-01750-0] [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: 01/31/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Invasive lobular breast carcinomas (ILC) have different histological features compared to non-special type carcinomas (NST), but the effect of histological subtypes on survival is controversial. In this study, we compared clinicopathological characteristics and outcomes between ILC and NST based on a large pooled data set from three adjuvant breast cancer trials (SUCCESS A, B, and C) and investigated a potential differential effect of recurrence risk related to nodal stage on survival. METHODS From 2005 to 2017, the large randomized controlled SUCCESS A, B, and C trials enrolled 8190 patients with primary, intermediate-to-high-risk breast carcinoma. All patients received adjuvant chemotherapy, and endocrine and/or HER2-targeted treatment was given where appropriate. Survival outcomes in terms of disease-free survival (DFS), overall survival (OS), breast cancer-specific survival (BCSS), and distant disease-free survival (DDFS) were estimated using the Kaplan-Meier method and analyzed using log-rank tests as well as univariable and adjusted multivariable Cox regression models. RESULTS In the SUCCESS trials, 6284 patients had NST and 952 had ILC. The median follow-up time was 64 months. ILC patients were older, more likely to receive mastectomy, and more likely to have larger tumor sizes, lymph node infiltration, hormone receptor-positive, HER2neu-negative, and luminal A-like tumors than NST patients. In the overall cohort, no significant differences between ILC and NST were detectable regarding the four survival endpoints, with hazard ratios obtained in adjusted multivariable cox regressions of 0.96 (95% CI 0.77-1.21, p = 0.743) for DFS, 1.13 (95% CI 0.85-1.50, p = 0.414) for OS, 1.21 (95% CI 0.89-1.66, p = 0.229) for BCSS, and 0.95 (95% CI 0.73-1.24, p = 0.689) for DDFS. However, a differential effect of nodal stage on survival was observed, with better survival for ILC patients with pN0/pN1 tumors and worse survival for ILC patients with pN2/pN3 tumors compared to NST patients. CONCLUSIONS Our results revealed that ILC was associated with worse survival compared to NST for patients at high risk of recurrence due to advanced lymph node infiltration. These findings should be taken into account for treatment decisions and monitoring.
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Affiliation(s)
- Davut Dayan
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Stefan Lukac
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Florian Ebner
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
- Gyn-Freising, Freising, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Kristina Veselinovic
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Sabine Schütze
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Ziad El Taie
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
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Lukac S, Dayan D, Fink V, Leinert E, Hartkopf A, Veselinovic K, Janni W, Rack B, Pfister K, Heitmeir B, Ebner F. Evaluating ChatGPT as an adjunct for the multidisciplinary tumor board decision-making in primary breast cancer cases. Arch Gynecol Obstet 2023; 308:1831-1844. [PMID: 37458761 PMCID: PMC10579162 DOI: 10.1007/s00404-023-07130-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 04/03/2023] [Accepted: 06/27/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND As the available information about breast cancer is growing every day, the decision-making process for the therapy is getting more complex. ChatGPT as a transformer-based language model possesses the ability to write scientific articles and pass medical exams. But is it able to support the multidisciplinary tumor board (MDT) in the planning of the therapy of patients with breast cancer? MATERIAL AND METHODS We performed a pilot study on 10 consecutive cases of breast cancer patients discussed in MDT at our department in January 2023. Included were patients with a primary diagnosis of early breast cancer. The recommendation of MDT was compared with the recommendation of the ChatGPT for particular patients and the clinical score of the agreement was calculated. RESULTS Results showed that ChatGPT provided mostly general answers regarding chemotherapy, breast surgery, radiation therapy, chemotherapy, and antibody therapy. It was able to identify risk factors for hereditary breast cancer and point out the elderly patient indicated for chemotherapy to evaluate the cost/benefit effect. ChatGPT wrongly identified the patient with Her2 1 + and 2 + (FISH negative) as in need of therapy with an antibody and called endocrine therapy "hormonal treatment". CONCLUSIONS Support of artificial intelligence by finding individualized and personalized therapy for our patients in the time of rapidly expanding amount of information is looking for the ways in the clinical routine. ChatGPT has the potential to find its spot in clinical medicine, but the current version is not able to provide specific recommendations for the therapy of patients with primary breast cancer.
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Affiliation(s)
- Stefan Lukac
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany.
| | - Davut Dayan
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Andreas Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Kristina Veselinovic
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Kerstin Pfister
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Benedikt Heitmeir
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Florian Ebner
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
- Gynäkologische Gemeinschaftspraxis Freising & Moosburg, Munich, Germany
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Schäffler H, Mergel F, Pfister K, Lukac S, Fink A, Veselinovic K, Rack B, Fink V, Leinert E, Dimpfl M, Englisch A, Tegeler CM, Seller A, Grischke EM, Hahn M, Volmer LL, Engler T, Frevert ML, Taran FA, Janni W, Brucker SY, Hartkopf AD, Dannehl D. The Clinical Relevance of the NATALEE Study: Application of the NATALEE Criteria to a Real-World Cohort from Two Large German Breast Cancer Centers. Int J Mol Sci 2023; 24:16366. [PMID: 38003555 PMCID: PMC10671738 DOI: 10.3390/ijms242216366] [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: 09/29/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
The NATALEE study showed a significant benefit in invasive disease-free survival (iDFS) for patients with HR+/HER2- early breast cancer (eBC) at intermediate and high risk of recurrence who were treated with the CDK4/6 inhibitor Ribociclib in combination with endocrine therapy (ET). This retrospective study aims to apply the NATALEE inclusion criteria to a representative real-world cohort to estimate the proportion of HR+/HER2- breast cancer patients eligible for adjuvant Ribociclib therapy. Patients who underwent full surgical treatment for eBC between January 2018 and December 2020 at two large German university breast cancer centers (University of Ulm, University of Tuebingen) were included. Descriptive statistics were used to characterize the patient population eligible for Ribociclib treatment based on the NATALEE study's inclusion criteria. Out of 2384 enrolled patients, 1738 had HR+/HER2- eBC, of whom 43% (747/1738) met the NATALEE inclusion criteria. Of note, these patients were older, received less chemotherapy and presented with less advanced tumor stages compared to the NATALEE study cohort. Additionally, compared to the NATALEE study cohort, fewer patients had lymph node involvement (72.4% vs. 88.7%). Our analysis suggests that approximately 43% of all HR+/HER2- breast cancer patients will qualify for Ribociclib treatment. Given the numerous treatment options for patients with HR+/HER2- eBC, as well as the differences between the NATALEE cohort and patients in the real-world clinical setting, future analyses will be needed to determine which patients would benefit most from adjuvant CDK4/6 inhibitor treatment.
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Affiliation(s)
- Henning Schäffler
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Franziska Mergel
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Kerstin Pfister
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Stephan Lukac
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Angelina Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Kristina Veselinovic
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Moritz Dimpfl
- Department of Gynecology and Obstetrics, University Hospital Mannheim, 68135 Mannheim, Germany;
| | - Alexander Englisch
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Christian Martin Tegeler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Anna Seller
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Eva-Maria Grischke
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Markus Hahn
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Léa Louise Volmer
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Tobias Engler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Marie Louise Frevert
- Department of Obstetrics and Gynecology, University of Freiburg, 79106 Freiburg, Germany; (M.L.F.)
| | - Florin Andrei Taran
- Department of Obstetrics and Gynecology, University of Freiburg, 79106 Freiburg, Germany; (M.L.F.)
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Sara Yvonne Brucker
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Andreas Daniel Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Dominik Dannehl
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
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Dannehl D, Engler T, Volmer LL, Tegeler CM, Fusshoeller J, Gabrysch E, Eissler K, Seller A, Grischke EM, Hahn M, Gruber I, Schochter F, Pfister K, Veselinovic K, Leinert E, Rack B, Fink V, Janni W, Brucker SY, Hartkopf AD, Schäffler H. Which Patients Do We Need to Test for BRCA1/2 Mutation? Feasibility of Adjuvant Olaparib Treatment in Early Breast Cancer-Real-World Data from Two Large German Breast Centers. Cancers (Basel) 2023; 15:3847. [PMID: 37568663 PMCID: PMC10417328 DOI: 10.3390/cancers15153847] [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: 06/21/2023] [Revised: 07/18/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Approximately 6% of women with breast cancer carry pathogenic germline variants in predisposition genes such as BRCA1 and BRCA2. Depending on personal and family cancer history, it is therefore recommended to test for hereditary breast cancer. Moreover, as shown by the phase III OlympiA trial, olaparib significantly improves overall survival in patients with HER2 negative (HER2-) early breast cancer who (1) carry a BRCA1 or BRCA2 germline mutation (gBRCA1/2-positive), (2) have received (neo)adjuvant chemotherapy and (3) are at high clinical risk. The objective of the current analysis was to determine the number of patients with early HER2- breast cancer who are at high clinical risk, according to the inclusion criteria of OlympiA, and to estimate how many of these patients would meet the criteria for hereditary cancer testing in a real-world analysis. METHODS All patients included in this retrospective analysis were treated for early breast cancer (eBC) at the Department of Gynecology and Obstetrics, Ulm University Hospital, Germany, and the Department of Women's Health at Tuebingen University Hospital, Germany, between January 2018 and December 2020. Patients were identified as high risk, in line with the clinicopathological determiners used in the OlympiA trial. The criteria of the German Consortium for Hereditary Breast and Ovarian Cancer were used to identify patients who qualify for hereditary cancer testing. RESULTS Of 2384 eligible patients, 1738 patients (72.9%) showed a hormone receptor positive (HR+)/HER2- tumor biology, 345 patients (14.5%) displayed HER2+ breast cancer and 301 patients (12.6%) suffered from HR-/HER2- breast cancer (TNBC). Of 2039 HER2- breast cancer patients, 271 patients (13.3%) were at high clinical risk. This cohort encompassed 130 of the 1738 patients with HR+/HER2- breast cancer (7.5%) and 141 of 301 patients with TNBC (46.8%). A total of 121 of 271 patients (44.6%) with high clinical risk met the criteria for hereditary cancer testing (34 of 130 (26.2%) HR+/HER2- patients and 87 of 141 (61.7%) patients with TNBC). CONCLUSION Approximately one in ten patients with HR+/HER2-, and half of the patients with TNBC, meet the high-risk criteria according to OlympiA. Half of these patients do not meet the criteria for hereditary cancer testing and should therefore be tested for the presence of gBRCA1/2 mutations, irrespective of their own or family cancer history. The overall number of patients with early breast cancer benefiting from olaparib needs to be investigated in future studies.
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Affiliation(s)
- Dominik Dannehl
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Tobias Engler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Léa Louise Volmer
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | | | - Julia Fusshoeller
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Emma Gabrysch
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Kenneth Eissler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Anna Seller
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Eva-Maria Grischke
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Markus Hahn
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Ines Gruber
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Fabienne Schochter
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Kerstin Pfister
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Kristina Veselinovic
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Sara Yvonne Brucker
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Andreas Daniel Hartkopf
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Henning Schäffler
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
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Tzschaschel M, Friedl TWP, Schochter F, Schütze S, Polasik A, Fehm T, Pantel K, Schindlbeck C, Schneeweiss A, Schreier J, Tesch H, Lorenz R, Aivazova-Fuchs V, Häberle L, Fasching P, Janni W, Rack BK, Fink V. Association Between Obesity and Circulating Tumor Cells in Early Breast Cancer Patients. Clin Breast Cancer 2023:S1526-8209(23)00132-5. [PMID: 37336651 DOI: 10.1016/j.clbc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Obesity and the presence of circulating tumor cells (CTCs) before and/or after chemotherapy are associated with poor outcome in breast cancer (BC) patients. The activation of oncogenic pathways in fatty tissue leads to cell proliferation, suggesting a possible link between obesity and CTCs. MATERIALS AND METHODS In the phase III SUCCESS A trial, 3754 patients with early BC were randomized to 3 cycles of fluorouracil, epirubicin and cyclophosphamide followed by 3 cycles of docetaxel with or without gemcitabine. Data of 1088 patients with CTC assessments (CellSearch-System; Menarini Silicon Biosystems, Italy) and body mass index (BMI) measurements both before and after chemotherapy were available. Patients were classified according to the WHO's international definitions as underweight, normal weight, overweight, or obese, and according to their weight-change during chemotherapy into a weight-loss group (> 5% decrease), stable-weight group (≤ 5% weight-change) or weight-gain group (>5% increase). Associations between CTC positivity and, BMI or weight-change group were analyzed using frequency-table methods. RESULTS At study entry, 47.4% patients were underweight or normal weight, 33.6% were overweight and 18.9% were obese. Before and after chemotherapy, CTCs were detected in 20.1% and 22.6% of patients, respectively. There was no association between CTC positivity and BMI before (P = 0.104) or after (P = 0.051) chemotherapy. Furthermore, there was no association between weight-change group and CTC status before/after chemotherapy (P = 0.332). CONCLUSIONS According to our analysis, the risk factors obesity and prevalence of CTCs are not associated and may represent independent prognostic factors.
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Affiliation(s)
- Marie Tzschaschel
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Fabienne Schochter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Sabine Schütze
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Arkadius Polasik
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Hans Tesch
- Onkologische Gemeinschaftspraxis, Frankfurt, Germany
| | - Ralf Lorenz
- Gemeinschaftspraxis Dr. Lorenz, Hecker und Wesche, Braunschweig, Germany
| | | | - Lothar Häberle
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, ComprehensiveCancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Fasching
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, ComprehensiveCancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Brigitte Kathrin Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Munich, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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Paepke S, Klein E, Andrulat A, Ankel C, Bauer L, Faridi A, Fink V, Gerber-Schäfer C, Gschwantler-Kaulich D, Heil J, Kümmel S, Ohlinger R, Thill M. Mesh-Pocket Supported Prepectoral Direct-to-Implant Breast Reconstruction: Preliminary Results of a Prospective Analysis. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Paepke S, Andrulat A, Ankel C, Bauer L, Baumann K, Blohmer J, Faridi A, Fink V, Gerber-Schäfer C, Gschwantler-Kaulich D, Heil J, Kümmel S, Mau C, Kossmann-Meiré A, Ohlinger R, Thill M. Underestimated risk of involved margins in Skin (SMM)- and Nipple Sparing Mastectomies (NSM) – Data and Multimodal Approach for Improvement. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Grootes I, Keeman R, Blows FM, Milne RL, Giles GG, Swerdlow AJ, Fasching PA, Abubakar M, Andrulis IL, Anton-Culver H, Beckmann MW, Blomqvist C, Bojesen SE, Bolla MK, Bonanni B, Briceno I, Burwinkel B, Camp NJ, Castelao JE, Choi JY, Clarke CL, Couch FJ, Cox A, Cross SS, Czene K, Devilee P, Dörk T, Dunning AM, Dwek M, Easton DF, Eccles DM, Eriksson M, Ernst K, Evans DG, Figueroa JD, Fink V, Floris G, Fox S, Gabrielson M, Gago-Dominguez M, García-Sáenz JA, González-Neira A, Haeberle L, Haiman CA, Hall P, Hamann U, Harkness EF, Hartman M, Hein A, Hooning MJ, Hou MF, Howell SJ, Ito H, Jakubowska A, Janni W, John EM, Jung A, Kang D, Kristensen VN, Kwong A, Lambrechts D, Li J, Lubiński J, Manoochehri M, Margolin S, Matsuo K, Taib NAM, Mulligan AM, Nevanlinna H, Newman WG, Offit K, Osorio A, Park SK, Park-Simon TW, Patel AV, Presneau N, Pylkäs K, Rack B, Radice P, Rennert G, Romero A, Saloustros E, Sawyer EJ, Schneeweiss A, Schochter F, Schoemaker MJ, Shen CY, Shibli R, Sinn P, Tapper WJ, Tawfiq E, Teo SH, Teras LR, Torres D, Vachon CM, van Deurzen CHM, Wendt C, Williams JA, Winqvist R, Elwood M, Schmidt MK, García-Closas M, Pharoah PDP. Incorporating progesterone receptor expression into the PREDICT breast prognostic model. Eur J Cancer 2022; 173:178-193. [PMID: 35933885 PMCID: PMC10412460 DOI: 10.1016/j.ejca.2022.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/24/2021] [Revised: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Predict Breast (www.predict.nhs.uk) is an online prognostication and treatment benefit tool for early invasive breast cancer. The aim of this study was to incorporate the prognostic effect of progesterone receptor (PR) status into a new version of PREDICT and to compare its performance to the current version (2.2). METHOD The prognostic effect of PR status was based on the analysis of data from 45,088 European patients with breast cancer from 49 studies in the Breast Cancer Association Consortium. Cox proportional hazard models were used to estimate the hazard ratio for PR status. Data from a New Zealand study of 11,365 patients with early invasive breast cancer were used for external validation. Model calibration and discrimination were used to test the model performance. RESULTS Having a PR-positive tumour was associated with a 23% and 28% lower risk of dying from breast cancer for women with oestrogen receptor (ER)-negative and ER-positive breast cancer, respectively. The area under the ROC curve increased with the addition of PR status from 0.807 to 0.809 for patients with ER-negative tumours (p = 0.023) and from 0.898 to 0.902 for patients with ER-positive tumours (p = 2.3 × 10-6) in the New Zealand cohort. Model calibration was modest with 940 observed deaths compared to 1151 predicted. CONCLUSION The inclusion of the prognostic effect of PR status to PREDICT Breast has led to an improvement of model performance and more accurate absolute treatment benefit predictions for individual patients. Further studies should determine whether the baseline hazard function requires recalibration.
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Affiliation(s)
- Isabelle Grootes
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK.
| | - Renske Keeman
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Pathology, Amsterdam, 1066 CX, the Netherlands
| | - Fiona M Blows
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK
| | - Roger L Milne
- Cancer Council Victoria, Cancer Epidemiology Division, Melbourne, Victoria, 3004, Australia; The University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Victoria, 3010, Australia; Monash University, Precision Medicine, School of Clinical Sciences at Monash Health, Clayton, Victoria, 3168, Australia
| | - Graham G Giles
- Cancer Council Victoria, Cancer Epidemiology Division, Melbourne, Victoria, 3004, Australia; The University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Victoria, 3010, Australia; Monash University, Precision Medicine, School of Clinical Sciences at Monash Health, Clayton, Victoria, 3168, Australia
| | - Anthony J Swerdlow
- The Institute of Cancer Research, Division of Genetics and Epidemiology, London, SM2 5NG, UK; The Institute of Cancer Research, Division of Breast Cancer Research, London, SW7 3RP, UK
| | - Peter A Fasching
- University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, Los Angeles, CA, 90095, USA; Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, 91054, Germany
| | - Mustapha Abubakar
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, Bethesda, MD, 20850, USA
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Fred A. Litwin Center for Cancer Genetics, Toronto, ON, M5G 1X5, Canada; University of Toronto, Department of Molecular Genetics, Toronto, ON, M5S 1A8, Canada
| | - Hoda Anton-Culver
- University of California Irvine, Department of Medicine, Genetic Epidemiology Research Institute, Irvine, CA, 92617, USA
| | - Matthias W Beckmann
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, 91054, Germany
| | - Carl Blomqvist
- University of Helsinki, Department of Oncology, Helsinki University Hospital, Helsinki, 00290, Finland; Örebro University Hospital, Department of Oncology, Örebro, 70185, Sweden
| | - Stig E Bojesen
- Copenhagen University Hospital, Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev, 2730, Denmark; Copenhagen University Hospital, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Herlev, 2730, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, 2200, Denmark
| | - Manjeet K Bolla
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge, CB1 8RN, UK
| | - Bernardo Bonanni
- IEO, European Institute of Oncology IRCCS, Division of Cancer Prevention and Genetics, Milan, 20141, Italy
| | - Ignacio Briceno
- Universidad de La Sabana, Medical Faculty, Bogota, 140013, Colombia
| | - Barbara Burwinkel
- German Cancer Research Center (DKFZ), Molecular Epidemiology Group, C080, Heidelberg, 69120, Germany; University of Heidelberg, Molecular Biology of Breast Cancer, University Womens Clinic Heidelberg, Heidelberg, 69120, Germany
| | - Nicola J Camp
- University of Utah, Department of Internal Medicine and Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Jose E Castelao
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Xerencia de Xestion Integrada de Vigo-SERGAS, Oncology and Genetics Unit, Vigo, 36312, Spain
| | - Ji-Yeob Choi
- Seoul National University Graduate School, Department of Biomedical Sciences, Seoul, 03080, South Korea; Seoul National University, Cancer Research Institute, Seoul, 03080, South Korea; Seoul National University Medical Research Center, Institute of Health Policy and Management, Seoul, 03080, South Korea
| | - Christine L Clarke
- University of Sydney, Westmead Institute for Medical Research, Sydney, New South Wales, 2145, Australia
| | - Fergus J Couch
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, 55905, USA
| | - Angela Cox
- University of Sheffield, Sheffield Institute for Nucleic Acids (SInFoNiA), Department of Oncology and Metabolism, Sheffield, S10 2TN, UK
| | - Simon S Cross
- University of Sheffield, Academic Unit of Pathology, Department of Neuroscience, Sheffield, S10 2TN, UK
| | - Kamila Czene
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, 171 65, Sweden
| | - Peter Devilee
- Leiden University Medical Center, Department of Pathology, Leiden, 2333 ZA, the Netherlands; Leiden University Medical Center, Department of Human Genetics, Leiden, 2333 ZA, the Netherlands
| | - Thilo Dörk
- Hannover Medical School, Gynaecology Research Unit, Hannover, 30625, Germany
| | - Alison M Dunning
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK
| | - Miriam Dwek
- University of Westminster, School of Life Sciences, London, W1B 2HW, UK
| | - Douglas F Easton
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK; University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge, CB1 8RN, UK
| | - Diana M Eccles
- University of Southampton, Faculty of Medicine, Southampton, SO17 1BJ, UK
| | - Mikael Eriksson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, 171 65, Sweden
| | - Kristina Ernst
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - D Gareth Evans
- University of Manchester, Manchester Academic Health Science Centre, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester, M13 9WL, UK; St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester, M13 9WL, UK
| | - Jonine D Figueroa
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, Bethesda, MD, 20850, USA; The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, EH16 4UX, UK; The University of Edinburgh, Cancer Research UK Edinburgh Centre, Edinburgh, EH4 2XR, UK
| | - Visnja Fink
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - Giuseppe Floris
- Leuven Cancer Institute, University Hospitals Leuven, Leuven Multidisciplinary Breast Center, Department of Oncology, Leuven, 3000, Belgium
| | - Stephen Fox
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia, 3000
| | - Marike Gabrielson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, 171 65, Sweden
| | - Manuela Gago-Dominguez
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, SERGAS, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, 15706, Spain; University of California San Diego, Moores Cancer Center, La Jolla, CA, 92037, USA
| | - José A García-Sáenz
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Centro Investigación Biomédica en Red de Cáncer (CIBERONC), Medical Oncology Department, Hospital Clínico San Carlos, Madrid, 28040, Spain
| | - Anna González-Neira
- Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid, 28029, Spain
| | - Lothar Haeberle
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, 91054, Germany
| | - Christopher A Haiman
- University of Southern California, Department of Preventive Medicine, Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Per Hall
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, 171 65, Sweden; Södersjukhuset, Department of Oncology, Stockholm, 118 83, Sweden
| | - Ute Hamann
- German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg, 69120, Germany
| | - Elaine F Harkness
- University of Manchester, Manchester Academic Health Science Centre, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester, M13 9PT, UK; Wythenshawe Hospital, Manchester University NHS Foundation Trust, Nightingale & Genesis Prevention Centre, Manchester, M23 9LT, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Unit, Manchester, M13 9WL, UK
| | - Mikael Hartman
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore, 119077, Singapore; National University Health System, Department of Surgery, Singapore, 119228, Singapore
| | - Alexander Hein
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, 91054, Germany
| | - Maartje J Hooning
- Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, 3015 GD, the Netherlands
| | - Ming-Feng Hou
- Kaohsiung Municipal Hsiao-Kang Hospital, Department of Surgery, Kaohsiung, 812, Taiwan
| | - Sacha J Howell
- University of Manchester, Division of Cancer Sciences, Manchester, M13 9PL, UK
| | - Hidemi Ito
- Aichi Cancer Center Research Institute, Division of Cancer Information and Control, Nagoya, 464-8681, Japan; Nagoya University Graduate School of Medicine, Division of Cancer Epidemiology, Nagoya, 466-8550, Japan
| | - Anna Jakubowska
- Pomeranian Medical University, Department of Genetics and Pathology, Szczecin, 71-252, Poland; Pomeranian Medical University, Independent Laboratory of Molecular Biology and Genetic Diagnostics, Szczecin, 71-252, Poland
| | - Wolfgang Janni
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - Esther M John
- Stanford University School of Medicine, Department of Epidemiology & Population Health, Stanford, CA, 94305, USA; Stanford Cancer Institute, Stanford University School of Medicine, Department of Medicine, Division of Oncology, Stanford, CA, 94304, USA
| | - Audrey Jung
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, 69120, Germany
| | - Daehee Kang
- Seoul National University, Cancer Research Institute, Seoul, 03080, South Korea; Seoul National University College of Medicine, Department of Preventive Medicine, Seoul, 03080, South Korea
| | - Vessela N Kristensen
- Oslo University Hospital and University of Oslo, Department of Medical Genetics, Oslo, 0379, Norway; University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Oslo, 0450, Norway
| | - Ava Kwong
- Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong; The University of Hong Kong, Department of Surgery, Hong Kong; Hong Kong Sanatorium and Hospital, Department of Surgery and Cancer Genetics Center, Hong Kong
| | - Diether Lambrechts
- VIB Center for Cancer Biology, VIB, Leuven, 3001, Belgium; University of Leuven, Laboratory for Translational Genetics, Department of Human Genetics, Leuven, 3000, Belgium
| | - Jingmei Li
- Genome Institute of Singapore, Human Genetics Division, Singapore, 138672, Singapore
| | - Jan Lubiński
- Pomeranian Medical University, Department of Genetics and Pathology, Szczecin, 71-252, Poland
| | - Mehdi Manoochehri
- German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg, 69120, Germany
| | - Sara Margolin
- Södersjukhuset, Department of Oncology, Stockholm, 118 83, Sweden; Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, 118 83, Sweden
| | - Keitaro Matsuo
- Nagoya University Graduate School of Medicine, Division of Cancer Epidemiology, Nagoya, 466-8550, Japan; Aichi Cancer Center Research Institute, Division of Cancer Epidemiology and Prevention, Nagoya, 464-8681, Japan
| | - Nur Aishah Mohd Taib
- University of Malaya, Department of Surgery, Faculty of Medicine, Kuala Lumpur, 50603, Malaysia
| | - Anna Marie Mulligan
- University of Toronto, Department of Laboratory Medicine and Pathobiology, Toronto, ON, M5S 1A8, Canada; University Health Network, Laboratory Medicine Program, Toronto, ON, M5G 2C4, Canada
| | - Heli Nevanlinna
- University of Helsinki, Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, 00290, Finland
| | - William G Newman
- University of Manchester, Manchester Academic Health Science Centre, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester, M13 9WL, UK; St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester, M13 9WL, UK
| | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, Clinical Genetics Research Lab, Department of Cancer Biology and Genetics, New York, NY, 10065, USA; Memorial Sloan Kettering Cancer Center, Clinical Genetics Service, Department of Medicine, New York, NY, 10065, USA
| | - Ana Osorio
- Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid, 28029, Spain; Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, 28029, Spain
| | - Sue K Park
- Seoul National University, Cancer Research Institute, Seoul, 03080, South Korea; Seoul National University College of Medicine, Department of Preventive Medicine, Seoul, 03080, South Korea; Seoul National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul, 03080, South Korea
| | | | - Alpa V Patel
- American Cancer Society, Department of Population Science, Atlanta, GA, 30303, USA
| | - Nadege Presneau
- University of Westminster, School of Life Sciences, London, W1B 2HW, UK
| | - Katri Pylkäs
- University of Oulu, Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit, Biocenter Oulu, Oulu, 90570, Finland; Northern Finland Laboratory Centre Oulu, Laboratory of Cancer Genetics and Tumor Biology, Oulu, 90570, Finland
| | - Brigitte Rack
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - Paolo Radice
- Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Milan, 20133, Italy
| | - Gad Rennert
- Carmel Medical Center and Technion Faculty of Medicine, Clalit National Cancer Control Center, Haifa, 35254, Israel
| | - Atocha Romero
- Hospital Universitario Puerta de Hierro, Medical Oncology Department, Madrid, 28222, Spain
| | | | - Elinor J Sawyer
- King's College London, School of Cancer & Pharmaceutical Sciences, Comprehensive Cancer Centre, Guy's Campus, London, UK
| | - Andreas Schneeweiss
- University of Heidelberg, Molecular Biology of Breast Cancer, University Womens Clinic Heidelberg, Heidelberg, 69120, Germany; University Hospital and German Cancer Research Center, National Center for Tumor Diseases, Heidelberg, 69120, Germany
| | - Fabienne Schochter
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - Minouk J Schoemaker
- The Institute of Cancer Research, Division of Genetics and Epidemiology, London, SM2 5NG, UK
| | - Chen-Yang Shen
- Academia Sinica, Institute of Biomedical Sciences, Taipei, 115, Taiwan; China Medical University, School of Public Health, Taichung, Taiwan
| | - Rana Shibli
- Carmel Medical Center and Technion Faculty of Medicine, Clalit National Cancer Control Center, Haifa, 35254, Israel
| | - Peter Sinn
- University Hospital Heidelberg, Department of Pathology, Institute of Pathology, Heidelberg, 69120, Germany
| | - William J Tapper
- University of Southampton, Faculty of Medicine, Southampton, SO17 1BJ, UK
| | - Essa Tawfiq
- University of Auckland, Auckland, New Zealand
| | - Soo Hwang Teo
- University of Malaya, Department of Surgery, Faculty of Medicine, Kuala Lumpur, 50603, Malaysia; Cancer Research Malaysia, Breast Cancer Research Programme, Subang Jaya, Selangor, 47500, Malaysia
| | - Lauren R Teras
- American Cancer Society, Department of Population Science, Atlanta, GA, 30303, USA
| | - Diana Torres
- German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg, 69120, Germany; Pontificia Universidad Javeriana, Institute of Human Genetics, Bogota, 110231, Colombia
| | - Celine M Vachon
- Mayo Clinic, Department of Quantitative Health Sciences, Division of Epidemiology, Rochester, MN, 55905, USA
| | | | - Camilla Wendt
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, 118 83, Sweden
| | - Justin A Williams
- University of Utah, Department of Internal Medicine and Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Robert Winqvist
- University of Oulu, Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit, Biocenter Oulu, Oulu, 90570, Finland; Northern Finland Laboratory Centre Oulu, Laboratory of Cancer Genetics and Tumor Biology, Oulu, 90570, Finland
| | - Mark Elwood
- University of Auckland, Auckland, New Zealand
| | - Marjanka K Schmidt
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Pathology, Amsterdam, 1066 CX, the Netherlands; The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, Amsterdam, 1066 CX, the Netherlands
| | - Montserrat García-Closas
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, Bethesda, MD, 20850, USA
| | - Paul D P Pharoah
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK; University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge, CB1 8RN, UK
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Leinert E, Fink A, Veselinovic K, De Waal A, Wang-Gohrke S, Janni W, Fink V. Erstdiagnose einer heterozygoten TP53 Keimbahnmutation bei einer
28-jährigen Patientin mit triple-negativem Mammakarzinom und
kontralateralem DCIS. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Herbert LS, Wöckel A, Kreienberg R, Kühn T, Flock F, Felberbaum R, Janni W, Curtaz CJ, Kiesel M, Schlaiß T, Diessner J, Salmen J, Schwentner L, Fink V, Bekes I, Leinert E, Lato K, Polasik A, Schochter F, Singer S. Inwieweit fühlen sich die Brustkrebs-Überlebenden 5 Jahre nach der Diagnose gut über die Krankheit und die Behandlung informiert? Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- L S Herbert
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - A Wöckel
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - R Kreienberg
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - T Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen
| | | | - R Felberbaum
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kempten, Klinikverbund Allgäu gGmbH, Kempten
| | - W Janni
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - CJ Curtaz
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - M Kiesel
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - T Schlaiß
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - J Diessner
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - J Salmen
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - L Schwentner
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - V Fink
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - I Bekes
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - E Leinert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - K Lato
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - A Polasik
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - F Schochter
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - S Singer
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (UMBEI); Mainz
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Leinert E, Schwentner L, Janni W, Wöckel A, Herbert SL, Herr D, Kühn T, Flock F, Felberbaum R, Kreienberg R, Fink V, Dayan D, Ernst K, Singer S. Outcome analysis of primary breast cancer patients who declined adjuvant chemotherapy-results from the prospective multi-center BRENDA II study. Breast Cancer 2022; 29:429-436. [PMID: 35178667 PMCID: PMC9021155 DOI: 10.1007/s12282-021-01321-1] [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: 05/31/2021] [Accepted: 12/01/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND This study examined 5-year overall, recurrence and distant metastasis-free survival (OS, RFS, MFS) of high- and intermediate-risk breast cancer (BC) patients who declined guideline-recommended adjuvant chemotherapy (CHT). METHODS In the prospective multicenter cohort study BRENDA II, patients with primary BC were sampled over a period of four years (2009-2012). A multi-professional team (tumorboard) discussed recommendation for adjuvant CHT according to the German guideline. Potential differences in 5 year survival were analyzed using Kaplan-Meier curves and Cox regression. The hazard ratios (HR) were adjusted for age, Charlson Comorbidity Score, American Society of Anesthesiologist (ASA) physical status classification, and endocrine therapy. RESULTS A total of 759 patients were enrolled of which 688 could receive CHT according to the guidelines (n = 219 had a clear indication, in n = 304 it was possible). For 360 patients, the tumorboard advised to perform CHT, for 304 it advised against and in 24 cases, no decision was documented. Of those with a positive suggestion, 83% received CHT. Until 5 years after diagnosis, 57 patients were deceased, 41 had at least one distant metastasis and 29 a recurrence. There was no evidence for differences in OS and MFS in patients who declined CHT despite tumorboard recommendation (HR 3.5, 95% CI 0.8-15.1 for OS, HR 1.9, 95% 0.6-6.6 for MFS). Patients who received CHT had significantly better 5-year RFS compared to those who declined (HR 0.3, 95% CI 0.1-0.9, p = 0.03). There was no evidence for different survival in those who had no CHT because of comorbidity and those who declined actively, neither for OS, MFS nor RFS. CONCLUSION The prospective BRENDA II study demonstrates benefit in RFS by guideline adherence in adjuvant breast cancer treatment, indicating prospectively the value of internationally validated guidelines in breast cancer care.
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Affiliation(s)
- Elena Leinert
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany.
| | - Lukas Schwentner
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Achim Wöckel
- Department of Gynaecology and Obstetrics, University of Würzburg, Würzburg, Germany
| | - Saskia-L Herbert
- Department of Gynaecology and Obstetrics, University of Würzburg, Würzburg, Germany
| | - Daniel Herr
- Department of Gynaecology and Obstetrics, University of Würzburg, Würzburg, Germany
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Hospital Esslingen, Esslingen, Germany
| | - Felix Flock
- Department of Gynaecology and Obstetrics, Hospital Memmingen, Memmingen, Germany
| | - Ricardo Felberbaum
- Department of Gynaecology and Obstetrics, Hospital Kempten, Kempten, Germany
| | - Rolf Kreienberg
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Visnja Fink
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Davut Dayan
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Kristina Ernst
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
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14
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Friedl TWP, Fehm T, Müller V, Lichtenegger W, Blohmer J, Lorenz R, Forstbauer H, Fink V, Bekes I, Huober J, Jückstock J, Schneeweiss A, Tesch H, Mahner S, Brucker SY, Heinrich G, Häberle L, Fasching PA, Beckmann MW, Coleman RE, Janni W, Rack B. Prognosis of Patients With Early Breast Cancer Receiving 5 Years vs 2 Years of Adjuvant Bisphosphonate Treatment: A Phase 3 Randomized Clinical Trial. JAMA Oncol 2021; 7:1149-1157. [PMID: 34165508 DOI: 10.1001/jamaoncol.2021.1854] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Bisphosphonate treatment in patients with early breast cancer has become part of care, but the optimal treatment duration is still unclear. Objective To compare 2 vs 5 years of zoledronate treatment following adjuvant chemotherapy in patients with early breast cancer. Design, Setting, and Participants The SUCCESS A phase 3 multicenter randomized open-label clinical trial with a 2 × 2 factorial design enrolled 3754 patients from September 21, 2005, to March 12, 2007 (last patient out, May 7, 2014). Final data analysis was conducted from September 2019 to October 2020. In 250 German study centers, patients were eligible for participation in the SUCCESS A trial if they had either node-positive or high-risk node-negative (defined as at least 1 of the following: tumor size ≥ pT2, histologic grade 3, negative hormone receptor status, or age ≤35 years) primary invasive breast cancer. Interventions Patients were first randomized to adjuvant chemotherapy with 3 cycles of fluorouracil, epirubicin, and cyclophosphamide followed by 3 cycles of docetaxel with or without gemcitabine (not presented in this report). After chemotherapy, patients underwent a second randomization of 5 years of zoledronate treatment (4 mg intravenously every 3 months for 2 years, followed by 4 mg intravenously every 6 months for 3 years) vs 2 years of zoledronate treatment (4 mg intravenously every 3 months for 2 years). Main Outcomes and Measures The primary end point of the study was disease-free survival; secondary end points were overall survival, distant disease-free survival, and the incidence of skeletal-related adverse events. Survival times were measured from 2 years after the start of zoledronate treatment (landmark analysis). Results Overall, data on 2987 patients were available for analysis; median age was 53 (range, 21-86) years. Disease-free survival, overall survival, and distant disease-free survival did not differ significantly between the 2 treatment arms (5 vs 2 years) as shown by adjusted multivariable Cox proportional hazards regression models (disease-free survival: hazard ratio [HR], 0.97; 95% CI, 0.75-1.25; P = .81; overall survival: HR, 0.98; 95% CI, 0.67-1.42; P = .90; distant disease-free survival: HR, 0.87; 95% CI, 0.65-1.18; P = .38). Adverse events were observed more often in the 5-year (46.2%) vs 2-year (27.2%) zoledronate treatment arm, which was particularly true for the skeletal-related events bone pain (5 years, 8.3% vs 2 years, 3.7%) and arthralgia (5 years, 5.1% vs 2 years, 3.1%). Conclusions and Relevance The results of this phase 3 randomized clinical trial indicate that extending the zoledronate treatment beyond 2 years does not improve the prognosis of high-risk patients with early breast cancer receiving chemotherapy, suggesting that the currently recommended bisphosphonate treatment duration of 3 to 5 years could be reduced. Trial Registration ClinicalTrials.gov Identifier: NCT02181101.
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Affiliation(s)
- Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Duesseldorf, Heinrich-Heine University, Duesseldorf, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jens Blohmer
- Department of Gynecology and Obstetrics, Charité University Hospital Campus Virchow, Berlin, Germany
| | - Ralf Lorenz
- Gynecologic Practice Dres Lorenz, Hecker, Wesche, Braunschweig, Germany
| | - Helmut Forstbauer
- Hemato-Oncological Practice Dres Forstbauer and Ziske, Troisdorf, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Inga Bekes
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Julia Jückstock
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Hans Tesch
- Department of Oncology, Onkologie Bethanien, Frankfurt, Germany
| | - Sven Mahner
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sara Y Brucker
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | | | - Lothar Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Robert E Coleman
- Sheffield Cancer Research Centre, Weston Park Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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15
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Marchac A, El Haddad R, Boedec C, DE Greef C, Dubrulle F, Garcia Perez J, Rostane Renouard D, Sanchez Nebreda M, Morral S, Sanchez Lagarejo E, Moran Montepeque JL, Terezanov O, Fink V, DE Mortillet S, Gounot N, Bricout N. Three-Year Intermediate Results of a Prospective Multicenter Study Investigating the use of Smooth, Semi-Smooth, Microtextured and Macrotextured Implants from a Single Manufacturer in Breast Augmentation and Reconstruction Procedures. J Plast Reconstr Aesthet Surg 2021; 74:3150-3157. [PMID: 34088647 DOI: 10.1016/j.bjps.2021.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/11/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022]
Abstract
Silicone gel-filled implants exist in a wide range of shapes and textures, and yet there are relatively few long-term large-scale studies, particularly on recently developed "semi-smooth" implants. The present study fills this gap by presenting the 3-year findings from an ongoing 10-year multicenter prospective study on breast implants with four different surface types: smooth, semi-smooth, microtextured, and macrotextured. A total of 908 patients were recruited in 15 investigational sites across Europe and divided into three groups: 653 primary augmentations in Group 1, 144 revision augmentations in Group 2, and 111 reconstructions in Group 3. All 4 types of implant shells were manufactured by the same company using the same silicone material. Surgeons were free to choose their preferred technique and implant surface, but data were collected using a standardized software and included all complications, and satisfaction levels reported by the patients at each visit. The incidence of post-operative complications was estimated based on Kaplan-Meier risk rates, on a per patient basis. At 3 years post implantation, capsular contracture (Baker grade III/IV) was the most common complication, with a per-patient risk rate of 1.5% in Group 1. Interestingly, there was no capsular contracture in this group when semi-smooth implants were used. The risk of implant rupture in Group 1 was 0.2%. The preliminary findings of this 10-year prospective study indicate that, 3 years after the operation, the four types of silicone gel-filled implants investigated were safe, with a low complication rate in comparison with the most favorable results published in other similar studies.
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16
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Herbert SL, Wöckel A, Kreienberg R, Kühn T, Flock F, Felberbaum R, Janni W, Curtaz C, Kiesel M, Stüber T, Diessner J, Salmen J, Schwentner L, Fink V, Bekes I, Leinert E, Lato K, Polasik A, Schochter F, Singer S. To which extent do breast cancer survivors feel well informed about disease and treatment 5 years after diagnosis? Breast Cancer Res Treat 2020; 185:677-684. [PMID: 33104958 PMCID: PMC7921033 DOI: 10.1007/s10549-020-05974-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/08/2020] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In this study, we investigated to which extent patients feel well informed about their disease and treatment, which areas they wish more or less information and which variables are associated with a need for information about the disease, medical tests and treatment. METHODS In a German multi-centre prospective study, we enrolled 759 female breast cancer patients at the time of cancer diagnosis (baseline). Data on information were captured at 5 years after diagnosis with the European Organisation for Research and Treatment of Cancer (EORTC) Information Module (EORTC QLQ-INFO24). Good information predictors were analysed using linear regression models. RESULTS There were 456 patients who participated at the 5-year follow-up. They reported to feel well informed about medical tests (mean score 78.5) and the disease itself (69.3) but relatively poorly about other services (44.3) and about different places of care (31.3). The survivors expressed a need for more information concerning: side effects and long-term consequences of therapy, more information in general, information about aftercare, prognosis, complementary medicine, disease and therapy. Patients with higher incomes were better informed about medical tests (β 0.26, p 0.04) and worse informed with increasing levels of fear of treatment (β - 0.11, p 0.02). Information about treatment was reported to be worse by survivors > 70 years old (β -0.34, p 0.03) and by immigrants (β -0.11, p 0.02). Survivors who had received additional written information felt better informed about disease, medical tests, treatment and other services (β 0.19/0.19/0.20/0.25; each p < 0.01). CONCLUSION Health care providers have to reconsider how and what kind of information they provide. Providing written information, in addition to oral information, may improve meeting those information needs.
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Affiliation(s)
- S L Herbert
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany.
| | - A Wöckel
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - R Kreienberg
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - T Kühn
- Department of Gynaecology and Obstetrics, Hospital Esslingen, Esslingen, Germany
| | - F Flock
- Department of Gynaecology and Obstetrics, Hospital Memmingen, Memmingen, Germany
| | - R Felberbaum
- Department of Gynaecology and Obstetrics, Hospital Kempten, Kempten, Germany
| | - W Janni
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - C Curtaz
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - M Kiesel
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - T Stüber
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - J Diessner
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - J Salmen
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - L Schwentner
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - V Fink
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - I Bekes
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - E Leinert
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - K Lato
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - A Polasik
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - F Schochter
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - S Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre Mainz, Mainz, Germany
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17
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de Gregorio A, Häberle L, Fasching PA, Müller V, Schrader I, Lorenz R, Forstbauer H, Friedl TWP, Bauer E, de Gregorio N, Deniz M, Fink V, Bekes I, Andergassen U, Schneeweiss A, Tesch H, Mahner S, Brucker SY, Blohmer JU, Fehm TN, Heinrich G, Lato K, Beckmann MW, Rack B, Janni W. Gemcitabine as adjuvant chemotherapy in patients with high-risk early breast cancer-results from the randomized phase III SUCCESS-A trial. Breast Cancer Res 2020; 22:111. [PMID: 33097092 PMCID: PMC7583247 DOI: 10.1186/s13058-020-01348-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 04/23/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background When chemotherapy is indicated in patients with early breast cancer, regimens that contain anthracyclines and taxanes are established standard treatments. Gemcitabine has shown promising effects on the response and prognosis in patients with metastatic breast cancer. The SUCCESS-A trial (NCT02181101) examined the addition of gemcitabine to a standard chemotherapy regimen in high-risk early breast cancer patients. Methods A total of 3754 patients with at least one of the following characteristics were randomly assigned to one of the two treatment arms: nodal positivity, tumor grade 3, age ≤ 35 years, tumor larger than 2 cm, or negative hormone receptor status. The treatment arms received either three cycles of 5-fluorouracil, epirubicin, and cyclophosphamide, followed by three cycles of docetaxel (FEC → Doc); or three cycles of FEC followed by three cycles of docetaxel and gemcitabine (FEC → Doc/Gem). The primary study aim was disease-free survival (DFS), and the main secondary objectives were overall survival (OS) and safety. Results No differences were observed in the 5-year DFS or OS between FEC → Doc and FEC → Doc/Gem. The hazard ratio was 0.93 (95% CI, 0.78 to 1.12; P = 0.47) for DFS and 0.94 (95% CI, 0.74 to 1.19; P = 0.60) for OS. For patients treated with FEC → Doc and FEC → Doc/Gem, the 5-year probabilities of DFS were 86.6% and 87.2%, and the 5-year probabilities of OS were 92.8% and 92.5%, respectively. Conclusion Adding gemcitabine to a standard chemotherapy does not improve the outcomes in patients with high-risk early breast cancer and should therefore not be included in the adjuvant treatment setting. Trial registration Clinicaltrials.gov NCT02181101 and EU Clinical Trials Register EudraCT 2005-000490-21. Registered September 2005.
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Affiliation(s)
- Amelie de Gregorio
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany.
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, Comprehensive Cancer Center EMN, Erlangen, Germany.,Department of Gynecology and Obstetrics, Biostatistics Unit, Erlangen University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, Comprehensive Cancer Center EMN, Erlangen, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ralf Lorenz
- Gynecologic Practice Dr. Lorenz, N. Hecker, Dr. Kreiss-Sender, Braunschweig, Germany
| | - Helmut Forstbauer
- Hemato-Oncological Practice Dres Forstbauer and Ziske, Troisdorf, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Emanuel Bauer
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Nikolaus de Gregorio
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Miriam Deniz
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Inga Bekes
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Ulrich Andergassen
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Division of Gynecologic Oncology and German Cancer Research Center, Heidelberg, Germany
| | - Hans Tesch
- Department of Oncology, Onkologie Bethanien, Frankfurt, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sara Y Brucker
- Department of Gynecology and Obstetrics, Tübingen University Hospital, Tübingen, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Center, Charité University Hospital Campus Charité-Mitte, Berlin, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Heinrich
- Department of Gynecologic Oncology, Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany
| | - Krisztian Lato
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, Comprehensive Cancer Center EMN, Erlangen, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Prittwitzstrasse 43, 89075, Ulm, Germany
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18
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Paepke S, Kiechle M, Gerber-Schäfer C, Kümmel S, Faridi A, Bauer L, Thill M, Ankel C, Andrulat A, Gschwantler-Kaulich D, Heil J, Fink V, Ohlinger R. Präpektorale Implantateinlage in der plastisch-rekonstruktiven Mammachirurgie unter Verwendung des TiLOOP Bra Pocket – erste Daten der PRO-Pocket Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S Paepke
- Klinikum rechts der Isar,pechnische Universität München
| | - M Kiechle
- Klinikum rechts der Isar,pechnische Universität München
| | | | | | | | | | - M Thill
- Agaplesion Markus Krankenhaus
| | | | | | | | - J Heil
- Universitätsklinikum Heidelberg
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19
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Kersten M, Fink V, Korzoum A, Polasik A, Janni W, Bekes I. 13-jährige Patientin mit juvenilem Riesenfibroadenom der Mamma – ein Fallbericht. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - V Fink
- Universitätsfrauenklinik Ulm
| | | | | | - W Janni
- Universitätsfrauenklinik Ulm
| | - I Bekes
- Universitätsfrauenklinik Ulm
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Fritz J, Fink V, Sophia H, Kersten M, Braun T, Janni W, Bekes I. 61-jährige Patientin mit intramammärer Absiedelung eines extranodalen Mantelzell-Lymphoms der Tränendrüse – ein Fallbericht. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Fritz
- Universitätsfrauenklinik Ulm
| | - V Fink
- Universitätsfrauenklinik Ulm
| | | | | | - T Braun
- Universitätsfrauenklinik Ulm
| | - W Janni
- Universitätsfrauenklinik Ulm
| | - I Bekes
- Universitätsfrauenklinik Ulm
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Braun T, Baumann L, Rack B, Fritz J, Fink A, Koretz K, Fink V, Huober J, Janni W, De Gregorio A, De Gregorio N. Myofibroblastom der Brust – eine differentialdiagnostische Herausforderung. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- T Braun
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - L Baumann
- Universitätsklinikum Ulm, Institut für Pathologie
| | - B Rack
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - J Fritz
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - A Fink
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - K Koretz
- Universitätsklinikum Ulm, Institut für Pathologie
| | - V Fink
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - J Huober
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - W Janni
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - A De Gregorio
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - N De Gregorio
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
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22
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Bekes I, Eichler M, Singer S, Friedl TWP, Harbeck N, Rack B, Forstbauer H, Dannecker C, Huober J, Kiechle M, Lato K, Janni W, Fink V. Impact of Granulocyte Colony-Stimulating Factor (G-CSF) and Epoetin (EPO) on Hematologic Toxicities and Quality of Life in Patients During Adjuvant Chemotherapy in Early Breast Cancer: Results From the Multi-Center Randomized ADEBAR Trial. Clin Breast Cancer 2020; 20:439-447. [PMID: 32800493 DOI: 10.1016/j.clbc.2020.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/26/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hematologic toxicities are one of the greatest challenges in adjuvant chemotherapy for breast cancer. This analysis of the ADEBAR trial aims to evaluate application and effect of granulocyte colony-stimulating factor (G-CSF) and epoetin alfa (EPO) on hematologic parameters and fatigue in patients with breast cancer during chemotherapy. PATIENTS AND METHODS In the ADEBAR trial, 1493 patients with node-positive primary breast cancer were randomized to either 6 × 5-fluorouracil, epirubicin, and cyclophosphamide (FEC120) or 4 × epirubicin and cyclophosphamide followed by 4 × docetaxel (EC-DOC). Co-medication with G-CSF or EPO was applied to treat chemotherapy-induced leukopenia or anemia. Fatigue was assessed at baseline and after one-half of the chemotherapy. RESULTS In total, 899 patients could be included in the analysis. There was no evidence for an association between leucocyte or hemoglobin levels and application of G-CSF and EPO in the preceding cycle, respectively. Hemoglobin levels (B = -0.41; P < .001) were affected by treatment regimen. Fatigue during chemotherapy was mostly affected by the level of fatigue before the start of chemotherapy (B = 0.41; P < .001). Patients with G-CSF application in the preceding cycle showed an increased fatigue score (B = 5.43; P = .02). CONCLUSION We showed that fatigue during adjuvant chemotherapy was mostly affected by the level of fatigue present before the start of chemotherapy. This result suggests that the level of fatigue before the start of treatment should be included as an important factor when deciding on type and toxicity of chemotherapy in early breast cancer.
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Affiliation(s)
- Inga Bekes
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
| | - Martin Eichler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Susanne Singer
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Nadia Harbeck
- Breast Cancer Center, Department of Obstetrics and Gynecology, University of Munich, Munich, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Helmut Forstbauer
- Hemato-Oncological Practice Dres Forstbauer and Ziske, Troisdorf, Germany
| | - Christian Dannecker
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Krisztian Lato
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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Ernst K, DeGregorio A, Fink V, Janni W, Braun T, Bekes I. Gigantische Raumforderung der Brust - Der seltene Fall eines malignen Phylloidestumors. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
- K Ernst
- Universitätsfrauenklinik Ulm
| | | | - V Fink
- Universitätsfrauenklinik Ulm
| | - W Janni
- Universitätsfrauenklinik Ulm
| | - T Braun
- Universitätsfrauenklinik Ulm
| | - I Bekes
- Universitätsfrauenklinik Ulm
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24
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Ruddy KJ, Schaid DJ, Partridge AH, Larson NB, Batzler A, Häberle L, Dittrich R, Widschwendter P, Fink V, Bauer E, Schwitulla J, Rübner M, Ekici AB, Aivazova-Fuchs V, Stewart EA, Beckmann MW, Ginsburg E, Wang L, Weinshilboum RM, Couch FJ, Janni W, Rack B, Vachon C, Fasching PA. Genetic predictors of chemotherapy-related amenorrhea in women with breast cancer. Fertil Steril 2019; 112:731-739.e1. [PMID: 31371054 DOI: 10.1016/j.fertnstert.2019.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/16/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To study how genetics may play a role in determining risk of chemotherapy-related amenorrhea (CRA) in young women with breast cancer. DESIGN Genome-wide association study. SETTING Not applicable. PATIENT(S) Premenopausal women ≤45 years of age enrolled in one of these three trials were included if they had at least one menstrual case report form after chemotherapy ended and if they were of European ancestry. Forms during and up to 3 months after receipt of GnRH agonist were excluded. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The association of single-nucleotide polymorphisms with post-chemotherapy menstruation adjusted for trial and arm, age, tamoxifen use, and nodal status. RESULT(S) The median age of the 1,168 women was 41 years (range 19-45). Among these, 457 (39%) never resumed menses after chemotherapy. Older age, tamoxifen use, and node-negative disease were associated with increased risk of CRA. Adjusting for these, rs147451859, in an intron of PPCDC (phosphopantothenoylcysteine decarboxylase), and rs17587029, located 5' upstream of RPS20P11 (ribosomal protein S20 pseudogene 11), were associated with post-chemotherapy menstruation. CONCLUSION(S) Genetic variation may contribute to risk of CRA. Better prediction of who will experience CRA may inform reproductive and treatment decision making in young women with cancer.
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Affiliation(s)
| | - Daniel J Schaid
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ann H Partridge
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicholas B Larson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Anthony Batzler
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Dittrich
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Widschwendter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Emanuel Bauer
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Judith Schwitulla
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Rübner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Elizabeth A Stewart
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Elizabeth Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Liewei Wang
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota
| | | | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Celine Vachon
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Herr D, Wischnewsky M, Joukhadar R, Chow O, Janni W, Leinert E, Fink V, Stüber T, Curtaz C, Kreienberg R, Blettner M, Wollschläger D, Wöckel A. Does chemotherapy improve survival in patients with nodal positive luminal A breast cancer? A retrospective Multicenter Study. PLoS One 2019; 14:e0218434. [PMID: 31283775 PMCID: PMC6613686 DOI: 10.1371/journal.pone.0218434] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/02/2019] [Indexed: 12/15/2022] Open
Abstract
Background In this study based on the BRENDA data, we investigated the impact of endocrine ± chemotherapy for luminal A, nodal positive breast cancer on recurrence free (RFS) and overall survival (OS). In addition, we analysed if tumor size of luminal A breast cancer influences survival in patients with the same number of positive lymph nodes. Methods In this retrospective multi-centre cohort study data of 1376 nodal-positive patients with primary diagnosis of luminal A breast cancer during 2001–2008 were analysed. The results were stratified by therapy and adjusted by age, tumor size and number of affected lymph nodes. Results In our study population, patients had a good to excellent prognosis (5-year RFS: 91% and tumorspecific 5-year OS 96.5%). There was no significant difference in RFS stratified by patients with only endocrine therapy and with endocrine plus chemo-therapy. Patients with 1–3 affected lymph nodes had no significant differences in OS treated only with endocrine therapy or with endocrine plus chemotherapy, independent of tumor size. Patients with large tumors and more than 3 affected lymph nodes had a significant worse survival as compared to the small tumors. However, despite the worse prognosis of those, adjuvant chemotherapy failed in order to improve RFS. Conclusions According to our data, nodal positive patients with luminal A breast cancer have, if any, a limited benefit of adjuvant chemotherapy. Tumor size and nodal status seem to be of prognostic value in terms of survival, however both tumor size as well as nodal status were not predictive for a benefit of adjuvant chemotherapy.
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Affiliation(s)
- Daniel Herr
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
- * E-mail:
| | - Manfred Wischnewsky
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Ralf Joukhadar
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Olivia Chow
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynaecology, Ulm University Medical Centre, Ulm, Germany
| | - Elena Leinert
- Department of Obstetrics and Gynaecology, Ulm University Medical Centre, Ulm, Germany
| | - Visnja Fink
- Department of Obstetrics and Gynaecology, Ulm University Medical Centre, Ulm, Germany
| | - Tanja Stüber
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Carolin Curtaz
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Rolf Kreienberg
- Department of Obstetrics and Gynaecology, Ulm University Medical Centre, Ulm, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
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Cámara RJA, Schwentner L, Friedl TWP, Deniz M, Fink V, Lato K, Widschwendter P, Rack B, Janni W, Singer S, Bekes I. Quality of life during and after adjuvant anthracycline-taxane-based chemotherapy with or without Gemcitabine in high-risk early breast cancer: results of the SUCCESS A trial. Breast Cancer Res Treat 2019; 175:627-635. [PMID: 30900137 DOI: 10.1007/s10549-019-05171-6] [Citation(s) in RCA: 5] [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] [Received: 10/05/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE In high-risk early breast cancer, adjuvant taxane-Gemcitabine combinations result in a recurrence-free survival similar to single-agent taxanes. However, haematologic toxicities and need for dose reductions are more frequent in combinations. Which option ultimately provides a better quality of life (QoL) is unknown. We compared the QoL curves before, during, and up to one year after three cycles of Fluorouracil-epirubicin-cyclophosphamide followed by three cycles of Docetaxel-Gemcitabine or Docetaxel. METHODS Overall, 3691 women with recent R0-resection of a primary epithelial breast cancer participated in the nationwide SUCCESS A clinical trial. The centres sent QoL questionnaires of the European Organisation for Research and Treatment of Cancer before and up to 15 months after randomisation to Docetaxel-Gemcitabine versus Docetaxel. Multilevel analysis by chemotherapy arm estimated the QoL time curves, questionnaire return, and dropout. RESULTS The combination caused one-point higher global QoL (95% confidence ±1; p = 0.05) and 1.1 lower odds of adherence to the outcome (95% confidence 1.0-1.1; p = 0.23) than the monotherapy. In both groups, a 10-point decrease during therapy preceded a 16-point increase after chemotherapy (p < 0.001). The secondary QoL outcomes showed transient superiority of the combination at the end of chemotherapy. Discontinuation from chemotherapy and its reasons were equal in both groups. CONCLUSIONS While patients perceive a one-point QoL difference as meaningless, a six-point increase is clinically relevant for them. That is, both regimens cause the same relevant long-term QoL improvement. With the similar recurrence-free survival, the lower toxicity, and the shorter chemotherapy duration in mind, taxanes without Gemcitabine are the preference. This challenges previous recommendations supporting combinations.
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Affiliation(s)
- Rafael J A Cámara
- Institute for Medical Biometry, Epidemiology and Informatics, Medical Centre of the University of Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.
| | - Lukas Schwentner
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany.,GYNOVA, Praxis für Gynäkologie und Geburtshilfe, Reith bei Kitzbühel, Austria
| | - Thomas W P Friedl
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Miriam Deniz
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Krisztian Lato
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Peter Widschwendter
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Brigitte Rack
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Susanne Singer
- Institute for Medical Biometry, Epidemiology and Informatics, Medical Centre of the University of Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany
| | - Inga Bekes
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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27
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Huober J, Nagel G, Rempen A, Schlicht E, Flock F, Fritz S, Thiel F, Wiesmüller L, Felderbaum R, Heilmann V, Bekes I, Fink V, Albrecht S, De Gregorio N, Tzschaschel M, Ernst K, Wolf C, Kuhn P, Friedl T, Janni W, De Gregorio A. Abstract OT1-11-01: The BRandO BiO registry – A multicenter regional registry for patients with primary breast and ovarian cancer with longitudinal biobanking and evaluation of epidemiological, life style and quality of life factors. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-11-01] [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:
Further progress in the treatment of breast cancer will likely come from contributions of molecular biology and immunologic approaches. The search for druggable molecular aberrations may enable treatment based on the molecular profile. A better identification of patients with a high risk of relapse facilitates the selection of these pts for clinical trials investigating early therapeutic molecular-based interventions.
Trial Design:
The BRandO BiO Registry is a multi-center regional registry to record clinical, epidemiological, and biological data from patients with newly diagnosed breast and ovarian cancer at the University of Ulm, Dept. of Gynecology and 19 affiliated network hospitals and practices in the Alb-Allgäu Bodensee region (outreach area of the Comprehensive Cancer Center Ulm). Longitudinal biobanking is included with collection of paraffin-embedded samples of the primary tumor as well as blood samples at first diagnosis, after 6 and 12 months and at first relapse to isolate and investigate cell-free and germline DNA. Epidemiological, life style and quality of life (QOL) questionnaires are collected at first diagnosis, after 12, 36 and 60 months. The follow up is planned for 10 years.
Eligibility criteria:
Patients with primary newly diagnosed untreated breast or ovarian cancer of ≥ 18 years are eligible; primary metastatic untreated disease is allowed. Exclusion criteria comprise severe neurological or psychiatric disorders interfering with the ability to give an informed consent, no consent for registration, storage and processing of the individual disease characteristics and bio samples, and any malignant tumor in the last 3 years (except in situ disease).
Specific aims:
To register the majority of patients with newly diagnosed breast or ovarian cancer in all BRandO-BiO participating centers of a well-defined geographical area. To assess clinical characteristics and outcome data (event-free survival, overall survival) of these patients. To evaluate the primary tumor of all patients for mutational (druggable) aberrations. Further to assess cell-free DNA in the serial blood samples at baseline, 6 and 12 months and correlate these results with clinical outcome data as well as tumor and patient characteristics to look for early markers predicting relapse. To perform a longitudinal assessment of the patients' sociodemographic factors, comorbidities, lifestyle and QOL factors by analyzing serial questionnaires collected at recruitment and at 12, 36 and 60 months.
Present accrual and target accrual:
The BRandO BiO Registry started January 2016 in the Dept. of Gynecology, University of Ulm and February 2017 at the network hospitals and practices. Until June 2018, 1180 patients with primary breast or ovarian cancer have been enrolled. The current adherence to serial blood testing and serial questionnaires is good with a return rate of 90%. A sample size of 3000 patients is planned.
Contact information:
Jens Huober, University of Ulm, Dept of Gynecology, Breast Center, jens.huober@uniklinik-ulm.de
Amelie de Gregorio, University of Ulm, Dept of Gynecology, Breast Center, Amelie.de Gregorio@uniklinik-ulm.de
Citation Format: Huober J, Nagel G, Rempen A, Schlicht E, Flock F, Fritz S, Thiel F, Wiesmüller L, Felderbaum R, Heilmann V, Bekes I, Fink V, Albrecht S, De Gregorio N, Tzschaschel M, Ernst K, Wolf C, Kuhn P, Friedl T, Janni W, De Gregorio A. The BRandO BiO registry – A multicenter regional registry for patients with primary breast and ovarian cancer with longitudinal biobanking and evaluation of epidemiological, life style and quality of life factors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-11-01.
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Affiliation(s)
- J Huober
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - G Nagel
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - A Rempen
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - E Schlicht
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - F Flock
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - S Fritz
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - F Thiel
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - L Wiesmüller
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - R Felderbaum
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - V Heilmann
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - I Bekes
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - V Fink
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - S Albrecht
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - N De Gregorio
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - M Tzschaschel
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - K Ernst
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - C Wolf
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - P Kuhn
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - T Friedl
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - W Janni
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
| | - A De Gregorio
- University Hospital Ulm, Ulm, Germany; Diakonie-Hospital, Schwäbisch Hall, Schwäbisch-Hall, Germany; Staufer-Hospital, Schwäbisch Gmünd, Schwäbisch-Gmünd, Germany; Hospital Memmingen, Memmingen, Germany; Sana Clinics, Biberach, Biberach, Germany; Hospital Kempten-Oberallgäu GmbH, Kempten, Kempten, Germany; Private Practice Dr. Volkmar Heilmann, Günzburg, Günzburg, Germany; Medical Center-Dr. C. Wolf, Ulm, Ulm, Germany; Institute of Epidemiology, University Ulm, Ulm, Germany; Clinical Cancer Register, University Hospital of Ulm, Ulm, Germany; Hospital Alb-Fils, Clinic am Eichert, Alb-Fils, Göppingen, Germany
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Leinert E, Ernst K, Schwentner L, Bekes I, Fink V, Janni W. Risikoadaptierte Betreuungskonzepte bei Mammakarzinom-Hochrisikopatientinnen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0044-102033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Goodman CR, Seagle BLL, Friedl TWP, Rack B, Lato K, Fink V, Cristofanilli M, Donnelly ED, Janni W, Shahabi S, Strauss JB. Association of Circulating Tumor Cell Status With Benefit of Radiotherapy and Survival in Early-Stage Breast Cancer. JAMA Oncol 2018; 4:e180163. [PMID: 29800954 DOI: 10.1001/jamaoncol.2018.0163] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Importance Circulating tumor cells (CTCs) represent the liquid component of solid tumors and are a surrogate marker for residual cancer burden. Although CTC status is prognostic of recurrence and death in breast cancer, its role in guiding clinical management remains unknown. Objective To determine whether CTC status is predictive of radiotherapeutic benefit in early-stage breast cancer. Design, Setting, and Participants The cohort studies in the present analysis included patients with stages pT1 to pT2 and pN0 to pN1 breast cancer and known CTC status from the National Cancer Database (NCDB) and the multicenter phase 3 SUCCESS clinical trial. Multivariable parametric accelerated failure time models were used to evaluate the association of CTC status and radiotherapy (RT) with survival outcomes. Data were collected from January 1, 2004, through December 31, 2014, from the NCDB cohort. The SUCCESS trial collected data from September 1, 2005, through September 30, 2013. The analyses were completed from November 1, 2016, through December 17, 2017. Exposure Adjuvant RT. Main Outcomes and Measures Overall survival (OS), local recurrence-free survival (LRFS), and disease-free survival (DFS). Results A total of 1697 patients from the NCDB (16 men [0.9%] and 1681 women [99.1%]; median age, 63 years; interquartile range, 53-71 years) and 1516 patients from the SUCCESS clinical trial (median age, 52 years; interquartile range, 45-60 years) were identified. Circulating tumor cells were detected in 399 patients (23.5%) in the NCDB cohort and 294 (19.4%) in the SUCCESS cohort. The association of RT with survival was dependent on CTC status within the NCDB cohort (4-year OS, 94.9% for CTC-positive RT vs 88.0% for CTC-positive non-RT vs 93.9% for CTC-negative RT vs 93.4% for CTC-negative non-RT groups; P < .001) and 5-year DFS within the SUCCESS cohort (88.0% for CTC-positive RT vs 75.2% for CTC-positive non-RT vs 92.3% for CTC-negative RT vs 88.3% for CTC-negative non-RT; P = .04). In the NCDB cohort, RT was associated with longer OS in patients with CTCs (time ratio [TR], 2.04; 95% CI, 1.55-2.67; P < .001), but not in patients without CTCs (TR, 0.80; 95% CI, 0.52-1.25; P = .33). In the SUCCESS cohort, CTC-positive patients treated with RT exhibited longer LRFS (TR, 2.73; 95% CI, 1.62-4.80; P < .001), DFS (TR, 3.03; 95% CI, 2.22-4.13; P < .001), and OS (TR, 1.83; 95% CI, 1.23-2.72; P = .003). Among patients from both cohorts who underwent breast-conserving surgery, RT was associated with longer OS in patients with CTCs (TR, 4.37; 95% CI, 2.71-7.05; P < .001) but not in patients without CTCs (TR, 0.87; 95% CI, 0.47-1.62; P = .77). Radiotherapy was not associated with OS after mastectomy in CTC-positive or CTC-negative patients. Conclusions and Relevance Treatment with RT was associated with longer LRFS, DFS, and OS in patients with early-stage breast cancer and detectable CTCs. These results are hypothesis generating; a prospective trial evaluating CTC-based management for RT after breast-conserving surgery in women with early-stage breast cancer is warranted.
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Affiliation(s)
- Chelain R Goodman
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brandon-Luke L Seagle
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Thomas W P Friedl
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Brigitte Rack
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Krisztian Lato
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Massimo Cristofanilli
- Division of Medicine-Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric D Donnelly
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Shohreh Shahabi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan B Strauss
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Leinert E, Singer S, Janni W, Harbeck N, Weissenbacher T, Rack B, Augustin D, Wischnik A, Kiechle M, Ettl J, Fink V, Schwentner L, Eichler M. The Impact of Age on Quality of Life in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Comparative Analysis From the Prospective Multicenter Randomized ADEBAR trial. Clin Breast Cancer 2016; 17:100-106. [PMID: 27884722 DOI: 10.1016/j.clbc.2016.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/13/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Elderly breast cancer patients are affected by poorer quality of life (QoL) compared to younger patients. Because QoL has a relevant impact on guideline-adherent treatment, elderly breast cancer patients are often undertreated, especially with regard to adjuvant chemotherapy, and overall survival is decreased. Thus, understanding the impact of chemotherapy on QoL in elderly patients is crucial. This study compared QoL in patients aged < 65 years and 65 to 70 years receiving adjuvant chemotherapy as a secondary outcome in the prospective randomized multicenter ADEBAR trial. PATIENTS AND METHODS Patients with lymph node-positive breast cancer were prospectively randomized for either sequential anthracycline-taxane or epirubicin/fluorouracil/cyclophosphamid chemotherapy (FEC) therapy. QoL was assessed at baseline (t1), before cycle 4 FEC, and cycle 5 epirubicin/cyclophosphamid-docetaxel (EC-DOC) (t2), 4 weeks after chemotherapy (t3), and 6 weeks after radiation (t4) using the European Organization for Research and Treatment for Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Breast Cancer-Specific Module (QLQ-BR23). We compared patients aged < 65 years and 65 to 70 years with respect to QoL and discontinuation of chemotherapy. RESULTS A total of 1363 patients were enrolled onto the ADEBAR trial, with 16.7% of the patients aged 65 to 70 years. In elderly patients, Eastern Cooperative Oncology Group performance status was higher and global health status and physical functioning were lower at baseline. Global health status decreased between t1 and t3 by 7 points in patients < 65 years and by 11 points in patients 65 to 70 years, and physical functioning decreased in the same period by 13.4 points in patients aged < 65 years and by 15.9 points in patients 65 to 70 years. In both groups, at t4 global health status exceeded baseline by 6 points, and physical functioning was 1.3 points under baseline in patients < 65 years old and 3 points under baseline in patients 65 to 70 years. There was a trend to more fatigue in elderly patients and to more nausea and vomiting while receiving chemotherapy in younger patients at t3. There was a higher dropout rate in patients aged 65 to 70 years (25.7%) than in patients aged < 65 years (16.2%). CONCLUSION There were only small or trivial differences in QoL in patients aged < 65 years versus 65 to 70 years who were receiving adjuvant chemotherapy, although the dropout rate from chemotherapy was notably higher in elderly breast cancer patients.
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Affiliation(s)
- Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
| | - Susanne Singer
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Nadia Harbeck
- Breast Cancer Center, University of Munich, Munich, Germany
| | - Tobias Weissenbacher
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Doris Augustin
- Breast Center of Eastern Bavaria, DONAUISAR Hospital, Deggendorf, Germany
| | | | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Martin Eichler
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
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Eichler M, Singer S, Janni W, Harbeck N, Rack B, Augustin D, Wischnik A, Kiechle M, Ettl J, Scholz C, Fink V, Schwentner L. Pretreatment quality of life, performance status and their relation to treatment discontinuation and treatment changes in high-risk breast cancer patients receiving chemotherapy: results from the prospective randomized ADEBAR trial. Breast Cancer 2016; 24:319-325. [PMID: 27262301 DOI: 10.1007/s12282-016-0706-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 02/22/2016] [Accepted: 05/21/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Health-related quality of life (QoL) is a self-assessed construct indicating how people feel in regard to aspects of their health. Performance status (PS) is evaluated by the treating physician. We examined whether pretreatment QoL and PS are related to subsequent treatment discontinuation and treatment changes in high-risk breast cancer patients receiving chemotherapy. METHODS We conducted a prospective cohort study with data from a randomized phase III trial comparing FEC- and EC-DOC-chemotherapy in patients with primary breast cancer (ADEBAR). We examined the patient's request to discontinue the study, discontinuation due to toxicity, the prolongation of therapy, and dose reduction. Baseline QoL was assessed using the EORTC QLQ-C30. PS was evaluated using the Eastern Cooperative Oncology Group Scale (ECOG). Four QoL scales were selected prior to analysis as outcomes: global health, physical functioning, emotional functioning, and fatigue. Multivariate binary logistic regression analyses were used to test for differences within the independent variables. MAIN RESULTS 1322 patients were included. 1094 (82.8 %) patients completed therapy according to protocol. 6.3 % stopped therapy due to toxicity and 4.4 % refused treatment. Global health was not related to any of the four QoL outcomes. Physical functioning had the strongest impact on QoL, when comparing the fittest group to the lowest quintile [OR 2.14 (95 % CI 1.00-4.60)]. ECOG 0 compared to worse than 1 was strongly correlated to therapy discontinuation due to toxicity [OR 20.15 (95 % CI 9.48-42.83)] and treatment refusal [OR 8.32 (95 % CI 3.81-18.14)]. CONCLUSIONS Pretreatment QoL, especially physical functioning, is associated with subsequent therapy discontinuation due to toxicity and with changes of the treatment protocol. Pretreatment performance status is strongly associated with therapy discontinuation due to toxicity and with treatment refusal.
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Affiliation(s)
- Martin Eichler
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Susanne Singer
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Brigitte Rack
- Breast Center, Department of Gynecology and Obstetrics, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Doris Augustin
- Clinics Deggendorf Mammacenter Ostbayern, Deggendorf, Germany
| | | | - Marion Kiechle
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Johannes Ettl
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Christoph Scholz
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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Ebner F, Schramm A, Bottke D, Friedl TW, Wiegel T, Fink V, Lato K, Bekes I, Janni W, de Gregorio N. Comparison of seroma production in breast conserving surgery with or without intraoperative radiotherapy as tumour bed boost. Arch Gynecol Obstet 2016; 294:861-6. [PMID: 27256339 DOI: 10.1007/s00404-016-4124-8] [Citation(s) in RCA: 8] [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] [Received: 02/01/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION One of the most common complications in breast conserving surgery is seroma formation. The origin of seroma formation remains unclear. While intraoperative radiotherapy (IORT) has been shown to be an alternative to whole breast irradiation, the influence on seroma production is unclear. Therefore, this analysis compares seroma production in patients with breast conserving surgery with or without IORT as tumour bed boost during breast conserving surgery. METHOD A retrospective analysis of seroma production in patients with nodal-negative (pN0sn) pT1/2 primary breast cancer treated between September 2010 and October 2013 at the Breast Cancer Centre, University Hospital Ulm was performed. Patients with neoadjuvant chemotherapy, previous breast/axillary surgery or more than one intervention were excluded. IORT was applied as a tumour bed boost with 50-kV X-rays (Intra beam(®)) delivering 9 Gy at the applicator surface. Seroma formation was measured using wound drains placed in breast and in axilla. RESULTS Data of 152 patients (99 -IORT; 53 +IORT) were available for analysis. No significant differences between patients with or without IORT with regard to seroma production and number of days until drain removal were found (all p > 0.05). CONCLUSION Patients with IORT encountered no increased seroma production and removal of the drains was not delayed compared to patients with breast conserving surgery only. Our results indicate that IORT does not increase the seroma production compared to surgery alone.
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Affiliation(s)
- Florian Ebner
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Germany.
| | - Amelie Schramm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Dirk Bottke
- Klinik für Strahlentherapie und Radioonkologie, Universität Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Thomas Wp Friedl
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Thomas Wiegel
- Klinik für Strahlentherapie und Radioonkologie, Universität Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Visnja Fink
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Kristian Lato
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Inga Bekes
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Nikolaus de Gregorio
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
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Schwentner L, Harbeck N, Singer S, Eichler M, Rack B, Forstbauer H, Wischnik A, Scholz C, Huober J, Friedl TWP, Weissenbacher T, Härtl K, Kiechle M, Janni W, Fink V. Short term quality of life with epirubicin-fluorouracil-cyclophosphamid (FEC) and sequential epirubicin/cyclophosphamid-docetaxel (EC-DOC) chemotherapy in patients with primary breast cancer - Results from the prospective multi-center randomized ADEBAR trial. Breast 2016; 27:69-77. [PMID: 27054751 DOI: 10.1016/j.breast.2016.03.003] [Citation(s) in RCA: 8] [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] [Received: 10/17/2015] [Revised: 03/05/2016] [Accepted: 03/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The recommendation for adjuvant dose-dense chemotherapy in high risk primary breast cancer is heterogeneous among guidelines. Understanding the impact on QoL is thereby a crucial factor, especially if the benefit is potentially low. This study aims to assess QoL as a secondary outcome in the prospective randomized multi-center ADEBAR trial. METHODS QoL was assessed at baseline (t1), before cycle 4 FEC and cycle 5 EC-DOC (t2), 4 weeks after chemotherapy (t3) and 6 weeks after radiation (t4) using the European Organization for Research and Treatment for Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Breast Cancer-Specific Module (QLQ-BR23). RESULTS 1306 patients were enrolled into the ADEBAR trial. 675 were assigned to the FEC and 688 to the EC-DOC arm. After the beginning of treatment, global QoL dropped in both arm by 3-4 points. In the EC-DOC arm, QoL dropped further at t3 by 7 points and stayed stable in the FEC arm. 6 weeks after radiation, QoL exceeded baseline in both arms by 6-8 points. The differences between treatment arms were strongest at t3 (53.0 vs. 49.5) but did not reach clinical relevance at any point in time. Physical functioning, nausea and vomiting, fatigue and systemic therapy side effects followed with some minor exceptions similar patterns but showed higher amplitudes. CONCLUSION In conclusion, we could not detect a clinically relevant difference between the two treatment arms in global QoL, although the results consistently show that patients on EC-DOC report worse scores during the treatment.
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Affiliation(s)
- Lukas Schwentner
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
| | - Nadia Harbeck
- Breast Cancer Center, University of Munich, Munich, Germany
| | - Susanne Singer
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Martin Eichler
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | | | - Christoph Scholz
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Tobias Weissenbacher
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | - Marion Kiechle
- Department of Obstetrics and Gynecology, Technical University Clinics Rechts der Isar Munich, Munich, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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Schwentner L, Harbeck N, Singer S, Eichler M, Rack B, Forstbauer H, Wischnik A, Scholz C, Fink V, Huober J, Friedl T, Weissenbacher T, Härtl K, Kiechle M, Janni W. Abstract P1-12-03: Short term quality of life with epirubicin-fluorouracil-cyclophosphamid (FEC) and sequential epirubicin/cyclophosphamid-docetaxel (EC-DOC) chemotherapy in patients with primary breast cancer – Results from the prospective multi-center randomized Adebar trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-12-03] [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:
The grade of recommendation for adjuvant dose-dense chemotherapy in patients with high risk primary breast cancer is heterogeneous among international guidelines. Understanding the impact on quality of life (QOL) by adjuvant dose dense chemotherapy in comparison to standard adjuvant chemotherapy is thereby a crucial factor, especially if the benefit is potentially low. This study aims to assess the impact on QOL by adjuvant dose dense chemotherapy in the prospective randomized multi-center ADEBAR trial.
Methods:
QOL was assessed at baseline (t1), before cycle 4 FEC (Epirubicin 60mg/m2 i.v. d 1 + 8, 5-Fluoruracil 500mg/m2 i.v. d 1 + 8, Cyclophosphamide 75mg/m2 p.o. d 1–14, q4w x 6) and cycle 5 EC-DOC (Epirubicin 90mg/m2 plus Cyclophosphamide 600mg/m2 q3w x 4, sequentially followed by Docetaxel 100mg/m2 q3w x 4) (t2), 4 weeks after chemotherapy (t3), 6 weeks after radiation (t4) and 1 year after baseline (t5) using the European Organization for Research and Treatment for Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Breast Cancer-Specific Module (QLQ-BR23). A multivariate mixed model was fitted to test for differences between the two treatment arms. Primary endpoint was global QOL, secondary endpoints physical functioning, nausea&vomiting, fatigue and systemic therapy side effects. A minimum clinically meaningful difference was considered to be 10 points.
Results:
1306 patients were recruited between 3/2002 and 5/2005 675 were assigned to the FEC and 688 to the EC-DOC arm. Compliance to QOL assessment was 74% at baseline and 58% four weeks after therapy, but dropped to 11% after one year follow up. After the beginning of treatment global QOL dropped in both arm by 3 to 4 points. In the EC-DOC arm QOL dropped further at t3 by 7 points and stayed stable in the FEC arm. 6 weeks after radiation QOL exceeded baseline in both arms by 6 to 8 points. The differences between treatment arms were strongest at t3 (54.1 vs. 49.7) but did not reach clinical relevance at any point in time. Physical functioning, nausea vomiting, fatigue and systemic therapy side effects followed with some minor exceptions similar patterns, but showed higher amplitudes.
Conclusion:
In conclusion we could not detect a statistically significant difference between the two treatment arms in QOL parameters, indicating that dose dense adjuvant chemotherapy did not impact QOL at a clinically relevant level compared to standard adjuvant chemotherapy.
Citation Format: Schwentner L, Harbeck N, Singer S, Eichler M, Rack B, Forstbauer H, Wischnik A, Scholz C, Fink V, Huober J, Friedl T, Weissenbacher T, Härtl K, Kiechle M, Janni W. Short term quality of life with epirubicin-fluorouracil-cyclophosphamid (FEC) and sequential epirubicin/cyclophosphamid-docetaxel (EC-DOC) chemotherapy in patients with primary breast cancer – Results from the prospective multi-center randomized Adebar trial. [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 P1-12-03.
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Affiliation(s)
- L Schwentner
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - N Harbeck
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - S Singer
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - M Eichler
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - B Rack
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - H Forstbauer
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - A Wischnik
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - C Scholz
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - V Fink
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - J Huober
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - T Friedl
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - T Weissenbacher
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - K Härtl
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - M Kiechle
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
| | - W Janni
- University Ulm, Germany; Breast Cancer Center, University of Munich, Germany; IMBEI, University of Mainz, Germany; University Munich, Germany; Oncology Rhein-Sieg, Germany; Hospital Augsburg, Germany; Fresenius Universitiy of Applied Science, Germany; Technical University Rechts der Isar, Munich, Germany
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Schramm A, De Gregorio N, Widschwendter P, Fink V, Huober J. Targeted Therapies in HER2-Positive Breast Cancer - a Systematic Review. Breast Care (Basel) 2015; 10:173-8. [PMID: 26557822 DOI: 10.1159/000431029] [Citation(s) in RCA: 31] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
About 20% of all breast cancer patients have a human epidermal growth factor receptor 2 (HER2)-positive breast tumor. This entity underwent an impressive change in prognosis, with notable improvement of progression-free survival and overall survival. Due to more aggressive tumors and no specific therapy, HER2 overexpression was historically seen as a negative prognostic marker, with worse prognosis and increased risk of recurrent disease. Trastuzumab, the first anti-HER2 antibody, revolutionized the systemic therapy options in HER2-positive breast cancer and initiated several targeted therapies and more personalized treatment strategies. Over the years, multiple HER2-targeting drugs stepped into clinical practice, for the curative as well as the metastatic situation. This review summarizes the targeted treatment options in HER2-positive breast cancer and their current impact in the clinical routine. Results of the most outstanding trials in HER2-targeted therapies and important ongoing trials are subsequently described for an up-to-date overview.
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Affiliation(s)
- Amelie Schramm
- Department of Gynecology and Obstetrics, University Hospital Ulm, Germany
| | | | | | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Germany
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Vorwerk E, Degregorio N, Huober J, Fink V, Schramm A, Salmen J, Janni W, Ebner F. Unterscheidet sich die postoperative Seromproduktion in der Brust und Axilla bei Patientinnen mit bzw. ohne neoadjuvanter Chemotherapie? Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Perabò M, Fink V, Günthner-Biller M, von Bodungen V, Friese K, Dian D. Prophylactic mastectomy with immediate reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via a transmammary route: a novel surgical approach to female BRCA-mutation carriers. Arch Gynecol Obstet 2014; 289:1325-30. [PMID: 24389920 DOI: 10.1007/s00404-013-3133-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/12/2013] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Breast reconstruction with salpingo-oophorectomy can easily be performed in patients with genetic mutations increasing the risk for mammary and ovarian carcinoma. However, many patients are skeptical about having several surgeries, as they may result in additional anesthesiological risks as well as multiple visible scars. Therefore, the purpose of this study was to evaluate the feasibility of prophylactic mastectomy and breast reconstruction combined with simultaneous transmammary salpingo-oophorectomy for BRCA carriers. MATERIALS AND METHODS Of the six patients (1 %) who chose prophylactic mastectomy with salpingo-oophorectomy at our hospital four patients had BRCA-1 mutations, one patient had a BRCA-2 mutation and one patient had a family inheritance pattern with no mutations. All patients chose to reduce their risk for mammary and ovarian cancer by undergoing bilateral mastectomy and bilateral salpingo-oophorectomy. Prophylactic mastectomy with immediate reconstruction was performed, followed by bilateral salpingo-oophorectomy with a procedure that relies on transmammary access and reduces the number of necessary surgeries without compromising cosmetic results, surgical risks and operating time. RESULT The mean age of the patients was 46.7 ± 1.8 years (SD). The mean operative time was 190.2 ± 13.7 min. No complications were observed during the operations. The mean intra-operative loss of blood was 363.3 ± 77.9 ml. The operative method was successful in all six cases and was performed with no complications. All of the patients were satisfied with the cosmetic results. CONCLUSION In conclusion, prophylactic mastectomy and breast reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via transmammary access is feasible, easy to perform and provides an intriguing and novel approach to female BRCA carriers who desire operative prophylactic measures in one surgical session with no visible abdominal scars and no additional risks and complications.
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Affiliation(s)
- Marta Perabò
- 1st Department of Obstetrics and Gynecology, Campus Innenstadt, Ludwig-Maximilians-University Munich, Maistrasse 11, 80337, Munich, Germany
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Masys DR, Fang F, Ye I, Fink V, Gotuzzo E, Padgett D, Pape JW, Cortes C, Bacon M, Schechter M. Preliminary findings on cancer incidence in HIV-infected persons from six countries in Central and South America and the Caribbean. Infect Agent Cancer 2009. [PMCID: PMC4261722 DOI: 10.1186/1750-9378-4-s2-o18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Sued O, Lattner J, Gun A, Patterson P, Abusamra L, Cesar C, Fink V, Krolewiecki A, Cahn P. Use of darunavir and enfuvirtide in a pregnant woman. Int J STD AIDS 2008; 19:866-7. [DOI: 10.1258/ijsa.2008.008075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 41-year-old pregnant woman with multiple virological failures started darunavir, enfuvirtide, zidovudine and lamivudine at week 28 of pregnancy. During week 38, the patient had a viral load <400 copies/mL and a CD4 count of 180 cells/mm3 (13%). The child was found to be in good health, with negative HIV-polymerase chain reactions at birth, at two and at six months.
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Affiliation(s)
- O Sued
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - J Lattner
- Hospital Fernández, Servicio de Infectologia, CP1425 Buenos Aires, Argentina
| | - A Gun
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - P Patterson
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - L Abusamra
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - C Cesar
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - V Fink
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - A Krolewiecki
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - P Cahn
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
- Hospital Fernández, Servicio de Infectologia, CP1425 Buenos Aires, Argentina
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Mueller-Holzner E, Fink V, Frede T, Marth C. Immunohistochemical determination of HER2 expression in breast cancer from core biopsy specimens: a reliable predictor of HER2 status of the whole tumor. Breast Cancer Res Treat 2001; 69:13-9. [PMID: 11759824 DOI: 10.1023/a:1012281221647] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [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: 11/12/2022]
Abstract
HER2 overexpression in breast cancer is associated with a poor prognosis, resistance to endocrine therapy and chemosensitivity to anthracyclines and paclitaxel. Moreover, trastuzumab (Herceptin) shows therapeutic benefit in patients with HER2 overexpressing tumors. Therefore, knowledge of the pretherapeutical HER2 status allows an optimal selection of patients for treatment. In addition to a definitive histological diagnosis, core biopsies of tumors offer the opportunity to evaluate the HER2 status preoperatively. In 64 patients with invasive breast cancer, sections of core biopsies and of the subsequently removed whole tumor were investigated immuno-histochemically with the DAKO HercepTest. Fifteen tumors (23%) revealed HER2 overexpression, and 44 tumors (69%) were negative in both, the core biopsy and the whole tumor sections. Two core biopsies were negative whereas the corresponding final specimen was 2+ positive. In 3 cases weak overexpression was observed in the core biopsy, but the whole tumor was negative. The overall concordance of the results achieved at core biopsy and whole tumor sections was 92% (kappa = 0.8). A negative HER2 result on core biopsy was never associated with a score 3+ tumor specimen nor was there a case of negative whole tumor specimen with a preceding 3+ score in the biopsy. If one demands the highest degree of overexpression (3+), 100% of our study patients would have been selected correctly using the results on core biopsy alone. We thus conclude, that the immunohistochemical investigation of core biopsies offers the opportunity for a valid preoperative estimation of HER2 overexpression.
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Affiliation(s)
- E Mueller-Holzner
- Department of Obstetrics and Gynecology, Innsbruck University Hospital, Austria.
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