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Lüftner D, Schuetz F, Schneeweiss A, Hartkopf A, Bloch W, Decker T, Uleer C, Stötzer O, Foerster F, Schmidt M, Mundhenke C, Tesch H, Jackisch C, Fischer T, Kreuzeder J, Guderian G, Fasching PA. Efficacy and safety of everolimus plus exemestane in patients with hormone receptor-positive, HER-2-negative advanced breast cancer: Results from the open-label, multicentre, non-interventional BRAWO study. Int J Cancer 2024; 155:128-138. [PMID: 38447007 DOI: 10.1002/ijc.34912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
BRAWO, a real-world study, assessed the efficacy, quality of life (QoL) and safety of EVE + EXE in postmenopausal women with HR+/HER2- advanced breast cancer (ABC) in routine clinical practice. Postmenopausal women with HR+/HER2-ABC with recurrence or progression after a NSAI were included. Primary Observation parameters included the evaluation of the effectiveness of EVE + EXE. A multivariate-analysis using Cox proportional hazard model was built to identify predictors of progression. Overall, 2100 patients were enrolled (August 2012-December 2017); 2074 were evaluable for efficacy and safety analyses. Majority of patients (60.6%) received EVE + EXE as first (28.7%) or second-line (31.9%) therapy. Visceral metastases were present in 54.1% patients. Median progression-free survival (mPFS) reported as 6.6 months (95%CI: 6.3-7.0). Multivariate-analysis in a subset of patients (n = 1837) found higher body mass index (BMI) and non-visceral metastases to be independent predictors of favorable PFS. Patients with a BMI of 20 to <25 had a mPFS of 6.0 (95%CI: 5.4-6.4) and those with a BMI ≥30 had mPFS of 8.5 (95%CI: 6.9-9.9). 41.2% patients achieved stable disease and 7.3% partial response. No major changes were observed QoL; 86.4% patients received stomatitis prophylaxis and 41.4% experienced EVE related AEs of stomatitis, mainly low grade. AEs occurred in 91.2% of patients, of which stomatitis (42.6%) and fatigue (19.8%) were most frequent. The BRAWO study provides real-world evidence of efficacy and safety of EVE + EXE in patients with HR+, HER2- ABC. A high BMI and the absence of visceral metastases were independent predictors of PFS in this cohort of patients.
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Affiliation(s)
- Diana Lüftner
- Medical University of Brandenburg Theodor Fontane, Campus Rüdersdorf and Immanuel Hospital Märkische Schweiz, Buckow, Germany
| | | | - Andreas Schneeweiss
- Division of Gynecologic Oncology, National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Andreas Hartkopf
- Department of Women's Health, Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | | | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Christoph Uleer
- Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | | | | | - Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | - Hans Tesch
- Oncological Practice Bethanien, Frankfurt, Germany
| | | | | | | | | | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Krug D, Banys-Paluchowski M, Brucker SY, Denkert C, Ditsch N, Fasching PA, Haidinger R, Harbeck N, Heil J, Huober J, Jackisch C, Janni W, Kolberg HC, Loibl S, Lüftner D, van Mackelenbergh M, Radosa JC, Reimer T, Welslau M, Würstlein R, Untch M, Budach W. Radiotherapy statements of the 18th St. Gallen International Breast Cancer Consensus Conference-a German expert perspective. Strahlenther Onkol 2024; 200:461-467. [PMID: 38393398 DOI: 10.1007/s00066-024-02209-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To summarize the radiotherapy-relevant statements of the 18th St. Gallen Breast Cancer Consensus Conference and interpret the findings in light of German guideline recommendations. METHODS Statements and voting results from the 18th St. Gallen International Breast Cancer Consensus Conference were collected and analyzed according to their relevance for the radiation oncology community. The voting results were discussed in two hybrid meetings among the authors of this manuscript on March 18 and 19, 2023, in light of the German S3 guideline and the 2023 version of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) guidelines. RESULTS AND CONCLUSION There was a high level of agreement between the radiotherapy-related statements of the 18th St. Gallen International Breast Cancer Consensus Conference and the German S3 and AGO guidelines. Discrepancies include the impact of number of lymph node metastases for the indication for postmastectomy radiotherapy.
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Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany.
| | - Maggie Banys-Paluchowski
- Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | | | - Carsten Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Peter A Fasching
- Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Nadia Harbeck
- Brustzentrum, Frauenklinik, LMU Klinikum München, Munich, Germany
| | - Jörg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
- Medizinische Fakultät, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana-Klinikum Offenbach GmbH, Offenbach, Germany
| | | | | | - Sibylle Loibl
- German Breast Group (GBG), Neu-Isenburg, Germany
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz, Buckow, Germany
- Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf/Berlin, Germany
| | - Marion van Mackelenbergh
- Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Julia C Radosa
- Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik, Klinikum Südstadt Rostock, Rostock, Germany
| | - Manfred Welslau
- Onkologie Aschaffenburg, Hämato-Onkologische Schwerpunktpraxis, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Rachel Würstlein
- Brustzentrum, Frauenklinik, LMU Klinikum München, Munich, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Ditsch N, Untch M, Fasching PA, Busch S, Ettl J, Haidinger R, Jackisch C, Lüftner D, Müller L, Müller V, Ruckhäberle E, Schumacher-Wulf E, Thomssen C, Harbeck N, Wuerstlein R. ABC7 Consensus: Assessment by a German Group of Experts. Breast Care (Basel) 2024; 19:116-128. [PMID: 38638343 PMCID: PMC11023691 DOI: 10.1159/000535997] [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: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 04/20/2024] Open
Abstract
Background The "International Consensus Conference for Advanced Breast Cancer" was initiated more than 10 years ago. The rationale was to standardize treatment of advanced breast cancer (ABC) based on available evidence and to ensure that all ABC patients worldwide receive adequate treatment and access to new therapies. Topics of ABC7 The 7th International Consensus Conference for ABC (ABC7) took place from November 9 to 11, 2023 - as in previous years in Lisbon/Portugal. ABC7 focused not only on metastatic disease but also on locally advanced and inflammatory breast cancer. Special topics were the management of oligometastatic disease, leptomeningeal disease, brain metastases, and pregnant women with ABC. Due to the current situation worldwide, there was a special interest to patients living in conflict zones. As in previous years, patient advocates from around the world were integrated into the ABC conference and had a major input to the consensus. Rationale for the Manuscript A German breast cancer expert panel comments on the voting results of the ABC7 panelists regarding their relevance for routine clinical practice in Germany. As with previous meetings, the ABC7 votes focused on modified or new statements. Regarding the statements not modified for the ABC7 consensus, they are discussed in the published manuscript from 2021 in which the German experts commented on the ABC6 consensus. The German comments are always based on the current recommendations of the "Breast Committee" of the Gynecological Oncology Working Group (Arbeitsgemeinschaft Gynäkologische Onkologie, AGO Mamma).
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Affiliation(s)
- Nina Ditsch
- Department of Gynecology and Obstetrics, Breast Cancer Center, University Hospital Augsburg, Augsburg, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Multidisciplinary Breast Cancer and Gynecologic Oncology Center, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Peter A. Fasching
- Women’s Hospital at the University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Steffi Busch
- Onkologische Schwerpunktpraxis, Dr. Busch MVZ GmbH, Mühlhausen, Germany
| | - Johannes Ettl
- Department of Gynecology and Obstetrics, Clinic for Hematology, Oncology and Palliative Care, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Kempten, Germany
| | - Renate Haidinger
- Brustkrebs Deutschland e.V.; Patient Advocate, Board Member ABC Global Alliance, Munich, Germany
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach, Offenbach, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow, Germany, and Immanuel Hospital Rüdersdorf, Medical University of Brandenburg, Rüdersdorf, Germany
| | - Lothar Müller
- Onkologie UnterEms, Studienzentrum UnterEms, Leer, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hospital, Hamburg-Eppendorf, ABC7 Panel Member, Hamburg, Germany
| | - Eugen Ruckhäberle
- Department of Obstetrics and Gynecology of The Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eva Schumacher-Wulf
- Mamma Mia! Breast cancer magazine, Patient Advocate, Co-chair, ABC7 Panel Member, Köln, Germany
| | | | - Nadia Harbeck
- Breast Center and Comprehensive Cancer Center (CCC) Munich, University of Munich (LMU), Department of Obstetrics and Gynecology, ABC7 Panel Member, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center and Comprehensive Cancer Center (CCC) Munich, University of Munich (LMU), Department of Obstetrics and Gynecology, Munich, Germany
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Harbeck N, Wrobel D, Zaiss M, Terhaag J, Guth D, Distelrath A, Zahn MO, Wuerstlein R, Lorenz A, Bartsch R, Breitenstein U, Schwitter M, Balic M, Jackisch C, Müller V, Rinnerthaler G, Schmidt M, Zaman K, Schinköthe T, Resch A, Valenti R, Lüftner D. Neratinib as Extended Adjuvant Treatment of HER2-Positive/HR-Positive Early Breast Cancer Patients in Germany, Austria, and Switzerland: Interim Results of the Prospective, Observational ELEANOR Study. Breast Care (Basel) 2024; 19:1-9. [PMID: 38384488 PMCID: PMC10878708 DOI: 10.1159/000533657] [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: 01/30/2023] [Accepted: 08/15/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction Prognosis of patients diagnosed with HER2+ early breast cancer (eBC) has substantially improved, but distant recurrences impacting quality of life and survival still occur. One treatment option for extended adjuvant treatment of patients with HER2+/HR+ eBC is neratinib, available in Europe for patients who completed adjuvant trastuzumab-based therapy within 1 year. The ELEANOR study is investigating the real-world use of neratinib in Germany, Austria, and Switzerland. Results from an interim analysis of the first 200 patients observed for ≥3 months are reported. Methods The primary objective of this prospective, multicenter, observational study is to assess patient adherence to neratinib (defined as the percentage of patients taking neratinib on ≥75% prescribed days). Secondary objectives are patient characteristics and treatment outcomes. Results At cut-off (May 2, 2022), a total of 202 patients had been observed for ≥3 months, with neratinib treatment documented for 187 patients (median age: 53.0 years; 67.9% at increased risk of disease recurrence). In total, 151 (80.7%) patients had received prior neoadjuvant treatment; of these, 82 (54.3%) patients achieved a pathologically complete response. Neratinib was initiated at a median 3.6 months after trastuzumab-based treatment, with 36.4% starting at a dose <240 mg/day. Treatment is ongoing for 46.0% of patients, with median treatment duration of 11.2 (interquartile range 0.9-12.0) months. Diarrhea was the most common adverse event (78.6% any grade, 20.3% grade ≥3); pharmacologic prophylaxis was used in 85.6% of patients. Conclusions The pattern of anti-HER2 pretreatment observed reflected the current treatment for HER2+/HR+ eBC in Germany, Austria, and Switzerland. These interim results suggest that neratinib as an extended adjuvant is a feasible option after various anti-HER2 pretreatments and that its tolerability can be managed and improved with proactive diarrhea management.
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Affiliation(s)
- Nadia Harbeck
- Department of Obstetrics and Gynecology and CCC Munich, Breast Center, LMU University Hospital, Munich, Germany
| | - Denise Wrobel
- Sozialstiftung Bamberg Klinikum am Bruderwald, Bamberg, Germany
| | - Matthias Zaiss
- Praxis fuer Interdisziplinaere Onkologie, Freiburg, Germany
| | | | - Dagmar Guth
- Gyneco-Oncological Practice Dr. Guth, Plauen, Germany
| | | | | | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology and CCC Munich, Breast Center, LMU University Hospital, Munich, Germany
| | - Andreas Lorenz
- Gyneco-Oncological Practice Dr. Lorenz, Hildburghausen, Germany
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | | | - Marija Balic
- Divison of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Klinikum Offenbach, Offenbach, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Marcus Schmidt
- Department of Gynecology, University Hospital Mainz, Mainz, Germany
| | - Khalil Zaman
- Breast Center, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | - Anna Resch
- Pierre Fabre Pharma GmbH, Freiburg, Germany
| | | | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz & Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
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Fasching PA, Decker T, Hartkopf A, Nusch A, Heinrich BJ, Kurbacher C, Fuchs R, Tesch H, Krabisch P, Huober J, Kuemmel S, Brucker S, Janni W, Schneeweiss A, Schuler M, Fehm T, Lüftner D, Quiering C, Voges C, Kreuzeder J, Reinisch M. Efficacy, safety, and prognosis prediction in patients treated with ribociclib in combination with letrozole: Final results of phase 3b RIBECCA study in hormone receptor positive, human epidermal growth factor receptor-2 negative, locally advanced or metastatic breast cancer. Eur J Cancer 2024; 198:113480. [PMID: 38154393 DOI: 10.1016/j.ejca.2023.113480] [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: 09/27/2023] [Accepted: 12/03/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND In MONALEESA-2, addition of ribociclib to letrozole resulted in significantly longer progression-free survival (PFS) in postmenopausal women with HR+HER2- advanced breast cancer (ABC). RIBociclib for the treatment of advanCed breast CAncer (RIBECCA) study investigated ribociclib plus letrozole in a patient population reflecting routine clinical practice. PATIENTS AND METHODS In this multicenter, open-label, single-arm, phase 3b study, patients with HR+HER2- ABC not amenable to curative therapy and ECOG performance status ≤ 2 received ribociclib plus letrozole (cohort A: postmenopausal women and men in first-line; cohort B: pre-/perimenopausal women in first-line [B1], patients pretreated for advanced disease [B2]). The primary endpoint was clinical benefit rate (CBR) by week 24; secondary endpoints included overall response rate (ORR), PFS, overall survival (OS), and safety. Association of patient and tumor characteristics with PFS was analyzed by multivariable Cox regression analysis. RESULTS Overall, 487 patients were evaluable for efficacy, 502 for safety. By week 24, CBR was 60.8 % (95 % CI, 56.3-65.1), ORR was 19.3 % (95 % CI, 15.9-23.1). Median PFS was 21.8 months (95 % CI, 13.9-25.3) in first-line postmenopausal patients and 11.0 months (95 % CI, 8.2-16.4) in premenopausal and pretreated patients. Median OS was not reached. Higher baseline ECOG performance status, higher histological grade, and negative progesterone receptor status showed an unfavorable effect on PFS. Most common adverse events were neutropenia (50.0 %), nausea (42.0 %), and fatigue (39.2 %). CONCLUSION In this broad population of patients with HR+HER2- ABC, efficacy and safety results of ribociclib plus letrozole were similar to those observed in pivotal trials.
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Affiliation(s)
- Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | | | - Andreas Hartkopf
- University of Tübingen, Department of Gynecology and Obstetrics, Germany
| | - Arnd Nusch
- Practice for Hematology and Internal Oncology, Velbert, Germany
| | | | - Christian Kurbacher
- Gynecology I (Gynecologic Oncology), Gynecologic Center Bonn-Friedensplatz, Bonn, Germany
| | - Roswitha Fuchs
- Outpatient-Centre for Haematology and Oncology, Langen, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
| | - Petra Krabisch
- Department of Gynecology and Obstetrics, Klinikum Chemnitz, Chemnitz, Germany
| | - Jens Huober
- Department of Interdisciplinary Medical Services, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; University Hospital Ulm, Ulm, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken-Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Sara Brucker
- University of Tübingen, Department of Gynecology and Obstetrics, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - Martin Schuler
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner SiteUniversity Hospital Essen, Essen, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology, and Tumor Immunology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | | | | | | | - Mattea Reinisch
- Breast Unit, Kliniken-Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
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Harbeck N, Kates R, Schinköthe T, Schumacher J, Wuerstlein R, Degenhardt T, Lüftner D, Räth P, Hoffmann O, Lorenz R, Decker T, Reinisch M, Göhler T, Staib P, Gluz O, Fasching PA, Schmidt M. Favorable impact of therapy management by an interactive eHealth system on severe adverse events in patients with hormone receptor-positive, HER2-negative locally advanced or metastatic breast cancer treated by palbociclib and endocrine therapy. Cancer Treat Rev 2023; 121:102631. [PMID: 37862832 DOI: 10.1016/j.ctrv.2023.102631] [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: 07/20/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Oral cancer medications offer advantages but also pose challenges for therapy management and adherence. An eHealth-based platform such as CANKADO can help to support therapy management by probing the patient's quality of life (QoL) continuously throughout the course of treatment. MATERIAL AND METHODS AGO-B WSG PreCycle (NCT03220178) is a multicenter, randomized phase IV intergroup trial evaluating the impact of eHealth-based Patient-Reported Outcome (ePRO) assessment on QoL in patients with hormone receptor-positive (HR + )/HER2-negative (HER2-) advanced breast cancer treated with palbociclib and endocrine therapy. Patients were randomized (2:1) to CANKADO-active arm (supported by CANKADO PRO-React) or CANKADO-inform arm (drug intake documentation only) This exploratory analysis reports the impact of CANKADO PRO-React on safety. Time to first serious adverse event (SAE) was estimated taking competing risks into account. RESULTS While distributions of adverse events (AEs) were similar by arm overall, patients in the CANKADO-active arm had a favorable hazard ratio of 0.67 (95%CI 0.46-0.97; p = 0.04) for time to first SAE and were significantly less likely overall to suffer an SAE than patients in the inform arm. At 24 months, 22.9% [17.9%-27.8%] of patients in CANKADO-active had suffered an SAE vs. 30.3% [22.6%-38.0%] in CANKADO-inform. AE-related dose reductions affected approximately 20% of patients (CANKADO-active: 18.2%, CANKADO-inform: 21.1%). CONCLUSION Exploratory safety analysis of PreCycle demonstrates for the first time in a randomized prospective trial that interactive autonomous eHealth-based support has a substantial favorable impact on the risk of SAEs and mitigates their severity for patients with advanced HR+/HER2- breast cancer on oral tumor therapy.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany; West German Study Group, Moenchengladbach, Germany.
| | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Timo Schinköthe
- CANKADO GmbH, Ottobrunn, Germany; Research Center Smart Digital Health, University of the Bundeswehr Munich, Neubiberg, Germany
| | | | - Rachel Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany; West German Study Group, Moenchengladbach, Germany
| | - Tom Degenhardt
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany; Hausarztpraxis Wolfratshausen, Wolfratshausen, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische, Schweiz Buckow, Germany; Immanuel Hospital Rüdersdorf and Medical University of Brandenburg Theodor Fontane, Germany
| | | | | | - Ralf Lorenz
- Studien GbR Braunschweig, Braunschweig, Germany
| | - Thomas Decker
- Onkologie Ravensburg, Hematology / Oncology, Ravensburg, Germany
| | - Mattea Reinisch
- Breast Center, Kliniken Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | | | - Peter Staib
- St.-Antonius Hospital gGmbH, Clinic for Hematology and Oncology, Eschweiler, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | - Peter A Fasching
- University Hospital Erlangen, Obstetrics and Gynecology, Erlangen, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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7
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Schmoranz K, Schötz C, Merkel D, Lüftner D. How detection of immune-related adverse events fails during transfer of patients between medical sectors. J Cancer Res Clin Oncol 2023; 149:14465-14470. [PMID: 37515612 DOI: 10.1007/s00432-023-05203-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/22/2023] [Indexed: 07/31/2023]
Abstract
Immune-related adverse events (irAEs) induced by immune checkpoint inhibitors (ICIs) in mono- or combination therapy may be acute or delayed, partly arising long after termination of treatment. They may be reversible or persistent. Treatment duration with ICIs is usually one year in the adjuvant setting of solid tumors, and until progression or inacceptable toxicity in metastatic disease. In the case of a response in the palliative setting, a patient may be on treatment for many years, based on individual decision making. Thus, every patient is at risk of experiencing clinically highly relevant side effects for a very long time when she/he may be transferred between many sectors of acute medicine including intensive care units (ICUs) until later rehabilitation procedures and observation by general practitioners. While actively treating oncologists in hospitals and outpatient departments have already covered a long (and partly harmful) learning curve, most physicians in other sectors like ICUs or rehabilitation hospitals have not seen many patients and these dangerous side effects to a larger extent, and thus have not trained their awareness and clinical knowledge. In most cases, irAEs appeared before the admission of the patients to their institutions, and they are only asked to control preexisting medications. Only intersectoral education and communication can help to safely overcome this gap and lag time until all medical specialties have gained sufficient experience and gone through their learning processes.
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Affiliation(s)
- Kerstin Schmoranz
- Immanuel Hospital Märkische Schweiz, Lindenstraße 68-70, 15377, Buckow, Germany
| | - Cathrin Schötz
- Immanuel Hospital Märkische Schweiz, Lindenstraße 68-70, 15377, Buckow, Germany
| | - Daniel Merkel
- Medical University of Brandenburg Theodor Fontane, Immanuel Campus Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Lindenstraße 68-70, 15377, Buckow, Germany.
- Medical University of Brandenburg Theodor Fontane, Immanuel Campus Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
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8
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Untch M, Banys-Paluchowski M, Brucker SY, Budach W, Denkert C, Ditsch N, Fasching PA, Haidinger R, Heil J, Jackisch C, Janni W, Kolberg HC, Krug D, Loibl S, Lüftner D, van Mackelenbergh M, Radosa JC, Reimer T, Welslau M, Würstlein R, Harbeck N, Huober J. Treatment of Early Breast Cancer: The 18th St. Gallen International Breast Cancer Consensus Conference against the Background of Current German Treatment Recommendations. Geburtshilfe Frauenheilkd 2023; 83:1102-1116. [PMID: 37706057 PMCID: PMC10497346 DOI: 10.1055/a-2121-2495] [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: 04/25/2023] [Accepted: 06/29/2023] [Indexed: 09/15/2023] Open
Abstract
This year's 18th St. Gallen (SG) consensus conference on the treatment of early breast cancer (SGBCC: St. Gallen International Breast Cancer Conference) focused on practice-oriented questions. The individual situation and risk-benefit assessment were discussed in great detail. As in previous years, a German working group of leading breast cancer experts presented the results of the international SGBCC 2023 against the background of German treatment recommendations - especially the updated treatment recommendations of the Arbeitsgemeinschaft Gynäkologische Onkologie e. V. (AGO) - for everyday clinical practice in Germany. The German treatment recommendations of AGO are based on the current evidence. The comparison with the clinical approach in Germany has proven useful, as the SGBCC panel consists of experts from different countries and disciplines. That is why country-specific characteristics can be incorporated into the SGBCC recommendations.
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Affiliation(s)
- Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | | | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Carsten Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Peter A. Fasching
- Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Jörg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
- Medizinische Fakultät Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana-Klinikum Offenbach GmbH, Offenbach, Germany
| | | | | | - David Krug
- Klinik für Strahlentherapie (Radioonkologie), Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sibylle Loibl
- German Breast Group (GBG), Neu-Isenburg, Germany
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz, Buckow, Germany
- Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Germany
| | - Marion van Mackelenbergh
- Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Julia C. Radosa
- Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock, Germany
| | - Manfred Welslau
- Onkologie Aschaffenburg, Hämato-Onkologische Schwerpunktpraxis am Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Rachel Würstlein
- Brustzentrum, Frauenklinik, LMU Klinikum München, München, Germany
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik, LMU Klinikum München, München, Germany
| | - Jens Huober
- Brustzentrum Kantonsspital St. Gallen, St. Gallen, Switzerland
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9
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Kolberg HC, Hartkopf AD, Fehm TN, Welslau M, Müller V, Schütz F, Fasching PA, Janni W, Witzel I, Thomssen C, Beierlein M, Belleville E, Untch M, Thill M, Tesch H, Ditsch N, Lux MP, Aktas B, Banys-Paluchowski M, Kolberg-Liedtke C, Wöckel A, Harbeck N, Stickeler E, Bartsch R, Schneeweiss A, Ettl J, Krug D, Taran FA, Lüftner D, Würstlein R. Update Breast Cancer 2023 Part 3 - Expert Opinions of Early Stage Breast Cancer Therapies. Geburtshilfe Frauenheilkd 2023; 83:1117-1126. [PMID: 37706055 PMCID: PMC10497347 DOI: 10.1055/a-2143-8125] [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: 06/29/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023] Open
Abstract
The St. Gallen (SG) International Breast Cancer Conference is held every two years, previously in St. Gallen and now in Vienna. This year (2023) marks the eighteenth edition of this conference, which focuses on the treatment of patients with early-stage breast carcinoma. A panel discussion will be held at the end of this four-day event, during which a panel of experts will give their opinions on current controversial issues relating to the treatment of early-stage breast cancer patients. To this end, questions are generally formulated in such a way that clinically realistic cases are presented - often including poignant hypothetical modifications. This review reports on the outcome of these discussions and summarises the data associated with individual questions raised.
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Affiliation(s)
| | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Isabell Witzel
- Universitätsspital Zürich, Klinik für Gynäkologie, Zürich, Switzerland
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Milena Beierlein
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | | | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Bahriye Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany
| | - Rupert Bartsch
- Medical University of Vienna, Department of Medicine I, Division of Oncology, Vienna, Austria
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Johannes Ettl
- Klinikum Kempten, Klinikverbund Allgäu, Klinik für Frauenheilkunde und Gynäkologie, Kempten, Germany
| | - David Krug
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Strahlentherapie, Kiel, Germany
| | - Florin-Andrei Taran
- Department of Gynecology and Obstetrics, University Hospital Freiburg, Freiburg, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow, Germany
- Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
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10
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Park-Simon TW, Müller V, Jackisch C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Ditsch N, Fallenberg EM, Fasching PA, Fehm T, Friedrich M, Gerber B, Gluz O, Harbeck N, Hartkopf AD, Heil J, Huober J, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Wuerstlein R, Janni W, Thill M. Arbeitsgemeinschaft Gynäkologische Onkologie Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2023. Breast Care (Basel) 2023; 18:289-305. [PMID: 37900552 PMCID: PMC10601667 DOI: 10.1159/000531578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 10/31/2023] Open
Abstract
Background Each year the interdisciplinary Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), German Gynecological Oncology Group Breast Committee on Diagnosis and Treatment of Breast Cancer provides updated state-of-the-art recommendations for early and metastatic breast cancer. Summary The updated evidence-based treatment recommendation for early and metastatic breast cancer has been released in March 2023. Key Messages This paper concisely captures the updated recommendations for early breast cancer chapter by chapter.
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Affiliation(s)
- Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie und Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Klinik für Gynäkologie und Geburtshilfe, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Eva Maria Fallenberg
- Institut für diagnostische und Interventionelle Radiologie, Klinikum der Technischen Universität München, Rechts der Isar, Munich, Germany
| | - Peter A. Fasching
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld GmbH, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Andreas D. Hartkopf
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Joerg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth und Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Cornelia Kolberg-Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Phaon GmbH, Wiesbaden, Germany
| | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz (Buckow) & Immanuel Klinik Rüdersdorf/Medizinische Hochschule Brandenburg Theodor Fontane (Rüdersdorf), Rüdersdorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Centrum für Integrierte Onkologie (CIO), Universitätsklinikum Köln, Cologne, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Zurich, University of Zurich, Zurich, Switzerland
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Rachel Wuerstlein
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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11
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Thill M, Kolberg-Liedtke C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Ditsch N, Fallenberg EM, Fasching PA, Fehm T, Friedrich M, Gerber B, Gluz O, Harbeck N, Hartkopf AD, Heil J, Huober J, Jackisch C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Müller V, Würstlein R, Janni W, Park-Simon TW. AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2023. Breast Care (Basel) 2023; 18:306-315. [PMID: 37900553 PMCID: PMC10601669 DOI: 10.1159/000531579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 10/31/2023] Open
Abstract
The Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO) presents the 2023 update of the evidence-based recommendations for the diagnosis and treatment of patients with locally advanced and metastatic breast cancer (mBC).
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Affiliation(s)
- Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | | | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Eva Maria Fallenberg
- Institut für Klinische Radiologie, Klinikum der Universität München Campus Großhadern, Munich, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang, Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Andreas D. Hartkopf
- Department für Frauengesundheit, Forschungsinstitut für Frauengesundheit, Universitätsfrauenklinik, Tübingen, Germany
| | - Jörg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Fachklinik für Onkologische Rehabilitation, Immanuel Hospital Märkische Schweiz, Buckow & Immanuel Hospital Rüdersdorf/Medical University of Brandenburg Theodor Fontane, Rüdersdorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik für Gynäkologie, Universitäts Spital, Zürich, Switzerland
| | - Achim Wöckel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Rachel Würstlein
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Wolfgang Janni
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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12
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Lux MP, Hartkopf AD, Fehm TN, Welslau M, Müller V, Schütz F, Fasching PA, Janni W, Witzel I, Thomssen C, Beierlein M, Belleville E, Untch M, Thill M, Tesch H, Ditsch N, Aktas B, Banys-Paluchowski M, Kolberg-Liedtke C, Wöckel A, Kolberg HC, Harbeck N, Bartsch R, Schneeweiss A, Ettl J, Würstlein R, Krug D, Taran FA, Lüftner D, Stickeler E. Update Breast Cancer 2023 Part 2 - Advanced-Stage Breast Cancer. Geburtshilfe Frauenheilkd 2023; 83:664-672. [PMID: 37916184 PMCID: PMC10617389 DOI: 10.1055/a-2074-0125] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 11/03/2023] Open
Abstract
In recent years, a number of new therapies have led to advances in the treatment of patients with advanced breast carcinoma. These substances are mainly CDK4/6 inhibitors and other substances that can overcome endocrine resistance, oral selective estrogen receptor degraders, antibody drug conjugates (ADCs), and PARP inhibitors. This review summarizes and evaluates the latest study results that have been published in recent months. This includes the overall survival data of the Destiny-Breast03 study, the first analysis of the CAPItello-291 study, the comparison of CDK4/6 inhibitor treatment with chemotherapy in the first line of therapy (RIGHT Choice study), the first analysis of the Destiny-Breast02 study in the treatment setting after T-DM1 treatment, and the first analysis of the Serena-2 study. Most of these studies have the potential to significantly change the therapeutic landscape for patients with advanced breast carcinoma and show that the continued rapid development of new therapies is always producing new results.
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Affiliation(s)
- Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg,
Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Isabell Witzel
- Klinik für Gynäkologie, Universitätsspital Zürich, Zürich, Switzerland
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Milena Beierlein
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg,
Erlangen, Germany
| | | | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Bahriye Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | | | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, München, Germany
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Johannes Ettl
- Klinik für Frauenheilkunde und Gynäkologie, Klinikum Kempten, Klinikverbund Allgäu, Kempten, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, München, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinkum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Florin-Andrei Taran
- Department of Gynecology and Obstetrics, University Hospital Freiburg, Freiburg, Germany
| | - Diana Lüftner
- Medical University of Brandenburg Theodor-Fontane, Immanuel Hospital Märkische Schweiz, Buckow, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany
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13
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Hartkopf AD, Fehm TN, Welslau M, Müller V, Schütz F, Fasching PA, Janni W, Witzel I, Thomssen C, Beierlein M, Belleville E, Untch M, Thill M, Tesch H, Ditsch N, Lux MP, Aktas B, Banys-Paluchowski M, Kolberg-Liedtke C, Wöckel A, Kolberg HC, Harbeck N, Stickeler E, Bartsch R, Schneeweiss A, Ettl J, Würstlein R, Krug D, Taran FA, Lüftner D. Update Breast Cancer 2023 Part 1 - Early Stage Breast Cancer. Geburtshilfe Frauenheilkd 2023; 83:653-663. [PMID: 37916183 PMCID: PMC10617391 DOI: 10.1055/a-2074-0551] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 11/03/2023] Open
Abstract
With abemaciclib (monarchE study) and olaparib (OlympiA study) gaining approval in the adjuvant treatment setting, a significant change in the standard of care for patients with early stage breast cancer has been established for some time now. Accordingly, some diverse developments are slowly being transferred from the metastatic to the adjuvant treatment setting. Recently, there have also been positive reports of the NATALEE study. Other clinical studies are currently investigating substances that are already established in the metastatic setting. These include, for example, the DESTINY Breast05 study with trastuzumab deruxtecan and the SASCIA study with sacituzumab govitecan. In this review paper, we summarize and place in context the latest developments over the past months.
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Affiliation(s)
- Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics; Comprehensive Cancer Center Erlangen EMN, Friedrich-Alexander University Erlangen-Nuremberg,
Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Isabell Witzel
- Klinik für Gynäkologie, Universitätsspital Zürich, Zürich, Switzerland
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Milena Beierlein
- Erlangen University Hospital, Department of Gynecology and Obstetrics; Comprehensive Cancer Center Erlangen EMN, Friedrich-Alexander University Erlangen-Nuremberg,
Erlangen, Germany
| | | | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Bahriye Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | | | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, München, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Johannes Ettl
- Klinik für Frauenheilkunde und Gynäkologie, Klinikum Kempten, Klinikverbund Allgäu, Kempten, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, München, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinkum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Florin-Andrei Taran
- Department of Gynecology and Obstetrics, University Hospital Freiburg, Freiburg, Germany
| | - Diana Lüftner
- Medical University of Brandenburg Theodor-Fontane, Immanuel Hospital Märkische Schweiz, Buckow, Germany
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Degenhardt T, Fasching PA, Lüftner D, Müller V, Thomssen C, Schem C, Witzel I, Decker T, Tesch H, Kümmel S, Uleer C, Wuerstlein R, Hoffmann O, Warm M, Marschner N, Schinköthe T, Kates RE, Schumacher J, Otremba B, Zaiss M, Harbeck N, Schmidt M. PRECYCLE: multicenter, randomized phase IV intergroup trial to evaluate the impact of eHealth-based patient-reported outcome (PRO) assessment on quality of life in patients with hormone receptor positive, HER2 negative locally advanced or metastatic breast cancer treated with palbociclib and an aromatase inhibitor or palbociclib and fulvestrant. Trials 2023; 24:338. [PMID: 37198674 DOI: 10.1186/s13063-023-07306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Efficacy and quality of life (QoL) are key criteria for therapy selection in metastatic breast cancer (MBC). In hormone receptor positive (HR +) human epidermal growth factor receptor 2 negative (HER2 -) MBC, addition of targeted oral agents such as everolimus or a cycline-dependent kinase 4/6 (CDK 4/6) inhibitor (e.g., palbociclib, ribociclib, abemaciclib) to endocrine therapy substantially prolongs progression-free survival and in the case of a CDK 4/6i also overall survival. However, the prerequisite is adherence to therapy over the entire course of treatment. However, particularly with new oral drugs, adherence presents a challenge to disease management. In this context, factors influencing adherence include maintaining patients' satisfaction and early detection/management of side effects. New strategies for continuous support of oncological patients are needed. An eHealth-based platform can help to support therapy management and physician-patient interaction. METHODS PreCycle is a multicenter, randomized, phase IV trial in HR + HER2 - MBC. All patients (n = 960) receive the CDK 4/6 inhibitor palbociclib either in first (62.5%) or later line (37.5%) together with endocrine therapy (AI, fulvestrant) according to national guidelines. PreCycle evaluates and compares the time to deterioration (TTD) of QoL in patients supported by eHealth systems with substantially different functionality: CANKADO active vs. inform. CANKADO active is the fully functional CANKADO-based eHealth treatment support system. CANKADO inform is a CANKADO-based eHealth service with a personal login, documentation of daily drug intake, but no further functions. To evaluate QoL, the FACT-B questionnaire is completed at every visit. As little is known about relationships between behavior (e.g., adherence), genetic background, and drug efficacy, the trial includes both patient-reported outcome and biomarker screening for discovery of forecast models for adherence, symptoms, QoL, progression free survival (PFS), and overall survival (OS). DISCUSSION The primary objective of PreCycle is to test the hypothesis of superiority for time to deterioration (TTD) in terms of DQoL = "Deterioration of quality of life" (FACT-G scale) in patients supported by an eHealth therapy management system (CANKADO active) versus in patients merely receiving eHealth-based information (CANKADO inform). EudraCT Number: 2016-004191-22.
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Affiliation(s)
- Tom Degenhardt
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany
- Hausarztpraxis Wolfratshausen, Wolfratshausen, Germany
| | - Peter A Fasching
- Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow, Germany
- Immanuel Hospital Rüdersdorf and Medical University of Brandenburg Theodor Fontane, Brandenburg, Germany
| | - Volkmar Müller
- Clinic and Polyclinic for Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Christoph Thomssen
- Gynecology, Martin-Luther-University Halle-Wittenberg, Halle-Saale, Germany
| | | | - Isabell Witzel
- Clinic and Polyclinic for Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Thomas Decker
- Hematology/Oncology, Onkologie Ravensburg, Ravensburg, Germany
| | - Hans Tesch
- Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt, Germany
| | | | | | - Rachel Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany
- West German Study Group, Moenchengladbach, Germany
| | | | - Mathias Warm
- Breast Center, Academic Hospital Cologne-Holweide, Cologne, Germany
| | | | - Timo Schinköthe
- CANKADO Service GmbH, Kirchheim, Germany
- Research Center Smart Digital Health, University of the Bundeswehr, Neubiberg, Germany
| | | | | | | | - Matthias Zaiss
- Praxis Interdisziplinäre Onkologie U. Hämatologie, Freiburg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany.
- West German Study Group, Moenchengladbach, Germany.
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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15
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Harbeck N, Fasching PA, Würstlein R, Degenhardt T, Lüftner D, Kates RE, Schumacher J, Räth P, Hoffmann O, Lorenz R, Decker T, Reinisch M, Göhler T, Staib P, Gluz O, Schinköthe T, Schmidt M. Significantly longer time to deterioration of quality of life due to CANKADO PRO-React eHealth support in HR+ HER2- metastatic breast cancer patients receiving palbociclib and endocrine therapy: Primary outcome analysis of the multicenter randomized AGO-B WSG PreCycle trial. Ann Oncol 2023:S0923-7534(23)00684-1. [PMID: 37201751 DOI: 10.1016/j.annonc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The multicenter, randomized phase IV intergroup AGO-B WSG PreCycle trial (NCT03220178) evaluated the impact of CANKADO-based ePRO (electronic patient-reported outcomes) assessment on quality of life (QoL) in HR+ HER2- locally advanced or metastatic breast cancer (MBC) patients receiving palbociclib (P) and an aromatase inhibitor or P+fulvestrant. CANKADO PRO-React, an EU-registered medical device, is an interactive autonomous application reacting to patient self-reported observations. PATIENTS AND METHODS Between 2017 and 2021, 499 patients (median age 59 years) from 71 centers were randomized (2:1, stratified by therapy line) between an active version of CANKADO PRO-React (CANKADO-active arm) or a version with limited functionality (CANKADO-inform arm). 412 patients (271 CANKADO-active; 141 CANKADO-inform) were available for analysis of the primary endpoint, time to deterioration (TTD) of QoL (10-point drop on FACT-G), using an Aalen-Johansen estimator for cumulative incidence function of TTD DQoL with 95% pointwise confidence intervals (CI). Secondary endpoints included PFS, OS, and DQoL (QoL deterioration). RESULTS In all pts (ITT-ePRO), cumulative incidence of DQoL was significantly more favorable (lower) in the CANKADO-active arm (HR=0.698, 95%CI [0.506 - 0.963]). Among 1stL patients (n=295), the corresponding HR was 0.716 (0.484-1.060; p=0.09), and in 2ndL patients (n=117) it was 0.661 (0.374-1.168; p=0.2). Absolute patient numbers declined in later visits; FACT-G completion rates were 80% and higher until about visit 30; mean FACT-G scores showed steady decline from baseline and an offset in favor of CANKADO-active. No significant differences in clinical outcome were observed between arms: Median PFS (ITT population) was 21.4 (95%CI 19.4-23.7) (CANKADO-active) and 18.7 (15.1-23.5) months (CANKADO-inform); median OS was not reached (CANKADO-active) and 42.6 months (CANKADO-inform). CONCLUSIONS PreCycle is the first multicenter randomized eHealth trial demonstrating a significant benefit for MBC patients receiving oral tumor therapy when using an interactive autonomous patient empowerment application.
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Affiliation(s)
- N Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; West German Study Group, Statistics, Moenchengladbach, Germany.
| | - P A Fasching
- University Hospital Erlangen, Obstetrics and Gynecology, Erlangen, Germany
| | - R Würstlein
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; West German Study Group, Statistics, Moenchengladbach, Germany
| | - T Degenhardt
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; Hausarztpraxis Wolfratshausen, Wolfratshausen, Germany
| | - D Lüftner
- Immanuel Hospital Märkische Schweiz Buckow, Germany; Immanuel Hospital Rüdersdorf and Medical University of Brandenburg Theodor Fontane, Germany
| | - R E Kates
- West German Study Group, Statistics, Moenchengladbach, Germany
| | | | - P Räth
- palleos healthcare GmbH, Wiesbaden, Germany
| | - O Hoffmann
- University Hospital Essen, Breast Center, Essen, Germany
| | - R Lorenz
- Studien GbR Braunschweig, Braunschweig, Germany
| | - T Decker
- Hematology / Oncology, Ravensburg, Germany
| | - M Reinisch
- Breast Center, Kliniken Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - T Göhler
- Oncocenter Dresden, Dresden, Germany
| | - P Staib
- St.-Antonius Hospital gGmbH, Clinic for Hematology and Oncology, Eschweiler, Germany
| | - O Gluz
- West German Study Group, Statistics, Moenchengladbach, Germany
| | - T Schinköthe
- CANKADO Service GmbH, Kirchheim, Germany; Research Center Smart Digital Health, University of the Bundeswehr, Neubiberg, Germany
| | - M Schmidt
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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16
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Pivot X, Cortés J, Lüftner D, Lyman GH, Curigliano G, Bondarenko IM, Ahn JH, Im SA, Litwiniuk M, Shparyk YV, Ho GF, Kislov NV, Wojtukiewicz M, Sarosiek T, Chae YS, Ahn JS, Jang H, Kim S, Lee J, Yoon Y. Cardiac Safety and Efficacy of SB3 Trastuzumab Biosimilar for ERBB2-Positive Early Breast Cancer: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e235822. [PMID: 37022687 PMCID: PMC10080377 DOI: 10.1001/jamanetworkopen.2023.5822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Importance Trastuzumab has been the standard of care for the treatment of patients with ERBB2-positive breast cancer; however, cardiac events have been reported. This long-term follow-up study provides clinical evidence supporting the similarity of a trastuzumab biosimilar (SB3) to reference trastuzumab (TRZ). Objective To compare cardiac safety and efficacy between SB3 and TRZ for patients with ERBB2-positive early or locally advanced breast cancer after up to 6 years of follow-up. Design, Setting, and Participants This prespecified secondary analysis of a randomized clinical trial, conducted from April 2016 to January 2021, included patients with ERBB2-positive early or locally advanced breast cancer from a multicenter double-blind, parallel-group, equivalence phase 3 randomized clinical trial of SB3 vs TRZ with concomitant neoadjuvant chemotherapy who completed neoadjuvant and adjuvant treatment. Interventions In the original trial, patients were randomized to either SB3 or TRZ with concomitant neoadjuvant chemotherapy for 8 cycles (4 cycles of docetaxel followed by 4 cycles of fluorouracil, epirubicin, and cyclophosphamide). After surgery, patients continued SB3 or TRZ monotherapy for 10 cycles of adjuvant treatment per previous treatment allocation. Following neoadjuvant and adjuvant treatment, patients were monitored for up to 5 years. Main Outcomes and Measures The primary outcomes were the incidence of symptomatic congestive heart failure and asymptomatic, significant decrease in left ventricular ejection fraction (LVEF). The secondary outcomes were event-free survival (EFS) and overall survival (OS). Results A total of 538 female patients were included (median age, 51 years [range, 22-65 years]). Baseline characteristics were comparable between the SB3 and TRZ groups. Cardiac safety was monitored for 367 patients (SB3, n = 186; TRZ, n = 181). Median follow-up was 68 months (range, 8.5-78.1 months). Asymptomatic, clinically significant LVEF decreases were rarely reported (SB3, 1 patient [0.4%]; TRZ, 2 [0.7%]). No patient experienced symptomatic cardiac failure or death due to a cardiovascular event. Survival was evaluated for the 367 patients in the cardiac safety cohort and an additional 171 patients enrolled after a protocol amendment (538 patients [SB3, n = 267; TRZ, n = 271]). No difference was observed in EFS or OS between treatment groups (EFS: hazard ratio [HR], 0.84; 95% CI, 0.58-1.20; P = .34; OS: HR, 0.61; 95% CI, 0.36-1.05; P = .07). Five-year EFS rates were 79.8% (95% CI, 74.8%-84.9%) in the SB3 group and 75.0% (95% CI, 69.7%-80.3%) in the TRZ group, and OS rates were 92.5% (95% CI, 89.2%-95.7%) in the SB3 group and 85.4% (95% CI, 81.0%-89.7%) in the TRZ group. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, SB3 demonstrated cardiac safety and survival comparable to those of TRZ after up to 6 years of follow-up in patients with ERBB2-positive early or locally advanced breast cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02771795.
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Affiliation(s)
- Xavier Pivot
- Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Javier Cortés
- International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona, Spain
- Scientific Department, Medica Scientia Innovation Research, Valencia, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Diana Lüftner
- Campus Rüdersdorf, Immanuel Hospital Märkische Schweiz and Medical University of Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Igor M Bondarenko
- Dnipropetrovsk City Multi-Field Clinical Hospital #4, Dnipropetrovsk, Ukraine
| | - Jin-Hee Ahn
- Asan Medical Center, Seoul, Republic of Korea
| | - Seock-Ah Im
- Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Maria Litwiniuk
- Greater Poland Cancer Centre and Poznan University of Medical Sciences, Poznan, Poland
| | - Yaroslav V Shparyk
- Lviv State Oncological Regional Therapeutical and Diagnostic Center, Lviv, Ukraine
| | - Gwo Fuang Ho
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nikolay V Kislov
- State Budgetary Healthcare Institution of Yaroslavl Region, Regional Clinical Oncology Hospital, Yaroslavl, Russian Federation
| | - Marek Wojtukiewicz
- Bialostockie Centrum Onkologii im. Marii Skłodowskiej-Curie, Bialystok, Poland
| | | | - Yee Soo Chae
- Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jin Seok Ahn
- Samsung Medical Center, Seoul, Republic of Korea
| | | | - Sujung Kim
- Samsung Bioepis, Incheon, Republic of Korea
| | - Jiwon Lee
- Samsung Bioepis, Incheon, Republic of Korea
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Fehm TN, Welslau M, Müller V, Lüftner D, Schütz F, Fasching PA, Janni W, Thomssen C, Witzel I, Beierlein M, Belleville E, Untch M, Thill M, Tesch H, Ditsch N, Lux MP, Aktas B, Banys-Paluchowski M, Kolberg-Liedtke C, Hartkopf AD, Wöckel A, Kolberg HC, Harbeck N, Stickeler E. Update Breast Cancer 2022 Part 5 - Early Stage Breast Cancer. Geburtshilfe Frauenheilkd 2023; 83:289-298. [PMID: 36908285 PMCID: PMC9998178 DOI: 10.1055/a-2018-9053] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/27/2022] [Indexed: 03/14/2023] Open
Abstract
The treatment of patients with early stage breast cancer has changed in recent years due to the introduction of pembrolizumab, olaparib, and abemaciclib. These and other drugs with the same class of active ingredient are currently in trial for various indications. This review article summarizes the latest results that have either been presented at major conferences such as the ESMO 2022 or published recently in international journals. This includes reports on newly discovered breast cancer genes, atezolizumab in neoadjuvant therapy in HER2-positive patients, long-term data from the APHINITY study, and on how preoperative peritumoral application of local anesthetics can influence the prognosis. We also present solid data on dynamic Ki-67 from the ADAPT studies.
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Affiliation(s)
- Tanja N Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow; Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Isabell Witzel
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Milena Beierlein
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Bahriye Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Andreas D Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | | | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany
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Fasching PA, Brucker C, Decker T, Engel A, Göhler T, Jackisch C, Janssen J, Köhler A, Lüdtke-Heckenkamp K, Lüftner D, van Mackelenbergh M, Marmé F, Nusch A, Rautenberg B, Reimer T, Schmidt M, Weide R, Wimberger P, Roos C, Wöckel A. Abstract P4-01-03: Progression-free survival and patient-reported outcomes in HR+, HER2– ABC patients treated with first-line ribociclib + endocrine therapy (ET) or ET monotherapy or chemotherapy in real world setting: 5th interim analysis of RIBANNA. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-03] [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: 03/06/2023]
Abstract
Abstract
Background: Ribociclib in combination with endocrine therapy (ET) has demonstrated survival benefits in a broad patient population with hormone receptor–positive (HR+), human epidermal growth factor receptor 2–negative (HER2–) advanced breast cancer (ABC). RIBANNA (CLEE011ADE03) is an ongoing, prospective, noninterventional study assessing the efficacy and safety of first-line (1L) ribociclib in combination with ET in routine clinical practice in women with HR+, HER2– ABC. This study will provide insights into the use of ribociclib in combination with ET with regard to effectiveness and patient-reported outcomes (PRO) in the real-world setting in a large patient population.
Methods: Patients with HR+, HER2– ABC starting their 1L treatment with ribociclib + ET, or ET monotherapy, or chemotherapy (CT) were included. Data after disease progression to second-line (2L) and further lines of therapy are being collected too. The progression-free survival (PFS) in 1L, 2L and PFS2 (time from inclusion into the trial in the 1L setting until progression from 2L to third-line therapy) for individual treatment sequences will be analyzed using the Kaplan–Meier method. PRO for all the patients in the 1L and 2L treatment cohorts are being evaluated using the Morisky Medication Adherence Scale (MMAS-8), questionnaires related to quality-of-life (EORTC QLQ-C30) and its breast cancer–specific module (EORTC QLQ-BR23) as well as the Hospital Anxiety and Depression Scale (HADS). Data were collected at baseline and at every 3 months until the end of treatment.
Results: By the cutoff date (October 11, 2021) of the fourth interim analysis, data were available for 2187 patients (Table 1). Overall, 633 patients progressed after 1L therapy, including 27.6%, 30.6%, and 43.4% of patients from the 1L ribociclib + ET, ET monotherapy, and CT cohorts, respectively. A total of 286 patients received CDK4/6 inhibitors in 2L, which represents 48.3%, 37.3%, and 27.0% of patients from the 1L ribociclib + ET, ET monotherapy, and CT cohorts, respectively. The PFS in 1L, 2L and PFS2 results for individual treatment sequences will be presented at SABCS 2022. PRO compliance rates at baseline were 88.2%, 89.8%, and 89.4% for EORTC QLQ-C30 global health status, QLQ-BR23, and HADS-D/A, respectively, in the overall population, and 84.5% for MMAS-8 in the 1L ribociclib + ET cohort. Data for patient-reported adherence to 1L ribociclib + ET and for questionnaires related to global health-related quality of life, functioning, and symptoms from patients receiving treatment in 1L and 2L settings will be analyzed and presented at SABCS 2022.
Conclusion: The RIBANNA study has shown diverse population characteristics among patients who received ribociclib treatment in a real-world setting. The 5th interim analysis is planned in October 2022. Data on PFS, PFS2, specific therapy sequences and PRO from 1L and 2L that will provide insights on therapy sequencing strategy will be presented at SABCS 2022.
Table 1. Patient disposition at the data cutoff date (October 11, 2021).
Citation Format: Peter A. Fasching, Cosima Brucker, Thomas Decker, Anne Engel, Thomas Göhler, Christian Jackisch, Jan Janssen, Andreas Köhler, Kerstin Lüdtke-Heckenkamp, Diana Lüftner, Marion van Mackelenbergh, Frederik Marmé, Arnd Nusch, Beate Rautenberg, Toralf Reimer, Marcus Schmidt, Rudolf Weide, Pauline Wimberger, Christian Roos, Achim Wöckel. Progression-free survival and patient-reported outcomes in HR+, HER2– ABC patients treated with first-line ribociclib + endocrine therapy (ET) or ET monotherapy or chemotherapy in real world setting: 5th interim analysis of RIBANNA [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-03.
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Affiliation(s)
- Peter A. Fasching
- 1Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Cosima Brucker
- 2Department of Obstetrics and Gynecology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | | | - Anne Engel
- 4Winicker Norimed GmbH, Nürnberg, Germany
| | | | - Christian Jackisch
- 6Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Germany
| | - Jan Janssen
- 7Medizinische Studiengesellschaft Nord-West GmbH, Westerstede, Germany
| | | | | | - Diana Lüftner
- 10Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Berlin, Germany, Brandenburg, Germany
| | | | - Frederik Marmé
- 12Med. Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Arnd Nusch
- 13Practice for Hematology and Medical Oncology Velbert, Velbert, Germany
| | | | - Toralf Reimer
- 15University Hospital Rostock, Rostock, Germany;, Germany
| | - Marcus Schmidt
- 16Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - Rudolf Weide
- 17InVO - Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | - Pauline Wimberger
- 18Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany, Dresden, Sachsen, Germany
| | | | - Achim Wöckel
- 20Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
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Lüftner D, Lux MP, Fehm TN, Welslau M, Müller V, Schütz F, Fasching PA, Janni W, Thomssen C, Witzel I, Beierlein M, Belleville E, Untch M, Thill M, Ditsch N, Aktas B, Banys-Paluchowski M, Kolberg-Liedtke C, Wöckel A, Kolberg HC, Harbeck N, Stickeler E, Tesch H, Hartkopf AD. Update Breast Cancer 2022 Part 6 - Advanced-Stage Breast Cancer. Geburtshilfe Frauenheilkd 2023; 83:299-309. [PMID: 36908287 PMCID: PMC9998183 DOI: 10.1055/a-2018-9184] [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: 11/27/2022] [Accepted: 01/23/2023] [Indexed: 03/12/2023] Open
Abstract
Large-scale study programs on CDK4/6 inhibitors, targeted therapies, and antibody-drug conjugates launched in recent years have yielded results from current studies which are now being published in journals and presented at international conferences. In this context, new results are available from the major CDK4/6 inhibitor studies. Also, an increasing amount of data is being published from large-scale genomic studies on efficacy and resistance mechanisms in patients treated with CDK4/6 inhibitors. These results now form the basis for further research plans to investigate combination therapies and treatment sequencing. Based on the latest published results, sacituzumab govitecan is now available as a second antibody-drug conjugate; this brings an advantage in terms of overall survival for patients with hormone receptor-positive (HRpos)/HER2-negative (HER2neg) breast cancer. In this review article, we summarize the latest developments and place them in context according to the current status of research.
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Affiliation(s)
- Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow; Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
| | - Michael P Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Isabell Witzel
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Milena Beierlein
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Bahriye Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | | | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Andreas D Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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Jackisch C, Brucker C, Decker T, Engel A, Fasching PA, Göhler T, Janssen J, Köhler A, Lüdtke-Heckenkamp K, Lüftner D, van Mackelenbergh M, Marmé F, Nusch A, Rautenberg B, Reimer T, Schmidt M, Weide R, Wimberger P, Roos C, Wöckel A. Abstract P4-01-01: RIBANNA 5th interim analysis: Matched-pair analysis of progression-free survival (PFS) across treatment cohorts and comparison of frontline ribociclib + endocrine therapy PFS data from RIBANNA vs MONALEESA trials, in HR+, HER2– ABC. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-01] [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: 03/06/2023]
Abstract
Abstract
Background: Ribociclib (RIB) plus endocrine therapy (ET) has demonstrated a statistically significant survival benefit across the three phase 3 MONALEESA (ML) trials, irrespective of menopausal status, line of therapy, or combination partner. RIBANNA (CLEE011ADE03), a prospective, noninterventional study assessing the efficacy and safety of RIB + ET, or ET monotherapy or chemotherapy (CT) in first-line (1L) setting in pre-, peri- and postmenopausal patients (pts) with hormone receptor–positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer (ABC) is ongoing in Germany since October 2017 to gain insights into real-world scenario. In the 5th interim analysis (IA) from RIBANNA, a matched-pair analysis of 1L PFS data from the three treatment cohorts and comparison of 1L PFS data on RIB + ET from RIBANNA versus (vs) ML trials will be performed.
Methods: Pre-, peri- and postmenopausal women receiving RIB + ET, ET monotherapy, or CT as 1L treatments for HR+, HER2– ABC, in accordance with German treatment guidelines, were included. Propensity score matched (PSM) analysis of PFS data from the 3 treatment cohorts will be conducted to reduce the bias due to confounding variables. In addition to safety analyses, comparison of 1L PFS data on RIB + ET from RIBANNA vs ML trials will be performed.
Results: By the cutoff date of the 4th IA (October 11, 2021), data were available for 2187 pts, including 1849 (83.0%), 193 (78.1%), and 145 (73.6%) pts from the RIB + ET, ET monotherapy, and CT cohorts in 1L setting, respectively (Table 1). Of these 2187 pts, 1111 postmenopausal pts received 1L RIB + letrozole; 357 postmenopausal pts received 1L RIB + fulvestrant, and 158 pre- and perimenopausal pts received 1L RIB + anastrazole/letrozole. The unadjusted Kaplan–Meïer estimate for median PFS was 31.7 months (95% confidence interval [CI], 28.5–36.2) in the RIB + ET cohort, 25.7 months (95% CI, 18.0–not reached) in the ET monotherapy cohort, and 15.3 months (95% CI, 9.5–17.5) in the CT cohort. The most frequent treatment-emergent adverse events (grade 3 or 4) in the RIB + ET and ET monotherapy cohorts were neutropenia (14.8% and 6.6%, respectively) while that in CT cohort was general physical health deterioration (9.1%).
Conclusions: In RIBANNA, a diverse pt population is being analyzed in a real-world setting; treatment with RIB + ET has been observed to be well adopted. The 5th IA is planned in October 2022 and data will be presented in SABCS 2022, which will include PSM analysis to compare 1L PFS data across treatment cohorts as well as comparison of 1L PFS data on RIB + ET from RIBANNA vs ML trials. The safety profile of RIB was found to be similar to those observed in ML trials.
Table 1. Patient demographics and baseline clinical characteristics from the 4th IA.
Citation Format: Christian Jackisch, Cosima Brucker, Thomas Decker, Anne Engel, Peter A. Fasching, Thomas Göhler, Jan Janssen, Andreas Köhler, Kerstin Lüdtke-Heckenkamp, Diana Lüftner, Marion van Mackelenbergh, Frederik Marmé, Arnd Nusch, Beate Rautenberg, Toralf Reimer, Marcus Schmidt, Rudolf Weide, Pauline Wimberger, Christian Roos, Achim Wöckel. RIBANNA 5th interim analysis: Matched-pair analysis of progression-free survival (PFS) across treatment cohorts and comparison of frontline ribociclib + endocrine therapy PFS data from RIBANNA vs MONALEESA trials, in HR+, HER2– ABC [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-01.
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Affiliation(s)
- Christian Jackisch
- 1Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Germany
| | - Cosima Brucker
- 2Department of Obstetrics and Gynecology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | | | - Anne Engel
- 4Winicker Norimed GmbH, Nürnberg, Germany
| | - Peter A. Fasching
- 5Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | | | - Jan Janssen
- 7Medizinische Studiengesellschaft Nord-West GmbH, Westerstede, Germany
| | | | | | - Diana Lüftner
- 10Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Berlin, Germany, Brandenburg, Germany
| | | | - Frederik Marmé
- 12Med. Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Arnd Nusch
- 13Practice for Hematology and Medical Oncology Velbert, Velbert, Germany
| | | | - Toralf Reimer
- 15University Hospital Rostock, Rostock, Germany;, Germany
| | - Marcus Schmidt
- 16Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - Rudolf Weide
- 17InVO - Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | - Pauline Wimberger
- 18Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany, Dresden, Sachsen, Germany
| | | | - Achim Wöckel
- 20Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
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Bartsch R, Harbeck N, Wrobel D, Zaiss M, Terhaag J, Guth D, Distelrath A, Wuerstlein R, Zahn MO, Lüftner D, Schwitter M, Balic M, Jackisch C, Müller V, Rinnerthaler G, Schmidt M, Zaman K, Schinköthe T, Resch A, Breitenstein U. Abstract P2-01-01: Interim analysis (n=200) from ELEANOR: a multi-national, prospective, non-interventional study among patients with HER2+ and HR+ early breast cancer treated with extended adjuvant neratinib in the clinical routine. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-01-01] [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: 03/06/2023]
Abstract
Abstract
Background Recent advances in the treatment of human epidermal growth factor receptor positive (HER2+) early breast cancer (eBC) have led to a reduction in recurrence risk; still a relevant percentage of patients relapses over time, predominantly presenting with distant recurrence. Neratinib is registered in Europe as extended adjuvant treatment for adult patients with HER2+, hormone receptor positive (HR+) eBC, who completed adjuvant trastuzumab-based therapy within one year prior to start of neratinib. In the ExteNET study, neratinib improved the absolute 5-year invasive disease-free survival (iDFS) rate by 5.1% versus placebo in this population (90.8% vs. 85.7%; HR 0.58 [95% CI 0.41-0.82]), mainly by reducing the rate of distant metastases. According to explorative analyses from ExteNET, the effect may be even more pronounced in patients with non-pCR after neoadjuvant trastuzumab treatment and/or in patients completing the full duration of neratinib therapy (i.e. ≥11 months of neratinib treatment). Diarrhea, the most common grade 3 adverse event (neratinib: 39% without primary diarrhea prophylaxis, median cumulative duration 5 days; placebo: 1%; no grade 4 events) can generally be managed through adequate prophylaxis and treatment management. ELEANOR is the first non-interventional study (NIS) of real-world use of neratinib and its management in eBC patients in Germany, Austria and Switzerland. Methods Enrollment of 300 adult female patients with HER2+/HR+ eBC is planned in accordance with the SmPC specifications. Primary endpoint is the rate of patients adherent to neratinib treatment (i.e. neratinib use for ≥75% of treatment days). Secondary objectives include characterization of patients scheduled to receive neratinib, details on neratinib treatment, recurrences, safety/tolerability, and health-related quality of life (HRQoL). CANKADO, an eHealth application developed to support patient/physician communication, is an integral part of the NIS. Here, we report results of the preplanned interim analysis based on 200 enrolled patients. Results At data cut-off (May 2022), 202 patients had been observed for 3 months; patient enrollment is ongoing. Median age was 53.0 years and 66.3% of patients were at increased risk of disease recurrence (defined as non-pCR or AJCC stage > I). Most patients had received prior neoadjuvant treatment (79.7%). Post-neoadjuvant treatment included dual HER2 blockade with trastuzumab and pertuzumab (38.8%/23.9% of pCR/non-pCR patients) and trastuzumab-emtansine (T-DM1, 53.5% of non-pCR patients). Neratinib treatment had been documented for 187 patients, treatment was ongoing for 46.0% of patients. Diarrhea was the most common adverse event (78.6% any grade, 19.3% grade 3, 2 patients grade 4), but was markedly lower when indirectly compared to ExteNET (39% grade 3). The neratinib dose escalation schedule was chosen for 36.4% of patients and led to a decreased incidence of severe diarrhea (16.2% grade 3, no grade 4 events). 93.9% (95% CI: 87.9-97.5%) of 115 evaluable patients adhered to neratinib treatment. Conclusion The results of this preplanned interim analysis reflect the current treatment landscape in Germany, Austria and Switzerland. These results confirm, in line with the observed adherence data, that extended adjuvant neratinib use is feasible in typical clinical practice settings. Furthermore, treatment management strategies such as diarrhea prophylaxis or neratinib dose escalation are routinely used and can increase treatment tolerability markedly. The study is funded by Pierre Fabre Pharma GmbH (Freiburg, Germany), Pierre Fabre Pharma Austria (Wels, Austria) and Pierre Fabre Pharma AG (Allschwil, Switzerland).
Citation Format: Rupert Bartsch, Nadia Harbeck, Denise Wrobel, Matthias Zaiss, Jürgen Terhaag, Dagmar Guth, Andrea Distelrath, Rachel Wuerstlein, Mark-Oliver Zahn, Diana Lüftner, Michael Schwitter, Marija Balic, Christian Jackisch, Volkmar Müller, Gabriel Rinnerthaler, Marcus Schmidt, Khalil Zaman, Timo Schinköthe, Anna Resch, Urs Breitenstein. Interim analysis (n=200) from ELEANOR: a multi-national, prospective, non-interventional study among patients with HER2+ and HR+ early breast cancer treated with extended adjuvant neratinib in the clinical routine [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-01-01.
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Affiliation(s)
- Rupert Bartsch
- 1Medical University of Vienna, Department of Medicine I, Division of Oncology, Vienna, Austria
| | | | - Denise Wrobel
- 3Sozialstiftung Bamberg Klinikum am Bruderwald, Bamberg, Germany
| | | | | | - Dagmar Guth
- 6Gyneco-oncological practice Dr. Guth, Plauen, Germany
| | | | - Rachel Wuerstlein
- 8Breast Center, Dept. OB&GYN and CCC Munich, LMU University Hospital, Munich, Germany
| | | | - Diana Lüftner
- 10Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Brandenburg, Berlin, Germany
| | | | - Marija Balic
- 12Divison of Oncology, Department of Internal Medicine, Medical University Graz, Austria
| | - Christian Jackisch
- 13Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Germany
| | - Volkmar Müller
- 14Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Rinnerthaler
- 15Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Marcus Schmidt
- 16Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - Khalil Zaman
- 17Breast Center, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Lüftner D. New treatment options for hormone receptor positive breast cancer in 2023. Curr Opin Obstet Gynecol 2023; 35:62-66. [PMID: 36341983 DOI: 10.1097/gco.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW Hormone receptor positive, human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer does respond to chemotherapy but can be addressed with a better therapeutic index by using biologically modified endocrine therapy. The most pronounced recent successes were reached by antibody drug conjugates (ADCs). RECENT FINDINGS In early HR+/HER2- disease, adjuvant treatment escalations have taken place for high-risk patients using abemaciclib for the HR+ BRCA- subset and olaparib for HR+ BRCA+ patients. In metastatic spread, among all CDK (cyclin-dependent kinase) 4/6 inhibitors used for first-line therapy, only ribociclib improved overall survival in pre and postmenopausal patients. Palbociclib failed to demonstrate overall survival benefits. New options come up with oral selective oestrogen receptor degraders (SERDs) such as elacestrant, which will replace fulvestrant and is clinically important in combination therapies. ADCs, together with new patient categories such as HER2low or HER3+, enlarge the treatment portfolio and challenge the need of supportive care. The antitrophoblast antigen 2 (TROP2) ADC sacituzumab govitecan improves overall survival in heavily pretreated HR+/HER2- patients by 3.2 months. The best improvement of overall survival was shown bý trastuzumab deruxtecan in less pretreated HER2low (HER2 1+ or HER2 2+/no gene amplification) patients with a gained life span of 6 months. SUMMARY Real-world data on the sequence of different ADCs with similar payloads are needed to establish best possible treatment algorithms. All these new agents will find their place after CDK4/6 inhibitor-based endocrine combination therapy.
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Affiliation(s)
- Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow
- Medical University of Brandenburg Theodor Fontane, Immanuel Campus Rüdersdorf, Rüdersdorf bei Berlin, Germany
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23
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Miemietz B, Busson-Spielberger M, Giesler M, de Wit M, Lüftner D, Weisel K. Karriere in der Hämatologie und medizinischen Onkologie. Onkologie 2023. [PMCID: PMC9842199 DOI: 10.1007/s00761-022-01280-y] [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] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | | | | | - Maike de Wit
- Klinik für Innere Medizin, Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz, Buckow, Deutschland
| | - Katja Weisel
- II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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24
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Huebner H, Ruebner M, Kurbacher C, Hadji P, Hartkopf AD, Lux MP, Huober J, Uhrig S, Taran FA, Overkamp F, Tesch H, Häberle L, Lüftner D, Wallwiener M, Müller V, Beckmann MW, Hein A, Belleville E, Untch M, Janni W, Fehm TN, Kolberg HC, Wallwiener D, Brucker SY, Schneeweiss A, Ettl J, Fasching PA, Michel LL. Return of individual genomic research results within the PRAEGNANT multicenter registry study. Breast Cancer Res Treat 2023; 197:355-368. [PMID: 36409394 PMCID: PMC9822879 DOI: 10.1007/s10549-022-06795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/30/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE The PRAEGNANT study is a registry study for metastatic breast cancer patients, focusing on biomarker detection. Recently, within this study, genetic alterations in 37 breast cancer predisposition genes were analyzed and genetic findings were detected for 396 participants. The aim of this project was to return genetic results to the physicians and to analyze actions taken (e.g., disclosure of results to patients, validation of results, clinical impact, and impact on the patient's quality of life) using a questionnaire. METHODS 235 questionnaires were sent out to the study centers, with each questionnaire representing one patient with a genetic finding. The questionnaire consisted of twelve questions in the German language, referring to the disclosure of results, validation of test results, and their impact on treatment decisions and on the patient's quality of life. RESULTS 135 (57.5%) questionnaires were completed. Of these, 46 (34.1%) stated that results were returned to the patients. In 80.0% (N = 36) of cases where results were returned, the patient had not been aware of the finding previously. For 27 patients (64.3%), genetic findings had not been validated beforehand. All validation procedures (N = 15) were covered by the patients' health insurance. For 11 (25.0%) patients, physicians reported that the research results influenced current or future decision-making on treatment, and for 37.8% (N = 17) the results influenced whether family members will be genetically tested. CONCLUSION This study provides novel insights into the return of research results and into clinical and personal benefits of disclosure of genetic findings within a German registry.
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Affiliation(s)
- Hanna Huebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christian Kurbacher
- Department of Gynecology and Obstetrics, Medizinisches Zentrum Bonn Friedensplatz, Bonn, Germany
| | - Peyman Hadji
- Frankfurt Center for Bone Health, 60313 Frankfurt, Germany
| | - Andreas D. Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Michael P. Lux
- Klinik Für Gynäkologie und Geburtshilfe Frauenklinik St. Louise, St. Josefs-Krankenhaus, Salzkotten, Kooperatives Brustzentrum Paderborn, Paderborn, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Sabrina Uhrig
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | - Hans Tesch
- Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany ,Biostatistics Unit, Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow, Germany ,Immanuel Campus Rüdersdorf/Medical University of Brandenburg, Brandenburg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin Buch, Berlin, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital of Düsseldorf, Düsseldorf, Germany
| | | | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y. Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Laura L. Michel
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
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25
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Kiechle M, Schem C, Lüftner D, Hipp J, Stetzer E, Köhler U. Prophylaxis of Neutropenia with Lipegfilgrastim in Breast Cancer Patients with Dose-Dense Chemotherapy: Results of a Noninterventional Study on Therapeutic Routine in Germany (NADENS). Breast Care (Basel) 2022; 17:508-513. [PMID: 36684406 PMCID: PMC9851063 DOI: 10.1159/000524984] [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: 05/28/2021] [Accepted: 05/10/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Noninterventional study (NIS) on application and effectiveness of primary G-CSF prophylaxis with lipegfilgrastim in primary breast cancer patients undergoing dose-dense (dd) or intense-dose-dense (idd) chemotherapy (CTx) regimen in daily clinical practice. Methods Prospective, multicenter, single-arm, NIS in 41 private practices and 27 hospitals in Germany. Results Data analysis of 282 patients with a mean age of 49 years (93.6% of patients <65 years) was performed. Hormone receptor status was triple negative in 29.8% of patients, and 81.9% of patients were HER2 negative. A total of 73.8% of patients received "EC dd → taxane CTx." Patients received lipegfilgrastim prophylaxis in 97.5% of 1,121 documented dd/idd cycles. Overall, the study registered 275 events of SN (CTCAE grade 3 or 4) and 9 events of FN. During the first dd cycle, SN occurred in 33.3% and FN in 1.1% of patients. CTx delay or dose reduction due to neutropenia was required in 2.5% of patients during the 4 dd cycles with lipegfilgrastim support. Overall, 314 adverse events (AEs) were reported from 107 patients and 27 serious AEs from 21 patients. None of the SAEs was "fatal," and CTCAE grade was mostly (89.6%) assessed as "1" or "2." According to the treating physicians, 99.3% of all patients benefitted from lipegfilgrastim prophylaxis, and tolerability was mostly rated "very good" or "good." Conclusion These results suggest that primary lipegfilgrastim prophylaxis is effective and safe in clinical routine and is beneficial in primary breast cancer patients undergoing dd/idd-ETC CTx.
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Affiliation(s)
- Marion Kiechle
- aFrauen- und Poliklinik, Technische Universität München, Munich, Germany
| | - Christian Schem
- bMammazentrum Hamburg am Krankenhaus Jerusalem, Hamburg, Germany
| | - Diana Lüftner
- cKlinik für Hämatologie und Onkologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Uwe Köhler
- fKlinik für Gynäkologie und Geburtshilfe, Klinikum St. Georg, Leipzig, Germany
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26
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Banys-Paluchowski M, Thill M, Kühn T, Ditsch N, Heil J, Wöckel A, Fallenberg E, Friedrich M, Kümmel S, Müller V, Janni W, Albert US, Bauerfeind I, Blohmer JU, Budach W, Dall P, Fasching P, Fehm T, Gluz O, Harbeck N, Huober J, Jackisch C, Kolberg-Liedtke C, Kreipe HH, Krug D, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Gerber B. AGO Recommendations for the Surgical Therapy of Breast Cancer: Update 2022. Geburtshilfe Frauenheilkd 2022; 82:1031-1043. [PMID: 36186147 PMCID: PMC9525149 DOI: 10.1055/a-1904-6231] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
The recommendations of the AGO Breast Committee on the surgical therapy of breast cancer were last updated in March 2022 (www.ago-online.de). Since surgical therapy is one of several partial steps in the treatment of breast cancer, extensive diagnostic and oncological expertise of a breast surgeon and good interdisciplinary cooperation with diagnostic radiologists is of great importance. The most important changes concern localization techniques, resection margins, axillary management in the neoadjuvant setting and the evaluation of the meshes in reconstructive surgery. Based on meta-analyses of randomized studies, the level of recommendation of an intraoperative breast ultrasound for the localization of non-palpable lesions was elevated to "++". Thus, the technique is considered to be equivalent to wire localization, provided that it is a lesion which can be well represented by sonography, the surgeon has extensive experience in breast ultrasound and has access to a suitable ultrasound device during the operation. In invasive breast cancer, the aim is to reach negative resection margins ("no tumor on ink"), regardless of whether an extensive intraductal component is present or not. Oncoplastic operations can also replace a mastectomy in selected cases due to the large number of existing techniques, and are equivalent to segmental resection in terms of oncological safety at comparable rates of complications. Sentinel node excision is recommended for patients with cN0 status receiving neoadjuvant chemotherapy after completion of chemotherapy. Minimally invasive biopsy is recommended for initially suspect lymph nodes. After neoadjuvant chemotherapy, patients with initially 1 - 3 suspicious lymph nodes and a good response (ycN0) can receive the targeted axillary dissection and the axillary dissection as equivalent options.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany,Correspondence/Korrespondenzadresse Priv.-Doz. Dr. med. Maggie Banys-Paluchowski Klinik für Frauenheilkunde und GeburtshilfeUniversitätsklinikum
Schleswig-Holstein Campus LübeckRatzeburger Allee 16023538
LübeckGermany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Jörg Heil
- Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Eva Fallenberg
- Institut für Radiologie, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Peter Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Schweiz
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sibylle Loibl
- German Breast Group c/o GBG Forschungs GmbH, Neu-Isenburg, Neu-Isenburg, Germany,Zentrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Goethe Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Diana Lüftner
- Medical University of Brandenburg Theodor-Fontane & Immanuel Hospital Märkische Schweiz, Buckow, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus
GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Ulrike Nitz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Tjoung Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - H. Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
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Untch M, Fasching PA, Haidinger R, Harbeck N, Jackisch C, Lüftner D, Müller V, Schumacher-Wulf E, Würstlein R, Thomssen C. Advanced Breast Cancer: AGO Recommendations 2022 - Focus on ABC6 Consensus. Geburtshilfe Frauenheilkd 2022; 82:1044-1054. [PMID: 36186150 PMCID: PMC9525147 DOI: 10.1055/a-1904-6100] [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: 05/15/2022] [Accepted: 07/18/2022] [Indexed: 12/05/2022] Open
Abstract
Over the past few years, there have been many developments in the treatment of advanced breast cancer; these have been incorporated into national and international treatment guidelines, resulting in an improved prognosis for these patients. The 6th International Consensus Conference for Advanced Breast Cancer (ABC6) was held in November 2021. The aim is to standardize the treatment of advanced breast cancer based on a high level of evidence, and to make new treatment options accessible to all patients. In this article we discuss the ABC6 consensus in the context of German treatment guidelines, and compare it with clinical practice in Germany. The authors refer to the current recommendations of the Breast Cancer Working Group for Gynecological Oncology (AGO Mamma) published in March 2022. The AGO Breast Cancer Guidelines are updated annually. Since discrepancies between national and international guidelines can occur due to country-specific regulations, this is a useful comparison to make. The German authors refer to the voting results of the ABC6 panelists from 6 November 2021.
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Affiliation(s)
- Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Multidisziplinäres Brustzentrum und Zentrum für gynäkologische Onkologie, HELIOS Klinikum Berlin Buch, Berlin, Germany,Correspondence/Korrespondenzadresse Prof. Dr. med. Michael Untch Brustzentrum und Zentrum für gynäkologische OnkologieHELIOS Klinikum Berlin
BuchSchwanebecker Chaussee 5013125
BerlinGermany
| | - Peter A. Fasching
- Universitätsfrauenklinik Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Renate Haidinger
- Brustkrebs Deutschland e. V., Hohenbrunn, Germany; Patientenvertreterin, ABC6-Ko-Vorsitz, ABC-Panelistin
| | - Nadia Harbeck
- Brustzentrum, Klinik und Poliklinik für Frauenheilkunde und Comprehensive Cancer Center (CCC) München, LMU Klinikum, München, Germany; ABC-Panelistin
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz, Medizinische Hochschule Brandenburg Theodor-Fontane, Buckow, Germany
| | - Volkmar Müller
- Universitätsklinik für Gynäkologie, Hamburg-Eppendorf, Hamburg, Germany
| | | | - Rachel Würstlein
- Brustzentrum, Klinik und Poliklinik für Frauenheilkunde und Comprehensive Cancer Center (CCC) München, LMU Klinikum, München, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität, Halle an der Saale, Germany; ABC-Panelist
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28
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Aktas B, Fehm TN, Welslau M, Müller V, Lüftner D, Schütz F, Fasching PA, Janni W, Thomssen C, Witzel I, Belleville E, Untch M, Thill M, Tesch H, Ditsch N, Lux MP, Banys-Paluchowski M, Kolberg-Liedtke C, Hartkopf AD, Wöckel A, Kolberg HC, Stickeler E, Harbeck N, Schneeweiss A. Update Breast Cancer 2022 Part 4 - Advanced-Stage Breast Cancer. Geburtshilfe Frauenheilkd 2022; 82:922-931. [PMID: 36110891 PMCID: PMC9470282 DOI: 10.1055/a-1912-7362] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/31/2022] [Indexed: 12/05/2022] Open
Abstract
For the treatment of patients with advanced HER2-negative hormone receptor-positive breast cancer, several substances have been introduced into practice in recent years. In addition, other drugs are under development. A number of studies have been published over the past year which have shown either an advantage for progression-free survival or for overall survival. This review summarizes the latest results, which have been published at current congresses or in specialist journals, and classifies them in the clinical treatment context. In particular, the importance of therapy with CDK4/6 inhibitors - trastuzumab deruxtecan, sacituzumab govitecan and capivasertib - is discussed. For trastuzumab deruxtecan, an overall survival benefit in HER2-negative breast cancer with low HER2 expression (HER2-low expression) was reported in the Destiny-Breast-04 study. Similarly, there was an overall survival benefit in the FAKTION study with capivasertib. The lack of overall survival benefit for palbociclib in the first line of therapy raises the question of clinical classification.
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Affiliation(s)
- Bahriye Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz & Medical University of Brandenburg Theodor-Fontane, Brandenburg, Buckow, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Isabell Witzel
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | | | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | | | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
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Fehm TN, Welslau M, Müller V, Lüftner D, Schütz F, Fasching PA, Janni W, Thomssen C, Witzel I, Belleville E, Untch M, Thill M, Tesch H, Ditsch N, Lux MP, Aktas B, Banys-Paluchowski M, Schneeweiss A, Kolberg-Liedtke C, Hartkopf AD, Wöckel A, Kolberg HC, Harbeck N, Stickeler E. Update Breast Cancer 2022 Part 3 - Early-Stage Breast Cancer. Geburtshilfe Frauenheilkd 2022; 82:912-921. [PMID: 36110894 PMCID: PMC9470293 DOI: 10.1055/a-1912-7105] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022] Open
Abstract
This review summarizes recent developments in the prevention and treatment of patients with early-stage breast cancer. The individual disease risk for different molecular subtypes was investigated in a large epidemiological study. With regard to treatment, new data are available from long-term follow-up of the Aphinity study, as well as new data on neoadjuvant therapy with atezolizumab in HER2-positive patients. Biomarkers, such as residual cancer burden, were investigated in the context of pembrolizumab therapy. A Genomic Grade Index study in elderly patients is one of a group of studies investigating the use of modern multigene tests to identify patients with an excellent prognosis in whom chemotherapy may be avoided. These and other aspects of the latest developments in the diagnosis and treatment of breast cancer are described in this review.
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Affiliation(s)
- Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz & Medical University of Brandenburg Theodor-Fontane, Brandenburg, Buckow, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany,Correspondence/Korrespondenzadresse Peter A. Fasching, MD Erlangen University Hospital, Department of Gynecology and ObstetricsComprehensive Cancer
Center Erlangen EMNFriedrich Alexander University of Erlangen-NurembergUniversitätsstraße 21 – 2391054
ErlangenGermany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Isabell Witzel
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | | | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Bahriye Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | | | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | | | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
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30
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Schettini F, Venturini S, Giuliano M, Lambertini M, Pinato DJ, Elisa Onesti C, De Placido P, Harbeck N, Lüftner D, Denys H, Van Dam P, Arpino G, Zaman K, Mustacchi G, Gligorov J, Awada A, Campone M, Wildiers H, Gennari A, Tjan-Heijnen V, Bartsch R, Cortes J, Paris I, Martín M, De Placido S, Del Mastro L, Jerusalem G, Curigliano G, Prat A, Generali D. Multiple Bayesian Network Meta-Analyses to Establish Therapeutic Algorithms for Metastatic Triple Negative Breast Cancer. Cancer Treat Rev 2022; 111:102468. [DOI: 10.1016/j.ctrv.2022.102468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 12/23/2022]
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31
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Ditsch N, Wöcke A, Untch M, Jackisch C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm TN, Friedrich M, Gerber B, Gluz O, Harbeck N, Heil J, Huober J, Kreipe HH, Krug D, Kühn T, Kümmel S, Kolberg-Liedtke C, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Witzel I, Müller V, Janni W, Thill M. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2022. Breast Care (Basel) 2022; 17:403-420. [PMID: 36156915 PMCID: PMC9453658 DOI: 10.1159/000524879] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 04/30/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The AGO (Arbeitsgemeinschaft Gynäkologische Onkologie, German Gynecological Oncology Group) Task Force on Diagnosis and Treatment of Breast Cancer as an interdisciplinary team consists of specialists from gynecological oncology, pathology, diagnostic radiology, medical oncology, and radiation oncology with a special focus on breast cancer. Methods The updated evidence-based treatment recommendation 2022 for early breast cancer (EBC) and metastatic breast cancer of the AGO Task Force has been released. Results and Conclusion This paper captures the update of EBC.
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Affiliation(s)
- Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Achim Wöcke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Klinik für Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Klinik für Gynäkologie und Geburtshilfe, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva Maria Fallenberg
- Institut für Klinische Radiologie, Klinikum der Technischen Universität München, Rechts der Isar, Munich, Germany
| | - Peter A. Fasching
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja N. Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jörg Heil
- Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Cornelia Kolberg-Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Phaon GmbH, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charite, Berlin, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Ulrike Nitz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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Thill M, Lüftner D, Kolberg-Liedtke C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm T, Friedrich M, Gerber B, Gluz O, Harbeck N, Heil J, Huober J, Jackisch C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lux M, Maass N, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Müller V, Janni W, Ditsch N. AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2022. Breast Care (Basel) 2022; 17:421-429. [PMID: 36156913 PMCID: PMC9453659 DOI: 10.1159/000524789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 08/03/2023] Open
Abstract
The Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO) presents the 2022 update of the evidence-based recommendations for the diagnosis and treatment of patients with locally advanced and metastatic breast cancer.
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Affiliation(s)
- Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Berlin, Germany
| | | | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva Maria Fallenberg
- Institut für Klinische Radiologie, Klinikum der Universität München Campus Großhadern, Munich, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang, Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jörg Heil
- Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Michael Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Paderborn, Germany
| | - Nicolai Maass
- St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Ulrike Nitz
- Brustzentrum, Evang, Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hanover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Cologne, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
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Engler T, Fasching PA, Lüftner D, Hartkopf AD, Müller V, Kolberg HC, Hadji P, Tesch H, Häberle L, Ettl J, Wallwiener M, Beckmann MW, Hein A, Belleville E, Uhrig S, Wimberger P, Hielscher C, Kurbacher CM, Wuerstlein R, Untch M, Taran FA, Enzinger HM, Krabisch P, Welslau M, Maasberg M, Hempel D, Lux MP, Michel LL, Janni W, Wallwiener D, Brucker SY, Fehm TN, Schneeweiss A. Implementation of CDK4/6 Inhibitors and its Influence on the Treatment Landscape of Advanced Breast Cancer Patients - Data from the Real-World Registry PRAEGNANT. Geburtshilfe Frauenheilkd 2022; 82:1055-1067. [PMID: 36186151 PMCID: PMC9525148 DOI: 10.1055/a-1880-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 10/31/2022] Open
Abstract
Background Comprehensive data from prospective clinical trials have led to a high level of evidence establishing CDK4/6 inhibitors in combination with endocrine treatment (CDK4/6i + ET) as a standard for the treatment of HER2-negative, hormone receptor-positive (HER2- HR+) breast cancer patients in the first-line advanced therapy setting. Data on patient populations that have been treated in the real-world setting may provide an insight into changes of patient characteristics and prognosis over time. Methods The data were extracted from the prospective real-world registry PRAEGNANT (NCT02338167). Patients had to have HER2- HR+ advanced breast cancer in the first-line metastatic setting. The chosen therapies were described as well as progression-free survival (PFS) and overall survival (OS) in relation to the given therapies and time periods during which they were indicated. Results CDK4/6 inhibitors have been rapidly implemented since their introduction in November 2016. In recent years (2018 - 2022), about 70 - 80% of the patient population have been treated with CDK4/6 inhibitors, while endocrine monotherapy was given to about 10% and chemotherapy to about 15% of all patients. The prognosis was worst in patients treated with chemotherapy. Recently, mainly patients with a good prognosis are being treated with endocrine monotherapy, and patients who are treated with chemotherapy have an unfavorable prognosis. The PFS and OS of patients treated with CDK4/6i + ET have remained similar over time despite changes in patient characteristics. Conclusion A treatment with CDK4/6i + ET has rapidly become the therapy standard for patients in the first-line advanced breast cancer setting. After the implementation of CDK4/6i + ET, endocrine monotherapy is only given to patients with a very favorable prognosis, while chemotherapy is provided to patients with a rather unfavorable prognosis. These changes in patient characteristics did not seem to influence the prognosis of patients treated with CDK4/6i + ET.
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Affiliation(s)
- Tobias Engler
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany,Correspondence Peter A. Fasching, MD Department of Gynecology and Obstetrics, Erlangen University HospitalComprehensive Cancer
Center Erlangen EMNFriedrich Alexander University of Erlangen–NurembergUniversitätsstraße 21 – 2391054
ErlangenGermany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz & Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
| | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | | | - Peyman Hadji
- Frankfurt Center for Bone Health, Frankfurt am Main, Germany; Philips-University of Marburg, Marburg, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany
| | | | - Sabrina Uhrig
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Carl Gustav Carus Faculty of Medicine and University Hospital, TU Dresden, Dresden, Germany,National Center for Tumor Diseases (NCT), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Carl Gustav Carus Faculty of Medicine and University
Hospital, TU Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany,German Cancer Consortium (DKTK), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carsten Hielscher
- Gynäkologie Kompetenzzentrum – Onkologisches Zentrum Stralsund, Stralsund, Germany
| | - Christian M. Kurbacher
- Department of Gynecology I (Gynecologic Oncology), Gynecologic Center Bonn-Friedensplatz, Bonn, Germany
| | - Rachel Wuerstlein
- Department of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich University Hospital, Munich, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin-Buch, Berlin, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, Freiburg University Hospital, Freiburg, Germany
| | - Hans-Martin Enzinger
- Department of Gynecology and Obstetrics, Klinikum Bamberg, Sozialstiftung Bamberg, Bamberg, Germany
| | - Petra Krabisch
- Department of Gynecology and Obstetrics, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | | | | | - Dirk Hempel
- Onkologiezentrum Donauwörth, Donauwörth, Germany
| | - Michael P. Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise, Paderborn, Germany; Frauenklinik St. Josefs-Krankenhaus, Salzkotten, Germany; Kooperatives Brustzentrum
Paderborn, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Laura L. Michel
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y. Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Müller V, Hein A, Hartkopf AD, Fasching PA, Kolberg HC, Hadji P, Tesch H, Häberle L, Ettl J, Lüftner D, Wallwiener M, Beckmann MW, Schneeweiss A, Belleville E, Uhrig S, Wimberger P, Hielscher C, Meyer J, Wurmthaler LA, Kurbacher CM, Wuerstlein R, Untch M, Janni W, Taran FA, Lux MP, Wallwiener D, Brucker SY, Fehm TN, Michel LL. Occurrence and characteristics of patients with de novo advanced breast cancer according to patient and tumor characteristics - A retrospective analysis of a real world registry. Eur J Cancer 2022; 172:13-21. [PMID: 35728342 DOI: 10.1016/j.ejca.2022.05.015] [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: 03/04/2021] [Revised: 04/30/2022] [Accepted: 05/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with de novo metastatic breast cancer (dnMBC) may have different clinical and pathological characteristics. In studies concerned with first-line metastatic patients, the proportion of these patients without secondary resistance mechanisms may have a large influence ont the study results. The aim of this study was to identify patient and tumor characteristics that are associated with dnMBC vs. recurrent MBC (rMBC). METHODS This is a retrospective analysis of data prospectively collected in the PRAEGNANT metastatic breast cancer registry (NCT02338167). Firs line treated patients were eligible. Patient and tumor characteristics were compared with common disease and tumor characteristics relative to de novo metastatic status, as well as early and late recurrences after primary disease without metastases. RESULTS Among the 947 patients identified, 355 were included with de novo metastatic disease (37.5%). Older age and HER2-positive disease were significantly associated with a higher frequency of dnMBC. Patients younger than 50, 50-69, or 70 years or older had dnMBC frequencies of 22.7%, 44.0%, and 57.6%, respectively. HER2-positive patients had dnMBC at initial presentation in 49.1% of cases, in comparison with 21.9%, 35.5%, and 37.6% in patients with triple-negative, luminal A-like and luminal B-like breast cancer, respectively. CONCLUSION Age and breast cancer subtype are associated with the frequency of first-line MBC patients. Inclusion criteria concerning age or breast cancer subtype can influence the frequency of these patients in a selected patient population and can therefore modify the number of patients with secondary resistance to specific therapies in clinical trials.
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Affiliation(s)
- Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany.
| | | | - Peyman Hadji
- Frankfurt Center for Bone Health, Frankfurt am Main, Ühilips-University of Marburg, Marburg, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Berlin, Germany; Immanuel Hospital Märkische Schweiz & Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Sabrina Uhrig
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Carl Gustav Carus Faculty of Medicine and University Hospital, TU Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Carl Gustav Carus Faculty of Medicine and University Hospital, TU Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Julia Meyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Lena A Wurmthaler
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Christian M Kurbacher
- Department of Gynecology I (Gynecologic Oncology), Gynecologic Center Bonn-Friedensplatz, Bonn, Germany
| | - Rachel Wuerstlein
- Department of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich University Hospital, Munich, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin-Buch, Berlin, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | | | - Michael P Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Germany; Kooperatives Brustzentrum Paderborn, Paderborn, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Laura L Michel
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
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35
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Welslau M, Müller V, Lüftner D, Schütz F, Stickeler E, Fasching PA, Janni W, Thomssen C, Witzel I, Fehm TN, Belleville E, Bader S, Seitz K, Untch M, Thill M, Tesch H, Ditsch N, Lux MP, Aktas B, Banys-Paluchowski M, Schneeweiss A, Harbeck N, Würstlein R, Hartkopf AD, Wöckel A, Seliger B, Massa C, Kolberg HC. Update Breast Cancer 2022 Part 1 – Early Stage Breast Cancer. Geburtshilfe Frauenheilkd 2022; 82:580-589. [PMID: 35903719 PMCID: PMC9315400 DOI: 10.1055/a-1811-6106] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 10/26/2022] Open
Abstract
AbstractEvidence relating to the treatment of breast cancer patients with early-stage disease has increased significantly in the past year. Abemaciclib, olaparib, and pembrolizumab are new drugs
with good efficacy in the relevant patient groups. However, some questions remain unanswered. In particular, it remains unclear which premenopausal patients with hormone receptor-positive
breast cancer should be spared unnecessary treatment. The question of the degree to which chemotherapy exerts a direct cytotoxic effect on the tumor or reduces ovarian function through
chemotherapy could be of key importance. This group of patients could potentially be spared chemotherapy. New, previously experimental biomarker analysis methods, such as spatial analysis of
gene expression (spatial transcriptomics) are gradually finding their way into large randomized phase III trials, such as the NeoTRIP trial. This in turn leads to a better understanding of
the predictive factors of new therapies, for example immunotherapy. This review summarizes the scientific innovations from recent congresses such as the San Antonio Breast Cancer Symposium
2021 but also from recent publications.
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Affiliation(s)
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Diana Lüftner
- Charité University Hospital, Department of Hematology, Oncology and Tumour Immunology, University Medicine Berlin, Berlin, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Isabell Witzel
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Simon Bader
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Katharina Seitz
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Genecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Bahriye Aktas
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Barbara Seliger
- Martin-Luther-Universitat Halle-Wittenberg, Institute of Medical Immunology, Halle (Saale), Germany
| | - Chiara Massa
- Martin-Luther-Universitat Halle-Wittenberg, Institute of Medical Immunology, Halle (Saale), Germany
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Müller V, Welslau M, Lüftner D, Schütz F, Stickeler E, Fasching PA, Janni W, Thomssen C, Witzel I, Fehm TN, Belleville E, Bader S, Seitz K, Untch M, Thill M, Tesch H, Ditsch N, Lux MP, Aktas B, Banys-Paluchowski M, Schneeweiss A, Harbeck N, Würstlein R, Hartkopf AD, Kolberg HC, Wöckel A. Update Breast Cancer 2022 Part 2 – Advanced Stage Breast Cancer. Geburtshilfe Frauenheilkd 2022; 82:590-600. [PMID: 35903715 PMCID: PMC9315399 DOI: 10.1055/a-1811-6148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 12/11/2022] Open
Abstract
For patients with advanced breast cancer, several novel therapies have emerged in recent years, including CDK4/6 inhibitors, immune checkpoint inhibitors, PARP inhibitors, alpelisib,
tucatinib and trastuzumab-deruxtecan, and sacituzumab-govitecan, which have transformed and expanded the therapeutic landscape for patients with advanced breast cancer. Some of these
substances have now been approved for use in the early stages of the disease, or are expected to be approved in the near future, so the therapeutic landscape will change once again.
Therefore, current scientific efforts are focused on the introduction of new substances and understanding their mechanisms of progression and efficacy. This review summarizes recent
developments with reference to recent publications and conferences. Findings on the treatment of patients with HER2-positive breast cancer and brain metastases are presented, as are a number
of studies looking at biomarkers in patients with HER2-negative, hormone receptor-positive breast cancer. In particular, the introduction of oral selective estrogen receptor degraders
provides new opportunities to establish biomarker-based therapy. Molecular diagnostics is establishing itself as a diagnostic marker and parameter of progression.
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Affiliation(s)
- Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | | | - Diana Lüftner
- Charité University Hospital, Department of Hematology, Oncology and Tumour Immunology, University Medicine Berlin, Berlin, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Simon Bader
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Katharina Seitz
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Genecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Bahriye Aktas
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | | | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
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Lüftner D, Brucker C, Decker T, Fasching PA, Göhler T, Jackisch C, Janssen J, Koehler A, Luedtke-Heckenkamp K, Mackelenbergh MV, Marmé F, Nusch A, Rautenberg B, Reimer T, Schmidt M, Weide R, Wimberger P, Nabieva N, Roos C, Woeckel A. Real-world efficacy of ribociclib (RIB) plus aromatase inhibitor (AI)/fulvestrant (FUL), or endocrine monotherapy (ET), or chemotherapy (CT) as first-line (1L) treatment (tx) in patients (pts) with hormone receptor–positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer (ABC): Results of fourth interim analysis (IA) from RIBANNA. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1065 Background: RIBANNA is a real-world, noninterventional study conducted in Germany evaluating efficacy, safety, and tolerability of RIB in combination with AI/FUL aiming to gain insights into routine clinical practice for pts with HR+, HER2– ABC. Here, we present results of the fourth IA from RIBANNA. Methods: Pre-, peri- and postmenopausal pts who received 1L tx with RIB+AI/FUL, or ET or CT for HR+, HER2– ABC were included in accordance with the German tx guideline. The effect of baseline demographic characteristics, including histological grade, age, previous adjuvant tx, Eastern Cooperative Oncology Group-performance score (ECOG-PS), and metastatic sites on progression-free survival was evaluated using Cox regression model. Results: At data cutoff October 11, 2021, 2598 pts were enrolled in the study (RIB+AI/FUL, n = 2177; ET, n = 239; CT, n = 182). Data from 1L tx were available for 2492 pts (95.9%), second-line tx for 689 pts (26.5%), third-line tx for 263 pts (10.1%), and fourth-line tx for 94 pts (3.6%). Significant differences were observed in baseline mean age and metastatic sites for pts in RIB+AI/FUL cohort vs ET and CT cohorts (both < 0.001). At baseline, the mean (SD) ages of pts were 65.5 (11.6), 70.7 (11.5) and 61.6 (11.6) years in RIB+AI/FUL, ET, and CT cohorts, respectively. While comparing the performance status, 44.2% of pts in RIB+AI/FUL, 34.7% of pts in ET and 42.1% of pts in CT cohort were fully active with ECOG-PS = 0. CNS, liver, or lung metastases were recorded in 42.6% of pts in RIB+AI/FUL, 26.8% of pts in ET and 67.1% of pts in CT cohort. Bone only metastases were reported in 30.8%, 47.9% and 15.0% of pts in RIB+AI/FUL, ET, and CT cohorts, respectively. Overall, 32.1%, 37.7%, and 52.7% of pts discontinued the study in RIB+AI/FUL, ET, and CT cohorts, respectively, the most common reasons being deaths (16.1%,17.2%, and 31.9%, respectively) and lost to follow-up (5.9%, 8.8%, and 9.3%, respectively). The most common tx-emergent adverse event (grade 3 or 4) observed in RIB+AI/FUL cohort was neutropenia (14.8%), while 6.6% and 6.9% of pts in ET and CT cohorts, respectively, experienced neutropenia. The efficacy results from all 3 cohorts, including Kaplan-Meier curves, will be presented during ASCO 2022. Conclusions: RIBANNA study showed diverse population characteristics among pts who received RIB tx in a real-world setting. Overall higher number of pts were treated in 1L with RIB+AI/FUL followed by ET and CT. The differences in baseline characteristics on metastatic pattern, age, and ECOG-PS reflect different selection strategies for 1L tx decision. No new safety signals were identified. Clinical trial information: CLEE011ADE03.
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Affiliation(s)
| | | | | | | | | | | | - Jan Janssen
- Medizinische Studiengesellschaft Nord-West GmbH, Westerstede, Germany
| | | | | | | | - Frederik Marmé
- Med. Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Arnd Nusch
- Practice for Hematology and Medical Oncology Velbert, Velbert, Germany
| | | | | | - Marcus Schmidt
- Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | | | - Pauline Wimberger
- Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Kolberg-Liedtke C, Lüftner D, Brucker SY, Budach W, Denkert C, Fasching PA, Haidinger R, Harbeck N, Huober J, Jackisch C, Janni W, Krug D, Kühn T, Loibl S, Müller V, Schneeweiss A, Thomssen C, Untch M, Thill M. Practice-Changing Perspectives regarding Systemic Therapy in Early Breast Cancer: Opinions of German Experts regarding the 17th St. Gallen International Consensus Conference. Breast Care (Basel) 2022; 17:336-345. [PMID: 35957945 PMCID: PMC9247526 DOI: 10.1159/000517501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 09/22/2023] Open
Abstract
The general topic of this year's 17th St. Gallen (SG) International Consensus Conference on the treatment of patients with early breast cancer (SG-BCC) was "Customizing local and systemic therapies for women with early breast cancer." This topic considers that each treatment decision must also consider the cancer-specific situation of the individual patient. This year, the votes of the SG-BCC were again discussed taking into account the multidisciplinary German S3 Guidelines and the recommendations of the Breast Cancer Working Group of the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie; AGO Mamma). As the international panel of the SG-BCC consists of experts from different countries, the votes do represent an international cross-section of opinions. Therefore, it is useful to discuss the voting results with respect to the German evidence-based treatment guidelines. This publication focuses mainly on systemic treatment.
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Affiliation(s)
- Cornelia Kolberg-Liedtke
- Clinic for Gynecology and Obstetrics, University Hospital of Essen, Essen, Germany
- Palleos Healthcare GmbH, Wiesbaden, Germany
- Phaon Scientific GmbH, Wiesbaden, Germany
| | - Diana Lüftner
- Medical Clinic Specializing in Hematology, Oncology, and Tumor Immunology, Charité Berlin, Virchow Hospital Campus, Berlin, Germany
| | - Sara Y. Brucker
- Department of Women's Health, University Women's Hospital Tübingen, Tübingen, Germany
| | - Wilfried Budach
- Clinic for Radiation Therapy and Radiation Oncology, University Clinic of Düsseldorf, Düsseldorf, Germany
| | - Carsten Denkert
- Pathology Institute, Philipps University of Marburg and University Hospital of Marburg (UKGM), Marburg, Germany
| | - Peter A. Fasching
- Women's Clinic at the University Hospital of Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Nadia Harbeck
- Breast Center, Department of OB&GYN and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Jens Huober
- Breast Center, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | | | | | - David Krug
- Clinic for Radiation Therapy (Radiation Oncology), University Hospital of Schleswig-Holstein, Kiel Campus, Kiel, Germany
| | - Thorsten Kühn
- Clinic for Gynecology and Obstetrics, Esslingen Hospital, Esslingen, Germany
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany
- Bethany Center for Hematology and Oncology, Frankfurt, Germany
| | - Volkmar Müller
- Clinic and Outpatient Clinic for Gynecology, University Clinic of Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), University Hospital of Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christoph Thomssen
- University Clinic and Outpatient Clinic for Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Clinic for Gynecology and Obstetrics, Interdisciplinary Breast Center, HELIOS Hospital of Berlin-Buch, Berlin, Germany
| | - Marc Thill
- Clinic for Gynecology and Gynecological Oncology, Interdisciplinary Breast Center, Agaplesion Markus Hospital, Frankfurt, Germany
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Stintzing S, Seufferlein T, Rosé C, Reichenbach F, Lüftner D. Encorafenib in combination with cetuximab after systemic therapy in patients with BRAFV600E mutant metastatic colorectal cancer: German health technology assessment-driven analyses from the BEACON CRC study. Clin Colorectal Cancer 2022; 21:244-251. [DOI: 10.1016/j.clcc.2022.04.002] [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] [Received: 03/13/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
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Lüftner D, Schütz F, Stickeler E, Fasching PA, Janni W, Kolberg-Liedtke C, Kolberg HC, Thomssen C, Müller V, Fehm TN, Belleville E, Bader S, Untch M, Welslau M, Thill M, Tesch H, Ditsch N, Lux MP, Wöckel A, Aktas B, Schneeweiss A, Würstlein R, Hartkopf AD. Correction: Update Breast Cancer 2021 Part 5 – Advanced Breast Cancer. Geburtshilfe Frauenheilkd 2022; 82:e1. [PMID: 35283689 PMCID: PMC8916847 DOI: 10.1055/a-1784-9971] [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: 10/29/2022] Open
Affiliation(s)
- Diana Lüftner
- Charité University Hospital, Department of Hematology, Oncology and Tumour Immunology, University Medicine Berlin, Berlin, Germany
| | - Florian Schütz
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
- palleos healthcare, Wiesbaden, Germany
- Phaon Scientific, Wiesbaden, Germany
| | | | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Tanja N. Fehm
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | | | - Simon Bader
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Genecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | | | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Bahriye Aktas
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Andreas D. Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
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Galsky MD, Del Conte G, Foti S, Yu EY, Machiels JPH, Doger B, Necchi A, De Braud FG, Hamilton EP, Hennequin A, Van den Mooter T, Debruyne PR, Moreno I, Arkenau HT, Tsuchihashi Z, Cheng FC, Augustine B, Cheng B, Barrios D, Lüftner D. Primary analysis from DS8201-A-U105: A phase 1b, two-part, open-label study of trastuzumab deruxtecan (T-DXd) with nivolumab (nivo) in patients (pts) with HER2-expressing urothelial carcinoma (UC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.438] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
438 Background: HER2 overexpression has been found in invasive UC, suggesting a role for HER2 in disease progression and prognosis (Kruger Int J Oncol 2002). T-DXd is an antibody-drug conjugate comprising an anti-HER2 antibody, a cleavable linker, and a topoisomerase I inhibitor payload. Preclinical models showed that T-DXd combined with an anti-PD-1 antibody had greater efficacy versus either agent alone (Iwata Mol Cancer Ther 2018). We conducted a phase 1b, 2-part, open-label, multicenter study of T-DXd in combination with nivo in pts with HER2-expressing advanced/metastatic UC (NCT03523572). Methods: Pts aged ≥18 y had pathologically documented advanced/metastatic UC with centrally confirmed HER2 expression by immunohistochemistry (IHC) 2+/3+ (cohort 3; high expression) or IHC 1+ (cohort 4; low expression) who received prior platinum-based therapy with documented progression. Pts received T-DXd at 5.4 mg/kg and nivo 360 mg IV every 3 weeks (recommended dose for expansion). The primary endpoint was confirmed objective response rate (ORR) assessed by independent central review (ICR) per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints (assessed by ICR) included duration of response (DOR), progression-free survival (PFS), time to response (TTR), and overall survival (OS), and safety. Results: At the primary analysis data cutoff (July 22, 2021), 34 pts (cohort 3, n = 30; cohort 4, n = 4) received T-DXd and nivo. Median age was 70.9 y (range, 41.4-80.5), 88.2% were male, 61.8% received ≥1 prior regimens for locally advanced/metastatic disease, and 26.5% had a history of liver metastases. Median treatment duration (all pts) was 3.2 mo (range, 1-21) for T-DXd and 4.1 mo (range, 1-20) for nivo. In cohort 3, ORR by ICR was 36.7% (95% CI, 19.9-56.1; complete response, 13.3%; partial response, 23.3%), median DOR was 13.1 mo (95% CI, 4.1- NE), median PFS was 6.9 mo (95% CI, 2.7-14.4), median TTR was 1.9 mo (range 1.2-6.9), and median OS was 11.0 mo (95% CI, 7.2-NE). Grade (G) ≥3 treatment-emergent adverse events (TEAEs) occurred in 73.5% of all pts (44.1% related to T-DXd; 26.5% related to nivo). TEAEs leading to drug discontinuation occurred in 32.4% of all pts (17.6% related to T-DXd; 23.5% related to nivo). The most common any-grade TEAEs were nausea (73.5%), fatigue (52.9%), and vomiting (44.1%). Adjudicated drug-related interstitial lung disease (ILD)/pneumonitis occurred in 23.5% of all pts (2 G1; 4 G2; 1 G3; 1 G5). Conclusions: T-DXd combined with nivo showed antitumor activity in pts with high-expressing HER2 UC. The safety profile was consistent with prior studies for T-DXd in other indications and nivo monotherapy in UC pts. Adjudicated ILD/pneumonitis was within the range observed in other T-DXd monotherapy studies. Ongoing clinical trials are further exploring T-DXd in this population. Clinical trial information: NCT03523572.
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Affiliation(s)
| | | | | | - Evan Y. Yu
- University of Washington and Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | - Andrea Necchi
- Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | - Philip R. Debruyne
- AZ Groeninge Hospital, Kortrijk, Belgium, and Anglia Ruskin University, Cambridge, United Kingdom
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Lüftner D, Bartsch R, Breitenstein U, Balic M, Jackisch C, Müller V, Rinnerthaler G, Schmidt M, Schwitter M, Zaman K, Wrobel D, Guth D, Terhaag J, Zaiss M, Schinköthe T, Harbeck N. Abstract P2-13-30: First interim analysis from ELEANOR: A multi-national, prospective, non-interventional study (NIS) in patients with human epidermal growth factor receptor positive (HER2+) early breast cancer observing real-life extended adjuvant treatment with neratinib. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-13-30] [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: Recent advances in (post-)/(neo)adjuvant treatment for HER2+ breast cancer have led to a major reduction in recurrence risk; still a relevant percentage of patients relapses over time, predominantly presenting with distant recurrence. Neratinib is registered in Europe as extended adjuvant treatment for adult patients with HER2+, HR+ early-stage breast cancer (eBC), who completed adjuvant trastuzumab-based therapy less than one year ago. In the ExteNET study, neratinib improved the 5-year iDFS absolute-rate by 5.1% versus placebo in this population (90.8% vs. 85.7%; HR 0.58 [95% CI 0.41-0.82]), mainly by prolonging time to development of distant metastases. According to explorative (post-hoc) analyses from ExteNET, the effect might be even more pronounced in patients with non-pCR after neoadjuvant trastuzumab treatment and/or in patients with completion of neratinib therapy (i.e. ≥11 months of neratinib treatment). Diarrhea, the most common grade 3 adverse event (neratinib: 39% without primary diarrhea prophylaxis, median cumulative duration 5 days; placebo: 1%; no grade 4 events) can generally be managed through adequate prophylaxis and treatment management. ELEANOR is the first international NIS to investigate real-world use of neratinib and its treatment management in eBC patients in Germany, Austria and Switzerland. Methods: The primary objective of this ongoing NIS is to investigate the rate of patients being adherent to neratinib treatment (i.e. neratinib intake for ≥75% of treatment days). Secondary objectives include detailed patient and disease characteristics, details on prior trastuzumab-based therapies (including pertuzumab and T-DM1), neratinib doses, dose modifications and neratinib treatment management, relapses, safety/tolerability, and quality of life (QoL), among others. 300 adult female patients with HER2+/HR+ eBC are planned in accordance with the SmPC specifications (planned end of documentation: 2023). CANKADO, an application developed to support patient/physician communication, is an integral part of the NIS. Different CANKADO modules can be used optionally, including QoL documentation (EQ-5D-5L- and diarrhea-specific questionnaires) and continuous documentation of health status and symptoms. Results: Between July 2020 and July 2021, 141 patients have been enrolled; patient enrollment is ongoing. The first pre-planned interim analysis will be performed after the 100th patient has been observed for 3 months (data cut July 2021). Here, we will present baseline demographic and tumor characteristics for the first 100 patients, as well as prior trastuzumab-based treatments and first safety and tolerability data of real-world neratinib use. Conclusion: The results of the first interim analysis present a preliminary snapshot of the current treatment landscape and real-life neratinib use in Germany and Austria. The ELEANOR NIS should help to understand adherence to neratinib treatment and use of extended adjuvant HER2-targeted therapy in the current treatment landscape focussing on treatment management after different pre-therapies. The study is funded by Pierre Fabre Pharma GmbH (Freiburg, Germany), Pierre Fabre Pharma Austria (Wels, Austria) and Pierre Fabre Pharma AG (Allschwil, Switzerland).
Citation Format: Diana Lüftner, Rupert Bartsch, Urs Breitenstein, Marija Balic, Christian Jackisch, Volkmar Müller, Gabriel Rinnerthaler, Marcus Schmidt, Michael Schwitter, Khalil Zaman, Denise Wrobel, Dagmar Guth, Jürgen Terhaag, Matthias Zaiss, Timo Schinköthe, Nadia Harbeck. First interim analysis from ELEANOR: A multi-national, prospective, non-interventional study (NIS) in patients with human epidermal growth factor receptor positive (HER2+) early breast cancer observing real-life extended adjuvant treatment with neratinib [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-30.
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Affiliation(s)
| | - Rupert Bartsch
- Medical University of Vienna, Department of Medicine I, Division of Oncology, Vienna, Austria
| | | | - Marija Balic
- Divison of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Klinikum Offenbach, Offenbach, Germany
| | - Volkmar Müller
- Department of Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Austria
| | - Marcus Schmidt
- University Hospital Mainz, Dept. Gynecology, Mainz, Germany
| | | | - Khalil Zaman
- Breast Center, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Denise Wrobel
- Sozialstiftung Bamberg Klinikum am Bruderwald, Bamberg, Germany
| | - Dagmar Guth
- Gyneco-oncological practice Dr. Guth, Plauen, Germany
| | | | | | | | - Nadia Harbeck
- Breast Center, Dept. OB&GYN, LMU University Hospital, Munich, Germany
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Pivot X, Pegram MD, Cortes J, Lüftner D, Lyman GH, Curigliano G, Bondarenko IM, Dvorkin M, Ahn JH, Im SA, Litwiniuk M, Shparyk YV, Ho GF, Kislov NV, Wojtukiewicz M, Sarosiek T, Chae YS, Ahn JS, Jang H, Kim S, Lee J, Lee SY, Yoon YC. Abstract P2-13-04: Final survival analysis of a phase 3 study comparing SB3 (trastuzumab biosimilar) and reference trastuzumab in HER2-positive early or locally advanced breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-13-04] [Citation(s) in RCA: 1] [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: 11/16/2022]
Abstract
Abstract
Background: SB3 (trastuzumab-dttb) is a biosimilar approved globally based on its similarity with reference trastuzumab (TRZ) demonstrated by thorough comparability exercises in analytical, biological, and clinical studies. In a randomized, double-blind, multicenter Phase 3 study of 875 patients with HER2-positive early or locally advanced breast cancer in the neoadjuvant setting, equivalent efficacy, similar safety, pharmacokinetics, and immunogenicity between SB3 and TRZ were shown. However, when quality attributes of TRZ were examined, downward drifts in antibody-dependent cell-mediated cytotoxicity activities (ADCC) were observed in the TRZ lots with expiry dates ranging from Aug 2018 to Dec 2019. Some of these lots of the reference product were found to be used in the Phase 3 study. After completing the Phase 3 study, patients from select countries were included in a follow-up observational study to monitor cardiac safety and survival. Here, we report the final survival results, including post-hoc subgroup analysis based on ADCC status, at a median follow-up of 68 months. Methods: During the follow-up observational study, the protocol was amended to include additional patients who originally were enrolled in the Phase 3 study but had not been followed in the observational study, in order to collect a larger sample of survival data. For these additional patients, medical records from the last assessment in the Phase 3 study through the date of enrollment in the follow-up study were collected retrospectively. As post-hoc analysis, patients in the TRZ arm were stratified into two subgroups: patients who received during neoadjuvant treatment at least one vial of TRZ with downward drift in ADCC as “Drifted TRZ”, and the others as “Non-drifted TRZ”. Event-free survival (EFS) and overall survival (OS) were assessed. Results: Of 875 patients randomized in the Phase 3 study, 538 patients (SB3, N=267; TRZ, N=271) were enrolled in the follow-up observational study: 367 patients were initially enrolled in the follow-up study, and 171 patients were additionally enrolled following the protocol amendment. The median follow-up duration was 68 months from randomization in the Phase 3 study. 54 events (20.2%) in the SB3 arm, and 67 events (24.7%) in the TRZ arm were reported (HR 0.84 [0.58, 1.20], p=0.335). 22 deaths (8.2%) and 38 deaths (14%) were reported in SB3 and TRZ arms, respectively (HR 0.61 [0.36, 1.05], p=0.073). In post-hoc analysis, of 271 patients in TRZ arm, 107 patients were grouped as “Non-drifted TRZ”, and 164 patients as “Drifted TRZ”. 19 events (17.8%) in the Non-drifted TRZ group and 48 (29.3%) events in the Drifted TRZ group occurred (HR 2.57 [1.28, 5.14], p=0.008). 9 deaths (8.4%) in the Non-drifted TRZ group and 29 deaths (17.7%) in the Drifted TRZ group were reported (HR 3.87 [1.37, 10.93], p=0.011). No difference was observed between SB3 arm and Non-drifted TRZ group in terms of EFS (HR 1.28 [0.73, 2.22], p=0.391) and OS (HR 0.99 [0.42, 2.31], p=0.975). Conclusions: Comparable long-term efficacy results in EFS and OS were shown at 68 months of follow-up, further supporting biosimilarity of SB3 to the reference product. Currently, these follow-up results represent the longest monitoring data of patients treated with a trastuzumab biosimilar for HER2-positive early or locally advanced breast cancer.
Citation Format: Xavier Pivot, Mark D Pegram, Javier Cortes, Diana Lüftner, Gary H Lyman, Giuseppe Curigliano, Igor M Bondarenko, Mikhail Dvorkin, Jin Hee Ahn, Seock-Ah Im, Maria Litwiniuk, Yaroslav V Shparyk, Gwo Fuang Ho, Nikolay V Kislov, Marek Wojtukiewicz, Tomasz Sarosiek, Yee Soo Chae, Jin Seok Ahn, Hyerin Jang, Sujung Kim, Jiwon Lee, Soo Young Lee, Ye Chan Yoon. Final survival analysis of a phase 3 study comparing SB3 (trastuzumab biosimilar) and reference trastuzumab in HER2-positive early or locally advanced breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-04.
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Affiliation(s)
- Xavier Pivot
- Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | | | - Javier Cortes
- Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Igor M Bondarenko
- Dnipropetrovsk City Multy-Field Clinical Hospital #4, Dnipropetrovsk, Ukraine
| | - Mikhail Dvorkin
- Omsk Region Budgetary Healthcare Institution “Clinical Oncology Dispensary”, Omsk, Russian Federation
| | - Jin Hee Ahn
- Asan Medical Center, Seoul, Korea, Republic of
| | - Seock-Ah Im
- Seoul National University Hospital, Seoul, Korea, Republic of
| | | | - Yaroslav V Shparyk
- Lviv State Oncological Regional Therapeutical and Diagnostic Center, Lviv, Ukraine
| | - Gwo Fuang Ho
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nikolay V Kislov
- State Budgetary Healthcare Institution of Yaroslavl Region “Regional Clinical Oncology Hospital”, Yaroslavl, Russian Federation
| | - Marek Wojtukiewicz
- Bialostockie Centrum Onkologii im.M.Sklodowskiej-Curie, Bialystok, Poland
| | | | - Yee Soo Chae
- Kyungpook National University Chilgok Hospital, Daegu, Korea, Republic of
| | - Jin Seok Ahn
- Samsung Medical Center, Seoul, Korea, Republic of
| | - Hyerin Jang
- Samsung Bioepis, Incheon, Korea, Republic of
| | - Sujung Kim
- Samsung Bioepis, Incheon, Korea, Republic of
| | - Jiwon Lee
- Samsung Bioepis, Incheon, Korea, Republic of
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Lüftner D, Brucker C, Decker T, Fasching P, Göhler T, Jackisch C, Janssen J, Köhler A, Lüdtke-Heckenkamp K, van Mackelenbergh M, Marmé F, Nusch A, Rautenberg B, Reimer T, Schmidt M, Weide R, Wimberger P, Nabieva N, Roos C, Wöckel A. Abstract P1-18-15: Real-world efficacy of ribociclib + aromatase inhibitor/fulvestrant, or endocrine monotherapy, or chemotherapy as first-line treatment in women with hormone receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-) locally advanced or metastatic breast cancer: Fourth interim analysis from the RIBANNA study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-18-15] [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: Ribociclib (RIB; a selective CDK4/6 inhibitor) + endocrine therapy (ET; aromatase inhibitor or fulvestrant along with ovarian suppression in pre- and perimenopausal patients [pts]) received USFDA and EMA approval for pre-, peri- and postmenopausal pts with HR+, HER2- advanced breast cancer (ABC) based on results from phase 3 MONALEESA (ML) trials. In ML-2 trial, first-line treatment (tx) with RIB + letrozole (LET) vs placebo (PBO) + LET significantly improved median progression-free survival (mPFS) in postmenopausal pts with HR+, HER2- ABC. In ML-3 and ML-7 trials, RIB + ET vs PBO + ET showed a significant improvement in mPFS and overall survival among pts with HR+, HER2- ABC, irrespective of menopausal status, line of tx and combination partner. Real-world evidence on the effectiveness, safety, and tolerability of RIB + ET in pts with HR+, HER2- ABC would help to gain insight into routine clinical practice. Methods: RIBANNA is a prospective, noninterventional study ongoing in Germany since October 2017. Pre-, peri- and postmenopausal pts who received first-line tx with RIB + ET, or ET alone or chemotherapy (CT) for HR+, HER2- ABC in accordance with German tx guidelines were included. Data from routine clinical practice in all 3 cohorts, including further lines of sequential therapy, were collected. The third interim analysis data from RIBANNA study was presented in SABCS 2020. Fourth interim analysis data will be presented during SABCS 2021. Results: Till February 11, 2021, 2594 pts were included in the study (RIB + ET, n = 2183; ET, n = 229; CT, n = 182) and the enrollment was stopped; however, pt follow-up will be continued for an additional 4 years. For the fourth interim analysis, full analysis set (comprising all pts, except screening failures and locked pts, who received at least one dose of study medication [safety analysis set] and for whom ≥ 1 post-baseline evaluation was recorded) included 2131 pts (RIB + ET, n = 1814 [81.2%]; ET, n = 175 [73.8%]; CT, n = 142 [72.1%]), while the safety analysis set comprised 2452 pts (RIB + ET, n = 2062 [92.3%]; ET, n = 216 [91.1%]; CT, n = 174 [88.3%]). Until last patient first visit, among 2594 treated pts (including screening failures), data from first-line (1L) tx are available for 2452 pts (94.5%), from second-line (2L) tx for 343 pts (13.2%), and from third-line (3L) tx for 74 pts (2.9%, Table 1). Overall, 23.9%, 27.9%, and 43.4% of pts discontinued the study in RIB + ET, ET, and CT cohorts, respectively. The fourth interim analysis is planned in October 2021, and the final baseline demographic data as well as updated information on safety will be presented during SABCS 2021. Conclusion: RIBANNA study showed diverse population characteristics among pts who received RIB tx in a real-world setting. The data from fourth interim analysis, which is planned in October 2021, including final baseline demographic data and updated safety data will be presented.
Table 1. Patient disposition following last patient first visit on February 11, 2021PatientsTotal. (N = 2594). n (%)RIB + AI/FUL (n = 2183). n (%)ET (n = 229). n (%)CT. (n = 182). n (%)Includeda2594 (100.0)2183 (100.0)229 (100.0)182 (100.0)Treated (including screening failures)2452 (94.5)2062 (94.5)216 (94.3)174 (95.6)1L therapyb2452 (94.5)2062 (94.5)216 (94.3)174 (95.6)2L therapyb343 (13.2)264 (12.1)36 (15.7)43 (23.6)3L therapyb74 (2.9)53 (2.4)10 (4.4)11 (6.0)4L therapyb7 (0.3)7 (0.3)0 (0.0)0 (0.0)Discontinued studyc664 (25.6)521 (23.9)64 (27.9)79 (43.4)aAll pts signing informed consent form, bNumber of data set available till February11, 2021, cEnd of documentation with reason other than ‘end of study.
Citation Format: Diana Lüftner, Cosima Brucker, Thomas Decker, Peter Fasching, Thomas Göhler, Christian Jackisch, Jan Janssen, Andreas Köhler, Kerstin Lüdtke-Heckenkamp, Marion van Mackelenbergh, Frederik Marmé, Arnd Nusch, Beate Rautenberg, Toralf Reimer, Marcus Schmidt, Rudolf Weide, Pauline Wimberger, Naiba Nabieva, Christian Roos, Achim Wöckel. Real-world efficacy of ribociclib + aromatase inhibitor/fulvestrant, or endocrine monotherapy, or chemotherapy as first-line treatment in women with hormone receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-) locally advanced or metastatic breast cancer: Fourth interim analysis from the RIBANNA study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-15.
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Affiliation(s)
- Diana Lüftner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Berlin, Germany
| | - Cosima Brucker
- Klinikum Nürnberg Nord, Paracelsus Medical University, Nürnberg, Germany
| | | | - Peter Fasching
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | | | - Christian Jackisch
- Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Jan Janssen
- Medizinische Studiengesellschaft Nord-West GmbH, Westerstede, Germany
| | | | | | | | - Frederik Marmé
- Med. Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Arnd Nusch
- Practice for Hematology and Medical Oncology Velbert, Velbert, Germany
| | | | | | - Marcus Schmidt
- Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | | | - Pauline Wimberger
- Universitätsklinikum Carl Gustav Carus, Technische Universität, Dresden, Germany
| | | | | | - Achim Wöckel
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
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Thomssen C, Fehm TN, Stickeler E, Fasching PA, Janni W, Kolberg-Liedtke C, Kolberg HC, Lüftner D, Müller V, Schütz F, Belleville E, Bader S, Untch M, Welslau M, Thill M, Hartkopf AD, Tesch H, Ditsch N, Lux MP, Wöckel A, Aktas B, Schneeweiss A, Würstlein R. Update Breast Cancer 2021 Part 4 – Prevention and Early Stages. Geburtshilfe Frauenheilkd 2022; 82:206-214. [PMID: 35169388 PMCID: PMC8837401 DOI: 10.1055/a-1724-9639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/18/2021] [Indexed: 12/18/2022] Open
Abstract
This past year has seen new and effective options for further improving treatment outcome in many patients with early-stage breast cancer. Patients with hormone receptor-positive disease
benefited significantly from the addition of the CDK4/6 inhibitor abemaciclib to endocrine adjuvant therapy. In triple-negative disease, data were presented for two treatment regimens.
Patients with advanced disease (stage 2 and 3) benefit from neoadjuvant treatment with the immune checkpoint inhibitor pembrolizumab in combination with standard chemotherapy, regardless of
PD-L1 expression. When neoadjuvant therapy has failed to achieve the desired remission in BRCA1 and BRCA2 mutations, the administration of the PARP inhibitor olaparib has demonstrated an
impressive response. Other data address translational issues in HER2-positive breast cancer and neoadjuvant therapy approaches with the oral SERD giredestrant and the PARP inhibitor
talazoparib. This review presents and analyses the findings of this yearʼ s most important study outcomes.
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Affiliation(s)
- Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
- palleos healthcare, Wiesbaden, Germany
- Phaon Scientific, Wiesbaden, Germany
| | | | - Diana Lüftner
- Charité University Hospital, Department of Hematology, Oncology and Tumour Immunology, University Medicine Berlin, Berlin, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | | | - Simon Bader
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Genecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | | | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main, Germany
| | - Andreas D. Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Bahriye Aktas
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
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Lüftner D, Schütz F, Stickeler E, Fasching PA, Janni W, Kolberg-Liedtke C, Kolberg HC, Thomssen C, Müller V, Fehm TN, Belleville E, Bader S, Untch M, Welslau M, Thill M, Tesch H, Ditsch N, Lux MP, Wöckel A, Aktas B, Schneeweiss A, Würstlein R, Hartkopf AD. Update Breast Cancer 2021 Part 5 – Advanced Breast Cancer. Geburtshilfe Frauenheilkd 2022; 82:215-225. [PMID: 35169389 PMCID: PMC8837406 DOI: 10.1055/a-1724-9569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/18/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the COVID 19 pandemic and mostly virtual congresses, innovation in the treatment of breast cancer patients continues at an unabated pace. This review summarises the current
developments. Initial overall survival data for CDK4/6 inhibitor treatment in combination with an aromatase inhibitor as the first advanced line of therapy in treatment-naive postmenopausal
patients have been published. Similarly, a trial comparing trastuzumab-deruxtecan versus trastuzumab-emtansine revealed a clear benefit regarding progression-free survival. Understanding of
biomarkers making checkpoint inhibitor therapy particularly effective is increasing, and new compounds such as oral selective estrogen receptor destabilisers (SERDs) are entering clinical
development and completing the first phase III trials.
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Affiliation(s)
- Diana Lüftner
- Charité University Hospital, Department of Hematology, Oncology and Tumour Immunology, University Medicine Berlin, Berlin, Germany
| | - Florian Schütz
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
- palleos healthcare, Wiesbaden, Germany
- Phaon Scientific, Wiesbaden, Germany
| | | | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Tanja N. Fehm
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | | | - Simon Bader
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Genecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | | | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Bahriye Aktas
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Rachel Würstlein
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Andreas D. Hartkopf
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
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Lüftner D, Fasching PA, Haidinger R, Harbeck N, Jackisch C, Müller V, Schumacher-Wulf E, Thomssen C, Untch M, Würstlein R. ABC6 Consensus: Assessment by a Group of German Experts. Breast Care (Basel) 2022; 17:90-100. [PMID: 35355695 PMCID: PMC8914214 DOI: 10.1159/000522068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/17/2022] [Indexed: 02/03/2023] Open
Abstract
Background The first International Consensus Conference for Advanced Breast Cancer (ABC1) took place 10 years ago in November 2011. The rationale was - and still is - to standardize treatment of advanced breast cancer (ABC) based on the available evidence and to ensure that worldwide all breast cancer patients receive adequate treatment and access to new therapies. Rationale for the Manuscript The 6th International Consensus Conference for ABC (ABC6) took place from November 4 to 6, 2021 and was the first in a purely online format, due to the COVID-19 pandemic. In the present manuscript, a working group of German breast cancer experts comments on the voting results of the ABC6 panelists regarding their applicability for routine clinical practice in Germany. Method The ABC6 votes mainly include modified or new statements. With regard to all statements not modified for the ABC6 consensus, the German experts refer to the published paper of the ABC5 consensus. The German experts base their comments on the current recommendations of the Breast Committee of the Gynecological Oncology Working Group (Arbeitsgemeinschaft Gynäkologische Onkologie, AGO Mamma). Topics ABC6 focused on new treatment options and their implications for clinical practice. Optimal therapy sequencing for example was one of the issues. To solve the challenge of a more individualized treatment, precision medicine is fundamental. Oligometastatic disease, brain metastases and adequate supportive and palliative care were also addressed. Of special interest was the treatment of inoperable locally advanced breast cancer, which was discussed as a separate topic. As in previous years, patient advocates from around the world were an integral part of the ABC6 conference and had a major input into the consensus.
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Affiliation(s)
- Diana Lüftner
- Medical Department of Hematology, Oncology, and Tumor Immunology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany,*Diana Lüftner,
| | - Peter A. Fasching
- Women's Hospital at the University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Renate Haidinger
- Brustkrebs Deutschland [German Breast Cancer Association] e.V., Hohenbrunn, Germany
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center (CCC) Munich, LMU University Hospital, Munich, Germany
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Sana Hospital Offenbach, Offenbach, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hospital, Hamburg-Eppendorf, Germany
| | | | - Christoph Thomssen
- Department of Gynecology, Martin Luther University Halle-Wittenberg, Halle an der Saale, Germany
| | - Michael Untch
- Clinic of Gynecology and Obstetrics, Multidisciplinary Breast Cancer Center, Department of Gynecologic Oncology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Rachel Würstlein
- Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center (CCC) Munich, LMU University Hospital, Munich, Germany
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Quinn B, Laurent S, Dargan S, Lapuente M, Lüftner D, Drudge-Coates L, Palma MD, Lago LD, Flynn J, Panter C, Seesaghur A. Managing Advanced Cancer Pain Together (MACPT) conversation tool: an evaluation of use in clinical practice. Pain Manag 2021; 12:435-446. [PMID: 34866400 DOI: 10.2217/pmt-2021-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate use of the 'Managing Advanced Cancer Pain Together' conversation tool between individuals with advanced cancer and healthcare professionals (HCPs) during routine consultations. Methods: Twenty-one patients and six HCPs completed questionnaires before and after use of the tool (at their routine consultation 1 and consecutive consultation 2, respectively). Results: Patients and HCPs were satisfied with communication during both consultations. When using the tool, patients most frequently selected physical pain descriptors (95.2%), followed by emotional (81.0%), social (28.6%) and spiritual (28.6%) descriptors. Patients found the tool useful, stating that it helped them describe their pain. HCPs considered the tool difficult to incorporate into consultations. Conclusion: The study highlighted the need to consider the various aspects of cancer pain.
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Affiliation(s)
| | | | - Susan Dargan
- Ashford & St Peter's Hospital NHS Foundation Trust, Surrey, TW15 3AA, UK
| | | | | | | | - Mario Di Palma
- Hôpital Américain de Paris, Neuilly-sur-Seine, 92200, France
| | | | - Jessica Flynn
- Adelphi Values, Patient-Centered Outcomes, Cheshire, SK10 5JB, UK
| | - Charlotte Panter
- Adelphi Values, Patient-Centered Outcomes, Cheshire, SK10 5JB, UK
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Friedrich M, Kühn T, Janni W, Müller V, Banys-Paluchowski M, Kolberg-Liedtke C, Jackisch C, Krug D, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm T, Gerber B, Gluz O, Hanf V, Harbeck N, Heil J, Huober J, Kreipe HH, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Thill M, Ditsch N. Correction: AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update. Geburtshilfe Frauenheilkd 2021; 81:e31. [PMID: 34720743 PMCID: PMC8548988 DOI: 10.1055/a-1674-1114] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
[This corrects the article DOI: 10.1055/a-1499-8431.].
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Affiliation(s)
- Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Wolfgang Janni
- Frauenklinik, Klinikum der Universität Ulm, Ulm, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Frauenheilkunde und Geburtshilfe, UK-SH, Lübeck, Germany.,Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | | | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | - David Krug
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Campus Kiel, Kiel, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva M Fallenberg
- Klinikum der Universität München, Campus Großhadern, Institut für Klinische Radiologie, München, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Oleg Gluz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Volker Hanf
- Frauenklinik, Nathanstift Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jörg Heil
- Universitäts-Klinikum Heidelberg, Brustzentrum, Heidelberg, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik, St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | | | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Nina Ditsch
- Frauenklinik, Universitätsklinikum Augsburg, Augsburg, Germany
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Friedrich M, Kühn T, Janni W, Müller V, Banys-Pachulowski M, Kolberg-Liedtke C, Jackisch C, Krug D, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm T, Gerber B, Gluz O, Hanf V, Harbeck N, Heil J, Huober J, Kreipe HH, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Thill M, Ditsch N. AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update. Geburtshilfe Frauenheilkd 2021; 81:1112-1120. [PMID: 34629490 PMCID: PMC8494519 DOI: 10.1055/a-1499-8431] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022] Open
Abstract
For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives
during surgical staging of the axilla in pN+
CNB
stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy.
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Affiliation(s)
- Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Wolfgang Janni
- Frauenklinik, Klinikum der Universität Ulm, Ulm, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maggie Banys-Pachulowski
- Klinik für Frauenheilkunde und Geburtshilfe, UK-SH, Lübeck, Germany.,Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | | | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | - David Krug
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Campus Kiel, Kiel, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva M Fallenberg
- Klinikum der Universität München, Campus Großhadern, Institut für Klinische Radiologie, München, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Oleg Gluz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Volker Hanf
- Frauenklinik, Nathanstift Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jörg Heil
- Universitäts-Klinikum Heidelberg, Brustzentrum, Heidelberg, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik, St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | | | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Nina Ditsch
- Frauenklinik, Universitätsklinikum Augsburg, Augsburg, Germany
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