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Linnemann B, Blank W, Doenst T, Erbel C, Isfort P, Janssens U, Kalka C, Klamroth R, Kotzerke J, Ley S, Meyer J, Mühlberg K, Müller OJ, Noppeney T, Opitz C, Riess H, Solomayer EF, Volk T, Beyer-Westendorf J. Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism. The revised AWMF S2k Guideline. VASA 2023; 52:1-146. [PMID: 37904504 DOI: 10.1024/0301-1526/a001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
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Kofla G, Radecke C, Frentsch M, Walther W, Stintzing S, Riess H, Bullinger L, Na IK. Conventional amphotericin B elicits markers of immunogenic cell death on leukemic blasts, mediates immunostimulatory effects on phagocytic cells, and synergizes with PD-L1 blockade. Oncoimmunology 2022; 11:2068109. [PMID: 35496500 PMCID: PMC9045824 DOI: 10.1080/2162402x.2022.2068109] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Immunostimulatory regimens are a game changer in the fight against cancer, but still only a minority of patients achieve clinical benefit. Combination with immunomodulatory drugs and agents converting otherwise non-immunogenic forms of cell death into bona fide “immunogenic cell death” (ICD) could improve the efficacy of these novel therapies. The aim of our study was to investigate conventional Amphotericin B (AmB) as an enhancer of antitumor immune responses. In tumor cell line models, AmB induced ICD with its typical hallmarks of calreticulin (CALR) expression and release of high mobility group box 1 (HMGB1) as well as Adenosine 5’-triphosphate (ATP). Interestingly, in contrast to non-ICD inducing treatments, ICD induction led to up-regulation of PD-L1-expression by ICD experiencing cells, resulting in decreased maturation of dendritic cells (DCs). Blocking this PD-L1 expression on tumor cells could unleash full ICD effects on antigen presenting cells. Even at sub-toxic concentrations, AmB was able to enhance CALR on leukemic blasts, particularly on phagocytic monoblastic THP-1 cells, which also showed features of “M1-like” differentiation after AmB exposure. The ability of AmB to increase the immunogenicity of tumor cells was confirmed in vivo in a mouse vaccination experiment. In conclusion, we demonstrate that AmB can promote antitumor immune responses in a dose-dependent manner by ICD induction, surface translocation of CALR on leukemic blasts even at sub-toxic concentrations, and “M1-like” polarization of phagocytic cells, making it noteworthy as potential booster for cancer immunotherapy. We additionally report for the first time that PD-L1 expression may be a feature of ICD, possibly as a negative feedback mechanism regulating the maturation status of DCs and thus indirectly affecting T-cell priming.
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Affiliation(s)
- G. Kofla
- Department of Hematology, Oncology, and Tumor Immunology (CVK), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - C. Radecke
- Department of Hematology, Oncology, and Tumor Immunology (CCM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - M. Frentsch
- Department of Hematology, Oncology, and Tumor Immunology (CVK), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin, Berlin, Germany
| | - W. Walther
- Experimental and Clinical Research Center of the Charité – University Medicine and the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - S. Stintzing
- Department of Hematology, Oncology, and Tumor Immunology (CCM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung; DKTK), Berlin, Germany
| | - H. Riess
- Department of Hematology, Oncology, and Tumor Immunology (CCM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - L. Bullinger
- Department of Hematology, Oncology, and Tumor Immunology (CVK), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung; DKTK), Berlin, Germany
| | - I-K. Na
- Department of Hematology, Oncology, and Tumor Immunology (CVK), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin, Berlin, Germany
- German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung; DKTK), Berlin, Germany
- ECRC Experimental and Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaet zu Berlin, Berlin, Germany
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Hoyer K, Hablesreiter R, Inoue Y, Yoshida K, Briest F, Christen F, Kakiuchi N, Yoshizato T, Shiozawa Y, Shiraishi Y, Striefler JK, Bischoff S, Lohneis P, Putter H, Blau O, Keilholz U, Bullinger L, Pelzer U, Hummel M, Riess H, Ogawa S, Sinn M, Damm F. A genetically defined signature of responsiveness to erlotinib in early-stage pancreatic cancer patients: Results from the CONKO-005 trial. EBioMedicine 2021; 66:103327. [PMID: 33862582 PMCID: PMC8054140 DOI: 10.1016/j.ebiom.2021.103327] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/18/2022] Open
Abstract
Background high recurrence rates of up to 75% within 2 years in pancreatic ductal adenocarcinoma (PDAC) patients resected for cure indicate a high medical need for clinical prediction tools and patient specific treatment approaches. Addition of the EGFR inhibitor erlotinib to adjuvant chemotherapy failed to improve outcome but its efficacy in some patients warrants predictors of responsiveness. Patients and Methods we analysed tumour samples from 293 R0-resected patients from the randomized, multicentre phase III CONKO-005 trial (gemcitabine ± erlotinib) with targeted sequencing, copy number, and RNA expression analyses. Findings a total of 1086 mutations and 4157 copy-number aberrations (CNAs) with a mean of 17.9 /tumour were identified. Main pathways affected by genetic aberrations were the MAPK-pathway (99%), cell cycle control (92%), TGFβ signalling (77%), chromatin remodelling (71%), and the PI3K/AKT pathway (65%). Based on genetic signatures extracted with non-negative matrix factorization we could define five patient clusters, which differed in mutation patterns, gene expression profiles, and survival. In multivariable Cox regression analysis, SMAD4 aberrations were identified as a negative prognostic marker in the gemcitabine arm, an effect that was counteracted when treated with erlotinib (DFS: HR=1.59, p = 0.016, and OS: HR = 1.67, p = 0.014). Integration of differential gene expression analysis established SMAD4 alterations with low MAPK9 expression (n = 91) as a predictive biomarker for longer DFS (HR=0.49; test for interaction, p = 0.02) and OS (HR = 0.32; test for interaction, p = 0.001). Interpretation this study identified five biologically distinct patient clusters with different actionable lesions and unravelled a previously unappreciated association of SMAD4 alteration status with erlotinib effectiveness. Confirmatory studies and mechanistic experiments are warranted to challenge the hypothesis that SMAD4 status might guide addition of erlotinib treatment in early-stage PDAC patients.
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Affiliation(s)
- K Hoyer
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - R Hablesreiter
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Inoue
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - K Yoshida
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - F Briest
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - F Christen
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - N Kakiuchi
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Yoshizato
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Shiozawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Shiraishi
- Laboratory of DNA information Analysis, Human Genome Centre, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - J K Striefler
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - S Bischoff
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - P Lohneis
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany; Institute of Pathology, University of Cologne, Cologne, Germany
| | - H Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - O Blau
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - U Keilholz
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - L Bullinger
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - U Pelzer
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - M Hummel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - H Riess
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - S Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan; Department of Medicine, Centre for Haematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden
| | - M Sinn
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Damm
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; German Cancer Consortium (DKTK), partner site Berlin, Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Sinn M, Pollich C, Riess H, Bischoff S, Habbel P, Scholz C, Spaeth-Schwalbe E, de Wit M, Jühling A, Wolter E, Wislocka L, Klamroth R. PO-37 How are patients with active cancer and venous thromboembolism (VTE) treated in Germany? Answers from GECAT (German Evaluation of Cancer Associated Thrombosis). Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00210-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schellong S, Kretzschmar A, Heinken A, May M, Kolbe K, Schreiber S, Riess H. Anticoagulation treatment of cancer patients with deep or superficial leg vein thrombosis - a retrospective observational study of German statutory health insurance claims data (the CERTIFICAT initiative). VASA 2020; 49:403-409. [PMID: 32520658 DOI: 10.1024/0301-1526/a000878] [Citation(s) in RCA: 2] [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] [Indexed: 11/19/2022]
Abstract
Background: Thrombosis is a common complication of cancer with a negative impact on quality of life and overall prognosis. Guidelines recommend low-molecular-weight heparin (LMWH) as initial and prolonged anticoagulation treatment. Little is known about current treatment patterns of these patients in ambulatory care. Patients and methods: The current retrospective observational study interrogates a large German statutory health insurance claims database in order to understand which kind of data can be extracted and analysed. An age- and sex-adjusted sample of about 4.1 million insured people from 2011 to 2016 could be used. Cancer patients with incident deep and superficial leg vein thrombosis were identified. Patients with preexisting cancer were allocated to a normal risk group; those who suffered from simultaneously diagnosed cancer and thrombosis were classified as high-risk group. Results: We identified 322,600 patients with inpatient or outpatient documented cancer diagnosis in at least two different quarters within one year. 87,755 patients were identified with an incident deep or superficial vein thrombosis. 8,201 patients suffered from both cancer and incident thrombosis. 56.9% of the patients received an anticoagulation regimen with predominant LMWH prescription, 24.2% vitamin K antagonists, 17.2% direct oral anticoagulants; in 1.7% of patients, no predominant anticoagulant drug/regime could be identified. On average, patients were prescribed anticoagulants for 4.5 months. An estimate of clinically relevant gastrointestinal bleeding could be derived (1.8% of patients). Conclusions: The dataset allows assigning detailed information of anticoagulant prescriptions in ambulatory care to well-defined groups of cancer patients. A first analysis suggests that in Germany current medical care of patients with cancer-related deep or superficial vein thrombosis does not entirely comply with guideline recommendations regarding type and duration of anticoagulation.
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Affiliation(s)
- S Schellong
- Medical Clinic Department for Cardiovascular Disease, Städtisches Klinikum Dresden, Germany
| | - A Kretzschmar
- Department for Haematology and Internist Oncology, Klinikum St. Georg, Leipzig, Germany
| | | | - M May
- HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - K Kolbe
- HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - S Schreiber
- HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - H Riess
- Medical Department, Division of Oncology and Hematology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Germany
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Reni M, Braverman J, Hendifar A, Li CP, Macarulla Mercade T, Oh DY, Riess H, Tempero M, Lu B, Marcus J, Joshi N, Botterman M, Dueck A. Evaluation of minimal important difference (MID) for the European organisation for research and treatment of cancer (EORTC) pancreatic cancer module (PAN26) in patients with surgically resected pancreatic adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tempero M, Reni M, Riess H, O’Reilly E, Krishnamurthi S, Österlund P, Ales-Diaz I, Milella M, Siena S, Tabernero J, Van Cutsem E, Philip P, Goldstein D, Berlin J, Li M, Ferrara S, Bruchec YL, McGovern D, Biankin A. Phase III, international, multicenter, randomized, open-label trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) alone for surgically resected pancreatic adenocarcinoma (APACT): Subgroup analyses. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Riess H, Braverman J, Reni M, Dueck A, Hendifar A, Oh DY, Li CP, Mercade TM, Shah A, Joshi N, Botterman M, Mantovani E, Lu B, Tempero M. Impact of adjuvant treatment with nab-paclitaxel and gemcitabine (nab-P+GEM) vs gemcitabine alone (GEM) on health-related quality of life (QoL) in patients (pts) with surgically resected pancreatic adenocarcinoma (PA) in the adjuvant pancreatic adenocarcinoma clinical trial (APACT). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reni M, Riess H, O’Reilly E, Santoro A, Park J, Bekaii-Saab T, Tempero M, Shan Y, Macarulla T, Van Cutsem E, Noel M, Berlin J, Biankin A, Dhani N, Frassineti G, Goldstein D, Romano A, Bruchec YL, Philip P. An international, randomized, open-label, phase III trial of adjuvant nab-paclitaxel plus gemcitabine vs gemcitabine alone for surgically resected pancreatic adenocarcinoma (APACT): primary analysis and quality of life outcomes. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Reni M, Winter J, Tortora G, Pelzer U, Riess H, Chang H, O’Reilly E, Oh D, Diaz IA, Milella M, Bendell J, Garlipp B, Tempero M, Macarulla T, Van Cutsem E, Berlin J, Goldstein D, Lu B, Jeanes J, Philip P. Analysis of patient screening in the phase III, international, randomized, open-label APACT trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Armbrust R, Neeb C, Thuss-Patience P, Lüftner D, Pietzner K, Riess H, Oskay-Öczelik G, Richter R, Keller M, Sehouli J. Patients' perspectives towards malignant ascites: results of a prospective observational trial regarding expectations, characteristics and quality of life-a study of the North-Eastern-German Society of Gynecological Oncology. Arch Gynecol Obstet 2019; 299:1385-1389. [PMID: 30834969 DOI: 10.1007/s00404-019-05071-6] [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: 08/23/2018] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Malignant ascites (MA) is a frequent and common symptom in (gyneco-) oncological patients. The present trial evaluated and assessed patients' characteristics, clinical features and the possible influence of MA on QoL measurements. METHODS A prospective observational trial was conducted from Oct 2013 until Nov 2016. Therefore an interdisciplinary questionnaire was developed. Overall 250 patients with histological confirmed MA were included with different cancer entities (gynecological, gastrointestinal). The correlation of MA caused symptoms and QoL measurements was assessed using Kendall's tau b. Multivariable logistic regression models were applied to analyze the risks of symptoms or severe limitation in daily activities. RESULTS 125 questionnaires could be analyzed. The majority of patients with MA had diagnosis of ovarian cancer (68.8%) and were under current cancer treatment (57.6%), mostly chemotherapy. Over 50% reported abdominal tension as major symptom, around 56% of the patients had MA when cancer was firstly diagnosed. Regression analysis showed that patients with MA above 2l were significantly more likely to be harmed in everyday activities. However, the age, gender, type of malignancy and the current treatment (chemotherapy vs. no chemotherapy) had no significant influence. CONCLUSION MA has a significantly impact on QoL measurements in cancer patients and might influence everyday activities including basic needs like eating, walking and body care. There is a high need for more information and education of patients with MA.
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Affiliation(s)
- Robert Armbrust
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany.
| | - C Neeb
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Thuss-Patience
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Lüftner
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - K Pietzner
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany
| | - H Riess
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - G Oskay-Öczelik
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany
| | - R Richter
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Keller
- North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Sehouli
- Department of Gynecology With Center for Oncological Surgery, Charité European Competence Center for Ovarian Cancer, University Hospital Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,North-Eastern German Society of Gynecological Oncology (NOGGO), Augustenburger Platz 1, 13353, Berlin, Germany
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Kretzschmar A, May M, Heinken A, Riess H. Anticoagulant treatment of patients (pts) with cancer associated thromboembolism (CAT) in Germany: Real world data from a 4 million people sample generated by insurance captured data. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy297.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Macarulla Mercade T, Hendifar A, Li CP, Reni M, Riess H, Tempero M, Dueck A, Botteman M, Deshpande C, Lucas E, Oh DY. Health-related quality of life (HRQoL) in patients with early-stage pancreatic cancer (ESPC) receiving adjuvant or neoadjuvant chemotherapy (A/NAC): A systematic literature review (SLR). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Himmelreich G, Dooijewaard G, Neuhaus P, Kluft C, Bechstein WO, Riess H. Increased Urokinase-Type Plasminogen Activator (u-PA) Levels in Graft Liver Perfusate and Decreased Single Chain u-PA Activation with Higher Levels of Aprotinin. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn orthotopic liver transplantation (OLT) the graft liver is perfused with arterial blood prior to the opening of the hepatocaval anastomosis. In the present investigation we focused on the reperfusion of the graft liver in order to study the hepatic influence in the regulation of urokinase-type plasminogen activator (u-PA levels). Two different aprotinin schedules were used in 43 patients. We measured u-PA levels in the perfusate and in the corresponding systemic circulation. u-PA levels were higher in the perfusate as compared to systemic blood samples despite the dilution of the perfusate sample by the preservation fluid. This suggests u-PA secretion by the graft liver. In the presence of lower aprotinin levels signs of single-chain n-PA (scu-PA) activation was in the perfusate more prominent than systemically – a difference which was not seen in the presence of higher aprotinin levels. This seems to be an argument for the effectiveness of higher dosed aprotinin application in preventing scu-PA activation.
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Affiliation(s)
- G Himmelreich
- The Department of Internal Medicine, University Clinic Rudolf Virchow, Berlin, Germany
- Gaubius Institute TNO Leiden, The Netherlands
| | | | - P Neuhaus
- The Department of Surgery, University Clinic Rudolf Virchow, Berlin, Germany
| | - C Kluft
- Gaubius Institute TNO Leiden, The Netherlands
| | - W O Bechstein
- The Department of Surgery, University Clinic Rudolf Virchow, Berlin, Germany
| | - H Riess
- The Department of Internal Medicine, University Clinic Rudolf Virchow, Berlin, Germany
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Schellong SM, Riess H, Spannagl M, Omran H, Schwarzbach M, Langer F, Gogarten W, Bramlage P, Bauersachs RM. [Bridging anticoagulation in patients receiving vitamin K antagonists : Current status]. Anaesthesist 2018; 67:599-606. [PMID: 29926118 DOI: 10.1007/s00101-018-0463-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Approximately 30% of patients receiving oral anticoagulation using vitamin K antagonists (VKA) require surgery within 2 years. In this context, a clinical decision on the need and the mode of a peri-interventional bridging with heparin is needed. While a few years ago, bridging was almost considered a standard of care, recent study results triggered a discussion on which patients will need bridging at all. Revisiting the currently available recommendations and study results the conclusion can be drawn that the indications for bridging with heparin must nowadays be taken more narrowly and considering the individual patient risk of bleeding and thromboembolism. Bridging with heparin is only needed in patients with a very high risk of thromboembolism. This overview aims to give guidance for a risk-adapted peri-interventional approach to management of patients with a need for long-term anticoagulation using VKA.
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Affiliation(s)
- S M Schellong
- Medizinische Klinik 2, Krankenhaus Dresden-Friedrichstadt, Friedrichstr. 41, 01067, Dresden, Deutschland.
| | - H Riess
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Spannagl
- Hämostaseologie, Campus Innenstadt, Klinikum der Universität München, München, Deutschland
| | - H Omran
- St. Marien Hospital, Bonn, Deutschland
| | - M Schwarzbach
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Thoraxchirurgie, Klinikum Frankfurt Höchst, Frankfurt, Deutschland
| | - F Langer
- II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - W Gogarten
- Klinik für Anästhesiologie, operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Bielefeld, Bielefeld, Deutschland
| | - P Bramlage
- Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Deutschland
| | - R M Bauersachs
- Klinik für Gefäßmedizin - Angiologie, Klinikum Darmstadt GmbH, Darmstadt, Deutschland.,Centrum für Thrombose und Hämostase, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
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Encke A, Haas S, Krauspe R, Riess H, Stürmer KM, Kopp I, Lorenz W, Beckmann MW, Breddin HK, Gams E, Gerhardus A, Gogarten W, Joppich I, Kujath P, Kussmann J, Mittelkötter U, Mittelkötter U, Partsch H, Pauschert R, Rabe E, Rohde U, Schellong S, Steudel I, Swoboda L, Ulsenheimer K, Vogt PM, Walz P, Weber H. Stationäre und ambulante Thromboembolieprophylaxe in der Chirurgie und der perioperativen Medizin. Phlebologie 2018. [DOI: 10.1055/s-0038-1639002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Präambel: Alle aufgeführten medizinischen Fachgesellschaften haben sich zusammengefunden, um die früheren verschiedenen Empfehlungen zur Thromboembolieprophylaxe zu aktualisieren und in einer gemeinsamen »Leitlinie zur stationären und ambulanten Thromboembolieprophylaxe in der perioperativen Medizin« zusammenzufassen. Dazu wurden in einem ersten Schritt durch eine Konsensuskonferenz mit nominalem Gruppenprozess die früheren Empfehlungen (Fassung vom Juni 2000) überarbeitet (S2-Leitlinie). Dies erschien notwendig, um neue Therapieprinzipien und neu zugelassene Medikamente zu berücksichtigen. Als nächster Schritt erfolgt die Weiterentwicklung der vorliegenden Leitlinie nach der Vorgaben der 3. Stufe der Leitlinienentwicklung der AWMF (S3-Leitlinie).
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Gerlach M, Föhre B, Keh D, Riess H, Falke K, Gerlach H. Global and Extended Coagulation Monitoring during Extracorporeal Lung Assist with Heparin-Coated Systems in ARDS Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Heparin-coated systems for extracorporeal lung-assist (ECLA) were developed to reduce hemorrhagic risk by lowering the systemic heparinization, monitored by global tests, e.g. activated coagulation time (ACT) and activated partial thromboplastin time (APTT). Since this strategy gives no insight into procoagulant states, five ARDS patients receiving ECLA with heparin-coated systems were investivated for changes in coagulation using both global and extended tests. During ECLA onset the APTT and ACT were within or near normal ranges, platelets decreased 76.5% within 48h, fibrinogen decreased 28.7%, thrombin-antithrombin-III complexes were elevated before ECLA (53 μg/L), but demonstrated an additional peak (238 μg/L), plasminogen-activator-inhibitor-1 increased 12-fold, and the C1-inhibitor dropped 14.1%. In conclusion, after the onset of ECLA from a previous prethrombotic state, the precoagulant, anticoagulant, fibrinolytic and complement systems were activated in a similar way to that reported for non-heparinized systems with high-dose heparin. This was however only monitored by an extended test panel which was unable to predict thromboembolic events during ECLA.
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Affiliation(s)
- M. Gerlach
- Clinic for Anesthesiology and Critical Care Medicine, Virchow-Klinikum of the Humboldt University, Berlin - Germany
| | - B. Föhre
- Clinic for Anesthesiology and Critical Care Medicine, Virchow-Klinikum of the Humboldt University, Berlin - Germany
| | - D. Keh
- Clinic for Anesthesiology and Critical Care Medicine, Virchow-Klinikum of the Humboldt University, Berlin - Germany
| | - H. Riess
- Medical Clinic, Department of Hematology and Hemostaseology, Virchow-Klinikum of the Humboldt University, Berlin - Germany
| | - K.J. Falke
- Clinic for Anesthesiology and Critical Care Medicine, Virchow-Klinikum of the Humboldt University, Berlin - Germany
| | - H. Gerlach
- Clinic for Anesthesiology and Critical Care Medicine, Virchow-Klinikum of the Humboldt University, Berlin - Germany
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Denecke T, Hildebrandt B, Rühl R, Miersch A, Nicolaou A, Ruf J, Plotkin M, Hänninen EL, Stroszczynski C, Gutberlet M, Langrehr J, Riess H, Ricke J, Amthauer H. Evaluation of patients with liver metastases from colorectal cancer for locally ablative treatment with laser induced thermotherapy. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryPurpose: Before locally ablative treatment of colorectal liver metastases, patients have to be carefully evaluated to decide whether this is the adequate therapy. In this study we determined the value of FDG-PET in comparison to conventional staging procedures. Patients, methods: In 68 consecutive patients referred for laser induced thermotherapy (LITT) of liver metastases from colorectal cancer, pretherapeutic staging with conventional imaging (thoracic and abdominal CT, liver MRI, chest X-ray) and FDG-PET was performed. The examinations were analysed separately and blinded. Based on the staging information, therapeutic decisions were made by an interdisciplinary review board according to a standardized algorithm. The results were compared between conventional imaging and FDG-PET, and were validated by clinical follow up data and histopathology, respectively. Results: On FDG-PET 210 lesions were interpreted as tumour manifestations. 48 of these were not seen on conventional imaging (true positive, n=46). In contrast, 24 lesions were visualized by conventional imaging only (true positive, n=12). Compared to conventional imaging, discrepant findings on FDG-PET led to treatment modifications in 25 patients (37%); these were correct in 20/25 patients. According to the actual treatment course, the inadequate treatment modifications in the remaining 5 patients were avoided by further diagnostic procedures (i.e. biopsies). Conclusion: In the evaluation of patients with known liver metastases from colorectal cancer before LITT, FDG-PET depicts relevant findings subsidiary to conventional imaging and thus is of high value for therapeutic decision making.
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Bauersachs R, Debus ES, Gawaz M, Gerlach H, Haas S, Hach-Wunderle V, Lindhoff-Last E, Riess H, Schellong S, Schinzel H, Bode C, Spannagl M. Therapie mit Dabigatran. Hamostaseologie 2017; 32:294-305. [DOI: 10.5482/ha-2012030004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Indexed: 11/05/2022] Open
Abstract
Summary Dabigatran, an oral, reversible direct factor IIa inhibitor, is approved in Europe for stroke prevention in atrial fibrillation and for the prevention of venous thromboembolism after elective hip and knee replacement. In contrast to vitamin K antagonists, a routine coagulation monitoring during the treatment with dabigatran etexilate is not necessary. However, in specific clinical situations such as invasive emergency procedures or serious haemorrhage, the actual anticoagulant status of dabigatran may be of importance for the treating clinician and can be assessed by clotting tests (aPTT, TT, ECT). The diluted thrombin time test (Hemoclot®), which is specifically calibrated for dabigatran, is useful for quantitative determination of the dabigatran serum concentration. In general, discontinuation of dabigatran etexilate 24 hours before standard elective surgery is sufficient to normalise the bleeding risk in patients with normal renal function. In patients with renal impairment and/or in the case of a high bleeding risk procedure the recommended duration of discontinuation is prolonged. If a bleeding episode occurs in a patient on dabigatran, further treatment should be based on the severity and localisation of the bleeding. A distinct feature of dabigatran is the possibility of effectively removing dabigatran from the circulation by haemodialysis. Recommendation: In the case of clinically minor bleedings, a delay in the administration of the next dabigatran etexilate dose is recommended. The length of the delay is based on the patient’s individual thromboembolic risk. In minor bleedings the use of prothrombin complex concentrates is not indicated. In the case of moderate or major bleedings the main focus should be on stabilising the circulation by using fluids and blood products and, if a lesion can be identified, the local treatment thereof. If time and infrastructure is available, dialysis offers an effective and fast option to remove dabigatran out of the circulation. In the incidence of severe and life threatening bleedings, an additional, more complex haemostasis management is required. Besides haemodynamic stabilisation of the circulation, administration of prothrombin complex concentrates should not be delayed. It has to be kept in mind that standard laboratory coagulation parameters may not accurately reflect the effect of prothrombin complex concentrates in patients on dabigatran. Hence the effect of the prothrombin complex concentrate should be monitored clinically and adjusted by means of onset of coagulation in vivo.
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Pabinger I, Alt-Epping B, Demarmels Biasutti F, Langer F, Wörmann B, Riess H. Venöse Thrombembolien bei Tumorpatienten. Hamostaseologie 2017; 31:281-90; quiz 291-2. [DOI: 10.5482/ha-1174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 08/24/2011] [Indexed: 02/04/2023] Open
Abstract
SummaryVenous thrombembolism (VTE) is one of the most frequent complication in cancer patients. The current options in prophylaxis and therapy have to be balanced against the risks of major bleeding and the burden for the patients. The Gesellschaft für Thrombose- und Hämostaseforschung, the Deutsche Gesellschaft für Palliativmedizin and the German speaking Societies of Hematology and Oncology have recently published guidelines on VTE in cancer patients. Recommendations include diagnostics, individual prophylaxis and treatment.
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Affiliation(s)
- I Pabinger
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin I, Klinische Abteilung für Hämatologie und Hämostaseologie, Wien.
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Abstract
ZusammenfassungPräklinische und klinische Untersuchungen der vergangenen Jahre erweiterten das pathophysiologische Verständnis der bei Patienten mit schwerer Sepsis ablaufenden Störungen deutlich . Dabei wurde deutlich, dass die den septischen Krankheitsbildern zugrunde liegende Infektion im engeren Sinne für die Schwere und ungünstige Prognose der Sepsis weniger verantwortlich ist. Vielmehr ist es die außer Kontrolle geratene Reaktion des Organismus auf diese Infektion, die sich bei nicht (mehr) lokalisierter Infektion in Form einer im Wesentlichen Zytokin-vermittelten Entzündungsreaktion dem systemischen inflammatorischen Response-Syndrom mit seinen Folgen widerspiegelt.Die im Rahmen dieses Syndroms freigesetzten Mediatoren, z.T. in Zusammenwirkung mit Produkten aus infektiösen Mikroorganismen, führen auch zu einer systemischen Aktivierung der Hämostase. Die Aktivierung von Monozyten/Makrophagen sowie die des Endothels stehen dabei im Zentrum des pathophysiologischen Modells. Die davon ausgehende Aktivierung von plasmatischen Kaskadensystemen betreffen auch Gerinnungs-und Fibrinolysesystem, wobei die bei Sepsis beobachtete Gerinnungsaktivierung und Fibrinolysehemmung ihrerseits mit Leukozyten und Endothel interagiert und zur zunehmenden Schädigung der Mikrozirkulation beiträgt. Als deren klinisches Korrelat können Organdysfunktionszustände aufgefasst werden. Es kommt zu einem individuell unterschiedlichen Nebeneinander von überschießender Fibrinbildung, Faktoren-, Inhibitoren-und Thrombozytenverbrauch sowie Störungen des Fibrinolysesystems. Klinisch kann dies neben Organdysfunktionen zu einer disseminierten intravasalen Gerinnung, z.T. mit Blutungskomplikationen, führen.
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Sinn M, Sinn BV, Striefler JK, Lindner JL, Stieler JM, Lohneis P, Bischoff S, Bläker H, Pelzer U, Bahra M, Dietel M, Dörken B, Oettle H, Riess H, Denkert C. SPARC expression in resected pancreatic cancer patients treated with Gemcitabine: results from the CONKO-001 study. Ann Oncol 2017; 28:2900. [PMID: 27578776 DOI: 10.1093/annonc/mdw269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Sinn M, Budczies J, Damm F, Lohneis P, Schmuck R, Treue D, Striefler J, Bahra M, Pelzer U, Jühling A, Bläker H, Bischoff S, Oettle H, Denkert C, Riess H, Sinn B. TP53 mutation predicts sensitivity to adjuvant gemcitabine in pancreatic cancer: Results from the CONKO-001 study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Striefler J, Wislocka L, Sinn M, Pelzer U, Denkert C, Juehling A, Bischoff S, Bahra M, Hendrik B, Oettle H, Riess H, Lohneis P. PD-007 CXCR4, CXCR7 and CXCL12 expression is not a prognostic predictive factor in patients with resected pancreatic cancer - results from the CONKO-001 trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw200.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Sinn M, Riess H, Sinn BV, Stieler JM, Pelzer U, Striefler JK, Oettle H, Bahra M, Denkert C, Bläker H, Lohneis P. Human equilibrative nucleoside transporter 1 expression analysed by the clone SP 120 rabbit antibody is not predictive in patients with pancreatic cancer treated with adjuvant gemcitabine - Results from the CONKO-001 trial. Eur J Cancer 2015; 51:1546-54. [PMID: 26049689 DOI: 10.1016/j.ejca.2015.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/25/2015] [Accepted: 05/05/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND High expression of human equilibrative nucleoside transporter 1 (hENT1) is considered to predict survival in patients treated with adjuvant gemcitabine for pancreatic cancer. A standard evaluation system for immunohistochemical analysis (antibody, scoring system) has not yet been established. METHODS CONKO-001, a prospective randomised phase III study investigated the role of adjuvant gemcitabine (gem) as compared to observation (obs). Tumour samples of 156 patients were analysed by immunohistochemistry with the rabbit monoclonal antibody SP120 (Ventana Medical Systems) for expression of hENT1. Kaplan-Meier analyses for median disease-free survival (DFS) and overall survival (OS) were performed in dependence of hENT1 expression measured analogously to Farrell et al. 2009 and Poplin et al. 2013. RESULTS For the 88 gem and 68 obs patients, median DFS/OS was 12.9/22.7 months and 6.2/19.1 months. High hENT1 expression was not associated with improved median DFS (Farrell: no hENT1 22.2 months, low hENT1 13.7 months, high hENT1 12.1 months, p=0.248; Poplin: low hENT1 13.2 months versus high hENT1 11.5 months, p=0.5) or median OS (Farrell: no hENT1 21.7 months, low hENT1 24.7 months, high hENT1 19.5, p=0.571; Poplin: low hENT1 24.4 months versus high hENT1 19.7 months, p=0.92;) in the gem group or in the obs group (median DFS Farrell: no hENT1 5.1 months, low hENT1 6.2 months, high hENT1 7.5 months, p=0.375; Poplin: low hENT1 6.2 months versus high hENT1 5.9 months, p=0.83; median OS Farrell: no hENT1 20.2months, low hENT1 17.7 months, high HENT1 19.1 months, p=0.738; Poplin: low hENT1 17.7 months versus high hENT1 20.4 months, p=0.65) measured by the Farrell or Poplin Score. CONCLUSIONS We cannot confirm a predictive role of hENT1 measured by the clone SP120 rabbit antibody in our study population. Reproducible standard procedures are urgently needed prior to the implementation or exclusion of hENT1 as a predictive biomarker in the treatment of pancreatic cancer. TRIAL REGISTRATION ISRCTN34802808.
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Affiliation(s)
- M Sinn
- Charité - Universitätsmedizin Berlin, Department of Medical Oncology and Haematology, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - H Riess
- Charité - Universitätsmedizin Berlin, Department of Medical Oncology and Haematology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B V Sinn
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - J M Stieler
- Charité - Universitätsmedizin Berlin, Department of Medical Oncology and Haematology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - U Pelzer
- Charité - Universitätsmedizin Berlin, Department of Medical Oncology and Haematology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J K Striefler
- Charité - Universitätsmedizin Berlin, Department of Medical Oncology and Haematology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - H Oettle
- Outpatient Department Hematology/Oncology, Friedrichstr. 53, 88045 Friedrichshafen, Germany
| | - M Bahra
- Charité - Universitätsmedizin Berlin, Department of General, Visceral and Transplantation Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C Denkert
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - H Bläker
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - P Lohneis
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
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Riess H, Kunzmann V, Philip P, Seufferlein T, McGovern D, Chen P, Romano A, Ramanathan R. P-184 nab-Paclitaxel (nab-P) plus gemcitabine (Gem) for patients with advanced pancreatic cancer who have cholestatic hyperbilirubinemia (CH) secondary to bile duct obstruction: a phase I safety and pharmacokinetics study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tempero M, Cardin D, Biankin A, Goldstein D, Moore M, O'Reilly E, Philip P, Riess H, Macarulla T, Yung L, Li M, Lu B. P-185 Randomized phase III trial of nab-paclitaxel (nab-P) plus gemcitabine (Gem) vs Gem alone as adjuvant therapy for patients with resected pancreatic cancer: APACT. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Trappe RU, Choquet S, Dierickx D, Mollee P, Zaucha JM, Dreyling MH, Dührsen U, Tarella C, Shpilberg O, Sender M, Salles G, Morschhauser F, Jaccard A, Lamy T, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Leithäuser M, Schlattmann P, Anagnostopoulos I, Raphael M, Riess H, Leblond V, Oertel S. International prognostic index, type of transplant and response to rituximab are key parameters to tailor treatment in adults with CD20-positive B cell PTLD: clues from the PTLD-1 trial. Am J Transplant 2015; 15:1091-100. [PMID: 25736912 DOI: 10.1111/ajt.13086] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 10/13/2014] [Accepted: 10/19/2014] [Indexed: 01/25/2023]
Abstract
Tailoring treatment by patient strata based on the risk of disease progression and treatment toxicity might improve outcomes of patients with posttransplant lymphoproliferative disorder (PTLD). We analysed the cohort of 70 patients treated in the international, multicenter phase II PTLD-1 trial (NCT01458548) to identify such factors. Of the previously published scoring systems in PTLD, the international prognostic index (IPI), the PTLD prognostic index and the Ghobrial score were predictive for overall survival. None of the scoring systems had a considerable effect on the risk for disease progression. Age and ECOG performance status were the baseline variables with the highest prognostic impact in the different scoring systems. Baseline variables not included in the scoring systems that had an impact on overall survival and disease progression were the type of transplant and the response to rituximab at interim staging. Thoracic organ transplant recipients who did not respond to rituximab monotherapy were at particularly high risk for death from disease progression with subsequent CHOP-based chemotherapy. Patients in complete remission after four courses of rituximab and patients in partial remission with low-risk IPI had a low risk of disease progression. We speculate that chemotherapy might not be necessary in this patient cohort.
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Affiliation(s)
- R U Trappe
- Department of Internal Medicine II: Hematology and Oncology, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Hematology, Oncology and Tumor Immunology Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Fuchs CS, Azevedo S, Okusaka T, Van Laethem JL, Lipton LR, Riess H, Szczylik C, Moore MJ, Peeters M, Bodoky G, Ikeda M, Melichar B, Nemecek R, Ohkawa S, Świeboda-Sadlej A, Tjulandin SA, Van Cutsem E, Loberg R, Haddad V, Gansert JL, Bach BA, Carrato A. A phase 3 randomized, double-blind, placebo-controlled trial of ganitumab or placebo in combination with gemcitabine as first-line therapy for metastatic adenocarcinoma of the pancreas: the GAMMA trial. Ann Oncol 2015; 26:921-927. [PMID: 25609246 DOI: 10.1093/annonc/mdv027] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/30/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This double-blind, phase 3 study assessed the efficacy and safety of ganitumab combined with gemcitabine as first-line treatment of metastatic pancreatic cancer. PATIENTS AND METHODS Patients with previously untreated metastatic pancreatic adenocarcinoma were randomly assigned 2 : 2 : 1 to receive intravenous gemcitabine 1000 mg/m(2) (days 1, 8, and 15 of each 28-day cycle) plus placebo, ganitumab 12 mg/kg, or ganitumab 20 mg/kg (days 1 and 15 of each cycle). The primary end point was overall survival (OS). Secondary end points included progression-free survival (PFS), safety, and efficacy by levels of circulating biomarkers. RESULTS Overall, 322 patients were randomly assigned to placebo, 318 to ganitumab 12 mg/kg, and 160 to ganitumab 20 mg/kg. The study was stopped based on results from a preplanned futility analysis; the final results are reported. Median OS was 7.2 months [95% confidence interval (CI), 6.3-8.2] in the placebo arm, 7.0 months (95% CI, 6.2-8.5) in the ganitumab 12-mg/kg arm [hazard ratio (HR), 1.00; 95% CI, 0.82-1.21; P = 0.494], and 7.1 months (95% CI, 6.4-8.5) in the ganitumab 20-mg/kg arm (HR, 0.97; 95% CI, 0.76-1.23; P = 0.397). Median PFS was 3.7, 3.6 (HR, 1.00; 95% CI, 0.84-1.20; P = 0.520), and 3.7 months (HR, 0.97; 95% CI, 0.77-1.22; P = 0.403), respectively. No unexpected toxicity was observed with ganitumab plus gemcitabine. The circulating biomarkers assessed [insulin-like growth factor-1 (IGF-1), IGF-binding protein-2, and -3] were not associated with a treatment effect on OS or PFS by ganitumab. CONCLUSION Ganitumab combined with gemcitabine had manageable toxicity but did not improve OS, compared with gemcitabine alone in unselected patients with metastatic pancreatic cancer. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01231347.
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Affiliation(s)
- C S Fuchs
- Department of Medical Oncology/Solid Tumor Oncology, Dana-Farber Cancer Institute, Boston, USA.
| | - S Azevedo
- Oncology Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - T Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - J-L Van Laethem
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - L R Lipton
- Medical Oncology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - H Riess
- Department of Hematology, Oncology, and Tumor Immunology, Charité University, Berlin, Germany
| | - C Szczylik
- Department of Oncology, Military Institute of Health Services, Warsaw, Poland
| | - M J Moore
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegum, Belgium
| | - G Bodoky
- Department of Oncology, St László Hospital, Budapest, Hungary
| | - M Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - B Melichar
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc
| | - R Nemecek
- Department of Oncology, Masaryk University Medical School and Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - S Ohkawa
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - A Świeboda-Sadlej
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - S A Tjulandin
- Department of Clinical Pharmacology and Chemotherapy, Russian Cancer Research Center, Moscow, Russia
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg/Leuven and KU Leuven, Leuven, Belgium
| | - R Loberg
- Medical Sciences, Amgen Inc., Thousand Oaks, USA
| | - V Haddad
- Global Biostatistical Science, Amgen Ltd, Cambridge, UK
| | | | - B A Bach
- Development Oncology Therapeutics, Amgen Inc., Thousand Oaks, USA
| | - A Carrato
- Medical Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain
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Fink SEK, Gandhi MK, Nourse JP, Keane C, Jones K, Crooks P, Jöhrens K, Korfel A, Schmidt H, Neumann S, Tiede A, Jäger U, Dührsen U, Neuhaus R, Dreyling M, Borchert K, Südhoff T, Riess H, Anagnostopoulos I, Trappe RU. A comprehensive analysis of the cellular and EBV-specific microRNAome in primary CNS PTLD identifies different patterns among EBV-associated tumors. Am J Transplant 2014; 14:2577-87. [PMID: 25130212 DOI: 10.1111/ajt.12858] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 01/25/2023]
Abstract
Primary central nervous system (pCNS) posttransplant lymphoproliferative disorder (PTLD) is a complication of solid organ transplantation characterized by poor outcome. In contrast to systemic PTLD, Epstein-Barr virus (EBV)-association of pCNS PTLD is almost universal, yet viral and cellular data are limited. To identify differences in the pattern of EBV-association of pCNS and systemic PTLD, we analyzed the expression of latent and lytic EBV transcripts and the viral and cellular microRNAome in nine pCNS (eight EBV-associated) and in 16 systemic PTLD samples (eight EBV-associated). Notably although 15/16 EBV-associated samples exhibited a viral type III latency pattern, lytic transcripts were also strongly expressed. Members of the ebv-miR-BHRF1 and ebv-miR-BART clusters were expressed in virtually all EBV-associated PTLD samples. There were 28 cellular microRNAs differentially expressed between systemic and pCNS PTLD. pCNS PTLD expressed lower hsa-miR-199a-5p/3p and hsa-miR-143/145 (implicated in nuclear factor kappa beta and c-myc signaling) as compared to systemic PTLD. Unsupervised nonhierarchical clustering of the viral and cellular microRNAome distinguished non-EBV-associated from EBV-associated samples and identified a separate group of EBV-associated pCNS PTLD that displayed reduced levels of B cell lymphoma associated oncomiRs such as hsa-miR-155, -21, -221 and the hsa-miR-17-92 cluster. EBV has a major impact on viral and cellular microRNA expression in EBV-associated pCNS PTLD.
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Affiliation(s)
- S E K Fink
- Clinical Immunohaematology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
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Abstract
Adenocarcinoma of the exocrine pancreas is one of the most aggressive types of solid tumor and stands at fourth position in the tumor death frequency scale due to a high mortality rate. Effective screening methods are not available and only radical surgery offers a curative option. With adjuvant chemotherapy the median survival time can be prolonged up to 23 months and approximately 25 % of patients are still alive after 5 years. Of these patients approximately 75-80 % are already in a palliative therapy situation at the time of diagnosis. In the last 5 years treatment options have been increased by the introduction of new chemotherapeutic drugs. For patients with metastasized disease median survival times of 6-12 months can currently be achieved depending on the general performance status at diagnosis but less than 5 % of these patients are still alive after 5 years. Neoadjuvant treatment strategies, radiation and immunotherapy do not play a role in evidence-based clinical practice. Despite progress in the understanding of cancer biology and new treatment options, non-resectable adenocarcinoma of the pancreas remains a disease with a very poor prognosis.
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Affiliation(s)
- U Pelzer
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland,
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Tempero M, Cardin D, Biankin A, Goldstein D, Moore M, O'Reilly E, Philip P, Riess H, Macarulla T, Yung L, Wei X, Lu B. Apact: a Phase III Trial of Nab-Paclitaxel (Nab-P) Plus Gemcitabine (Gem) Vs Gem Alone for Resected Pancreatic Cancer (Pc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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33
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Sinn M, Liersch T, Gellert K, Riess H, Stübs P, Waldschmidt D, Pelzer U, Stieler J, Striefler J, Bahra M, Dörken B, Oettle H. Conko-006: a Randomized Double-Blinded Phase Iib-Study of Adjuvant Therapy with Gemcitabine + Sorafenib/Placebo for Patients with R1-Resection of Pancreatic Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Kreher S, Riess H. [Prophylaxis and treatment of venous thromboembolism in cancer patients. Clinical value of low-molecular-weight heparins]. Internist (Berl) 2014; 55:448-54. [PMID: 24599489 DOI: 10.1007/s00108-014-3476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Venous thromboembolism (VTE) is a common complication in patients with cancer. Because of their improved subcutaneous bioavailability and reliable antithrombotic efficiency low-molecular-weight heparins (LMWH) are preferably used for prevention and treatment of cancer-related VTE. Thromboprophylaxis with LMWH is well established in patients undergoing cancer surgery and hospitalized cancer patients, while outpatient prophylaxis remains contentious. LMWH are recommended over unfractionated heparins and vitamin K antagonists for initial treatment and secondary prophylaxis (3-6 months) after cancer-related VTE. Long-term secondary prophylaxis should be considered for patients with ongoing active malignancy and low bleeding risk. Due to absence of clinical studies in cancer patients, the use of novel oral anticoagulants is currently not recommended.
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Affiliation(s)
- S Kreher
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland,
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Sinn M, Sinn BV, Striefler JK, Lindner JL, Stieler JM, Lohneis P, Bischoff S, Bläker H, Pelzer U, Bahra M, Dietel M, Dörken B, Oettle H, Riess H, Denkert C. SPARC expression in resected pancreatic cancer patients treated with gemcitabine: results from the CONKO-001 study. Ann Oncol 2014; 25:1025-32. [PMID: 24562449 DOI: 10.1093/annonc/mdu084] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous investigations in pancreatic cancer suggested a prognostic role for secreted protein acidic and rich in cysteine (SPARC) expression in the peritumoral stroma but not for cytoplasmic SPARC expression. The aim of this study was to evaluate the impact of SPARC expression in pancreatic cancer patients treated with gemcitabine compared with untreated patients. PATIENTS AND METHODS CONKO-001 was a prospective randomized phase III study investigating the role of adjuvant gemcitabine when compared with observation. Tissue samples of 160 patients were available for SPARC immunohistochemistry on tissue microarrays to evaluate its impact on patient outcome. RESULTS Strong stromal SPARC expression was associated with worse disease-free survival (DFS) and overall survival (OS) in the overall study population (DFS: P = 0.005, OS: P = 0.033). Its negative prognostic impact was restricted to patients treated with gemcitabine (DFS: P = 0.007, OS: P = 0.006). High cytoplasmic SPARC expression also was associated with worse patient outcome (DFS: P = 0.041, OS: P = 0.011). Again the effect was restricted to patients treated with gemcitabine (DFS: P = 0.002, OS: P = 0.003). In multivariable analysis, SPARC expression was independently predictive of patient outcome. CONCLUSIONS Our data confirm the prognostic significance of SPARC expression after curatively intended resection. The negative prognostic impact was restricted to patients who received adjuvant treatment with gemcitabine, suggesting SPARC as a predictive marker for response to gemcitabine.
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Affiliation(s)
- M Sinn
- Department of Medical Oncology and Haematology
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Pelzer U, Sinn M, Stieler J, Riess H. [Primary pharmacological prevention of thromboembolic events in ambulatory patients with advanced pancreatic cancer treated with chemotherapy?]. Dtsch Med Wochenschr 2013; 138:2084-8. [PMID: 24085361 DOI: 10.1055/s-0033-1349608] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE The indication for medical venous thrombosis prophylaxis in ambulatory cancer patients is still under discussion. To provide more data on this topic we conducted an analysis in ambulatory patients with advanced pancreatic adenocarcinoma, reflecting a patient cohort at high risk of symptomatic venous thromboembolism (sVTE). PATIENTS AND METHODS Data from 312 consecutively recruited patients of the CONKO-004 trial were analysed according to predefined parameters and additionally with respect to established scores. To focus on patients with highest risk of sVTE unvaried and multivariate analyses were conducted. RESULTS The global analyses had educed a number needed to treat (NNT) by medical thrombosis prophylaxis of 12 patients to prevent one sVTE. The modified score model did not provide further clinical benefit. However, the regression model can identify single parameters with a trend to higher risk of sVTE or higher risk of severe bleeding. Most of the parameters do not have enough power to be significant, but they can support clinical decisions. CONCLUSION These data suggest that medical thrombosis prophylaxis should be performed in patients with advanced pancreatic cancer at least for the initial 3 months of first line chemotherapy.
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Affiliation(s)
- U Pelzer
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin
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Pelzer U, Klein F, Bahra M, Sinn M, Dörken B, Neuhaus P, Meyer O, Riess H. Blood group determinates incidence for pancreatic cancer in Germany. Front Physiol 2013; 4:118. [PMID: 23745115 PMCID: PMC3662880 DOI: 10.3389/fphys.2013.00118] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/07/2013] [Indexed: 12/14/2022] Open
Abstract
Background: Genetic risk factors for sporadic pancreatic cancer are largely unknown but actually under high exposure. Findings of correlations between the AB0 blood group system (Chromosome 9q34,1—q34,2) and the risk of pancreatic cancer (PC) in patients from Asia, America and south Europe have already been published. So far it is unclear, whether this correlation between blood group an PC incidence can be found in German patients as well. Methods: One hundred and sixty-six patients who underwent a resection of PC were evaluated in a period between 2000 and 2010. Blood group reference distribution for the German population is given as: 0: 41%; A: 43%; B: 11%; AB: 5%; Rhesus positive: 85%; Rhesus negative: 15%. Analyses were done using the non-parametric Chi2-test (p-value two sided; SPSS 19.0). Results: Median age was 62 (34–82) years. Gender: female 73/44%; male: 93/56%. Observed blood group proportions: 0: 43 (25.9%)/A: 94 (56.6%)/B: 16 (9.6%)/AB: 13 (7.8%)/Rhesus positive: 131 (78.9%)/negative: 35 (21.1%). We detected a significant difference to the German reference distribution of the AB0 system (Chi2 19.34, df 3, p < 0.001). Rhesus factor has no impact on AB0-distribution (Chi2 4.13, df 3, p = 0.25), but differs significantly from reference distribution—probably due to initial AB0-variation (Chi2 4.82, df 1, p = 0.028). The odds ratio for blood group A is 2.01 and for blood group 0 is 0.5. Conclusions: The incidence of PC in the German cohort is highly associated with the AB0-system as well. More patients with blood group A suffer from PC (p < 0.001) whereas blood group 0 was less frequent in patients with PC (p < 0.001). Thus, our findings support the results from other non-German surveys. The causal trigger points of this carcinogenesis correlation are still not known.
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Affiliation(s)
- U Pelzer
- Department of Hematology/Oncology, Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin Berlin, Germany
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38
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Steiner T, Böhm M, Dichgans M, Diener HC, Ell C, Endres M, Epple C, Grond M, Laufs U, Nickenig G, Riess H, Röther J, Schellinger PD, Spannagl M, Veltkamp R. Recommendations for the emergency management of complications associated with the new direct oral anticoagulants (DOACs), apixaban, dabigatran and rivaroxaban. Clin Res Cardiol 2013; 102:399-412. [PMID: 23669868 DOI: 10.1007/s00392-013-0560-7] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/21/2013] [Indexed: 02/07/2023]
Abstract
Dabigatran, apixaban, and rivaroxaban have been approved for primary and secondary stroke prevention in patients with atrial fibrillation. However, questions have arisen about how to manage emergency situations, such as when thrombolysis would be required for acute ischemic stroke or for the managing intracranial or gastrointestinal bleedings. We summarize the current literature and provide recommendations for the management of these situations. Peak plasma levels of the direct oral anticoagulants (DOACs) apixaban, dabigatran, or rivaroxaban are observed about 2-4 h after intake. Elimination of dabigatran is mainly dependent on renal function. Consequently, if renal function is impaired, there is a risk of drug accumulation that is highest for dabigatran followed by rivaroxaban and then apixaban and thus dosing recommendations are different. To date, no bedside tests are available that reliably assess the anticoagulatory effect of DOACs, nor are specific antidotes available. We recommend performing the following tests if DOAC intake is unknown: dabigatran-associated bleeding risk is minimized or can be neglected if thrombin time, Hemoclot test, or Ecarin clotting time is normal. Apixaban and rivaroxaban effects can be ruled out if findings from the anti-factor Xa activity test are normal. High plasma levels of DOAC are also mostly excluded if PTT and PTZ are normal four or more hours after DOAC intake. However, normal values of global coagulation tests are not sufficient if thrombolysis is indicated for treating acute stroke. The decision for or against thrombolysis is an individual decision; in these cases, thrombolysis use is off-label. In case of bleeding, prothrombin complex concentrates seems to be the most plausible treatment. For severe gastrointestinal bleeding with life-threatening blood loss, the bleeding source needs to be identified and treated by invasive measures. Use of procoagulant drugs (antifibrinolytics) might also be considered. However, there is very limited clinical experience with these products in conjunction with DOAC.
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Affiliation(s)
- T Steiner
- Neurologische Klinik, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany.
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Collettini F, Schippers AC, Schnapauff D, Denecke T, Hamm B, Riess H, Wust P, Gebauer B. Percutaneous ablation of lymph node metastases using CT-guided high-dose-rate brachytherapy. Br J Radiol 2013; 86:20130088. [PMID: 23659925 DOI: 10.1259/bjr.20130088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess the technical feasibility, safety and clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) for achieving local tumour control (LTC) in isolated lymph node metastases. METHODS From January 2008 to December 2011, 10 patients (six males and four females) with isolated nodal metastases were treated with CT-HDRBT. Five lymph node metastases were para-aortic, three were at the liver hilum, one at the coeliac trunk and one was a left iliac nodal metastasis. The mean lesion diameter was 36.5 mm (range 12.0-67.0 mm). Patients were followed up by either contrast-enhanced CT or MRI 6 weeks and then every 3 months after the end of treatment. The primary end point was LTC. Secondary end points included primary technical effectiveness rate, adverse events and progression-free survival. RESULTS The first follow-up examination after 6 weeks revealed complete coverage of all nodal metastases treated. There was no peri-interventional mortality or major complications. The mean follow-up period was 13.2 months (range 4-20 months). 2 out of 10 patients (20%) showed local tumour progression 9 and 10 months after ablation. 5 out of 10 patients (50%) showed systemic tumour progression. The mean progression-free interval was 9.2 months (range 2-20 months). CONCLUSION CT-HDRBT is a safe and effective technique for minimally invasive ablation of nodal metastases. ADVANCES IN KNOWLEDGE CT-HDRBT of lymph node metastases is feasible and safe. CT-HDRBT might be a viable therapeutic alternative to obtain LTC in selected patients with isolated lymph node metastases.
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Affiliation(s)
- F Collettini
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Sucker C, Korfmacher S, Papp-Váry M, Grieser C, Riess H. [Spontaneous hematoma and hip pain in a 65-year old patient]. Internist (Berl) 2012; 53:1234-9. [PMID: 22948345 DOI: 10.1007/s00108-012-3105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The case of a 65-year-old woman with acquired hemophilia is reported. Acquired hemophilia is characterized by the development of inhibitors directed against coagulation factors. Impairment of plasmatic hemostasis leads to a severe bleeding tendency in individuals without a preexisting coagulation defect with considerable mortality. Pathophysiology, diagnostic work-up, and treatment are summarized and discussed.
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Affiliation(s)
- C Sucker
- LaboMed Gerinnungszentrum Berlin, Tauentzienstr. 7b/c, 10789, Berlin, Deutschland.
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41
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Collettini F, Golenia MJ, Schnapauff D, Poellinger A, Denecke T, Wust P, Riess H, Hamm B, Gebauer B. CT-gesteuerte Hochdosis Brachytherapie (CT-HDRBT) von Mammakarzinom-Lebermetastasen (BCLM) - Erste klinische Erfahrung mit 80 Läsionen. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pabinger I, Alt-Epping B, Demarmels Biasutti F, Langer F, Wörmann B, Riess H. Venous thrombembolism in tumour patients. Hamostaseologie 2011. [DOI: 10.5482/ha-1147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Schellong SM, Gerlach HE, Tebbe U, Haas S, Melzer N, Abletshauser C, Sieder C, Bramlage P, Riess H, Bauersachs R. Certoparin versus UFH to prevent venous thromboembolic events in the very elderly patient: an analysis of the CERTIFY study. Thromb Res 2011; 128:417-21. [PMID: 21658750 DOI: 10.1016/j.thromres.2011.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/26/2011] [Accepted: 05/02/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is an exponential rise of thromboembolic risk with age because of co-morbidities, immobility and pharmacotherapy. We aimed to investigate the benefits and risks of heparin prophylaxis in very elderly patients ≥80 years and the type of heparin used in a subgroup analysis of the CERTIFY trial. PATIENTS/METHODS 3,239 patients were randomized to 3,000 U aXa o.d. certoparin or 5,000 IU t.i.d. unfractionated heparin (UFH) for 8-20 days. RESULTS Patients ≥80 years (n=1,365) were more likely to be female, had a lower mean bodyweight, were more frequently using antiplatelets and had a GFR below 30 ml/min/1.73 m(2) more often than patients <80 years (n=1,875). The combined endpoint of proximal DVT, symptomatic non-fatal PE and VTE related death was experience by 5.26% of patients ≥80 years versus 3.51% in younger patients (OR 1.53; 95%CI 1.05-2.21; p=0.03). There were no significant differences in both minor (OR 1.11; 95%CI 0.75-1.62) and major (OR 2.53; 95%CI 0.93-6.86) bleeding risks. Certoparin and UFH were equally effective in reducing thromboembolic risk in either age group. The risk of any (OR 0.45; 95%CI 0.26-0.79) and minor bleeding (OR 0.42; 95%CI 0.23-0.78) was reduced with certoparin in the very elderly only. There were more adverse events in elderly patients (OR 1.26; 95%CI 1.1-1.46), but rates were otherwise comparable. CONCLUSIONS The analysis confirmed the increased thromboembolic risk in very elderly patients, but demonstrated no increased bleeding risk. Certoparin and UFH were equally effective and safe with a reduced risk of minor bleeding complications with certoparin in the very elderly.
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Bauersachs R, Schellong SM, Haas S, Tebbe U, Gerlach HE, Abletshauser C, Sieder C, Melzer N, Bramlage P, Riess H. CERTIFY: prophylaxis of venous thromboembolism in patients with severe renal insufficiency. Thromb Haemost 2011; 105:981-8. [PMID: 21505722 DOI: 10.1160/th10-09-0614] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 03/05/2011] [Indexed: 11/05/2022]
Abstract
Patients with severe renal insufficiency (sRI) have been suggested to be at an increased risk of bleeding with low-molecular-weight heparins (LMWH). We aimed at assessing the benefits and risks of certoparin in comparison to unfractionated heparin (UFH) in these patients. In this subgroup analysis of the CERTIFY trial, acutely ill, non-surgical patients ≥70 years received certoparin 3,000U aXa o.d. or UFH 5,000 IU t.i.d. One hundred eighty-nine patients had a glomerular filtration rate (GFR) ≤30 ml/min/1.73 m2, 3,050 patients served as controls. Patients with sRI had a mean age of 85.9 ± 6.6 years (controls 78.4 ± 6.0) and were treated for a mean of 9.3 ± 3.7 days (9.9 ± 4.3). Thromboembolic event rates were comparable (4.55 vs. 4.21%; OR1.08; 95%CI 0.5-2.37) but bleeding was increased in sRI (9.52 vs. 3.54%; OR2.87; 95%CI 1.70-4.83). The incidence of the combined end-point of proximal DVT, symptomatic non-fatal PE and VTE related death was 6.49% with certoparin and 2.60% with UFH (OR2.60; 95%CI 0.49-13.85). There was a decrease in total bleeding with certoparin (OR0.33; 95%CI 0.11-0.97), which was non-significant in patients with GFR >30 ml/min/1.73 m2. In two multivariable regression models certoparin and immobilisation <10 days were associated with less bleeding while a GFR ≤30 ml/min/1.73 m2 was associated with increased bleeding. A total of 11.3% of certoparin- and 18.5% of UFH-treated patients experienced serious adverse events (14.8 in patients with a GFR ≤30 vs. 5.6% vs. >30 ml/min/1.73 m2). In conclusion, certoparin 3,000U anti Xa o.d. was as efficacious as 5,000 IU UFH t.i.d. in patients with sRI but had a reduced risk of bleeding.
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Affiliation(s)
- R Bauersachs
- Medizinische Klinik IV, Max-Ratschow-Klinik für Angiologie, Klinikum Darmstadt GmbH, Grafenstraße 9, 64283 Darmstadt, Germany.
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Gebauer B, Bohnsack O, Riess H. Radiologische Evaluation des Tumoransprechens in onkologischen Therapiestudien (Tumor Response Evaluation). ROFO-FORTSCHR RONTG 2011; 183:695-703. [DOI: 10.1055/s-0029-1246074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The decision how to handle an antithrombotic treatment when an intervention during GI endoscopy is planned is influenced both by the risk of bleeding and by the thromboembolic risk when treatment is suspended. The risk of bleeding is negligible even when on oral anticoagulants in diagnostic procedures with standard forceps biopsies. Oral anticoagulation has to be stopped, however, when planning invasive procedures such as polypectomy or EPT. In the case of patients with a high risk of thromboembolic complications such as artificial valves in mitral position or atrial fibrillation with risk factors, one has to temporarily switch to anticoagulants with shorter action ("bridging"). Treatment with inhibitors of platelet function does not preclude procedures with a low risk of bleeding including forceps biopsy. Urgent procedures with a high risk of bleeding should be performed after stopping clopidogrel one week previously but only after consultation with the treating cardiologist. In the case of colonoscopy, in particular as a screening procedure, there are two options: 1) stopping oral anticoagulation (with or without bridging) or clopidogrel, respectively, or 2) continuing antithrombotic treatment and performing a second elective endoscopy for polypectomy with tapered antithrombotic medication if polyps are found which are not amenable to resection by biopsy forceps. The choice between these two options has to be made individually.
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Potthoff K, Hofheinz R, Hassel JC, Volkenandt M, Lordick F, Hartmann JT, Karthaus M, Riess H, Lipp HP, Hauschild A, Trarbach T, Wollenberg A. Interdisciplinary management of EGFR-inhibitor-induced skin reactions: a German expert opinion. Ann Oncol 2010; 22:524-535. [PMID: 20709812 DOI: 10.1093/annonc/mdq387] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Anti-epidermal growth factor receptor treatment strategies, i.e. monoclonal antibodies such as cetuximab and panitumumab, or epidermal growth factor receptor (EGFR) small molecule tyrosine kinase inhibitors, such as erlotinib and gefitinib, have expanded the treatment options for different tumor types. Dermatologic toxic effects are the most common side-effects of EGFR inhibitor therapy. They can profoundly affect the patient's quality of life. PURPOSE The aim of this study was to provide interdisciplinary expert recommendations on how to treat patients with skin reactions undergoing anti-EGFR treatment. MATERIAL AND METHODS An expert panel from Germany with expertise in medical oncology, dermatology or clinical pharmacology was convened to develop expert recommendations based on published peer-reviewed literature. RESULTS The expert recommendations for the state-of-the-art treatment of skin reactions induced by EGFR inhibitor therapy include recommendations for diagnostics and grading as well as grade-specific and stage-adapted treatment approaches and preventive measures. It was concluded that EGFR-inhibitor-related dermatologic reactions should always be treated combining basic care of the skin and a specific therapy adapted to stage and grade of skin reaction. For grade 2 and above, specific treatment recommendations for early- and later-stage skin reactions induced by EGFR-inhibitor therapy were proposed. CONCLUSION This paper presents a German national expert opinion for the treatment of skin reactions in patients receiving EGFR inhibitor therapy.
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Affiliation(s)
- K Potthoff
- Department of Radiation Oncology, University of Heidelberg, Heidelberg.
| | - R Hofheinz
- Department of Hematology and Oncology, University of Mannheim, Mannheim
| | - J C Hassel
- Department of Dermatology, University of Heidelberg, Heidelberg
| | - M Volkenandt
- Department of Dermatology and Allergology, Ludwig-Maximilians-University of Munich, Munich
| | - F Lordick
- Department of Hematology and Oncology, Klinikum Braunschweig, Braunschweig
| | - J T Hartmann
- Department of Hematology and Oncology, University of Tuebingen, Tuebingen
| | - M Karthaus
- Department of Hematology and Oncology, Städtisches Klinikum Neuperlach, Munich
| | - H Riess
- Department of Medical Oncology and Hematology, Charité University, Berlin
| | - H P Lipp
- Department of Pharmacology, University of Tuebingen, Tuebingen
| | - A Hauschild
- Department of Dermatology, University of Kiel, Kiel
| | - T Trarbach
- Department of Hematology and Oncology, University of Essen, Essen, Germany
| | - A Wollenberg
- Department of Dermatology and Allergology, Ludwig-Maximilians-University of Munich, Munich
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Riess H, Haas S, Tebbe U, Gerlach HE, Abletshauser C, Sieder C, Rossol S, Pfeiffer B, Schellong SM. A randomized, double-blind study of certoparin vs. unfractionated heparin to prevent venous thromboembolic events in acutely ill, non-surgical patients: CERTIFY Study. J Thromb Haemost 2010; 8:1209-15. [PMID: 20218984 DOI: 10.1111/j.1538-7836.2010.03848.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In medically ill patients, no contemporary double-blind head-to-head evaluation of low molecular weight heparin vs. unfractionated heparin (UFH) for the prevention of venous thromboembolic events is available. OBJECTIVES To compare the efficacy and safety of certoparin with those of UFH. PATIENTS/METHODS In this double-blind, randomized, controlled trial, acutely ill, non-surgical patients aged > or = 70 years were randomized to certoparin (3000 U of anti-factor Xa once daily) or to UFH (5000 IU t.i.d.). The primary endpoint was the composite of proximal deep vein thrombosis as assessed by bilateral compression ultrasonography, symptomatic non-fatal pulmonary embolism and venous thromboembolism-related death, and was assessed by a blinded central adjudication committee. Non-inferiority margins were set at 1.8 for the odds ratio (OR) and 3.45% for the absolute difference. RESULTS Three thousand two hundred and thirty-nine patients aged 78.8 + or - 6.3 years were treated for 9.1 + or - 3.4 days. The incidence of the primary endpoint was 3.94% in the certoparin group and 4.52% in the UFH group, with a difference in proportions of - 0.59% [95% confidence interval (CI) -2.09 to 0.92; P < 0.0001 for non-inferiority], and an OR of 0.87 (95% CI 0.60-1.26; P = 0.0001 for non-inferiority). Major bleeding occurred in 0.43% of certoparin-treated patients and 0.62% of UFH-treated patients (OR 0.69; 95% CI 0.26-1.83). Any bleeding occurred at 3.20% in certoparin-treated patients vs. 4.58% in UFH-treated patients (OR 0.69; 95% CI 0.48-0.99; P < 0.05), and 5.73% of certoparin-treated patients and 6.63% of UFH-treated patients experienced serious adverse events. All-cause mortality was 1.27% in certoparin-treated patients and 1.36% in UFH-treated patients. CONCLUSIONS In acutely ill, non-surgical elderly patients, thromboprophylaxis with certoparin (3000 U of anti-FXa once daily) was non-inferior to 5000 IU of UFH t.i.d., with a favorable safety profile.
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Affiliation(s)
- H Riess
- Charité, Campus Virchow Klinikum, Berlin, Germany.
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Stieler J, Pelzer U, Sinn M, Dörken B, Oettle H, Riess H. CONKO-008: Oxaliplatin (O)/folinic acid (FA)/5-fluorouracil (5-FU) (24 h) in combination with lapatinib as a second-line therapy in pancreatic cancer after gemcitabine failure: A phase I/II trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nicolaou A, Sinn M, Hildebrandt B, Gebauer B, Ricke J, Dörken B, Riess H. A phase II study in patients with advanced biliary tract carcinoma (BTC) treated with hepatic arterial infusion chemotherapy (HAI) with oxaliplatin (O), 5-fluorouracil (5FU), and folinic acid (FA). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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