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Benza R, Lang I, Matsubara H, Naeije R, Vizza C, Waxman A, Adamson P, Liu Y, Golden G. ARTISAN: A Novel Study of Mean Pulmonary Artery Pressure-Targeted Approach with Early and Rapid Treprostinil Therapy to Reverse Right Ventricular Remodeling in Pulmonary Arterial Hypertension. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.864] [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: 04/05/2023] Open
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Cecilia V, Ausserhofer T, Lang I, Mascherbauer J, Tschernko E, Dworschak M, Ankersmit H, Moser B. INCREASED SUPAR SERUM CONCENTRATIONS IN PATIENTS WITH LEFT AND RIGHT VENTRICULAR REMODELING DUE TO PRESSURE OVERLOAD IS ASSOCIATED WITH MYOCARDIAL MASS. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.100] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Di Cosimo S, Pizzamiglio S, Sotiriou C, Ciniselli C, Triulzi T, de Cecco L, El-Abed S, Izquierdo M, de Azambuja E, Saura C, Huober J, Untch M, Lang I, Loi S, Tagliabue E, Rubio I, Vingiani A, Colombo M, Verderio P, Pruneri G. Gene expression profile at week 2 of neoadjuvant therapy course predicts outcome in HER2-positive breast cancer patients: an explorative analysis from NeoALTTO. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01561-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Koskinas KC, Losdat S, Shibutani H, Ueki Y, Otsuka T, Haener J, Fahrni G, Iglesias JF, Spirk D, Van Geuns RJ, Daemen J, Windecker S, Engstrom T, Lang I, Raber L. Interrelation between baseline plaque characteristics and changes in coronary atherosclerosis with the PCSK9-inhibitor alirocumab: insights from the PACMAN-AMI randomized trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1206] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with acute myocardial infarction (AMI) frequently experience recurrent atherothrombotic events, largely attributable to non-culprit lesions with high-risk characteristics. Statins can halt the progression of coronary atherosclerosis, and addition of protein convertase subtilisin/kexin type 9-inhibitors (PCSK9i) results in incremental low-density lipoprotein cholesterol (LDL-C) lowering and atheroma regression.
Purpose
We sought to examine the interrelation between baseline imaging characteristics, on-treatment LDL-C levels, and changes in coronary atherosclerosis as assessed by serial, multi-modality intracoronary imaging in patients with AMI.
Methods
This is a post hoc analysis from the PACMAN-AMI randomized trial. Patients were randomly allocated to biweekly alirocumab 150 mg vs. placebo on top of high-intensity statin initiated within 24h of presentation with AMI, and underwent serial imaging of the two non-infarct-related arteries at baseline and after 52 weeks. The primary endpoint was percent atheroma volume (PAV) by intravascular ultrasound (IVUS). Powered secondary endpoints were maximal lipid core burden index (maxLCBI4mm) by near-infrared spectroscopy (NIRS) and minimum fibrous cap thickness (FCTmin) by optical coherence tomography (OCT).
Results
Of 300 randomized patients (mean age 58.5±9.8 years, 18.7% women, baseline LDL-C 3.94±0.87 mmol/L), IVUS was serially performed in 265 patients (537 arteries). LDL-C levels decreased to 1.92±0.79 mmol/L with placebo and 0.61±0.61 mmol/L with alirocumab (p<0.001). Compared with placebo (statin alone), alirocumab added to statin resulted in greater PAV reduction (−2.13% vs. −0.92%; p<0.001), greater maxLCBI4mm reduction (−79.42 vs. −37.60; p=0.006), and greater increase in FCTmin (62.67 vs. 33.19 μm; p=0.001). Changes in PAV and maxLCBI4mm were inversely related to on-treatment LDL-C levels, and change in FCTmin was positively related to on-treatment LDL-C levels (Figure 1). Across all patients, we found significant, inverse relationships between change in PAV and baseline PAV [slope: −0.072 (95% CI −0.101 to −0.042); p<0.001], between change in maxLCBI4mm and baseline maxLCBI4mm [slope: −0.437 (95% CI −0.505 to −0.369); p<0.001], and between change in FCTmin and baseline FCTmin [slope: −0.436 (95% CI −0.541 to −0.332); p<0.001]; these findings indicate greater PAV and maxLCBI4mm regression in lesions with greater PAV and LCBI4mm at baseline, and greater fibrous cap thickening in lesions with thinner fibrous caps at baseline.
Conclusion
In this study of intensive LDL-C lowering treatment initiated in the acute AMI setting, more favorable plaque changes were observed in patients with lower on-treatment LDL-C levels and in lesions with more adverse baseline plaque characteristics. Whether AMI patients with high-risk plaque features might derive greater clinical benefit from early initiation of intensive LDL-C-lowering therapies requires further investigation.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Sanofi, Regeneron
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Affiliation(s)
- K C Koskinas
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - S Losdat
- CTU Bern, University of Bern , Bern , Switzerland
| | - H Shibutani
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - Y Ueki
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - T Otsuka
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - J Haener
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - G Fahrni
- University Hospital Basel , Basel , Switzerland
| | - J F Iglesias
- Geneva University Hospitals, Cardiology , Geneva , Switzerland
| | - D Spirk
- University of Bern , Bern , Switzerland
| | - R J Van Geuns
- Radboud University Medical Centre , Nijmegen , The Netherlands
| | - J Daemen
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - S Windecker
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - T Engstrom
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - I Lang
- Medical University of Vienna , Vienna , Austria
| | - L Raber
- Bern University Hospital, Inselspital , Bern , Switzerland
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Schrutka L, Hagn G, Galli L, Poeschl A, Seidl V, Ondracek A, Bileck A, Lang I, Hengstenberg C, Krychtiuk K, Speidl W, Gerner C, Distelmaier K. Plasma eicosanoid profiling in the course of proprotein convertase subtilisin-kexin type 9 inhibition: insights from a metabolomic analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Treatment with monoclonal antibodies targeting circulating proprotein convertase subtilisin-kexin type 9 (PCSK9) was found to reduce all-cause mortality in addition to cardiovascular events, suggesting pleiotropic effects. Eicosanoids are bioactive metabolites involved in cardiovascular disease and have not yet been studied in the course of PCSK9 inhibition.
Methods
In this prospective translational single-center study, plasma samples were collected from 64 patients before and after initiation of PCSK9 inhibitor treatment. Metabolomic analyses were performed using liquid chromatography coupled to high-resolution mass spectrometry.
Results
A total of 62 bioactive eicosanoids were detected. Among the metabolites, four were significantly decreased by PCSK9 inhibition after one month and remained stable after 6 months (figure): arachidonic acid (p=0.003), 12,13-DiHOME (p<0.001), 9-HpODE_9.91 (p=0.007) and HpODE_7.71 (p=0.011). Phospholipase A2 levels were reduced by 40% after 1 month (p=0.003) and by additional 50% after 6 months of treatment (p=0.015), but did not correlate with eicosanoids (p=0.057). The change in arachidonic acid levels resulted in a significant increase in the ratio of omega-3 to omega-6 polyunsaturated fatty acids (p=0.002).
Conclusion
PCSK9 inhibition leads to significant changes in the eicosanoid profile already after one month, in particular to a downregulation of arachidonic acid. This discovery complements the presumed pleiotropic effects of PCSK9 inhibition and may provide additional benefit in the treatment of atherosclerotic disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Schrutka
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - G Hagn
- University of Vienna, Department of Analytical Chemistry , Vienna , Austria
| | - L Galli
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - A Poeschl
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - V Seidl
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - A Ondracek
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - A Bileck
- University of Vienna, Department of Analytical Chemistry , Vienna , Austria
| | - I Lang
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - C Hengstenberg
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - K Krychtiuk
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - W Speidl
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - C Gerner
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - K Distelmaier
- Medical University of Vienna, Cardiology , Vienna , Austria
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Eyileten C, Jarosz-Popek J, Jakubik D, Gasecka A, Wolska M, Czajka P, Nowak A, Ufnal M, Dizdarevic A, Toma A, Lang I, Postula M, Siller-Matula JM. Increased symmetric dimethyl-arginine is a predictor factor of decreased platelet reactivity and increased bleeding risk in patients with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1382] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
One of the promising biomarkers in CVD are asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), which are products of L-arginine methylation and are both involved in endothelial dysfunction. ADMA, SDMA and L-homoarginine, have emerged as biomarkers linked to cardiovascular outcomes [1].
Purpose
To investigate the association of SDMA with platelet reactivity and bleeding risk in patients with acute coronary syndrome (ACS) treated with potent P2Y12 inhibitors prasugrel and ticagrelor.
Methods
Our prospective observational study enrolled 292 patients with ACS undergoing percuteneus coronary intervention [2]. Plasma concentrations of SDMA were measured during the hospitalization for ACS. Impedance aggregometry was used. The primary study endpoint was the concentration of metabolites and platelet reactivity. The primary clinical outcome endpoint was the incidence of Thrombolysis in Myocardial Infarction (TIMI) bleeding events (major, minor and minimal). The efficacy endpoint was the composite of major adverse cardiac events (MACE: stent thrombosis, myocardial infarction, stroke and cardiac death).
Results
There was an inverse correlation between SDMA serum levels and platelet reactivity (r=−0.25; p<0.000). The ADP+PGE1-induced platelet reactivity was 33% lower among patients with the highest SDMA quartile (4th) as compared to those with the 1–3rd SDMA quartile (8 [0–29] vs 12 [0–126] U; p<0.001). The AA-induced platelet reactivity was 56% lower among patients with the highest SDMA quartile (4th) as compared to those with the 1–3rd SDMA quartile (4 [0–48] vs 9 [0–133]; p<0.001). In a multivariate model, the highest SDMA (4th) quartile was found to be an independent predictor of the lowest ADP+PGE1 and AA induced platelet aggregation (OR: 2.666, 95% CI [1.184–5.999], p=0.018).
Conclusions
Our study shows that high plasma concentration of SDMA, but not ADMA, is independently associated with low platelet reactivity to ADP and AA and is associated with major and minor bleeding events in patients with ACS on potent antiplatelet therapies. Therefore, SDMA might have a potential to be further evaluated as a blood biomarker for individualization of duration and potency of antiplatelet therapies in an ACS population at high risk of bleeding complications.
Acknowledgment
I-COMET research team
Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
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Affiliation(s)
- C Eyileten
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - J Jarosz-Popek
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - D Jakubik
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Gasecka
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Warsaw, Poland
| | - M Wolska
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - P Czajka
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Nowak
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - M Ufnal
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Dizdarevic
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Toma
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Postula
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - J M Siller-Matula
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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7
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Eyileten C, Jarosz-Popek J, Jakubik D, Wolska M, Fitas A, Czajka P, Nowak A, Ufnal M, Postula M, Toma A, Lang I, Siller-Matula JM. High concentrations of plasma trimethylamine-n-oxide is associated with long-term cardiovascular mortality in patients with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1383] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute coronary syndrome (ACS) remains a leading cause of mortality worldwide [1]. Patients who experienced ACS are at high risk of future cardiovascular events and death [2–4]. Identification of reliable predictive tools could potentially improve the risk stratification [5]. Numerous studies revealed that intestinal microbial organisms (microbiota) and its metabolites, as TMAO (trimethylamine-N-oxide) may play a pathogenic role in a cardiovascular disease (CVD) and ACS [6]. Elevated concentration of circulating TMAO has been associated with increased risk of CVD and major adverse cardiac events (MACE), including myocardial infarction (MI), stroke, major bleeding and all-cause mortality [7].
Purpose
To investigate the association of liver metabolite TMAO with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention.
Methods
Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted 7 years in the median. Adjusted Cox-regression analysis was used for prediction of mortality.
Results
ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p<0.001). The cut-off value of >4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR=11.62, 95% CI: 2.26–59.67; p=0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3% vs 2.6%; p=0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low.
Conclusions
High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS. TMAO concentration of 4 μmol/L may be a cut-off value for prognosis of ACS patients.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Kaplan-Meier curvesTable 1
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Affiliation(s)
- C Eyileten
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - J Jarosz-Popek
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - D Jakubik
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - M Wolska
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Fitas
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - P Czajka
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Nowak
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - M Ufnal
- Medical University of Warsaw, Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Rese, Warsaw, Poland
| | - M Postula
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Toma
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J M Siller-Matula
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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8
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Dona C, Koschutnik M, Nitsche C, Winter MP, Mach M, Andreas M, Bartko P, Kammerlander A, Goliasch G, Lang I, Hengstenberg C, Mascherbauer J. Cerebral protection in TAVR – can we do without? Impact on stroke rate, length of hospital stay and 12-month mortality. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1651] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Stroke associated with transcatheter aortic valve replacement (TAVR) is a potentially devastating complication. Until recently, the Sentinel™ Cerebral Protection System (CPS; Boston Scientific) has been the only commercially available device for mechanical prevention of TAVR-related stroke. However, its effectiveness is still undetermined.
Methods
Between January 2019 and August 2020 consecutive patients were randomly assigned to TAVR with or without Sentinel™ in a 1:1 fashion. We defined as primary endpoint clinically detectable cerebrovascular events within 72 hours after TAVR, and as secondary endpoints LOS and 12-month mortality. Logistic and linear regression analyses were used to assess associations of Sentinel™ use with endpoints.
Results
Of 411 patients (80±7 y/o, 47.4% female, EuroSCORE II 6.3±5.9%), Sentinel™ was used in 213 (51.8%), with both filters correctly deployed in 189 (46.0%). 20 (4.9%) cerebrovascular events were recorded, 10 (2.4%) of which were disabling strokes. Sentinel™ reduced cerebrovascular events in univariate analysis by 71% (OR 0.29, 95% CI 0.11–0.82; p=0.02) and after multivariate adjustment by 75% (adj. OR 0.25; 95% CI 0.08–0.80; p=0.02). Sentinel™ use was also significantly associated with shorter LOS (8.4±9.6 versus 6.7±6.1 days; p=0.03) and lower 12-month all-cause mortality (15.7% versus 7.5%, p=0.01).
Conclusions
In the present prospective all-comers TAVR cohort, Sentinel™ significantly 1) reduced cerebrovascular events, 2) shortened LOS, and 3) improved 12-month survival. These data promote the use of a CPS when implanting TAVR valves.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Dona
- Medical University of Vienna, Wien, Austria
| | | | - C Nitsche
- Medical University of Vienna, Wien, Austria
| | - M P Winter
- Medical University of Vienna, Wien, Austria
| | - M Mach
- Medical University of Vienna, Wien, Austria
| | - M Andreas
- Medical University of Vienna, Wien, Austria
| | - P Bartko
- Medical University of Vienna, Wien, Austria
| | | | - G Goliasch
- Medical University of Vienna, Wien, Austria
| | - I Lang
- Medical University of Vienna, Wien, Austria
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9
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Kahan Z, Gil-Gil M, Ruiz-Borrego M, Carrasco E, Ciruelos E, Muñoz M, Bermejo B, Margeli M, Antón A, Casas M, Csöszi T, Murillo L, Morales S, Calvo L, Lang I, Alba E, de la Haba-Rodriguez J, Ramos M, López IÁ, Gal-Yam E, Garcia-Palomo A, Alvarez E, González-Santiago S, Rodríguez CA, Servitja S, Corsaro M, Rodrigálvarez G, Zielinski C, Martín M. Health-related quality of life with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive metastatic breast cancer: Patient-reported outcomes in the PEARL study. Eur J Cancer 2021; 156:70-82. [PMID: 34425406 DOI: 10.1016/j.ejca.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The PEARL study showed that palbociclib plus endocrine therapy (palbociclib/ET) was not superior to capecitabine in improving progression-free survival in postmenopausal patients with metastatic breast cancer resistant to aromatase inhibitors, but was better tolerated. This analysis compared patient-reported outcomes. PATIENTS AND METHODS The PEARL quality of life (QoL) population comprised 537 patients, 268 randomised to palbociclib/ET (exemestane or fulvestrant) and 269 to capecitabine. Patients completed the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 and EQ-5D-3L questionnaires. Changes from the baseline and time to deterioration (TTD) were analysed using linear mixed-effect and stratified Cox regression models, respectively. RESULTS Questionnaire completion rate was high and similar between treatment arms. Significant differences were observed in the mean change in global health status (GHS)/QoL scores from the baseline to cycle 3 (2.9 for palbociclib/ET vs. -2.1 for capecitabine (95% confidence interval [CI], 1.4-8.6; P = 0.007). The median TTD in GHS/QoL was 8.3 months for palbociclib/ET versus 5.3 months for capecitabine (adjusted hazard ratio, 0.70; 95% CI, 0.55-0.89; P = 0.003). Similar improvements for palbociclib/ET were also seen for other scales as physical, role, cognitive, social functioning, fatigue, nausea/vomiting and appetite loss. No differences were observed between the treatment arms in change from the baseline in any item of the EQ-5D-L3 questionnaire as per the overall index score and visual analogue scale. CONCLUSION Patients receiving palbociclib/ET experienced a significant delay in deterioration of GHS/QoL and several functional and symptom scales compared with capecitabine, providing additional evidence that palbociclib/ET is better tolerated. TRIAL REGISTRATION NUMBER NCT02028507 (ClinTrials.gov). EUDRACT STUDY NUMBER 2013-003170-27.
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Affiliation(s)
- Zsuzsanna Kahan
- Department of Oncotherapy, University of Szeged, Szeged, Hungary.
| | - Miguel Gil-Gil
- Institut Catalá d'Oncologia (ICO), L'Hospitalet de Llobregat, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Manuel Ruiz-Borrego
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Carrasco
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Eva Ciruelos
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; HM Hospitales Madrid, Spain; SOLTI Group on Breast Cancer Research, Spain
| | - Montserrat Muñoz
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitari Clinic de Barcelona, Institut Clinic de Malalties Hemato-Oncològiques-ICHMO, Barcelona, Spain
| | - Begoña Bermejo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria-INCLIVA Valencia, Spain; Centro de Investigacion Biomedica en Red de Oncologia, CIBERONC-ISCIII, Madrid, Spain
| | - Mireia Margeli
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Badalona Applied Research Group in Oncology (ARGO Group), Institut Catalá d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antonio Antón
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigacion Biomedica en Red de Oncologia, CIBERONC-ISCIII, Madrid, Spain; Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón-IISA, Zaragoza, Spain
| | | | - Tibor Csöszi
- Department of Oncology, Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelőintezet, Szolnok, Hungary
| | - Laura Murillo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Clínico de Zaragoza Lozano Blesa, Zaragoza, Spain
| | - Serafín Morales
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Lourdes Calvo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Istvan Lang
- Istenhegyi Géndiagnosztika Private Health Center Oncology Clinic, Hungary
| | - Emilio Alba
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigacion Biomedica en Red de Oncologia, CIBERONC-ISCIII, Madrid, Spain; UGCI Medical Oncology, Hospitales Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Juan de la Haba-Rodriguez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Instituto Maimonides de Investigacion Biomedica, Hospital Reina Sofia Hospital, Universidad de Córdoba, Córdoba, Spain
| | - Manuel Ramos
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro Oncológico de Galicia, A Coruña, Spain
| | - Isabel Álvarez López
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario Donostia-Biodonostia, San Sebastián, Spain
| | - Einav Gal-Yam
- Institute of Oncology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Andrés Garcia-Palomo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology. Hospital de León, León, Spain
| | - Elena Alvarez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Santiago González-Santiago
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario San Pedro de Alcantara, Cáceres, Spain
| | - César A Rodríguez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Clínico Universitario de Salamanca-IBSAL, Spain
| | - Sonia Servitja
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital del Mar, Barcelona, Spain
| | | | | | - Christoph Zielinski
- Vienna Cancer Center, Medical University Vienna and Vienna Hospital Association, Vienna, Austria; CECOG Central European Cooperative Oncology Group, Vienna, Austria
| | - Miguel Martín
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigacion Biomedica en Red de Oncologia, CIBERONC-ISCIII, Madrid, Spain; Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain
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10
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Moreno-Aspitia A, Holmes EM, Jackisch C, de Azambuja E, Boyle F, Hillman DW, Korde L, Fumagalli D, Izquierdo MA, McCullough AE, Wolff AC, Pritchard KI, Untch M, Guillaume S, Ewer MS, Shao Z, Sim SH, Aziz Z, Demetriou G, Mehta AO, Andersson M, Toi M, Lang I, Xu B, Smith IE, Barrios CH, Baselga J, Gelber RD, Piccart-Gebhart M. Updated results from the international phase III ALTTO trial (BIG 2-06/Alliance N063D). Eur J Cancer 2021; 148:287-296. [PMID: 33765513 DOI: 10.1016/j.ejca.2021.01.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/14/2021] [Accepted: 01/24/2021] [Indexed: 01/03/2023]
Abstract
AIM To present the pre-specified analyses of >5-years follow-up of the Phase III ALTTO trial. PATIENTS AND METHODS 8381 patients with stage I-III HER2 positive breast cancer randomised to chemotherapy plus 1-year of trastuzumab (T), oral lapatinib (L; no longer evaluated), trastuzumab followed by lapatinib (T→L), and lapatinib + trastuzumab (L+T). The primary endpoint was disease-free survival (DFS). A secondary analysis examined DFS treatment effects by hormone receptor status, nodal status and chemotherapy timing; time to recurrence; overall survival (OS) and safety (overall and cardiac). RESULTS At a median follow-up of 6.9 years, 705 DFS events for L+T versus T were observed. Hazard Ratio (HR) for DFS was 0.86 (95% CI, 0.74-1.00) for L+T versus T and 0.93 (95% CI, 0.81-1.08) for T→L versus T. The 6-year DFS were 85%, 84%, and 82% for L+T, T→L, and T, respectively. HR for OS was 0.86 (95% CI, 0.70-1.06) for L+T versus T and 0.88 (95% CI, 0.71-1.08) for T→L versus T. The 6-year OS were 93%, 92%, and 91% for L+T, T→L, and T, respectively. Subset analyses showed a numerically better HR for DFS in favour of L+T versus T for the hormone-receptor-negative [HR 0.80 (95% CI, 0.64-1.00; 6-yr DFS% = 84% versus 80%)] and the sequential chemotherapy [HR 0.83 (95% CI, 0.69-1.00; 6-yr DFS% = 83% versus79%)] subgroups. CONCLUSION T+L did not significantly improve DFS and OS over T alone, both with chemotherapy, and, therefore, cannot be recommended for adjuvant treatment of early-stage HER2-positive breast cancer. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT00490139.
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Affiliation(s)
| | - Eileen M Holmes
- Dundee Epidemiology and Statistics Unit, University of Dundee, Dundee, UK
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - Evandro de Azambuja
- Institute Jules Bordet and l' Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Sydney, Australia
| | - David W Hillman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Larissa Korde
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Ann E McCullough
- Division of Anatomic Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Sébastien Guillaume
- Institute Jules Bordet and l' Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Michael S Ewer
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Zhimin Shao
- Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Sung Hoon Sim
- Center for Breast Cancer, National Cancer Centre, Gyeonggi-do, South Korea
| | - Zeba Aziz
- Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Ajay O Mehta
- Central India Cancer Research Institute, Nagpur, Maharashtra, India
| | | | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | - Binghe Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Ian E Smith
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Oncoclínicas, Porto Alegre, Brazil
| | - Jose Baselga
- Oncology Research and Development, Astra-Zeneca, Cambridge, UK
| | - Richard D Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health and Frontier Science Technology Research Foundation, Boston, MA, USA
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11
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Winter M, Bartko P, Krickl A, Gatterer C, Nitsche C, Koschutnik M, Dona C, Spinka G, Siller-Matula J, Lang I, Mascherbauer J, Hengstenberg C, Goliasch G. Adaptive development of concomitant secondary mitral and tricuspid regurgitation after TAVR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Concomitant secondary atrioventricular regurgitation is frequent in patients with severe aortic stenosis scheduled fortranscatheter aortic valve replacement (TAVR). The future implications of leaving associated valve lesions untreated after TAVR remain unknown. Aim of the present study wasto characterize the evolution of concomitant secondary atrioventricular regurgitations and to evaluate their impact on long-term prognosis.
Methods
We prospectively enrolled 429 consecutive TAVR patients. All patients underwent comprehensive clinical, laboratory, and echocardiographic assessments prior to TAVR, at discharge, and yearly thereafter. All-cause mortality was chosen as primary study endpoint.
Results
At baseline, severe concomitant secondary mitral regurgitation (sMR) was present in 54 (13%) and severe concomitant secondary tricuspid regurgitation (sTR) in 75 patients (17%). After TAVR 59% of patients with severe sMR at baseline experienced sMR regression, whereas analogously sTR regressed in 43% of patients with severe sTR at baseline. Persistence of sTR and sMR were associated with excess mortality after adjustment for our bootstrap-selected confounder model with an adjusted HR of 2.44 (95% CI 1.15–5.20, P=0.021) for sMR and of 2.09 (95% CI 1.20–3.66, P=0.01) for sTR (Figure 1). Furthermore patients showing regression of atrioventricular regurgitation exhibited survival rates indistinguishable to those seen in patients without concomitant atrioventricular regurgitation (sMR: P=0.83; sTR: P=0.74)
Conclusion
Concomitant secondary atrioventricular regurgitation in patients with severe AS is a highly dynamic process with up to half of all patients showing regression of associated valvular regurgitation after TAVR and subsequent favorable post-interventional outcome. Persistent atrioventricular regurgitation is a major determinant of TAVR futility and proposes a window of early sequel intervention.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M.P Winter
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - P.E Bartko
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Krickl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Gatterer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Nitsche
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Koschutnik
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Dona
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Spinka
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Siller-Matula
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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12
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Shafran I, Probst V, Campean J, Sadushi-Kolici R, Gerges C, Lang I, Skoro-Sajer N. The role of asymmetric dimethylarginine (ADMA) in the follow-up of patients with precapillary pulmonary hypertension (PH). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Asymmetric dimethylarginine (ADMA) interferes with L-arginine in the production of nitric oxide, a key mediator of endothelial cell function. ADMA is elevated in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) and is associated with unfavorable outcomes.
Aim
To assess the role of ADMA to monitor disease progression of PH patients treated with PAH-specific therapy.
Methods
ADMA was measured by competitive ELISA at baseline (BL) and follow-up (FU). Risk assessment including a clinical assessment, echocardiography, 6-minute walking test, NT-pro-BNP and hemodynamic assessment by right heart catheterization was performed accordingly. Risk was calculated according to the ESC/ERS 2015 guidelines by the SPHAR method.
Results
ADMA samples were collected from 113 patients treated at our institution between 2012 and 2019. 89 (79%) patients had PAH, 15 (13%) were diagnosed with CTEPH and 9 (8%) with group 3 – PH associated with lung disease. 69% were females. 15 (13.3%) patients had a low risk at baseline, 96 (85%) intermediate risk and 2 (1.8%) were high risk patients. 75% received oral medications, 31% received subcutaneous treprostinil. Median baseline ADMA was 0.738umol/l. At BL no significant difference of ADMA plasma levels was found among the different PH types (p=0.063), or between different risk categories (p=0.531).
Change in ADMA plasma levels correlated with change in risk (p=0.002, rs 0.291) and with change in mixed venous saturation (p=0.034, rs −0.205). Change in ADMA plasma levels also correlated with risk at FU (p=0.011, rs 0.240).
Patients categorized as low risk at FU had a median ADMA plasma level decrease of 22%, compared with −3 to 0% ADMA plasma level change in patients with moderate to high risk at FU (p=0.04). Patients who improved their risk category had a median decrease of ADMA plasma level of 23% vs. 2.3% in patients who did not improve (p=0.011). Decrease of ADMA plasma levels was a weak but significant discriminator for improvement of risk in ROC analysis (p=0.032, AUC 0.374).
Conclusion
ADMA plasma levels paralleled the hemodynamic and clinical benefit of PAH-specific treatments in patients with precapillary PH. ADMA could be used as a biomarker for monitoring treatment effects in precapillary PH.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I Shafran
- Medical University of Vienna, Vienna, Austria
| | - V Probst
- Medical University of Vienna, Vienna, Austria
| | - J Campean
- Medical University of Vienna, Vienna, Austria
| | | | - C Gerges
- Medical University of Vienna, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Vienna, Austria
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13
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Lang I, Liu D, Fritsch H, Taube T, Chizhikov E, Liptai B. Potential Drug-Drug Interactions with Combination Volasertib + Itraconazole: A Phase I, Fixed-sequence Study in Patients with Solid Tumors. Clin Ther 2020; 42:2214-2224. [PMID: 33139055 DOI: 10.1016/j.clinthera.2020.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/14/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE This drug-drug interaction study determined whether the metabolism and distribution of the Polo-like kinase 1 inhibitor, volasertib, is affected by co-administration of the P-glycoprotein and cytochrome P-450 3A4 inhibitor, itraconazole. METHODS This was an uncontrolled, open-label, fixed-sequence trial of two 21-day treatment cycles in patients with various solid tumors. In cycle 1 (test), eligible patients were administered volasertib (day 1) plus itraconazole (days -3 to 15). In cycle 2 (reference), patients received volasertib monotherapy. The primary end point was the influence of co-administration of itraconazole on the pharmacokinetic profile (AUC0-tz; Cmax) of volasertib and its main metabolite, CD 10899, compared with that of volasertib monotherapy. Other end points included tolerability and preliminary therapeutic efficacy. FINDINGS Concurrent administration of itraconazole resulted in a slight reduction in the AUC0-tz (geometric mean ratio, 93.6%; 90% CI, 82.1%-106.8%) and a 20% reduction in Cmax (geometric mean ratio, 79.4%; 90% CI, 64.9%-97.1%) of volasertib compared with monotherapy. Of note, concurrent administration of itraconazole + volasertib had no effect on the AUC0-∞ of volasertib. More patients reported at least one drug-related adverse event in cycle 1 than in cycle 2 (75% vs 71%). The most commonly reported drug-related adverse events (cycles 1 and 2) were thrombocytopenia (68% and 33%, respectively), leukopenia (50% and 46%), and anemia (36% and 33%). No objective responses were observed. Stable disease was observed in 25 of 28 patients (89%). IMPLICATIONS While there was no clear evidence of a pharmacokinetic interaction between volasertib and itraconazole, co-administration reduced the tolerability of volasertib. Clinicaltrials.gov identifier: NCT01772563.
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Affiliation(s)
- Istvan Lang
- Medical Oncology Unit, Istenhegyi Géndiagnosztika Private Health Center, Budapest, Hungary.
| | - Dan Liu
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Holger Fritsch
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Tillmann Taube
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | | | - Bela Liptai
- PRA Health Sciences Hungary, Budapest, Hungary
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14
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Martin M, Zielinski C, Ruiz-Borrego M, Carrasco EM, Ciruelos E, Muñoz M, Bermejo B, Vila MM, Turner NC, Casas M, Anton A, Murillo Jaso L, Lang I, Bartlett CH, Koehler M, Martin N, Corsaro M, Swift C, Nisenbaum B, Gil Gil MJ. Prognostic and predictive value of ESR1 mutations in postmenopausal metastatic breast cancer (MBC) patients (pts) resistant to aromatase inhibitors (AI), treated with palbociclib (PAL) in combination with endocrine therapy (ET) or capecitabine (CAP) in the PEARL study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1022 Background: Prior retrospective data has shown ESR1 mutation is an acquired resistant mechanism to AI. However, little is known about ist prognostic and predictive value to endocrine-based therapy and chemotherapy. PEARL study compared PAL+ET vs CAP in AI resistant patients. Here we wxplored prospectively the ESR1 mutational status based on updated PFS and OS. Methods: PEARL is a phase 3 study with 2 subsequent cohorts: cohort 1 with 296 pts randomized to PAL+Exemestane (EXE) vs CAP and cohort 2 with 305 pts randomized to PAL+ Fulvestran (FUL) vs CAP. ESR1 hotspot mutations were analyzed in circulating free DNA at baseline by digital PCR. Cox regresion analysis for PFS and OS were performed. Adjusted hazard ratios (aHR) and interaction test between treatment and ESR1 status were calculated. Results: ESR1 mutational status was assessed in 557 pts, 91% and 94% treated with CAP and PAL+ET, respectively; 164 (29%) had ESR1 mutations. Characteristics between ESR1 wild-type (WT) and mutated pts were balanced except for ECOG, prior sensitivity to ET, treatment line, prior AI for metastatic disease and time from first metastatic diagnosis to randomization. Median follow-up was 22.5 months (m). Median PFS was 9.6 vs. 7.5 m (HR: 1.06 [0.88 - 1.28], p = 0.522) and median OS was 30.2 vs 30.3 (HR: 0.99 [0.78 - 1.26] p = 0.934), for CAP vs. PAL+ET, respectively. No interaction was seen between treatment arm and ESR1 status either for PFS (p = 0.538) or OS (p = 0.957). Conclusions: In luminal MBC, ESR1-mutated pts had poorer OS than ESR1-WT pts regardless of treatment received. Clinical trial information: NCT02028507 . [Table: see text]
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Affiliation(s)
- Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, Madrid, Spain
| | | | - Manuel Ruiz-Borrego
- Hospital Universitario Virgen del Rocio, GEICAM Spanish Breast Cancer Group, Seville, Spain
| | | | - Eva Ciruelos
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Montserrat Muñoz
- Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques Pi i Sunyer-IDIBAPS, GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Begoña Bermejo
- Hospital Clinico Universitario de Valencia, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Mireia Margeli Vila
- Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, GEICAM Spanish Breast Cancer Group, Badalona, Spain
| | - Nicholas C. Turner
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | | | - Antonio Anton
- Hospital Universitario Miguel Servet, Geicam Spanish Breast Cancer Group, Zaragoza, Spain
| | - Laura Murillo Jaso
- Hospital Clínico Universitario Lozano Blesa, GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | - Istvan Lang
- Istenhegyi Géndiagnosztika Private Health Center Oncology Clinic, Budapest, Hungary
| | | | | | - Nuria Martin
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | - Claire Swift
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden, London, United Kingdom
| | | | - Miguel J. Gil Gil
- Breast Cancer Unit & Medical Oncology Department, Institut Català d'Oncologia, IDIBELL, Barcelona, Spain
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15
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Schneider M, Ran H, Pistritto AM, Gerges C, Heidari H, Hengstenberg C, Bergler-Klein J, Lang I, Binder T, Goliasch G. P1739 Diameter of the pulmonary artery in relation to the ascending aorta: a promising parameter for the diagnosis of pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1099] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is a disease with significant morbidity and mortality. The first imaging modality in the diagnostic algorithm is transthoracic echocardiography (TTE). Despite significant technological advances in recent years, there are still patients with PH who are missed by TTE. The pulmonary artery to ascending aorta ratio (PA/Ao-R) has been evaluated in cardiac magnetic resonance (CMR) and computed tomography (CT) studies. The ratio was able to detect patients with PH, it correlated with hemodynamics, and it was predictive for mortality. We sought to evaluate the diagnostic accuracy of PA/Ao-R measured by TTE in the detection of PH.
Methods
We evaluated consecutive patients who received quasi-simultaneous transthoracic echocardiography and right heart catheterization (RHC) for evaluation of pulmonary hypertension between July 2015 and July 2016.
Results
A total of 84 patients fulfilled the inclusion criteria, 47 were female, mean age was 65 years. Median PA/Ao-R was 0.8 (Q1;Q3 0.69;0.94). Seventy patients had PH (median mean pulmonary artery pressure (mPAP) was 35.5 mmHg, Q1;Q3 27;47). The area under the curve for the diagnosis of PH via PA/Ao-R was 0.853. A cut-off of 1 was chosen for further analysis. Sensitivity for the diagnosis of PH was 100%, specificity was 23%. PA/Ao-R correlated with mPAP (r = 0.65, p < 0.001), and pulmonary vascular resistance (r = 0.68, p < 0.001). In the subgroup of patients with PH, those patients with a PA/Ao-R of ≥1 had significantly (p < 0.001) higher pulmonary pressures than those below, with a mean mPAP of 53 mmHg as compared to 38.5 mmHg.
Conclusion
PA/Ao-R correlates with mPAP. A ratio of ≥1 should prompt suspicion for the presence of PH. PA/Ao-R should be reported in every patient who is evaluated for PH.
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Affiliation(s)
- M Schneider
- Medical University of Vienna, Vienna, Austria
| | - H Ran
- Nanjing 1st Hospital, Department of Echocardiography, Nanjing, China
| | - A M Pistritto
- San Paolo Hospital, Emergency Department, Division of Cardiology, Savona, Italy
| | - C Gerges
- Medical University of Vienna, Vienna, Austria
| | - H Heidari
- Medical University of Vienna, Vienna, Austria
| | | | | | - I Lang
- Medical University of Vienna, Vienna, Austria
| | - T Binder
- Medical University of Vienna, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Vienna, Austria
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16
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Langleben D, Gaine S, Sitbon O, Channick R, Chin K, Di Scala L, Galiè N, Hoeper M, McLaughlin V, Preiss R, Rubin L, Simonneau G, Tapson V, Ghofrani H, Lang I. THE IMPACT OF TIME FROM DIAGNOSIS AT BASELINE ON LONG-TERM OUTCOME IN THE GRIPHON STUDY: SELEXIPAG IN PULMONARY ARTERIAL HYPERTENSION (PAH). Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.180] [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: 10/25/2022] Open
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17
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Huober J, Holmes E, Baselga J, de Azambuja E, Untch M, Fumagalli D, Sarp S, Lang I, Smith I, Boyle F, Xu B, Lecocq C, Wildiers H, Jouannaud C, Hackman J, Dasappa L, Ciruelos E, Toral Pena JC, Adamchuk H, Hickish T, de la Pena L, Jackisch C, Gelber RD, Piccart-Gebhart M, Di Cosimo S. Survival outcomes of the NeoALTTO study (BIG 1–06): updated results of a randomised multicenter phase III neoadjuvant clinical trial in patients with HER2-positive primary breast cancer. Eur J Cancer 2019; 118:169-177. [DOI: 10.1016/j.ejca.2019.04.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/16/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
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18
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Solinas C, Silva PD, Venet D, Garaud S, Gu-Trantien C, Hilbers F, Azambuja ED, Werner O, Peña LDL, Dueck A, Cosimo SD, Lang I, Huober J, Küemmel S, Denkert C, Salgado R, Sotiriou C, Piccart-Gebhart M, Fumagalli D, Willard-Gallo K. Abstract 3132: Immune regulatory gene expression and clinical outcome in the NeoALTTO trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The level of immune suppression in an individual breast cancer (BC) patient is relevant for having a major benefit from treatments that act via or are directed to the immune response, such as anti-HER2 agents and immune checkpoint molecules, respectively. The link(s) between the tumor immune microenvironment and treatment responses has been investigated in HER2-positive BC. This study analyzed the association between baseline expression of genes regulating T cell activities (PD1, CTLA4, LAG3, TIM3, PDL1, PDL2, FOXP3, IL10, TGFβ (1-3), FOXP1 and other related genes) and pathologic complete response (pCR) rates in the NeoALTTO trial. Methods: NeoALTTO randomized early-stage HER2-positive BC patients to neoadjuvant trastuzumab (T), lapatinib (L) or T+L for 6 weeks followed by 12 weeks of concurrent paclitaxel. Anthracyclines were given after surgery (FEC). Patients with RNA sequencing data from their baseline tumor samples (N=254 patients out of 455 from the original cohort) were included in the current study. The primary endpoint, pCR, was defined as ypT0/is ypN0. Logistic regression was used for analysis of pCR. Cox regression univariate and multivariate (adjusted for clinicopathological parameters and treatment arms) analyses were performed. Results: In the total cohort analyzed, high PD1 (odds ratio, OR: 1.4, P=0.03), PDL2 (OR: 1.4, P=0.04), CTLA4 (OR: 1.4, P=0.03) and TGFβ3 (OR: 1.4, P=0.02) expression was associated with an increased probability of achieving pCR at the multivariate analysis. ERBB2 (HER2) expression was associated with pCR in the three arms (T: OR: 2.7, P=0.02; L: OR: 2.3, P=0.01; T+L: OR: 5, P<0.001). Additionally in the T+L arm, PAM50 HER2-enriched subtype (OR: 2.9, P=0.03), as well as immune genes PD1 (OR: 2.1, P=0.01), PDL1 (OR: 1.8, P=0.03) and CTLA4 (OR: 2; P=0.01), were also associated with pCR. Conclusions: In the NeoALTTO population examined, PD1, PDL2, CTLA-4 and TGFβ3 expression at diagnosis were all associated with improved pCR rates after anti-HER2 treatment. The effect of these treatments seemed to be dependent on HER2 expression levels, which was particularly relevant in the T+L arm. These observations confirm previous findings that link immune infiltrates to higher pCR rates, demonstrate the clinical significance of the PD-1 pathway and additionally show that CTLA-4 and TGFβ3 could also be important in early stage HER2-positive BC. The association of tumors linked with immune regulatory gene expression with positive responses to neoadjuvant anti-HER2 agents suggests that they act in a way that reinvigorates the antitumor immunity in the face of tumor-mediated suppression. Patients whose tumors highly express these genes may be good candidates for immunotherapy before the start or after the neoadjuvant treatment when residual disease is detected at surgery, although these hypotheses require further confirmation.
Citation Format: Cinzia Solinas, Pushpamali De Silva, David Venet, Soizic Garaud, Chunyan Gu-Trantien, Florentine Hilbers, Evandro de Azambuja, Olena Werner, Lorena De la Peña, Amylou Dueck, Serena Di Cosimo, Istvan Lang, Jens Huober, Sherko Küemmel, Carsten Denkert, Roberto Salgado, Christos Sotiriou, Martine Piccart-Gebhart, Debora Fumagalli, Karen Willard-Gallo. Immune regulatory gene expression and clinical outcome in the NeoALTTO trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3132.
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Affiliation(s)
- Cinzia Solinas
- 1Molecular Immunology Unit, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Pushpamali De Silva
- 1Molecular Immunology Unit, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - David Venet
- 2Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Soizic Garaud
- 1Molecular Immunology Unit, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Chunyan Gu-Trantien
- 3Institute for Medical Immunology, Université Libre de Bruxelles, Bruxelles, Charleroi, Belgium
| | | | - Evandro de Azambuja
- 5Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | | | | | | | | | - Istvan Lang
- 9National Institute of Oncology, Budapest, Hungary
| | - Jens Huober
- 10Universitätsfrauenklinik Ulm, Ulm, Germany
| | | | - Carsten Denkert
- 12Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christos Sotiriou
- 2Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Martine Piccart-Gebhart
- 5Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Karen Willard-Gallo
- 1Molecular Immunology Unit, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
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Schwartzberg L, Bhat G, Mezei K, Lang I, Moon YW, Senviratne L, Chawla S, Cobb P, Yang Z. Abstract P1-13-05: Efficacy and safety of eflapegrastim confirmed in reducing severe neutropenia in breast cancer patients treated with myelosuppressive chemotherapy in the second Phase 3 randomized controlled multinational trial compared to pegfilgrastim (RECOVER trial). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-13-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Eflapegrastim is a novel investigational biologic comprised of recombinant human G-CSF covalently linked to the human immunoglobulin G4FC fragment using proprietary LAPSCOVERY™ technology with potentially unique distribution to areas rich in FcRn receptors. RECOVER is the second Phase 3 study to investigate the non-inferiority (NI) of eflapegrastim to pegfilgrastim in patients receiving chemotherapy for breast cancer. The first Phase 3 study, ADVANCE, has demonstrated the non-inferiority of eflapegrastim comparing to pegfilgrastim in the duration of severe neutropenia (DSN) in breast cancer patients receiving docetaxel and cyclophosphamide (TC) and was previously published at ASCO 2018 meeting.
TrialDesign:
Patients with Stage I to Stage IIIA breast cancer from centers in the USA, Canada, Poland, Hungary, South Korea and India were treated on Day 1 of each of four 21-day cycles with adjuvant or neo-adjuvant TC. On Day 2 of each cycle, patients received a single subcutaneous dose of either eflapegrastim 13.2 mg/0.6 mL (equivalent to 3.6 mg G-CSF) or pegfilgrastim (6 mg) in a 1:1 ratio. Patients had CBCs drawn on Day 1 prior to chemotherapy and Days 4-15 daily or until recovery of neutropenia in Cycle 1. CBC was also collected on Days 1, 4, 7, 10 and 15 in Cycles 2-4. The primary endpoint was to demonstrate the non-inferiority of eflapegrastim comparing to pegfilgrastim as measured by the mean DSN in Cycle 1 with NI margin of <0.62 day.
Results:
In a total of 237 intent-to-treat patients (randomized to 118 eflapegrastim; 119 pegfilgrastim), median age was 59 years (range 29 to 88 years); mean (SD) DSN was 0.31 (0.688) days for eflapegrastim and 0.39 (0.949) days for pegfilgrastim, demonstrating the non-inferiority (95% CI of ΔDSN: [-0.292, 0.129]; p<0.0001). Non-inferiority of eflapegrastim for DSN was maintained across all 4 cycles. There were no statistically significant differences in secondary endpoints: time to ANC recovery, depth of ANC nadir and incidence of FN at Cycle 1. The common Grade 3/4 adverse events observed in≥5%of patients were similar across both arms and were mainly hematologic including neutropenia, lymphopenia, anemia and leukopenia. Grade 3/4 bone pain and febrile neutropenia rates were similar across both arms and were less than 5%.
Conclusions:
Eflapegrastim, a novel long acting G-CSF demonstrated non-inferiority to pegfilgrastim in the reduction of DSN in breast cancer patients treated with TC and has validated the results from the first Phase 3 ADVANCE study. Eflapegrastim was safe and well-tolerated with a similar safety profile to pegfilgrastim.
Citation Format: Schwartzberg L, Bhat G, Mezei K, Lang I, Moon YW, Senviratne L, Chawla S, Cobb P, Yang Z. Efficacy and safety of eflapegrastim confirmed in reducing severe neutropenia in breast cancer patients treated with myelosuppressive chemotherapy in the second Phase 3 randomized controlled multinational trial compared to pegfilgrastim (RECOVER trial) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-13-05.
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Affiliation(s)
- L Schwartzberg
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - G Bhat
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - K Mezei
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - I Lang
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - YW Moon
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - L Senviratne
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - S Chawla
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - P Cobb
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - Z Yang
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
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21
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Lambertini M, Campbell C, Bines J, Korde LA, Izquierdo M, Fumagalli D, Del Mastro L, Ignatiadis M, Pritchard K, Wolff AC, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Barrios CH, Baselga J, Moreno-Aspitia A, Piccart M, Gelber RD, de Azambuja E. Adjuvant Anti-HER2 Therapy, Treatment-Related Amenorrhea, and Survival in Premenopausal HER2-Positive Early Breast Cancer Patients. J Natl Cancer Inst 2019; 111:86-94. [PMID: 29878225 PMCID: PMC6335113 DOI: 10.1093/jnci/djy094] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/26/2018] [Accepted: 04/18/2018] [Indexed: 01/21/2023] Open
Abstract
Background In premenopausal patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer, the gonadotoxicity of trastuzumab and lapatinib remains largely uncertain, and the prognostic effect of treatment-related amenorrhea (TRA) is unknown. Methods In the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization (BIG 2-06) phase III trial, HER2-positive early breast cancer patients were randomized (1:1:1:1) to receive one year of trastuzumab, lapatinib, their sequence, or their combination. As per study protocol, menopausal status was collected in all patients at random assignment and at week 37 visit. We investigated TRA rates and whether TRA in patients with hormone receptor-positive and -negative tumors would impact disease-free survival (DFS) and overall survival (OS). Landmark and time-dependent modeling were used to account for guarantee-time bias. All statistical tests were two-sided. Results A total of 2862 premenopausal women were included, of whom 1679 (58.7%) had hormone receptor-positive disease. Median age was 43 (interquartile range = 38-47) years. Similar TRA rates were observed in the trastuzumab (72.6%), lapatinib (74.0%), trastuzumab→lapatinib (72.1%), and trastuzumab+lapatinib (74.8%) arms (P = .64). The association between TRA and survival outcomes differed according to hormone-receptor status (Pinteraction for DFS = .007; Pinteraction for OS = .003). For hormone receptor-positive patients, the TRA cohort had statistically significantly better DFS (adjusted hazard ratio [aHR] = 0.58, 95% confidence interval [CI] = 0.45 to 0.76) and OS (aHR = 0.63, 95% CI = 0.40 to 0.99) than the no TRA cohort. No difference was observed in hormone receptor-negative patients. Conclusions In this unplanned analysis, no association between TRA rate and type of anti-HER2 treatment was observed. TRA was associated with statistically significant survival benefits in premenopausal hormone receptor-positive/HER2-positive early breast cancer patients.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Larissa A Korde
- Breast Cancer Therapeutics, National Cancer Institute, Bethesda, MD
| | | | | | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, Policlinico San Martino-IRCCS per l’Oncologia, Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
| | - Michail Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Kathleen Pritchard
- Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada
| | | | - Christian Jackisch
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach, Offenbach, Germany
| | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | - Michael Untch
- Helios Klinikum Berlin Buch, Multidisciplinary Breast Cancer Center, Berlin, Germany
| | - Ian Smith
- Breast Unit, Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia
| | - Binghe Xu
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Carlos H Barrios
- Department of Medicine, PUCRS, School of Medicine, Porto Alegre, Brazil
| | - José Baselga
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Martine Piccart
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Richard D Gelber
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health and Frontier Science and Technology Research Foundation, Boston, MA
| | - Evandro de Azambuja
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
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22
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Rothman AMK, Vachiery JL, Howard L, Lang I, Avriel A, Jonas M, Kiely D, Leon M, Ben-Yehuda O, Rubin L. P567Pulmonary artery denervation for the treatment of pulmonary arterial hypertension: preliminary results of the TROPHY 1 Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A M K Rothman
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | | | - L Howard
- Hammersmith Hospital, London, United Kingdom
| | - I Lang
- Medical University of Vienna, Vienna, Austria
| | - A Avriel
- Soroka University Medical Center, Beer Sheva, Israel
| | - M Jonas
- Kaplan Medical Center, Rehovot, Israel
| | - D Kiely
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - M Leon
- Cardiovascular Research Foundation, New York, United States of America
| | - O Ben-Yehuda
- Cardiovascular Research Foundation, New York, United States of America
| | - L Rubin
- University of California San Diego, San Diego, United States of America
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23
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Winter MP, Smriti S, Altmann J, Seidl V, Alimohammadi A, Redwan B, Nagel F, Santer D, Podesser B, Sibilia S, Helbich T, Prager G, Ilhan-Mutlu A, Preusser M, Lang I. 1206Endothelial cell-specific deletion of vascular endothelial growth factor receptor 2/kinase insert domain protein receptor and proliferative pulmonary vasculopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M.-P Winter
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - S Smriti
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Altmann
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - V Seidl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Alimohammadi
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - B Redwan
- University of Witten/Herdecke, Department of Thoracic Surgery, Helios University Hospital of Wuppertal, Witten, Germany
| | - F Nagel
- Medical University of Vienna, Institute of Biomedical Research, Vienna, Austria
| | - D Santer
- Medical University of Vienna, Institute of Biomedical Research, Vienna, Austria
| | - B Podesser
- Medical University of Vienna, Institute of Biomedical Research, Vienna, Austria
| | - S Sibilia
- Medical University of Vienna, Institute for Cancer Research, Department of Medicine I, Comprehensive Cancer Center,, Vienna, Austria
| | - T Helbich
- Medical University of Vienna, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - G Prager
- Medical University of Vienna, Institute for Cancer Research, Department of Medicine I, Comprehensive Cancer Center,, Vienna, Austria
| | - A Ilhan-Mutlu
- Medical University of Vienna, Institute for Cancer Research, Department of Medicine I, Comprehensive Cancer Center,, Vienna, Austria
| | - M Preusser
- Medical University of Vienna, Institute for Cancer Research, Department of Medicine I, Comprehensive Cancer Center,, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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24
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Schneider M, Aschauer S, Mascherbauer J, Ran H, Binder C, Lang I, Goliasch G, Binder T. P5635Visual assessment of right ventricular function in echocardiography: how good are we? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Schneider
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - H Ran
- Nanjing 1st Hospital, Department of Echocardiography, Nanjing, China People's Republic of
| | - C Binder
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - I Lang
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - T Binder
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
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25
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Panzenboeck A, Sadushi-Kolici R, Plaimauer B, Gritsch H, Turecek P, Lang I. P1621Plasma ADAMTS13 in chronic thromboembolic pulmonary hypertension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Panzenboeck
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Sadushi-Kolici
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - B Plaimauer
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - H Gritsch
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - P Turecek
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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26
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Bartko PE, Pavo N, Perez-Serradilla A, Arfsten H, Neuhold S, Wurm R, Lang I, Strunk G, Dal-Bianco JP, Levine RA, Huelsmann M, Goliasch G. 6162Natural history of functional mitral regurgitation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P E Bartko
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - N Pavo
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Perez-Serradilla
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - H Arfsten
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - S Neuhold
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Wurm
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Strunk
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J P Dal-Bianco
- Massachusetts General Hospital, Institute for Heart, Vascular and Stroke Care, Boston, United States of America
| | - R A Levine
- Massachusetts General Hospital, Institute for Heart, Vascular and Stroke Care, Boston, United States of America
| | - M Huelsmann
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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27
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Winter MP, Zbiral M, Kietaibl A, Sulzgruber P, Kastner J, Rosenhek R, Binder T, Lang I, Goliasch G. P6302Normal values for doppler echocardiographic assessment of prosthetic valve function after TAVR - A systematic review and meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M.-P Winter
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Zbiral
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Kietaibl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - P Sulzgruber
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Kastner
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Rosenhek
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - T Binder
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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28
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Galie N, Gaine S, Channick R, Ghofrani HA, Hoeper M, Lang I, McLaughlin V, Preiss R, Rubin L, Shiraga Y, Simonneau G, Sitbon O, Tapson V, Chin K. 3016Long-term survival and safety with selexipag in patients with pulmonary arterial hypertension: results from the GRIPHON study and its open-label extension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Galie
- Bologna University Hospital, Department of Experimental, Diagnostic, and Specialty Medicine, Bologna, Italy
| | - S Gaine
- Mater Misericordiae University Hospital, National Pulmonary Hypertension Unit, Dublin, Ireland
| | - R Channick
- Massachusetts General Hospital, Pulmonary and Critical Care, Boston, United States of America
| | - H A Ghofrani
- University of Giessen and Marburg Lung Center (UGMLC) and German Center of Lung Research, Giessen, Germany; Imperial College London, Department of Medicine, London, United Kingdom
| | - M Hoeper
- Hannover Medical School and German Centre for Lung Research, Department of Respiratory Medicine, Hannover, Germany
| | - I Lang
- Medical University of Vienna, Division of Cardiology, Vienna, Austria
| | - V McLaughlin
- University of Michigan Health System, Department of Internal Medicine, Ann Arbor, United States of America
| | - R Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - L Rubin
- University of California San Diego, Department of Medicine, San Diego, United States of America
| | - Y Shiraga
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - G Simonneau
- Assistance Publique–Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre and, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Université Paris-Sud, Le Kremlin–Bicêtre; Inserm Unité 999, Le Plessis Robinson, France
| | - O Sitbon
- Assistance Publique–Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre and, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Université Paris-Sud, Le Kremlin–Bicêtre; Inserm Unité 999, Le Plessis Robinson, France
| | - V Tapson
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - K Chin
- University of Texas Southwestern Medical Center, Dallas, United States of America
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Huber K, Resch I, Stefenelli T, Lang I, Probst P, Kaindl F, Binder BR. Plasminogen Activator Inhibitor-1 Levels in Patients with Chronic Angina Pectoris with or without Angiographic Evidence of Coronary Sclerosis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1645042] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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
SummaryIncreased plasma levels of plasminogen activator inhibitor-1 (PAI-1) have been shown to exist in 40 to 60% of patients with stable coronary artery disease and have been suggested to be responsible for the development of coronary thrombotic complications. However, it is also discussed whether PAI-1 elevation might mainly be due to variables like increased age or to reactive mechanisms caused e.g. by the chest pain itself. To exclude age dependent ui pain related influences, age-matched patients with stable angina pectoris (NHYA II) and angiographically proven coronary artery disease (CAD, n = 16) or without evidence for coronary sclerosis (variant angina, n = 10; angina-like syndrome with normal coronary angiogram, n = 5; non-CAD, n = 15) have been investigated for their plasma PAI-1 activity and t-PA antigen levels. The mean PAI activity in CAD patients (17.5 U/ml) was significantly higher than in non-CAD patients (9.6 U/ml) (p <0.0001). In the CAD patients no significant variation in plasma PAI-1 values could be demonstrated when related to the extent of the disease or to a history of previous myocardial infarction t-PA antigen was also elevated m CAD patients as compared to the non-CAD group (p <0.02). The results suggest therefore a strong correlation between coronary artery disease itself and elevated levels of components of the plasma fibrinolytic system.
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Affiliation(s)
- K Huber
- The Department of Cardiology, University of Vienna, Vienna, Austria
- The Laboratory for Clinical and Experimental Physiology, Department of Medical Physiology, University of Vienna, Vienna, Austria
| | - I Resch
- The Laboratory for Clinical and Experimental Physiology, Department of Medical Physiology, University of Vienna, Vienna, Austria
| | - Th Stefenelli
- The Department of Cardiology, University of Vienna, Vienna, Austria
| | - I Lang
- The Department of Cardiology, University of Vienna, Vienna, Austria
| | - P Probst
- The Department of Cardiology, University of Vienna, Vienna, Austria
| | - F Kaindl
- The Department of Cardiology, University of Vienna, Vienna, Austria
| | - B R Binder
- The Laboratory for Clinical and Experimental Physiology, Department of Medical Physiology, University of Vienna, Vienna, Austria
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Chiritescu G, Dumon K, Mercadé TM, Lang I, Vivas CS, Papai Z, Janssens J, Hendrickx K, Pracht M, Van den Eynde M, Taïeb J, Moons V, Geboes K, Van Laethem J, Greil R, Cervantes A, Vergauwe P, Ferrante M, Vanderstraeten E, Fridrik M, Wöll E, Limón M, Rivera F, Sagaert X, Tejpar S, Van Cutsem E. A two arm phase II study of FOLFIRI in combination with standard or escalating dose of cetuximab as first line treatment for metastatic colorectal cancer: Everest 2 final results. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.014] [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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Regan MM, Francis PA, Pagani O, Fleming GF, Walley B, Viale G, Colleoni M, Lang I, Gomez HL, Tondini CA, Pinotti G, Di Leo A, Coates AS, Goldhirsch A, Gelber RD. Absolute improvements in freedom from distant recurrence with adjuvant endocrine therapies for premenopausal women with hormone receptor-positive (HR+) HER2-negative breast cancer (BC): Results from TEXT and SOFT. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Olivia Pagani
- Institute of Oncology of Southern Switzerland, Lugano Viganello, Switzerland
| | | | | | - Giuseppe Viale
- European Institute of Oncology, University of Milan, Milan, Italy
| | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | | | | | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | | | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston, MA
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Urruticoechea A, Rizwanullah M, Im SA, Sánchez Ruiz AC, Lang I, Tomasello G, Douthwaite H, Badovinac Crnjevic T, Heeson S, Eng-Wong J, Munoz M. Final overall survival (OS) analysis of PHEREXA: A randomized phase III trial of trastuzumab (H) + capecitabine (X) ± pertuzumab (P) in patients with HER2-positive metastatic breast cancer (MBC) who experienced disease progression during or after H-based therapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ander Urruticoechea
- Onkologikoa Foundation, San Sebastían and Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Seock-Ah Im
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | | | | | - Sarah Heeson
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | - Montserrat Munoz
- Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, Spain
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Panzenboeck A, Sadushi-Kolici R, Plaimauer B, Gritsch H, Turecek PL, Lang I. P163Plasma ADAMTS13 activity in chronic thromboembolic pulmonary hypertension. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Panzenboeck
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Sadushi-Kolici
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - B Plaimauer
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - H Gritsch
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - P L Turecek
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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Altmann J, Seidl V, Saito T, Rabinovitch M, Lang I. P378Circulating B cell phenotypes in chronic thromboembolic pulmonary hypertension. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Altmann
- Medical University of Vienna, Department of Internal Medicine II, Cardiology, Vienna, Austria
| | - V Seidl
- Medical University of Vienna, Department of Internal Medicine II, Cardiology, Vienna, Austria
| | - T Saito
- Stanford School of Medicine, Department of Pediatrics, Vera Moulton Wall Center for Pulmonary Vascular Diseases, Stanford, United States of America
| | - M Rabinovitch
- Stanford School of Medicine, Department of Pediatrics, Vera Moulton Wall Center for Pulmonary Vascular Diseases, Stanford, United States of America
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Cardiology, Vienna, Austria
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Ghofrani A, Hoeper MM, McLaughlin V, Channick R, Chin K, Delcroix M, Gaine S, Jansa P, Lang I, Mehta S, Pulido T, Sastry BKS, Simonneau G, Sitbon O, De Souza R, Torbicki A, Tapson V, Perchenet L, Preiss R, Verweij P, Rubin L, Galie N. Pulmonary arterial hypertension-related morbidity is prognostic for survival: Insights from the SERAPHIN and GRIPHON studies. Pneumologie 2018. [DOI: 10.1055/s-0037-1619325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Ghofrani
- Med. Klinik II/V, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - MM Hoeper
- Klinik für Pneumologie, Zentrum für Innere Medizin, Medizinische Hochschule Hannover
| | - V McLaughlin
- Health System Division of Cardiovascular Medicine, University of Michigan
| | - R Channick
- Massachusetts General Hospital; Harvard Medical School
| | - K Chin
- UT Southwestern Medical Center, Dallas, Texas
| | | | - S Gaine
- Mater Misericordiae Hospital, Dublin, Ireland
| | | | - I Lang
- Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Wien
| | - S Mehta
- Lhsc University Hospital, London, Ontario, Canada
| | - T Pulido
- Ignacio Chávez National Heart Institute, Mexico City
| | | | | | - O Sitbon
- Service de Pneumologie, Hôpital Bicêtre, Univ. Paris-Sud
| | - R De Souza
- Incor Heart Institute, University of Sao Paulo
| | | | - V Tapson
- Cedars-Sinai Medical Center, Los Angeles, California
| | - L Perchenet
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - R Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - P Verweij
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - L Rubin
- Division of Pulmonary and Critical Care Medicine University of California; San Diego Medical School
| | - N Galie
- Istituto DI Malattie Dell'apparato Cardiovascolare, Università DI Bologna, Italy
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Hall A, Lang I, Endacott R, Burrows L, Goodwin V. An exploratory qualitative study examining the experiences of people with dementia receiving physiotherapy. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.049] [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: 11/26/2022]
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Duchnowska R, Sperinde J, Czartoryska-Arłukowicz B, Myśliwiec P, Winslow J, Radecka B, Petropoulos C, Demlova R, Orlikowska M, Kowalczyk A, Lang I, Ziółkowska B, Dębska-Szmich S, Merdalska M, Grela-Wojewoda A, Żawrocki A, Biernat W, Huang W, Jassem J. Predictive value of quantitative HER2, HER3 and p95HER2 levels in HER2-positive advanced breast cancer patients treated with lapatinib following progression on trastuzumab. Oncotarget 2017; 8:104149-104159. [PMID: 29262628 PMCID: PMC5732794 DOI: 10.18632/oncotarget.22027] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/21/2017] [Indexed: 12/27/2022] Open
Abstract
Lapatinib is a HER1 and HER2 tyrosine kinase inhibitor (TKI) approved in second line treatment of advanced or metastatic breast cancer following progression on trastuzumab-containing therapy. Biomarkers for activity of lapatinib and other TKIs are lacking. Formalin-fixed, paraffin-embedded primary tumor samples were obtained from 189 HER2-positive patients treated with lapatinib plus capecitabine following progression on trastuzumab. The HERmark® Breast Cancer Assay was used to quantify HER2 protein expression. HER3 and p95HER2 protein expression was quantified using the VeraTag® technology. Overall survival (OS) was inversely correlated with HER2 (HR = 1.9/log; P = 0.009) for patients with tumors above the cut-off positivity level by the HERmark assay. OS was significantly shorter for those with above median HER2 levels (HR = 1.7; P = 0.015) and trended shorter for those below the cut-off level of positivity by the HERmark assay (HR = 1.7; P = 0.057) compared to cases with moderate HER2 overexpression. The relationship between HER2 protein expression and OS was best captured with a U-shaped parabolic function (P = 0.004), with the best prognosis at moderate levels of HER2 protein overexpression. In a multivariate model including HER2, increasing p95HER2 expression was associated with longer OS (HR = 0.35/log; P = 0.027). Continuous HER3 did not significantly correlate with OS. Patients with moderately overexpressed HER2 levels and high p95HER2 expression may have best outcomes while receiving lapatinib following progression on trastuzumab. Further study is warranted to explore the predictive utility of quantitative HER2 and p95HER2 in guiding HER2-directed therapies.
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Affiliation(s)
| | - Jeff Sperinde
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
| | | | | | - John Winslow
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
| | | | - Christos Petropoulos
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
| | | | | | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | | | | | | | | | | | - Weidong Huang
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
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Moser B, Jaksch P, Taghavi S, Muraközy G, Lang G, Hager H, Krenn C, Roth G, Faybik P, Bacher A, Aigner C, Matilla J, Hacker P, Lang I, Klepetko W. F-027LUNG TRANSPLANTATION FOR IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION ON INTRAOPERATIVE AND POSTOPERATIVELY PROLONGED EXTRACORPOREAL MEMBRANE OXYGENATION PROVIDES OPTIMALLY CONTROLLED REPERFUSION AND EXCELLENT OUTCOME. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.027] [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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Lambertini M, Campbell C, Bines J, Korde L, Izquierdo Delso M, Fumagalli D, Pritchard K, Wolff A, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Barrios C, Baselga J, Moreno-Aspitia A, Piccart M, Gelber R, De Azambuja E. Adjuvant anti-HER2 therapy, treatment-induced amenorrhea (TIA) and survival in premenopausal patients (pts) with HER2-positive (HER2+) early breast cancer (EBC): Analysis from the ALTTO trial (BIG 2-06). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.009] [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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Mohammad M, Koul S, Egerstedt A, Smith J, Noc M, Lang I, Holzer M, Clemmensen P, Jensen U, Engstrom T, Arheden H, Metzler B, Erlinge D. P5541A proteomic analysis of 131 biomarkers in relation to infarct size and long-term ejection fraction assessed by CMR in patients with ST-segment elevation myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5541] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mohammad M, Koul S, Noc M, Lang I, Holzer M, Clemmensen P, Jensen U, Lindahl B, Engstrom T, Arheden H, Metzler B, Erlinge D. P2124High sensitivity troponin T is a stronger predictor than early infarct size determined by CMR for long-term ejection fraction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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von Minckwitz G, Procter M, de Azambuja E, Zardavas D, Benyunes M, Viale G, Suter T, Arahmani A, Rouchet N, Clark E, Knott A, Lang I, Levy C, Yardley DA, Bines J, Gelber RD, Piccart M, Baselga J. Adjuvant Pertuzumab and Trastuzumab in Early HER2-Positive Breast Cancer. N Engl J Med 2017; 377:122-131. [PMID: 28581356 PMCID: PMC5538020 DOI: 10.1056/nejmoa1703643] [Citation(s) in RCA: 867] [Impact Index Per Article: 123.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pertuzumab increases the rate of pathological complete response in the preoperative context and increases overall survival among patients with metastatic disease when it is added to trastuzumab and chemotherapy for the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer. In this trial, we investigated whether pertuzumab, when added to adjuvant trastuzumab and chemotherapy, improves outcomes among patients with HER2-positive early breast cancer. METHODS We randomly assigned patients with node-positive or high-risk node-negative HER2-positive, operable breast cancer to receive either pertuzumab or placebo added to standard adjuvant chemotherapy plus 1 year of treatment with trastuzumab. We assumed a 3-year invasive-disease-free survival rate of 91.8% with pertuzumab and 89.2% with placebo. RESULTS In the trial population, 63% of the patients who were randomly assigned to receive pertuzumab (2400 patients) or placebo (2405 patients) had node-positive disease and 36% had hormone-receptor-negative disease. Disease recurrence occurred in 171 patients (7.1%) in the pertuzumab group and 210 patients (8.7%) in the placebo group (hazard ratio, 0.81; 95% confidence interval [CI], 0.66 to 1.00; P=0.045). The estimates of the 3-year rates of invasive-disease-free survival were 94.1% in the pertuzumab group and 93.2% in the placebo group. In the cohort of patients with node-positive disease, the 3-year rate of invasive-disease-free survival was 92.0% in the pertuzumab group, as compared with 90.2% in the placebo group (hazard ratio for an invasive-disease event, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In the cohort of patients with node-negative disease, the 3-year rate of invasive-disease-free survival was 97.5% in the pertuzumab group and 98.4% in the placebo group (hazard ratio for an invasive-disease event, 1.13; 95% CI, 0.68 to 1.86; P=0.64). Heart failure, cardiac death, and cardiac dysfunction were infrequent in both treatment groups. Diarrhea of grade 3 or higher occurred almost exclusively during chemotherapy and was more frequent with pertuzumab than with placebo (9.8% vs. 3.7%). CONCLUSIONS Pertuzumab significantly improved the rates of invasive-disease-free survival among patients with HER2-positive, operable breast cancer when it was added to trastuzumab and chemotherapy. Diarrhea was more common with pertuzumab than with placebo. (Funded by F. Hoffmann-La Roche/Genentech; APHINITY ClinicalTrials.gov number, NCT01358877 .).
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Affiliation(s)
- Gunter von Minckwitz
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Marion Procter
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Evandro de Azambuja
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Dimitrios Zardavas
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Mark Benyunes
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Giuseppe Viale
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Thomas Suter
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Amal Arahmani
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Nathalie Rouchet
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Emma Clark
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Adam Knott
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Istvan Lang
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Christelle Levy
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Denise A Yardley
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Jose Bines
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Richard D Gelber
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Martine Piccart
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Jose Baselga
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
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Von Minckwitz G, Procter MJ, De Azambuja E, Zardavas D, Knott A, Viale G, Suter TM, Arahmani A, Rouchet N, Clark E, Benyunes M, Lang I, Levy C, Yardley DA, Bines J, Gelber RD, Piccart-Gebhart MJ, Baselga J. APHINITY trial (BIG 4-11): A randomized comparison of chemotherapy (C) plus trastuzumab (T) plus placebo (Pla) versus chemotherapy plus trastuzumab (T) plus pertuzumab (P) as adjuvant therapy in patients (pts) with HER2-positive early breast cancer (EBC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.18_suppl.lba500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA500 Background: In previous trials P significantly prolonged progression free and overall survival and increased pCR rates when added to T+C in pts with HER2-positive breast cancer (BC). The APHINITY trial was designed to test whether the addition of P to adjuvant T+C improves pt outcomes. Methods: Pts with adequately excised HER2-positive, pT1-3 EBC were randomly assigned to receive standard adjuvant C plus one year of either T + P or T + Pla. Eligible pts had either node-positive disease, or node-negative disease (pN0) and a tumor size of > 1.0 cm. Pts with pN0, T1b tumors with high risk features were initially eligible. The primary efficacy endpoint was invasive disease-free survival (IDFS); we assumed a 3-year IDFS of 91.8% with P and 89,.2% with Pla. Results: 4805 pts were randomized to C and T plus either P (n = 2400) or Pla (n = 2405). Baseline demographics and tumor characteristics between the arms were well balanced, with 63% and 36% of pts having node-positive and hormone receptor negative EBC respectively. P and Pla treatments were completed in 84.5% and 87.4% of patients, respectively. IDFS events occurred in 171 (7.1%) P pts and 210 (8.7%) Pla pts (hazard ratio (HR) 0.81 (95% CI 0.68-1.00), P = 0.045). Estimates of IDFS at 3 years were 94.1% and 93.2% in the P and Pla arms, respectively. The node-positive cohort had a 3-year IDFS rate of 92.0% for P compared with 90.2% for Pla (HR 0.77 (95% CI 0.62-0.96), P = 0.019). The pN0 cohort had a 3-year IDFS rate of 97.5% for P and 98.4% for Pla; HR = 1.13 (95% CI 0.68-1.86). The safety profile of P was consistent with previous trials. For the primary cardiac endpoint (heart failure or cardiac death) and secondary cardiac endpoint (asymptomatic or mildly symptomatic LVEF decline) rates were low, 0.7% vs 0.3% and 2.7% vs 2.8%, in the P and Pla arms, respectively. Diarrhea grade ≥3 was more frequent with P (9.9% vs 3.7%). Conclusions: The APHINITY trial met its primary endpoint: P significantly improved IDFS in patients with HER2-positive EBC when added to T+C. No new safety signals were identified. Clinical trial information: NCT01358877.
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Affiliation(s)
| | | | | | | | - Adam Knott
- Roche Products, Ltd., Welwyn, United Kingdom
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology and University of Milan, Milan, Italy
| | | | | | | | - Emma Clark
- Roche Products, Ltd., Welwyn, United Kingdom
| | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | - Denise A. Yardley
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - Jose Bines
- National Cancer Institute, Rio de Janeiro, Brazil
| | | | | | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
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Adiwijaya BS, Kim J, Lang I, Csõszi T, Cubillo A, Chen JS, Wong M, Park JO, Kim JS, Rau KM, Melichar B, Gallego JB, Fitzgerald J, Belanger B, Molnar I, Ma WW. Population Pharmacokinetics of Liposomal Irinotecan in Patients With Cancer. Clin Pharmacol Ther 2017; 102:997-1005. [PMID: 28445610 PMCID: PMC5697569 DOI: 10.1002/cpt.720] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 03/29/2017] [Accepted: 04/19/2017] [Indexed: 12/18/2022]
Abstract
Nanoliposomal irinotecan (nal‐IRI) is a liposomal formulation of irinotecan with a longer half‐life (t1/2), higher plasma total irinotecan (tIRI), and lower SN‐38 maximum concentration (Cmax) compared with nonliposomal irinotecan. Population pharmacokinetic (PK) analysis of nal‐IRI was performed for tIRI and total SN‐38 (tSN38) using patient samples from six studies. PK‐safety association was evaluated for neutropenia and diarrhea in 353 patients. PK‐efficacy association was evaluated from a phase III study in pancreatic cancer NAPOLI1. Efficacy was associated with longer duration of unencapsulated SN‐38 (uSN38) above a threshold and higher Cavg of tIRI, tSN38, and uSN38. Neutropenia was associated with uSN38 Cmax and diarrhea with tIRI Cmax. Baseline predictive factors were race, body surface area, and bilirubin. Analysis identified PK factors associated with efficacy, safety, and predictive baseline factors. The results support the benefit of nal‐IRI dose of 70 mg/m2 (free‐base; equivalent to 80 mg/m2 salt base) Q2W over 100 mg/m2 Q3W.
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Affiliation(s)
- B S Adiwijaya
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - J Kim
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - I Lang
- National Institute of Oncology, Budapest, Hungary
| | - T Csõszi
- JNSZ Megyei Hetényi Géza Kórház Rendelöintézet, Szolnok, Hungary
| | - A Cubillo
- Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - J-S Chen
- Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - M Wong
- Westmead Hospital, Westmead, Australia
| | - J O Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J S Kim
- Korea University Guro Hospital, Seoul, South Korea
| | - K M Rau
- Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - B Melichar
- Onkologicka Klinika, Lekarska Fakulta Univerzity Palackeho a Fakultni Nemocnice, Olomouc, Czech Republic
| | | | - J Fitzgerald
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - B Belanger
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - I Molnar
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - W W Ma
- Mayo Clinic, Rochester, Minnesota, USA
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Finn RS, Crown J, Lang I, Boer K, Bondarenko I, Kulyk SO, Ettl J, Patel R, Pinter T, Schmidt M, Shparyk YV, Thummala A, Voytko NL, Fowst C, Huang X, Kim S, Slamon DJ. Overall survival results from the randomized phase II study of palbociclib (P) in combination with letrozole (L) vs letrozole alone for frontline treatment of ER+/HER2– advanced breast cancer (PALOMA-1; TRIO-18). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1001 Background: Preclinical data identified a synergistic role for P and hormone blockade in blocking growth of ER+ breast cancer (BC) cell lines. PALOMA-1 was an open-label phase II trial comparing progression-free survival (PFS) in patients (pts) with advanced ER+/HER2– BC treated with P+L or L alone. Median PFS increased with addition of P to L to 20.2 mos (vs 10.2 mos with L alone; HR = 0.488), with an acceptable safety profile, leading to accelerated approval by the US FDA. These results were confirmed in the phase 3 PALOMA-2 trial. At the time of the final PFS analysis, overall survival (OS) data were immature with only 61 events in both arms and a median follow-up of < 30 mos with a trend in favor of P+L vs L (37.5 vs 33.3 mos; HR = 0.813; P= 0.211). Here we present final OS results. Methods: PALOMA-1 was a 2-part study evaluating P+L in ER+/HER2– advanced BC. Part 1 enrolled postmenopausal pts with this subtype using only ER+/HER2– while Part 2 enrolled pts of this subtype additionally screened for CCND1 amplification and/or loss of p16. The primary endpoint was investigator-assessed PFS. Secondary endpoints included objective response rate, OS, safety, and correlative biomarker studies. A total of 165 pts were randomized; 66 in Part 1 and 99 in Part 2. Baseline characteristics were balanced between treatment arms. In both parts, pts were randomized 1:1 to receive P+L or L alone. OS data were collected as well as post-study therapy. Results: As of Dec 2016, there were 116 OS events. Median OS was 37.5 mos (95% CI: 31.4, 47.8) with P+L vs 34.5 mos (95% CI: 27.4, 42.6) for L (HR = 0.897 [95% CI: 0.623, 1.294]; P= 0.281). Median OS was 37.5 vs 33.3 mos (HR = 0.837; P= 0.280) for Part 1 and 35.1 vs 35.7 mos (HR = 0.935; P= 0.388) for Part 2. 78.6% of pts in the P+L arm received post-study systemic therapy vs 86.4% in the L arm. More pts in the L arm received ≥3 lines of therapy (37% vs 18%). Further subgroup analyses and details on post-study therapies will be presented. Conclusions: In PALOMA-1, P+L provided a statistically non-significant trend towards an improvement in OS. Survival data from the phase III, PALOMA-2 study is awaited. Sponsor: Pfizer; Clinical trial information: NCT00721409.
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Affiliation(s)
- Richard S. Finn
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - John Crown
- Irish Cooperative Oncology Research Group, Dublin, Ireland
| | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | - Katalin Boer
- Szent Margit Korhaz, Onkologia, Budapest, Hungary
| | - Igor Bondarenko
- Dnepropetrovsk State Medical Center, Dnipropetrovsk, Ukraine
| | - Sergey O. Kulyk
- Municipal Treatment-and-Prophylactic Institution, Donetsk, Ukraine
| | | | | | | | | | - Yaroslav V. Shparyk
- Lviv State Oncological Regional Medical and Diagnostic Center, Lviv, Ukraine
| | - Anu Thummala
- Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | | | | | | | | | - Dennis J. Slamon
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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Wapnir I, Price KN, Anderson SJ, Robidoux A, Martin M, Nortier JW, Paterson AHG, Rimawi MF, Lang I, Baena Cañada JM, Thurlimann BJK, Mamounas EP, Geyer CE, Gelber SI, Coates AS, Gelber RD, Rastogi P, Regan MM, Wolmark N, Aebi SP. Chemotherapy (CT) for isolated locoregional recurrence (ILRR) of breast cancer in ER-positive (ER+) and ER-negative (ER-) cohorts: Final analysis of the CALOR trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.513] [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: 11/20/2022] Open
Abstract
513 Background: ILRR is associated with a high risk of developing breast cancer distant metastases and death. The CALOR trial (NCT00074152) investigated the effectiveness of CT following local therapy for ILRR. Previously reported results at 5-yrs median follow-up (MFU) showed significant benefit of CT for ER- ILRR, but further follow-up was required in ER+ ILRR. This report presents results at 8.8 yrs MFU within ER status cohorts. Methods: CALOR is an open-label, randomized trial for patients with completely excised ILRR after unilateral breast cancer. Eligible patients were randomized to CT (selected by the investigator; multidrug for at least 3 months recommended) or No-CT, and stratified by prior CT, hormone-receptor (ER, PR) status, and location of ILRR. Patients with ER and/or PR positive ILRR received adjuvant endocrine therapy. Radiation therapy was mandated for patients with microscopically involved margins, and anti-HER2 therapy was optional. Endpoints are disease-free survival (DFS), overall survival (OS) and breast cancer-free interval (BCFI). Results: From August 2003 to January 2010, 162 patients were enrolled: 104 ER+ and 58 ER-. The results at 8.8 years MFU in ER status cohorts are summarized in the Table (40 and 27 DFS events, respectively). The reduction in the hazard of an event associated with CT for the ER- ILRR cohort was sustained, but no benefit was observed for the ER+ cohort; interactions were significant for DFS and BCFI. The reduction in the hazard of an event seen in the ER- cohort was not apparent in ER+, with significant interactions for DFS and BCFI. Results for the 3 endpoints were consistent in multi-variable analyses adjusting for location of ILRR, prior chemotherapy, and interval from primary surgery. Conclusions: The final analysis of CALOR confirms that CT benefits patients with resected ER- ILRR. Long-term CALOR trial results do not support the use of CT for ER+ ILRR. Clinical trial information: NCT00074152. [Table: see text]
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Affiliation(s)
- Irene Wapnir
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Karen N. Price
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Stewart J. Anderson
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Andre Robidoux
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Miguel Martin
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - J. W.R. Nortier
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Alexander H. G. Paterson
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Mothaffar F. Rimawi
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Istvan Lang
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - José Manuel Baena Cañada
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Beat J. K. Thurlimann
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Eleftherios P. Mamounas
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Charles E. Geyer
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Shari I. Gelber
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Alan S. Coates
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Richard D. Gelber
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Priya Rastogi
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Meredith M. Regan
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Norman Wolmark
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
| | - Stefan Paul Aebi
- International Breast Cancer Study Group, NSABP/NRG Oncology, Breast International Group, Bern, Switzerland
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Huober JB, Holmes EM, Baselga J, De Azambuja E, Untch M, Fumagalli D, Sarp S, Lang I, Smith IE, Boyle FM, Xu B, Lecocq C, De La Pena L, Jackisch C, Gelber RD, Piccart-Gebhart MJ, Di Cosimo S. Survival outcomes of the NeoALTTO study: Updated results of a randomized multicenter phase III neoadjuvant trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.512] [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] [Indexed: 11/20/2022] Open
Abstract
512 Background: In the neoadjuvant NeoALTTO trial dual HER2 blockade with lapatinib (L) plus trastuzumab (T) combined with weekly paclitaxel significantly increased the pathologic complete response rate (pCR) compared with either anti-HER2 agent alone plus paclitaxel. At first analysis pts with pCR had a better event free survival (EFS) and overall survival (OS) after median follow-up of 3.84 yrs. Methods: 455 pts with operable HER2-positive breast cancer were randomized to receive either L (n=154) 1500mg/day, T 4mg/kg loading dose followed by 2mg/kg/wk (n=149) or L 1000mg/day plus T (n=152) for 6 weeks followed by the assigned anti-HER2 treatment combined with paclitaxel weekly x 12. Following surgery pts received 3 cycles fluorouracil, epirubicin and cyclophosphamide q 3 weeks. The assigned anti-HER2 treatment was continued for 34 weeks thereafter. Primary endpoint was pCR (ypT0/is), secondary endpoints were EFS and OS and the association between pCR and OS analyzed by landmark analysis 30 weeks after randomization. Median follow-up was 6.7 years. Results: 6-yrs EFS rate was 67%/ 67%/74% with L/T/TL, respectively (L vs T HR 0.98 [95% CI 0.64–1.51] p=0.93; TL vs T HR 0.81 [95% CI 0.52–1.26] p=0.35). In the hormone receptor negative group 6- yrs EFS rate was 61%/ 63%/74% for the 3 groups, respectively (L vs T HR 1.09 [95% CI 0.61–1.95] p=0.76; TL vs T HR 0.81 [95% CI 0.44–1.51] p=0.52). OS at 6 yrs was 82%/79%/85% for L, T and TL, respectively (L vs T: HR 0.85 [95% CI 0.49-1.46] p=0.56; TL vs T HR 0.72 [95% CI 0.41-1.27] p=0.26). In landmark analyses, pts with a pCR had significantly higher 6-yrs EFS (77% /65%) and OS (89% /77%) compared to those without pCR, both overall and for the hormone receptor negative cohort. Conclusions: The updated results of the NeoALTTO study confirm the sustained survival benefits for pts who achieve a pCR. EFS and OS after 6 yrs did not differ significantly between the 3 treatment groups. The combination of T and L showed numerically higher EFS compared to T, especially in the hormone-receptor negative group. Clinical trial information: NCT00553358. [Table: see text]
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Affiliation(s)
| | | | - Jose Baselga
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Michael Untch
- Department of Gynecology and Obstetrics and Multidisciplinary Breast Cancer Center, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | | | - Binghe Xu
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Moreno-Aspitia A, Holmes EM, Jackisch C, De Azambuja E, Boyle FM, Hillman DW, Korde LA, Fumagalli D, Izquierdo MA, McCullough AE, Wolff AC, Pritchard KI, Untch M, Lang I, Xu B, Smith IE, Barrios CH, Gelber RD, Baselga J, Piccart-Gebhart MJ. Updated results from the phase III ALTTO trial (BIG 2-06; NCCTG (Alliance) N063D) comparing one year of anti-HER2 therapy with lapatinib alone (L), trastuzumab alone (T), their sequence (T→L) or their combination (L+T) in the adjuvant treatment of HER2-positive early breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.502] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
502 Background: Pre-specified 5-year analyses of the phase III Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation (ALTTO) Trial defined in Amendments 11&12. Methods: From June 2007 to July 2011, 8381 patients (pts) were randomised from 946 sites in 44 countries to receive either L+T, T→L, L, or T. In 2011, due to futility the L arm was closed and is not included in this analysis. The primary end point is disease-free survival (DFS). Secondary objectives include treatment comparisons with respect to overall survival (OS), time to recurrence (TTR), time to distant recurrence (TDR), cardiac and overall safety and tolerability. Primary analysis results of the study were published in JCO 2015 34:1034-1042. This updated analysis occurs at a 6.9 yrs median follow up (MFU). Results: All patients have reached 5-years of follow-up. 705 DFS events for L+T vs T have been observed. HR for DFS was 0.86 (95% CI, 0.74-1.00; 6-yr DFS%=85% vs 82%) for L+T vs T and 0.93 (95% CI, 0.81-1.08; 6-yr DFS%=84% vs 82%) for T→L vs. T. The 6-year OS was 93%, 92%, and 91% for L+T, T→L, and T, respectively. HR for OS was 0.86 (95% CI, 0.70-1.06) for L+T vs. T and 0.88 (95% CI, 0.71-1.08) for T→L vs. T. DFS differences for L+T vs. T were slightly higher for the hormone-receptor(ER)-negative [HR 0.80 (95% CI, 0.64-1.00; 6-yr DFS%=84% vs. 80%)] and the sequential chemotherapy [HR 0.83 (95% CI, 0.69-1.00; 6-yr DFS%=83% vs.79%)] subgroups. There were no differences in sites of first DFS events according to treatment arm for CNS, loco-regional, or distant recurrences. There were more AEs related to study treatment (L+T 93% vs T 64%). The incidence of primary cardiac end points was low: 1% for L+T, 0.5% for T→L and 0.9% for T. Conclusions: The HRs for this updated analysis are similar to those from the Primary Analysis and the event rate remains lower than anticipated (705 vs 850 planned). Cardiac toxicity remains low. This analysis suggests that HER2+/ER- tumors may have a different biology than HER2+/ER+ and may benefit more from dual HER2 blockade. Long-term follow up continues. Clinical trial information: NCT00490139.
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Affiliation(s)
| | | | | | | | | | | | - Larissa A. Korde
- Head, Breast Cancer Therapeutics, Clinical Investigations Branch, National Cancer Institute, Bethesda, MD
| | | | | | | | - Antonio C. Wolff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | - Binghe Xu
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Carlos H. Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | | | - Jose Baselga
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Von Minckwitz G, Procter MJ, De Azambuja E, Zardavas D, Knott A, Viale G, Suter TM, Arahmani A, Rouchet N, Clark E, Benyunes M, Lang I, Levy C, Yardley DA, Bines J, Gelber RD, Piccart-Gebhart MJ, Baselga J. APHINITY trial (BIG 4-11): A randomized comparison of chemotherapy (C) plus trastuzumab (T) plus placebo (Pla) versus chemotherapy plus trastuzumab (T) plus pertuzumab (P) as adjuvant therapy in patients (pts) with HER2-positive early breast cancer (EBC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.lba500] [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: 11/20/2022] Open
Abstract
LBA500 The full, final text of this abstract will be available at abstracts.asco.org at 7:30 AM (EDT) on Monday, June 5, 2017, and in the Annual Meeting Proceedings online supplement to the June 20, 2017, issue of the Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Monday edition of ASCO Daily News.
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Affiliation(s)
| | | | | | | | - Adam Knott
- Roche Products, Ltd., Welwyn, United Kingdom
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology and University of Milan, Milan, Italy
| | | | | | | | - Emma Clark
- Roche Products, Ltd., Welwyn, United Kingdom
| | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | - Denise A. Yardley
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - Jose Bines
- National Cancer Institute, Rio de Janeiro, Brazil
| | | | | | - Jose Baselga
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Alqahtani FF, Messina F, Kruger E, Gill H, Ellis M, Lang I, Broadley P, Offiah AC. Evaluation of a semi-automated software program for the identification of vertebral fractures in children. Clin Radiol 2017; 72:904.e11-904.e20. [PMID: 28506798 DOI: 10.1016/j.crad.2017.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/24/2017] [Accepted: 04/11/2017] [Indexed: 11/19/2022]
Abstract
AIM To assess observer reliability and diagnostic accuracy in children, of a semi-automated six-point technique developed for vertebral fracture (VF) diagnosis in adults, which records percentage loss of vertebral body height. MATERIALS AND METHODS Using a semi-automated software program, five observers independently assessed T4 to L4 from the lateral spine radiographs of 137 children and adolescents for VF. A previous consensus read by three paediatric radiologists using a simplified algorithm-based qualitative technique (i.e., no software involved) served as the reference standard. RESULTS Of a total of 1,781 vertebrae, 1,187 (67%) were adequately visualised according to three or more observers. Interobserver agreement in vertebral readability for each vertebral level for five observers ranged from 0.05 to 0.47 (95% CI: -0.19, 0.76). Intra-observer agreement using the intraclass correlation coefficient (ICC) ranged from 0.25 to 0.61. The overall sensitivity and specificity were 18% (95% CI: 14-22) and 97% (95% CI: 97-98), respectively. CONCLUSION In contrast to adults, the six-point technique assessing anterior, middle, and posterior vertebral height ratios is neither satisfactorily reliable nor sensitive for VF diagnosis in children. Training of the software on paediatric images is required in order to develop a paediatric standard that incorporates not only specific vertebral body height ratios but also the age-related physiological changes in vertebral shape that occur throughout childhood.
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Affiliation(s)
- F F Alqahtani
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK; Department of Radiological Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia.
| | - F Messina
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Kruger
- Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - H Gill
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - M Ellis
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - I Lang
- Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - P Broadley
- Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - A C Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK; Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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