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Schneider S, Robador J, Mayer F, Feinauer M, Keller L, Pantel K, Stadler J, Gorzelanny C, Winkler F, Bauer A. OC-03: Platelet-derived von Willebrand factor is involved in thrombosis and metastatic growth of melanoma in the brain. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Müller V, Banys-Paluchowski M, Friedl TWP, Fasching PA, Schneeweiss A, Hartkopf A, Wallwiener D, Rack B, Meier-Stiegen F, Huober J, Rübner M, Hoffmann O, Müller L, Janni W, Wimberger P, Jäger B, Pantel K, Riethdorf S, Harbeck N, Fehm T. Prognostic relevance of the HER2 status of circulating tumor cells in metastatic breast cancer patients screened for participation in the DETECT study program. ESMO Open 2021; 6:100299. [PMID: 34839105 PMCID: PMC8637493 DOI: 10.1016/j.esmoop.2021.100299] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/25/2021] [Accepted: 10/11/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Circulating tumor cells (CTCs) have been reported to predict clinical outcome in metastatic breast cancer (MBC). Biology of CTCs may differ from that of the primary tumor and HER2-positive CTCs are found in some patients with HER2-negative tumors. PATIENTS AND METHODS Patients with HER2-negative MBC were screened for participation in DETECT III and IV trials before the initiation of a new line of therapy. Blood samples were analyzed using CELLSEARCH. CTCs were labeled with an anti-HER2 antibody and classified according to staining intensity (negative, weak, moderate, or strong staining). RESULTS Screening blood samples were analyzed in 1933 patients with HER2-negative MBC. As many as 1217 out of the 1933 screened patients (63.0%) had ≥1 CTC per 7.5 ml blood; ≥5 CTCs were detected in 735 patients (38.0%; range 1-35 078 CTCs, median 8 CTCs). HER2 status of CTCs was assessed in 1159 CTC-positive patients; ≥1 CTC with strong HER2 staining was found in 174 (15.0%) patients. The proportion of CTCs with strong HER2 staining among all CTCs of an individual patient ranged between 0.06% and 100% (mean 15.8%). Patients with estrogen receptor (ER)- and progesterone receptor (PR)-positive tumors were more likely to harbor ≥1 CTC with strong HER2 staining. CTC status was significantly associated with overall survival (OS). Detection of ≥1 CTC with strong HER2 staining was associated with shorter OS [9.7 (7.1-12.3) versus 16.5 (14.9-18.1) months in patients with CTCs with negative-to-moderate HER2 staining only, P = 0.013]. In multivariate analysis, age, ER status, PR status, Eastern Cooperative Oncology Group performance status, therapy line, and CTC status independently predicted OS. CONCLUSION CTC detection in patients with HER2-negative disease is a strong prognostic factor. Presence of ≥1 CTC with strong HER2 staining was associated with shorter OS, supporting a biological role of HER2 expression on CTCs.
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Affiliation(s)
- V Müller
- Department of Gynecology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - M Banys-Paluchowski
- Gynecology and Obstetrics Department, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - T W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - A Schneeweiss
- Division Gynecologic Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - A Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - D Wallwiener
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - B Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - F Meier-Stiegen
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - J Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - M Rübner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - O Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - L Müller
- OnkologieUnterEms, Leer, Germany
| | - W Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - P Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus Dresden, TU Dresden, Germany; National Center for Tumor Diseases (NCT), Dresden, Germany
| | - B Jäger
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - K Pantel
- Institute of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Riethdorf
- Institute of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, Munich, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
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Asperger H, Cieslik JP, Alberter B, Köstler C, Polzer B, Müller V, Pantel K, Riethdorf S, Koch A, Hartkopf A, Wiesmüller L, Janni W, Schochter F, Franken A, Niederacher D, Fehm T, Neubauer H. ViBiBa: Virtual BioBanking for the DETECT multicenter trial program - decentralized storage and processing. Transl Oncol 2021; 14:101132. [PMID: 34051621 PMCID: PMC8176360 DOI: 10.1016/j.tranon.2021.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 12/05/2022] Open
Abstract
ViBiBa is an open-source sample banking tool. ViBiBa was purpose built for liquid biopsy specimen. ViBiBa allows for decentralized storage while promoting collaboration. ViBiBa's plugin support requires no change in existing data structures. ViBiBa empowers translational research projects and cohort formation.
Background Liquid Biopsy (LB) in the form of e.g., circulating tumor cells (CTCs) is a promising non-invasive approach to support current therapeutic cancer management. However, the proof of clinical utility of CTCs in informing therapeutic decision-making for e.g., breast cancer in clinical trials and associated translational research projects is facing the issues of low CTC positivity rates and low CTC numbers – even in the metastasized situation. To compensate for this dilemma, clinical CTC trials are designed as large multicenter endeavors with decentralized sample collection, processing and storage of products, making data management highly important to enable high-quality translational CTC research. Aim In the DETECT clinical CTC trials we aimed at developing a custom-made, browser-based virtual database to harmonize and organize both decentralized processing and storage of LB specimens and to enable the collection of clinically meaningful LB sample. Methods ViBiBa processes data from various sources, harmonizes the data and creates an easily searchable multilayered database. Results An open-source virtual bio-banking web-application termed ViBiBa was created, which automatically processes data from multiple non-standardized sources. These data are automatically checked and merged into one centralized databank and are providing the opportunity to extract clinically relevant patient cohorts and CTC sample collections. Summary ViBiBa, which is a highly flexible tool that allows for decentralized sample storage of liquid biopsy specimens, facilitates a solution which promotes collaboration in a user-friendly, federalist and highly structured way. The source code is available under the MIT license from https://vibiba.com or https://github.com/asperciesl/ViBiBa
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Affiliation(s)
- H Asperger
- Department of Obstetrics and Gynecology, University Hospital Duesseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - J-P Cieslik
- Department of Obstetrics and Gynecology, University Hospital Duesseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - B Alberter
- Division of Personalized Tumor Therapy, Fraunhofer ITEM, Germany, Am Biopark 9, Regensburg, Germany
| | - C Köstler
- Division of Personalized Tumor Therapy, Fraunhofer ITEM, Germany, Am Biopark 9, Regensburg, Germany
| | - B Polzer
- Division of Personalized Tumor Therapy, Fraunhofer ITEM, Germany, Am Biopark 9, Regensburg, Germany
| | - V Müller
- Department of Obstetrics and Gynecology, University Hospital Hamburg-Eppendorf, Germany, Martinistraße 52, Hamburg, Germany
| | - K Pantel
- Department of Tumor Biology, University Hospital Hamburg-Eppendorf, Germany, Martinistraße 52, Hamburg, Germany
| | - S Riethdorf
- Department of Tumor Biology, University Hospital Hamburg-Eppendorf, Germany, Martinistraße 52, Hamburg, Germany
| | - A Koch
- Department of Obstetrics and Gynecology, University of Tübingen, Germany, Calwerstraße 7, Tübingen, Germany
| | - A Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Germany, Calwerstraße 7, Tübingen, Germany
| | - L Wiesmüller
- Department of Obstetrics and Gynecology, University Hospital Ulm, Germany, Albert-Einstein-Allee 23, Ulm, Germany
| | - W Janni
- Department of Obstetrics and Gynecology, University Hospital Ulm, Germany, Albert-Einstein-Allee 23, Ulm, Germany
| | - F Schochter
- Department of Obstetrics and Gynecology, University Hospital Ulm, Germany, Albert-Einstein-Allee 23, Ulm, Germany
| | - A Franken
- Department of Obstetrics and Gynecology, University Hospital Duesseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - D Niederacher
- Department of Obstetrics and Gynecology, University Hospital Duesseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - T Fehm
- Department of Obstetrics and Gynecology, University Hospital Duesseldorf, Moorenstraße 5, Düsseldorf, Germany
| | - H Neubauer
- Department of Obstetrics and Gynecology, University Hospital Duesseldorf, Moorenstraße 5, Düsseldorf, Germany.
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Deutsch TM, Stefanovic S, Riethdorf S, Fischer C, Feißt M, Pantel K, Hartkopf AD, Fremd C, Schütz F, Schneeweiss A, Wallwiener M. Schwellenwert-Analyse der CTC-Veränderung unter Therapie zur Definition eines Therapieansprechens beim metastasierten Mammakarzinom. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | | | - S Riethdorf
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | - C Fischer
- Universitäts-Frauenklinik Heidelberg
| | - M Feißt
- Institut für Medizinische Biometrie und Informatik, Universitätsklinikum Heidelberg
| | - K Pantel
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | | | - C Fremd
- Nationales Centrum für Tumorerkrankungen (NCT)
| | - F Schütz
- Universitäts-Frauenklinik Heidelberg
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Stefanovic S, TM D, Riethdorf S, Fischer C, Hartkopf A, Sinn P, Feisst M, Pantel K, Hennigs A, Golatta M, Sütterlin M, Schneeweiss A, Wallwiener M. Receptor discordance between primary tumor and metastasis influences CTC-status. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S Stefanovic
- Universitätsfrauenklinik, Universitätsklinikum Mannheim, Universität Heidelberg
| | - Deutsch TM
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - S Riethdorf
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | - C Fischer
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - A Hartkopf
- Universitätsfrauenklinik, Universitätsklinikum Tübingen
| | - P Sinn
- Institut für Pathologie, Universitätsklinikum Heidelberg
| | - M Feisst
- Institut für Medizinische Biometrie und Informatik, Universitätsklinikum Heidelberg
| | - K Pantel
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | - A Hennigs
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - M Golatta
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - M Sütterlin
- Universitätsfrauenklinik, Universitätsklinikum Mannheim, Universität Heidelberg
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen (NCT)
- Deutsches Krebsforschungszentrum (DKFZ)
| | - M Wallwiener
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
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Thomsen L, Honoré A, Almås B, Reisæter L, Førde K, Kristoffersen E, Kaada S, Melve G, Helle S, Kvalheim G, Azeem W, Olsen J, Halvorsen O, Akslen L, Bahn D, Pantel K, Riethdorf S, Ragde H, Gjertsen B, Øyan A, Kalland K, Beisland C. Safety and efficacy of dendritic cell (DC)-based cryoimmunotherapy (CryoIT) combined with checkpoint inhibition in a prospective non-randomized Phase I trial of metastatic castration resistant prostate cancer (mCRPC). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33842-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
The emergence of immunotherapy in oncology requires the discovery, validation and subsequent adoption of robust, sensitive and specific predictive and prognostic biomarkers for daily practice. Until now, anti-PD-L1 immunohistochemistry (IHC) on tissue sections has been the only validated companion diagnostic test for first-line immunotherapy for advanced and metastatic cancer, notably non-small-cell lung cancer (NSCLC). However, detection of this biomarker presents limitations that have stimulated the development of other biomarkers and other approaches. Within this context, the use of a liquid biopsy (LB) could provide an important complementary or alternative added value to PD-L1 IHC. In this review, we discuss how LBs have been used in the field of immuno-oncology (I-O) to predict response, relapse or adverse advents for patients undergoing immune-checkpoint inhibitor (ICI) therapy (anti-PD-1/PD-L1 and CTLA-4) and we highlight recent developments. Circulating tumor cells (CTCs), cell-free DNA (cfDNA), proteins and cytokines detected in plasma as well as circulating T-lymphocytes are discussed as potential sources for developing new I-O biomarkers. The quantification of cfDNA as a predictive biomarker, as well as its sequencing for the determination of tumor mutational burden, is already well advanced. Additionally, the quantification of PD-L1 from CTCs, bound on exosomes or free in plasma, as well as the determination of cytokines, are also being actively investigated with promising results having recently been published. Lastly, analysis of T-lymphocytes, especially by analyzing the T-cell receptor, has recently emerged as a valuable biomarker that might become relevant for the prediction of response to ICIs. While LBs have not yet been implemented in routine I-O clinical practice, recent promising data and rapidly advancing technologies indicate that this approach has the potential to soon personalize the clinical management of cancer patients receiving ICIs.
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Affiliation(s)
- P Hofman
- IRCAN Team 4, Inserm U1081, CNRS 7284, Université Côte d'Azur, Antoine Lacassagne Cancer Center, Nice; Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, FHU OncoAge, Pasteur Hospital, Nice; Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice.
| | - S Heeke
- IRCAN Team 4, Inserm U1081, CNRS 7284, Université Côte d'Azur, Antoine Lacassagne Cancer Center, Nice; Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, FHU OncoAge, Pasteur Hospital, Nice
| | - C Alix-Panabières
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Centre, Montpellier; EA2415, Montpellier University, Montpellier, France
| | - K Pantel
- Department of Tumor Biology, Center of Experimental Medicine, University Cancer Center Hamburg, Hamburg, Germany
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Lindsay CR, Blackhall FH, Carmel A, Fernandez-Gutierrez F, Gazzaniga P, Groen HJM, Hiltermann TJN, Krebs MG, Loges S, López-López R, Muinelo-Romay L, Pantel K, Priest L, Riethdorf S, Rossi E, Terstappen L, Wikman H, Soria JC, Farace F, Renehan A, Dive C, Besse B, Michiels S. EPAC-lung: pooled analysis of circulating tumour cells in advanced non-small cell lung cancer. Eur J Cancer 2019; 117:60-68. [PMID: 31254940 DOI: 10.1016/j.ejca.2019.04.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/20/2019] [Accepted: 04/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We assessed the clinical validity of circulating tumour cell (CTC) quantification for prognostication of patients with advanced non-small cell lung cancer (NSCLC) by undertaking a pooled analysis of individual patient data. METHODS Nine European NSCLC CTC centres were asked to provide reported/unreported pseudo-anonymised data for patients with advanced NSCLC who participated in CellSearch CTC studies from January 2003 to March 2017. We used Cox regression models, stratified by centres, to establish the association between CTC count and survival. We assessed the added value of CTCs to prognostic clinicopathological models using likelihood ratio (LR) statistics and c-indices. RESULTS Seven out of nine eligible centres provided data for 550 patients with prognostic information for overall survival. CTC counts of ≥2 and ≥ 5 per 7·5 mL were associated with reduced progression-free survival (≥2 CTCs: hazard ratio [HR] = 1.72, p < 0·001; ≥5 CTCs: HR = 2.21, p < 0·001) and overall survival (≥2 CTCs: HR = 2·18, p < 0·001; ≥5 CTCs: HR = 2·75, p < 0·001), respectively. Survival prediction was significantly improved by addition of baseline CTC count to LR clinicopathological models (log-transformed CTCs p < 0·001; ≥2 CTCs p < 0·001; ≥5 CTCs p ≤ 0·001 for both survival end-points), whereas moderate improvements were observed with the use of c-index models. There was some evidence of between-centre heterogeneity, especially when examining continuous counts of CTCs. CONCLUSIONS These data confirm CTCs as an independent prognostic indicator of progression-free survival and overall survival in advanced NSCLC and also reveal some evidence of between-centre heterogeneity. CTC count improves prognostication when added to full clinicopathological predictive models.
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Affiliation(s)
- C R Lindsay
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK; Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK
| | - F H Blackhall
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK; Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK
| | - A Carmel
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, 114, Rue Edouard Vaillant, Villejuif, 94805, France; INSERM U1018 OncoStat, CESP, Université Paris-Sud, Université Paris-Saclay, France; Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France
| | - F Fernandez-Gutierrez
- Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK; Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - P Gazzaniga
- Circulating Tumor Cells Unit, Dept Molecular Medicine, Sapienza, University of Rome, Italy
| | - H J M Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - T J N Hiltermann
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - M G Krebs
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK; Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK
| | - S Loges
- Department of Tumor Biology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R López-López
- Liquid Biopsy Analysis Unit, Oncomet, Health Research Institute of Santiago de Compostela (IDIS), CIBERONC, Santiago de Compostela, Spain
| | - L Muinelo-Romay
- Liquid Biopsy Analysis Unit, Oncomet, Health Research Institute of Santiago de Compostela (IDIS), CIBERONC, Santiago de Compostela, Spain
| | - K Pantel
- Department of Tumor Biology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - L Priest
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - S Riethdorf
- Department of Tumor Biology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - E Rossi
- Department of Surgery, Oncology and Gastroenterology, Oncology Section, University of Padova, Padova, Italy; Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - L Terstappen
- Department of Medical Cell BioPhysics, University of Twente, Enschede, the Netherlands
| | - H Wikman
- Department of Tumor Biology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - J-C Soria
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France; INSERM, U981 "Predictive Biomarkers and New Therapeutics in Oncology", F-94805, Villejuif, France; Paris-Sud University, Orsay, France
| | - F Farace
- INSERM, U981 "Predictive Biomarkers and New Therapeutics in Oncology", F-94805, Villejuif, France; Gustave Roussy, Université Paris-Saclay. "Rare Circulating Cells" Translational Platform, CNRS UMS3655 - INSERM US23, AMMICA, F-94805, Villejuif, France
| | - A Renehan
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | - C Dive
- Cancer Research UK Lung Cancer Centre of Excellence, Manchester, UK; Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - B Besse
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France; Paris-Sud University, Orsay, France
| | - S Michiels
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, 114, Rue Edouard Vaillant, Villejuif, 94805, France; INSERM U1018 OncoStat, CESP, Université Paris-Sud, Université Paris-Saclay, France; Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France.
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Lindsay C, Blackhall F, Carmel A, Gazzaniga P, Groen H, Krebs M, Muinelo-Romay L, Pantel K, Rossi E, Terstappen L, Wikman H, Soria JC, Farace F, Renehan A, Dive C, Besse B, Michiels S. EPAC-Lung: Pooled analysis of circulating tumor cells in advanced non-small cell lung cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz073] [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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Fehm T, Meier-Stiegen F, Riethdorf S, Rack B, Taran FA, Pantel K, Müller V, Janni W, Huober J. Abstract P3-01-04: DETECT V – Expression analysis of human epidermal growth factor receptor 2 and estrogen receptor on circulating tumor cells of metastatic breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-01-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The prognostic relevance of Circulating Tumor Cells (CTCs) in patients with metastatic breast cancer (MBC) has been shown in multiple clinical trials. Beside their quantification it is of particular interest to analyze the predictive value of these cells and investigate if therapeutic decisions can be based on the phenotype of CTCs. The DETECT study concept evaluates this possible implication of CTCs. The DETECT V study compares endocrine therapy vs. chemotherapy, both combined with Trastuzumab and Pertuzumab in MBC patients with a HER2-positive (Human Epidermal Growth Factor Receptor 2), hormone receptor-positive tumor. Translational projects to identify potential predictive markers are associated to the study program. The expression of predictive markers HER2 and estrogen receptor (ER) on CTCs is analyzed to establish and validate an “Endocrine Responsiveness Score” (ERS). The ERS is aiming to estimate the potential benefit of endocrine therapy.
Methods: Quantification and characterization of CTCs was performed using Cell Search® CXC Kit. The staining protocol was validated using cell lines with known expression of ER and HER2. CTCs were quantified at randomization, after six weeks and at the end of treatment in two samples. Staining intensities of both markers were specified.
Results: Staining was successfully established. ER staining intensity was specified as negative or positive; HER2 staining intensity as negative, weak, moderate or strong. Detection and characterization of CTCs was analyzed for the first 30 patients. At time of randomization 17 of 26 samples were CTC positive with ≥1 CTC in one sample (HER2 and ER), 6/25 in both samples. After six weeks 8 of 26 patients contained ≥1 CTC in one sample and 5 of 26 in both samples. 11 of 15 CTC positive patients at time of randomization were CTC negative in the subsequent sample after six weeks. The cumulative frequency of ER- and HER2-positivity regarding CTCs detected in all samples was analyzed. 13% of all CTCs detected were ER positive (14/115). The percentage of HER2 3+ CTCs decreased from 27% at time of randomization (25/92) to 0% after six weeks (0/87). Analyzing the distribution of the expression of ER and HER2 in all CTCs of one sample, 10 of 19 samples containing ≥2 CTC showed heterogenic intensity of HER2-specific immunofluorescence. 8 of 14 samples containing ≥2 CTC showed heterogenic intensity of ER-specific immunofluorescence, respectively.
Conclusion: The implementation of “Endocrine Responsiveness Score” ERS aims to predict the potential benefit of endocrine therapy in patients with a HER2-positive, hormone receptor-positive tumor. Descriptive analysis of first patient samples has shown to detect heterogenic expression of HER2 and ER in CTCs of patients participating in the DETECT V study.
Citation Format: Fehm T, Meier-Stiegen F, Riethdorf S, Rack B, Taran F-A, Pantel K, Müller V, Janni W, Huober J. DETECT V – Expression analysis of human epidermal growth factor receptor 2 and estrogen receptor on circulating tumor cells of metastatic breast cancer patients [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 P3-01-04.
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Affiliation(s)
- T Fehm
- University Hospital Duesseldorf, Duesseldorf, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Tuebingen, Tuebingen, Germany
| | - F Meier-Stiegen
- University Hospital Duesseldorf, Duesseldorf, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Tuebingen, Tuebingen, Germany
| | - S Riethdorf
- University Hospital Duesseldorf, Duesseldorf, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Tuebingen, Tuebingen, Germany
| | - B Rack
- University Hospital Duesseldorf, Duesseldorf, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Tuebingen, Tuebingen, Germany
| | - F-A Taran
- University Hospital Duesseldorf, Duesseldorf, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Tuebingen, Tuebingen, Germany
| | - K Pantel
- University Hospital Duesseldorf, Duesseldorf, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Tuebingen, Tuebingen, Germany
| | - V Müller
- University Hospital Duesseldorf, Duesseldorf, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Tuebingen, Tuebingen, Germany
| | - W Janni
- University Hospital Duesseldorf, Duesseldorf, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Tuebingen, Tuebingen, Germany
| | - J Huober
- University Hospital Duesseldorf, Duesseldorf, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Tuebingen, Tuebingen, Germany
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Hartkopf AD, Brucker SY, Taran FA, Harbeck N, von Au A, Naume B, Pierga JY, Hoffmann O, Beckmann MW, Rydén L, Fehm T, Aft R, Montserrat S, Walter V, Rack B, Schuetz F, Borgen E, Ta MH, Bittner AK, Fasching P, Fernö M, Krawczyk N, Weilbaecher K, Margelí M, Hahn M, Jueckstock J, Domschke C, Bidard FC, Kasimir-Bauer S, Schoenfisch B, Kurt AG, Wallwiener M, Gebauer G, Wallwiener D, Janni W, Pantel K. Abstract GS5-07: International pooled analysis of the prognostic impact of disseminated tumor cells from the bone marrow in early breast cancer: Results from the PADDY study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs5-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
As early breast cancer might relapse even after complete removal of breast and lymphnodes, the disease must persist in secondary sites. The detection of disseminated tumor cells (DTC) in the bone marrow (BM) has been described as a surrogate of residual disease. Various trials showed an impaired prognosis of DTC positive early breast cancer (EBC) patients. The PADDY (Pooled Analysis of DTC Detection in Early Breast Cancer) study is a large international pooled analysis that aimed to assess the prognostic impact of DTC detection in patients with EBC.
Methods
A pre-specified protocol was followed, and centers known to practice BM sampling for DTC detection were contacted for individual patient data. Patients with EBC, with available follow-up data and BM sampling before any anti-cancer treatment were eligible. BM aspirates were collected at the time of primary surgery. DTC were identified by antibody (A45-B/B3, AE1/AE3, 2E11 and E29) staining against cytokeratin. The DTC status was compared to other prognostic factors using the chi-squared test. Univariate log-rank test and multivariate cox regression were used to compare survival of DTC positive versus DTC negative patients.
Results
Individual data from 10,320 patients (11 centers from Europe and USA) were included with a median follow-up of 91 months. Of all patients, 2,823 (27.4 %) were DTC positive. DTC detection was associated with higher tumor grade, higher T stage, nodal positivity, ER and PR negativity, and HER2 positivity (all p<0.001). In univariate analyses, overall, breast cancer specific, disease-free and distant disease-free survival (OS, BCSS, DFS, DDFS) were significantly shorter in DTC positive patients with p-values of <0.001. Multivariate analyses showed the DTC status to be an independent prognostic marker for OS, BCSS, DFS and DDFS with hazard ratios (HR) and 95%-confidence intervals (CI) of 1.23 (95%-CI: 1.06-1.42, p=0.007), 1.38 (95%-CI: 1.11-1.72, p=0.004), 1.29 (95%-CI: 1.10-1.50, p=0.001) and 1.32 (95%-CI: 1.10-1.58, p=0.003), respectively.
Conclusions
Detection of DTC in the bone marrow is an independent prognostic marker in patients with non-metastatic breast cancer. Further studies should investigate the impact of DTC on metastatic cancer progression and their role for clinical decision making.
Citation Format: Hartkopf AD, Brucker SY, Taran F-A, Harbeck N, von Au A, Naume B, Pierga J-Y, Hoffmann O, Beckmann MW, Rydén L, Fehm T, Aft R, Montserrat S, Walter V, Rack B, Schuetz F, Borgen E, Ta M-H, Bittner A-K, Fasching P, Fernö M, Krawczyk N, Weilbaecher K, Margelí M, Hahn M, Jueckstock J, Domschke C, Bidard F-C, Kasimir-Bauer S, Schoenfisch B, Kurt AG, Wallwiener M, Gebauer G, Wallwiener D, Janni W, Pantel K. International pooled analysis of the prognostic impact of disseminated tumor cells from the bone marrow in early breast cancer: Results from the PADDY study [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 GS5-07.
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Affiliation(s)
- AD Hartkopf
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - SY Brucker
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F-A Taran
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Harbeck
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A von Au
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Naume
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J-Y Pierga
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - O Hoffmann
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - MW Beckmann
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Rydén
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Fehm
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Aft
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Montserrat
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Walter
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Rack
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Schuetz
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Borgen
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M-H Ta
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A-K Bittner
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Fasching
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Fernö
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Krawczyk
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Weilbaecher
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Margelí
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Hahn
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Jueckstock
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Domschke
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F-C Bidard
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Kasimir-Bauer
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Schoenfisch
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - AG Kurt
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Wallwiener
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Gebauer
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Wallwiener
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Janni
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Pantel
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Thaler S, Roßwag S, Pantel K, Sleeman JP, Schmidt M, Cotarelo CL. Abstract P3-01-23: Targeting of endocrine therapy-induced estrogen-receptor/HER2-cross-talk in circulating tumor cells from metastatic ER+/HER2- breast cancer: Implications for treatment of ER+/HER2- breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-01-23] [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: Transient induction of HER2 expression upon inhibition of the estrogen-receptor (ERα) might be an underestimated rescue mechanism that enables ER+/HER2- breast cancer cells to survive and to grow in the presence of endocrine therapies. Besides protecting ER+/HER2- BC cells from endocrine treatment, transient HER2 expression is also considered to save circulating, disseminated and dormant ER+/HER2- BC cells from apoptotic cell death in hostile environments and might therefore be of importance for ER+ BC progression, metastasis formation and recurrence. Thus therapeutic strategies that efficiently target both ERα and HER2 simultaneously might improve treatment of patient with ER+/HER2- BCs.
Methods: Circulating tumor cells (CTCs) were originally isolated from a patient with bilateral ER+/HER2- metastatic BC. These cells have been treated with either the proteasome inhibitor (PI) carfilzomib or fulvestrant alone or with both drugs in combination. The consequences of these drugs upon ERα and HER2 expression were monitored by western blotting or qPCR. Induction of cell death upon treatment was measured by PARP and caspase cleavage or by quantification of SubG1 cells using propidium iodide staining or by the use of colony forming assays.
Results: Fulvestrant treatment of CTCs decreases the amount of ERα but immediately increases HER2 expression whereas carfilzomib markedly inhibits the expression of both ERα and HER2 simultaneously. Combined treatment of CTCs with carfilzomib + fulvestrant cause reduced expression of HER2 and lead to a much stronger decrease of ERα than carfilzomib or fulvestrant alone. Fulvestrant causes no significant reduction of proliferation and no induction of cell death. Conversely the combination of carfilzomib and fulvestrant causes a significant induction of apoptotic cell death and a massive reduction of colonies in colony forming assays.
Conclusion: These findings suggest that rapid and transient up-regulation of HER2 expression following endocrine treatment might be an important so far underestimated adaptive mechanism which enables ER+/HER2- BC cells to sustain proliferation in the presence of ERα-inhibitory drugs and to stay alive during the metastatic process. Furthermore these data also lead to the assumption that PIs such as carfilzomib in combination with ERα degraders could be a potential therapeutic strategy for efficient targeting of metastatic ER+/HER2- BC cells.
Citation Format: Thaler S, Roßwag S, Pantel K, Sleeman JP, Schmidt M, Cotarelo CL. Targeting of endocrine therapy-induced estrogen-receptor/HER2-cross-talk in circulating tumor cells from metastatic ER+/HER2- breast cancer: Implications for treatment of ER+/HER2- breast cancer [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 P3-01-23.
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Affiliation(s)
- S Thaler
- European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Karlruhe Institute of Technology (KIT) Campus Nord, Institute for Toxicology and Genetics, Karlsruhe, Germany; University Medical Center, Johannes Gutenberg University, Mainz, Germany; Institute of Pathology, University Medical Center, Johannes Gutenberg Universitys, Mainz, Germany
| | - S Roßwag
- European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Karlruhe Institute of Technology (KIT) Campus Nord, Institute for Toxicology and Genetics, Karlsruhe, Germany; University Medical Center, Johannes Gutenberg University, Mainz, Germany; Institute of Pathology, University Medical Center, Johannes Gutenberg Universitys, Mainz, Germany
| | - K Pantel
- European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Karlruhe Institute of Technology (KIT) Campus Nord, Institute for Toxicology and Genetics, Karlsruhe, Germany; University Medical Center, Johannes Gutenberg University, Mainz, Germany; Institute of Pathology, University Medical Center, Johannes Gutenberg Universitys, Mainz, Germany
| | - JP Sleeman
- European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Karlruhe Institute of Technology (KIT) Campus Nord, Institute for Toxicology and Genetics, Karlsruhe, Germany; University Medical Center, Johannes Gutenberg University, Mainz, Germany; Institute of Pathology, University Medical Center, Johannes Gutenberg Universitys, Mainz, Germany
| | - M Schmidt
- European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Karlruhe Institute of Technology (KIT) Campus Nord, Institute for Toxicology and Genetics, Karlsruhe, Germany; University Medical Center, Johannes Gutenberg University, Mainz, Germany; Institute of Pathology, University Medical Center, Johannes Gutenberg Universitys, Mainz, Germany
| | - CL Cotarelo
- European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Karlruhe Institute of Technology (KIT) Campus Nord, Institute for Toxicology and Genetics, Karlsruhe, Germany; University Medical Center, Johannes Gutenberg University, Mainz, Germany; Institute of Pathology, University Medical Center, Johannes Gutenberg Universitys, Mainz, Germany
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Banys-Paluchowski M, Fehm T, Witzel I, Aktas B, Fasching PA, Hartkopf A, Janni W, Kasimir-Bauer S, Pantel K, Schön G, Rack B, Riethdorf S, Solomayer EF, Müller V. The prognostic relevance of urokinase-type plasminogen activator (uPA) in the blood of patients with metastatic breast cancer. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1675453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- M Banys-Paluchowski
- Department of Gynecology and Obstetrics, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - T Fehm
- Department of Obstetrics and Gynecology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - I Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Aktas
- Department of Obstetrics and Gynecology, University Hospital Leipzig, Leipzig, Germany
| | - PA Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - A Hartkopf
- Department of Obstetrics and Gynecology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - W Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - S Kasimir-Bauer
- Department of Obstetrics and Gynecology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - K Pantel
- Department of Tumour Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Schön
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - B Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - S Riethdorf
- Department of Tumour Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - EF Solomayer
- Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Fischer CL, Deutsch TM, Riethdorf S, Nees J, Hartkopf AD, Schönfisch B, Domschke C, Sprick MR, Schütz F, Brucker SY, Stefanovic S, Sohn C, Pantel K, Trumpp A, Schneeweiss A, Wallwiener M. Vergleich der Anzahl zirkulierender Tumorzellen mit dem Proliferationsmarker Ki-67 beim metastasierten Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671015] [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] Open
Affiliation(s)
- CL Fischer
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Deutschland
| | - TM Deutsch
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Deutschland
| | - S Riethdorf
- Institut für Tumorbiologie, Universitäts-Klinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - J Nees
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Deutschland
| | - AD Hartkopf
- Universitäts-Frauenklinik Tübingen, Tübingen, Deutschland
| | - B Schönfisch
- Universitäts-Frauenklinik Tübingen, Tübingen, Deutschland
| | - C Domschke
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - MR Sprick
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmBH), Heidelberg, Deutschland
| | - F Schütz
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - SY Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen, Deutschland
| | - S Stefanovic
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - C Sohn
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - K Pantel
- Institut für Tumorbiologie, Universitäts-Klinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - A Trumpp
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmBH), Heidelberg, Deutschland
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - A Schneeweiss
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Deutschland
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - M Wallwiener
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
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Banys-Paluchowski M, Witzel I, Riethdorf S, Pantel K, Rack B, Janni W, Fasching PA, Aktas B, Kasimir-Bauer S, Hartkopf A, Solomayer EF, Fehm T, Müller V. The clinical relevance of circulating tumor cells in correlation to other serum biomarkers (VEGF, HER2, EGFR, TIMP1, CAIX, RASp21) in patients with metastatic breast cancer. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671206] [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] Open
Affiliation(s)
| | - I Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Riethdorf
- Department of Tumour Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - K Pantel
- Department of Tumour Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - B Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Deutschland
| | - W Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Deutschland
| | - PA Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Deutschland
| | - B Aktas
- Department of Obstetrics and Gynecology, University Hospital Leipzig, Leipzig, Deutschland
| | - S Kasimir-Bauer
- Department of Obstetrics and Gynecology, University Hospital Essen, University of Duisburg-Essen, Essen, Deutschland
| | - A Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Deutschland
| | - EF Solomayer
- Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg/Saar, Deutschland
| | - T Fehm
- Department of Obstetrics and Gynecology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Deutschland
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
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Schochter F, Rack B, Fasching PA, Häberle L, Tesch H, Lorenz R, Tzschaschel M, De Gregorio A, Fehm T, Müller V, Schneeweiss A, Lichtenegger W, Beckmann MW, Scholz C, Pantel K, Janni W, Friedl TWP. Nachweis von zirkulierenden Tumorzellen bei Patientinnen mit frühem Brustkrebs fünf Jahre nach adjuvanter Chemotherapie und späte Rezidive – Ergebnisse der SUCCESS A Studie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671512] [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] Open
Affiliation(s)
- F Schochter
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - B Rack
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - PA Fasching
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - L Häberle
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - H Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Deutschland
| | - R Lorenz
- Gemeinschaftspraxis Dr. Lorenz, Hecker und Wesche, Braunschweig, Deutschland
| | | | | | - T Fehm
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Deutschland
| | - V Müller
- Universitätsklinikum Hamburg Eppendorf, Klinik und Poliklinik für Gynäkologie, Hamburg, Deutschland
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen Heidelberg, Heidelberg, Deutschland
| | - W Lichtenegger
- Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Deutschland
| | - MW Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - C Scholz
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - K Pantel
- Universitätsklinikum Hamburg Eppendorf, Institut für Tumorbiologie, Hamburg, Deutschland
| | - W Janni
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - TWP Friedl
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
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Meier-Stiegen F, Riethdorf S, Friedl TWP, Rack B, Taran FA, Pantel K, Müller V, Janni W, Huober J, Fehm T. DETECT V – Expressionsnachweis von Estrogenrezeptor und Human Epidermal Growth Factor Receptor 2 in zirkulierenden Tumorzellen bei Patientinnen mit metastasiertem Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671303] [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] Open
Affiliation(s)
- F Meier-Stiegen
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Düsseldorf, Düsseldorf, Deutschland
| | - S Riethdorf
- Universitätsklinikum Hamburg-Eppendorf, Institut für Tumorbiologie, Hamburg, Deutschland
| | - TWP Friedl
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - B Rack
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - FA Taran
- Universitätsfrauenklinik Tübingen, Tübingen, Deutschland
| | - K Pantel
- Universitätsklinikum Hamburg-Eppendorf, Institut für Tumorbiologie, Hamburg, Deutschland
| | - V Müller
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie, Hamburg, Deutschland
| | - W Janni
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - J Huober
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - T Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Düsseldorf, Düsseldorf, Deutschland
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Ignatiadis M, Litière S, Rothe F, Riethdorf S, Proudhon C, Fehm T, Aalders K, Forstbauer H, Fasching P, Brain E, Vuylsteke P, Guardiola E, Lorenz R, Pantel K, Tryfonidis K, Janni W, Piccart M, Sotiriou C, Rack B, Pierga JY. Trastuzumab versus observation for HER2 nonamplified early breast cancer with circulating tumor cells (EORTC 90091-10093, BIG 1-12, Treat CTC): a randomized phase II trial. Ann Oncol 2018; 29:1777-1783. [DOI: 10.1093/annonc/mdy211] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Soave A, Riethdorf S, Dahlem R, Minner S, Weisbach L, Engel O, Fisch M, Pantel K, Rink M. Commentary on "Detection and oncological effect of circulating tumor cells in patients with variant urothelial carcinoma histology treated with radical cystectomy.". Urol Oncol 2018; 36:347-348. [PMID: 29880457 DOI: 10.1016/j.urolonc.2018.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To investigate for the presence of circulating tumor cells (CTC) in patients with variant urothelial carcinoma of the bladder (UCB) histology treated with radical cystectomy (RC), and to determine their impact on oncological outcomes. PATIENTS AND METHODS We, prospectively, collected data of 188 patients with UCB treated with RC without neoadjuvant chemotherapy. Pathological specimens were meticulously reviewed for pure and variant UCB histology. Preoperatively collected blood samples (7.5ml) were analyzed for CTC using the CellSearch system (Janssen, Raritan, NJ). RESULTS Variant UCB histology was found in 47 patients (25.0%), most frequently of squamous cell differentiation (16.5%). CTC were present in 30 patients (21.3%) and 12 patients (25.5%) with pure and variant UCB histology, respectively. At a median follow-up of 25 months, the presence of CTC and nonsquamous cell differentiation were associated with reduced recurrence-free survival (RFS) and cancer-specific survival (pairwise P ≤ 0.016). Patients without CTC had better RFS, independent of UCB histology, than patients with CTC with any UCB histology (pairwise P<0.05). In multivariable analyses, the presence of CTC, but not variant UCB histology, was an independent predictor for disease recurrence (hazard ratio = 3.45, P<0.001) and cancer-specific mortality (hazard ratio = 2.62, P = 0.002). CONCLUSION CTC are detectable in about a quarter of patients with pure or variant UCB histology before RC, and represent an independent predictor for outcomes, when adjusting for histological subtype. In addition, our prospective data confirm the unfavorable influence of nonsquamous cell-differentiated UCB on outcomes.
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Romashova T, Polasik A, Friedl TWP, Rack B, Tzschaschel M, Fasching PA, Taran FA, Hartkopf A, Schneeweiss A, Mueller V, Bahriye A, Pantel K, Meier-Stiegen F, Wimberger P, Janni W, Fehm T, Huober J. Abstract OT1-03-05: The DETECT V-Study – Comparison of dual HER2-targeted therapy with trastuzumab plus pertuzumab in combination with chemo- or endocrine therapy in addition with CDK4/6 inhibition in patients with HER2-positive and hormone-receptor positive metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-03-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Metastatic breast cancer (MBC) is usually an incurable disease and maintenance of quality of life (QoL) is one of the main aims of therapy. In patients with HER2-positive MBC taxane-based chemotherapy in combination with dual HER2 targeted therapy with trastuzumab and pertuzumab, has shown significantly increased progression free survival and overall survival. Adverse events are well-known side effects of any cytostatic treatment and can seriously impact the patients' QoL.
The synergistic combination of dual HER2-targeted therapy with trastuzumab and pertuzumab plus endocrine therapy might offer a better treatment option for these patients. Preclinical data and first clinical trial results suggest an additional benefit when a CDK4/6 inhibitor is added to the combination of endocrine therapy and anti HER2 treatment. DETECT V is a randomized phase III study comparing the safety and efficacy of trastuzumab plus pertuzumab in combination with either endocrine therapy or chemotherapy. In both treatment arms the CDK4/6 inhibitor ribociclib will be added.
Trial design and eligibility criteria: Patients are 1:1 randomized to receive dual HER2-targeted therapy with trastuzumab and pertuzumab combined with endocrine therapy and ribociclib or to chemotherapy with trastuzumab and pertuzumab followed by maintenance therapy with trastuzumab, pertuzumab, endocrine therapy and ribociclib when chemotherapy has stopped.
The sample size calculations are based on the assumption that the probability of having an adverse event as defined by the modified adverse event score for patients with HER2 positive metastatic breast cancer in the chemotherapy arm is 86.3%. Based on this assumption, a minimum of 121 patients per treatment arm is required to detect a 25% decreased risk of having an adverse event as defined by the modified adverse event score (i.e. a relative risk ratio of 0.75) for patients treated with dual HER2-targeted plus endocrine therapy and ribociclib as compared to patients treated with dual HER2-targeted plus chemotherapy with the combination of endocrine therapy and ribociclib as maintenance treatment (90% power, two-sided test, α = 0.05).
Specific aims: The primary objective of this study is to assess the tolerability of both treatment strategies, as assessed by the occurrence of AEs during the treatment period. Modified adverse event score was developed in order to better reflect the clinical, physiological and psychological impact of AEs on patients' QoL. Key secondary endpoint, besides the efficacy endpoints progression free survival (PFS) and overall survival, is to compare quality-adjusted survival (QAS), as measured using the quality-adjusted time without symptoms and toxicity (Q-TWiST) method, between both treatment arms.
The DETECT V trial comes along with a comprehensive translational program focusing on detection and phenotyping of circulating tumor cell (CTC)-and the assessment of marker expression on CTCs in order to calculate an endocrine responsiveness score.
Citation Format: Romashova T, Polasik A, Friedl TWP, Rack B, Tzschaschel M, Fasching PA, Taran F-A, Hartkopf A, Schneeweiss A, Mueller V, Bahriye A, Pantel K, Meier-Stiegen F, Wimberger P, Janni W, Fehm T, Huober J. The DETECT V-Study – Comparison of dual HER2-targeted therapy with trastuzumab plus pertuzumab in combination with chemo- or endocrine therapy in addition with CDK4/6 inhibition in patients with HER2-positive and hormone-receptor positive metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-03-05.
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Affiliation(s)
- T Romashova
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - A Polasik
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - TWP Friedl
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - B Rack
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - M Tzschaschel
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - PA Fasching
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - F-A Taran
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - A Hartkopf
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - A Schneeweiss
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - V Mueller
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - A Bahriye
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - K Pantel
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - F Meier-Stiegen
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - P Wimberger
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - W Janni
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - T Fehm
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - J Huober
- University of Ulm, Ulm, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine University Hospital Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
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Ignatiadis M, Litiere S, Rothe F, Riethdorf S, Proudhon C, Fehm T, Aalders K, Forstbauer H, Fasching P, Brain E, Vuylsteke P, Guardiola E, Lorenz R, Pantel K, Tryfonidis K, Janni W, Piccart M, Sotiriou C, Rack B, Pierga JY. Abstract P1-13-09: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- M Ignatiadis
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - S Litiere
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - F Rothe
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - S Riethdorf
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - C Proudhon
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - T Fehm
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - K Aalders
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - H Forstbauer
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - P Fasching
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - E Brain
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - P Vuylsteke
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - E Guardiola
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - R Lorenz
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - K Pantel
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - K Tryfonidis
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - W Janni
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - M Piccart
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - C Sotiriou
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - B Rack
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - J-Y Pierga
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
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Banys-Paluchowski M, Fehm T, Janni W, Aktas B, Fasching PA, Kasimir-Bauer S, Milde-Langosch K, Pantel K, Rack B, Riethdorf S, Solomayer EF, Witzel I, Müller V. Abstract P2-02-15: Elevated serum RAS p21 is an independent prognostic factor in metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-02-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
An important component of the RAS signalling pathway, the RAS p21 oncogene, is frequently hyperactivated in breast cancer. Its expression in tumor tissue has been linked to poor clinical outcome. This study was designed to evaluate the clinical relevance of RAS p21 levels in peripheral blood in a large cohort of metastatic breast cancer patients.
Methods
251 patients with metastatic breast cancer were enrolled in this prospective, multicentre, non-randomized study conducted on behalf of the DETECT Study Group (Current Controlled Trials ISRCTN59722891). Blood samples were collected before start of first-line or later-line treatment. RAS p21 was determined using a sandwich-type ELISA immunoassay. For the determination of the cutoff, blood samples from age-matched healthy controls were analyzed. A value above 452 pg/ml was regarded as elevated (mean + 2 x SD). In the univariate survival analysis, two other cutoffs were considered as well (50th and 75th percentile of patients, i.e. 229 pg/ml and 320 pg/ml). Circulating tumor cells (CTCs) were detected using the CellSearch system.
Results
29 of 251 (12%) patients had RAS p21 levels above the cut-off level of 452 pg/ml. Clinical-pathological parameters, such as hormone receptor and HER2 status, line of therapy and CTC status, did not correlate with RAS p21 levels.
Patients' characteristics. TotalRAS p21 elevated n (%)p-valueOverall25129 (12%) ER status 0.611Negative7610 (13%) Positive17419 (11%) PR status 0.358Negative10114 (14%) Positive14915 (10%) HER2 status 0.873Negative14318 (13%) Positive769 (12%) Metastatic site 0.482Visceral9813 (13%) Bone352 (6%) Both11814 (12%) Extent of metastatic disease 0.768One site849 (11%) Multiple sites16720 (12%) Therapeutic setting 0.2491st-line988 (8%) 2nd-line6611 (17%) 3rd-line or more8610 (12%) Grading 0.604G151 (20%) G212913 (10%) G310314 (14%) Circulating tumor cells 0.101< 5 CTCs / 7.5 ml12217 (14%) ≥ 5 CTCs / 7.5 ml1219 (7%)
Elevated RAS p21 was significantly associated with shorter progression-free and overall survival in the univariate analysis (median PFS: 3.9 months [95%-CI: 1.8-6.0] for patients with elevated RAS p21 levels versus 8.5 months [95%-CI: 7.4-9.5] with non-elevated levels [p = 0.01]; median OS: 7.1 months [95%-CI: 0.3-14.2] versus not reached [p = 0.002], respectively). When RAS p21 cutoffs other than 452 pg/ml were considered, elevated RAS p21 was significantly associated with OS (p = 0.019 in case of 229 pg/ml; p = 0.003 in case of 320 pg/ml), but not with PFS. Classical clinical-pathological factors were included into a multivariate Cox regression analysis. In addition, factors previously shown to influence survival in a univariate analysis, such as serum HER2, CAIX and TIMP1, were included as well. In the multivariate analysis, RAS p21, presence of ≥ 5 CTCs per 7.5 ml blood, higher grading and higher line of therapy remained independent predictors of shorter OS.
Conclusions
This is the first study to address the clinical relevance of circulating RAS p21 in a large group of metastatic breast cancer patients. Patients with elevated levels of circulating RAS p21 had significantly worse clinical outcome. Hypothetically, these patients might benefit from therapeutic strategies targeting RAS pathway.
Citation Format: Banys-Paluchowski M, Fehm T, Janni W, Aktas B, Fasching PA, Kasimir-Bauer S, Milde-Langosch K, Pantel K, Rack B, Riethdorf S, Solomayer E-F, Witzel I, Müller V. Elevated serum RAS p21 is an independent prognostic factor in metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-02-15.
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Affiliation(s)
- M Banys-Paluchowski
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - T Fehm
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - W Janni
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - B Aktas
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - PA Fasching
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - S Kasimir-Bauer
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - K Milde-Langosch
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - K Pantel
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - B Rack
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - S Riethdorf
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - E-F Solomayer
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - I Witzel
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
| | - V Müller
- Marienkrankenhaus Hamburg, Hamburg, Germany; Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Essen, University of Duisburg-Essen, Essen, Germany; University Erlangen, Erlangen, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Saarland University Hospital, Homburg/Saar, Germany
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23
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Bailey DL, Pichler BJ, Gückel B, Antoch G, Barthel H, Bhujwalla ZM, Biskup S, Biswal S, Bitzer M, Boellaard R, Braren RF, Brendle C, Brindle K, Chiti A, la Fougère C, Gillies R, Goh V, Goyen M, Hacker M, Heukamp L, Knudsen GM, Krackhardt AM, Law I, Morris JC, Nikolaou K, Nuyts J, Ordonez AA, Pantel K, Quick HH, Riklund K, Sabri O, Sattler B, Troost EGC, Zaiss M, Zender L, Beyer T. Combined PET/MRI: Global Warming-Summary Report of the 6th International Workshop on PET/MRI, March 27-29, 2017, Tübingen, Germany. Mol Imaging Biol 2018; 20:4-20. [PMID: 28971346 PMCID: PMC5775351 DOI: 10.1007/s11307-017-1123-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The 6th annual meeting to address key issues in positron emission tomography (PET)/magnetic resonance imaging (MRI) was held again in Tübingen, Germany, from March 27 to 29, 2017. Over three days of invited plenary lectures, round table discussions and dialogue board deliberations, participants critically assessed the current state of PET/MRI, both clinically and as a research tool, and attempted to chart future directions. The meeting addressed the use of PET/MRI and workflows in oncology, neurosciences, infection, inflammation and chronic pain syndromes, as well as deeper discussions about how best to characterise the tumour microenvironment, optimise the complementary information available from PET and MRI, and how advanced data mining and bioinformatics, as well as information from liquid biomarkers (circulating tumour cells and nucleic acids) and pathology, can be integrated to give a more complete characterisation of disease phenotype. Some issues that have dominated previous meetings, such as the accuracy of MR-based attenuation correction (AC) of the PET scan, were finally put to rest as having been adequately addressed for the majority of clinical situations. Likewise, the ability to standardise PET systems for use in multicentre trials was confirmed, thus removing a perceived barrier to larger clinical imaging trials. The meeting openly questioned whether PET/MRI should, in all cases, be used as a whole-body imaging modality or whether in many circumstances it would best be employed to give an in-depth study of previously identified disease in a single organ or region. The meeting concluded that there is still much work to be done in the integration of data from different fields and in developing a common language for all stakeholders involved. In addition, the participants advocated joint training and education for individuals who engage in routine PET/MRI. It was agreed that PET/MRI can enhance our understanding of normal and disrupted biology, and we are in a position to describe the in vivo nature of disease processes, metabolism, evolution of cancer and the monitoring of response to pharmacological interventions and therapies. As such, PET/MRI is a key to advancing medicine and patient care.
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Affiliation(s)
- D L Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, and Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - B J Pichler
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard-Karls-Universität, Tübingen, Germany
| | - B Gückel
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - G Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany
| | - H Barthel
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Z M Bhujwalla
- Division of Cancer Imaging Research, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - S Biskup
- Praxis für Humangenetik Tübingen, Paul-Ehrlich-Str. 23, 72076, Tübingen, Germany
| | - S Biswal
- Molecular Imaging Program at Stanford (MIPS) and Bio-X, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - M Bitzer
- Department of Internal Medicine I, Eberhard-Karls University, Tübingen, Germany
| | - R Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R F Braren
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - C Brendle
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - K Brindle
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
- Department of Biochemistry, University of Cambridge, Tennis Court Road, Cambridge, CB2 1GA, UK
| | - A Chiti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Nuclear Medicine, Humanitas Research Hospital, Milan, Italy
| | - C la Fougère
- Department of Radiology, Nuclear Medicine and Clinical Molecular Imaging, Eberhard-Karls-Universität, Tübingen, Germany
| | - R Gillies
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33621, USA
| | - V Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's & St Thomas' Hospitals London, London, UK
| | - M Goyen
- GE Healthcare GmbH, Beethovenstrasse 239, Solingen, Germany
| | - M Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - G M Knudsen
- Neurobiology Research Unit, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A M Krackhardt
- III. Medical Department, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - I Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J C Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO, USA
| | - K Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - J Nuyts
- Nuclear Medicine & Molecular Imaging, KU Leuven, Leuven, Belgium
| | - A A Ordonez
- Department of Pediatrics, Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K Pantel
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H H Quick
- High Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany
| | - K Riklund
- Department of Radiation Sciences, Umea University, Umea, Sweden
| | - O Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - B Sattler
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - E G C Troost
- OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany
- Institute of Radiooncology-OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy, University Hospital Carl Gustav Carus and Medical Faculty of Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
| | - M Zaiss
- High Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - L Zender
- Department of Internal Medicine VIII, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Beyer
- QIMP Group, Center for Medical Physics and Biomedical Engineering General Hospital Vienna, Medical University Vienna, 4L, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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24
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Müller V, Thomssen C, Karakas C, Eustermann I, Ramirez Porras J, Coith C, Berger J, Löning T, Jänicke F, Pantel K. Quantitative Assessment of HER-2/Neu Protein Concentration in Breast Cancer by Enzyme-Linked Immunosorbent Assay. Int J Biol Markers 2018; 18:13-20. [PMID: 12699058 DOI: 10.1177/172460080301800103] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The HER-2/neu protein (p185) has become a promising target for antibody therapy in breast cancer. We tested the feasibility of a quantitative approach for HER-2/neu testing based on the analysis of tumor tissue extracts by an enzyme-linked immunosorbent assay (ELISA). Experimental design Tumor tissue extracts of primary human breast cancers (n=124) were prepared using a triton-based buffer. HER-2/neu concentration was quantified by ELISA. Paraffin-embedded tissue sections of the same tumors were analyzed by immunohistochemical staining applying the monoclonal HER-2/neu antibody TAB 250 (n=124) and by chromogenic in situ hybridization (CISH) (n=73). Results Concentrations of p185 in tissue extracts determined by ELISA varied from 1 to 927 ng per mg protein with a median of 25 ng/mg protein, whereas normal breast tissue showed values from 0.4 to 5.5 ng/mg with a median of 2.2 ng/mg (p<0.0001, Mann-Whitney U test). A significant correlation between p185 concentration and immunohistochemical staining was observed (p<0.0001, Kruskal-Wallis test). In addition, p185 concentration measured by ELISA was correlated with the degree of HER-2/neu gene amplification determined by CISH. HER-2/neu-amplified tumors had significantly higher p185 concentrations (median value 181 ng/mg protein) than non-amplified tumors (median value 20 ng/mg; p<0.0001, Mann-Whitney U test). Conclusions ELISA-based measurement of HER-2/neu protein concentration in breast cancer tissue extracts is feasible and provides quantitative results for p185 protein concentrations that correlate closely with HER-2/neu immunoscore and gene amplification.
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Affiliation(s)
- V Müller
- Department of Obstetrics and Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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25
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Witzel I, Thomssen C, Krenkel S, Wilczak W, Bubenheim M, Pantel K, Neumann R, Jänicke F, Müller V. Clinical Utility of Determination of HER-2/neu and EGFR Fragments in Serum of Patients with Metastatic Breast Cancer. Int J Biol Markers 2018; 21:131-40. [PMID: 17013794 DOI: 10.1177/172460080602100301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The growth factor receptors EGFR and HER-2/neu are targets for new treatment strategies and are of potential use as prognostic and predictive factors. However, the optimal method of determination in order to obtain clinically relevant information remains a source of controversy. Methods HER-2/neu and EGFR expression was examined by immunohistochemistry in primary tumors of patients with breast cancer. In addition, serum was tested for the extracellular domains of HER-2/neu (HER-2/neu ECD) and EGFR (sEGFR) before initiation of therapy for metastatic disease (n=76). The course of disease from the time of metastasis with regard to these parameters was evaluated by univariate and multivariate analyses. Results HER-2/neu ECD levels at the time of metastatic disease were correlated with HER-2/neu expression determined by immunohistochemistry from primary tumors (p=0.001). No correlation was observed between expression of EGFR in primary tumors and sEGFR serum levels. HER-2/neu ECD and sEGFR levels at the onset of metastatic disease did not show a significant impact on overall survival. Conclusions Determination of HER-2/neu ECD levels in the serum measured by ELISA at the onset of metastatic disease could offer an alternative to immunohistochemistry of the primary tumor since serum levels are correlated with protein expression in primary tumors. In contrast, no such correlation was observed for EGFR.
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Affiliation(s)
- I Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Germany
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26
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Gschwend JE, Albers P, Bögemann M, Goebell P, Heidenreich A, Klier J, König F, Machtens S, Pantel K, Thomas C. [Metastatic castration-resistant prostate cancer : Use of cabazitaxel taking into consideration current data]. Urologe A 2017; 57:34-39. [PMID: 29071398 DOI: 10.1007/s00120-017-0533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND At the 2016 ASCO annual meeting, new data from two randomized phase III studies concerning taxane-based chemotherapy as a treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC) were presented. OBJECTIVES The focus is on the clinical impact of these data. MATERIALS AND METHODS A group of German experts in the field of urogenital-oncologic expertise discussed the clinical impact with respect to the current data. RESULTS The study results support the current clinical data. They confirm the efficacy and safety of cabazitaxel beyond first-line therapy with docetaxel for patients with mCRPC. CONCLUSIONS Cabazitaxel is an important treatment option after docetaxel progression. With respect to the performance status of a patient, it is adequate to reduce the dosage to 20 mg/m2 cabazitaxel.
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Affiliation(s)
- J E Gschwend
- Klinik und Poliklinik für Urologie, Universitätsklinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - P Albers
- Urologische Klinik und Poliklinik, Universität Düsseldorf, Düsseldorf, Deutschland
| | - M Bögemann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - P Goebell
- Urologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Heidenreich
- Klinik und Poliklinik für Urologie, Universitätsklinik Köln, Köln, Deutschland
| | - J Klier
- Urologie Bayenthal, Gemeinschaftspraxis Köln, Köln, Deutschland
| | - F König
- ATURO, Praxis für Urologie, Berlin, Deutschland
| | - S Machtens
- Klinik für Urologie und Kinderurologie, Marien-Krankenhaus gGmbH Bergisch Gladbach, Bergisch Gladbach, Deutschland
| | - K Pantel
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - C Thomas
- Urologische Klinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
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27
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Cheng J, Surowy H, Wallwiener M, Holland-Letz T, Cuk K, Schott S, Trumpp A, Pantel K, Sohn C, Schneeweiss A, Burwinkel B. Cell-free circulating DNA as independent prognostic markers in metastatic breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Wroblewski M, Bauer R, Cubas Córdova M, Udonta F, Ben-Batalla I, Legler K, Hauser C, Egberts J, Janning M, Velthaus J, Schulze C, Pantel K, Bokemeyer C, Loges S. Mast cells decrease efficacy of anti-angiogenic therapy by secreting matrix-degrading granzyme B. Nat Commun 2017; 8:269. [PMID: 28814715 PMCID: PMC5559596 DOI: 10.1038/s41467-017-00327-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/20/2017] [Indexed: 02/03/2023] Open
Abstract
Resistance towards VEGF-centered anti-angiogenic therapy still represents a substantial clinical challenge. We report here that mast cells alter the proliferative and organizational state of endothelial cells which reduces the efficacy of anti-angiogenic therapy. Consequently, absence of mast cells sensitizes tumor vessels for anti-angiogenic therapy in different tumor models. Mechanistically, anti-angiogenic therapy only initially reduces tumor vessel proliferation, however, this treatment effect was abrogated over time as a result of mast cell-mediated restimulation of angiogenesis. We show that mast cells secrete increased amounts of granzyme b upon therapy, which mobilizes pro-angiogenic laminin- and vitronectin-bound FGF-1 and GM-CSF from the tumor matrix. In addition, mast cells also diminish efficacy of anti-angiogenic therapy by secretion of FGF-2. These pro-angiogenic factors act beside the targeted VEGFA–VEGFR2-axis and reinduce endothelial cell proliferation and angiogenesis despite the presence of anti-angiogenic therapy. Importantly, inhibition of mast cell degranulation with cromolyn is able to improve efficacy of anti-angiogenic therapy. Thus, concomitant mast cell-targeting might lead to improved efficacy of anti-angiogenic therapy. Resistance towards VEGF-centered anti-angiogenic therapy is an important clinical challenge. Here, the authors show that mast cells mediate resistance to anti-angiogenetic inhibitors by altering the proliferative and organizational state of endothelial cells through mobilization of FGF-1 and GM-CSF from the tumor matrix and secretion of FGF-2.
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Affiliation(s)
- M Wroblewski
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - R Bauer
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - M Cubas Córdova
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - F Udonta
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - I Ben-Batalla
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - K Legler
- Division of Molecular Oncology, Institute for Experimental Cancer Research, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 25105, Kiel, Germany.,Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - C Hauser
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 25105, Kiel, Germany
| | - J Egberts
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 25105, Kiel, Germany
| | - M Janning
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - J Velthaus
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - C Schulze
- Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf, Falkenried 94, 20251, Hamburg, Germany
| | - K Pantel
- Institute of Tumor Biology, Center of Experimental Medicine University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - C Bokemeyer
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - S Loges
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. .,Institute of Tumor Biology, Center of Experimental Medicine University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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29
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Deutsch TM, Riethdorf S, Stefanovic S, Hartkopf AD, Taran FA, Trumpp A, Brucker SY, Schütz F, Pantel K, Schneeweiss A, Wallwiener M. Zirkulierende Tumorzellen zur individuellen Therapiekontrolle beim metastasierten Mammakarzinom. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- TM Deutsch
- Universitäts-Frauenklinik Heidelberg, Heidelberg
- Nationales Centrum für Tumoerkrankungen (NCT), Heidelberg, Heidelberg
| | - S Riethdorf
- Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - S Stefanovic
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - AD Hartkopf
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - FA Taran
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - A Trumpp
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - SY Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - F Schütz
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - K Pantel
- Nationales Centrum für Tumoerkrankungen (NCT), Heidelberg, Heidelberg
| | - A Schneeweiss
- Nationales Centrum für Tumoerkrankungen (NCT), Heidelberg, Heidelberg
| | - M Wallwiener
- Universitäts-Frauenklinik Heidelberg, Heidelberg
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30
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Jauch SF, Riethdorf S, Schönfisch B, Sprick MR, Schütz F, Hartkopf AD, Taran FA, Nees J, Deutsch TM, Saini M, Becker L, Burwinkel B, Brucker SY, Pantel K, Sohn C, Jäger D, Trumpp A, Schneeweiss A, Wallwiener M. Zur prognostischen Relevanz des CTC-Status bei Progress des metastasierten Mammakarzinoms. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- SF Jauch
- Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Heidelberg
- Universitäts-Frauenklinik Heidelberg, Heidelberg
- The Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg
- Abteilung Stammzellen und Krebs, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - S Riethdorf
- Institut für Tumorbiologie N27, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | | | - MR Sprick
- The Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg
- Abteilung Stammzellen und Krebs, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - F Schütz
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - AD Hartkopf
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - FA Taran
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - J Nees
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - TM Deutsch
- Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Heidelberg
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - M Saini
- The Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg
- Abteilung Stammzellen und Krebs, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - L Becker
- The Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg
- Abteilung Stammzellen und Krebs, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - B Burwinkel
- Abteilung Molekularbiologie des Mammakarzinoms, Universitäts-Frauenklinik Heidelberg, Heidelberg
- Abteilung Molekulare Epidemiologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - SY Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - K Pantel
- Institut für Tumorbiologie N27, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - C Sohn
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - D Jäger
- Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Heidelberg
| | - A Trumpp
- The Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg
- Abteilung Stammzellen und Krebs, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Heidelberg
| | - M Wallwiener
- Universitäts-Frauenklinik Heidelberg, Heidelberg
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31
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Jaeger BAS, Neugebauer J, Andergassen U, Melcher C, Schochter F, Mouarrawy D, Ziemendorff G, Clemens M, V Abel E, Heinrich G, Schueller K, Schneeweiss A, Fasching P, Beckmann MW, Scholz C, Friedl TWP, Friese K, Pantel K, Fehm T, Janni W, Rack B. The HER2 phenotype of circulating tumor cells in HER2-positive early breast cancer: A translational research project of a prospective randomized phase III trial. PLoS One 2017; 12:e0173593. [PMID: 28586395 PMCID: PMC5460789 DOI: 10.1371/journal.pone.0173593] [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: 05/25/2016] [Accepted: 02/22/2017] [Indexed: 12/14/2022] Open
Abstract
Background HER2 is one of the predominant therapeutic targets in breast cancer. The metastatic selection process may lead to discrepancies between the HER2 status of the primary tumor and circulating tumor cells (CTCs). This study analyzed the HER2 status of CTCs in patients with HER2-positive primary breast cancer at the time of diagnosis. Aim of the study was to assess potential discordance of HER2 status between primary tumor and CTCs, as this may have important implications for the use of HER2-targeted therapy. Methods The number and HER2 status of CTCs out of 30ml peripheral blood were assessed in 642 patients using the CellSearch System (Janssen Diagnostics, USA). The cutoff for CTC positivity was the presence of at least 1 CTC, and the cutoff for HER2 positivity of CTCs was the presence of at least 1 CTC with a strong HER2 staining. Results 258 (40.2%) of the 642 patients were positive for CTCs (median 2; range 1–1,689). 149 (57.8%) of these 258 patients had at least 1 CTC with strong HER2 staining. The presence of HER2-positive CTCs was not associated with tumor size (p = 0.335), histopathological grading (p = 0.976), hormone receptor status (ER: p = 0.626, PR: p = 0.263) or axillary lymph node involvement (p = 0.430). Overall, 83 (32.2%) of the CTC-positive patients exclusively had CTCs with strong HER2 staining, whereas 31 (12.0%) had only CTCs with negative HER2 staining. Within-sample variation in the HER2 status of CTCs was found in 86 (57.8%) of the 149 patients with more than 1 CTC. Conclusion This study demonstrated that discordance between the HER2 expression of CTCs and that of the primary tumor frequently occurs in early breast cancer. Future follow-up evaluation will assess whether this discrepancy may contribute to trastuzumab resistance.
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Affiliation(s)
- B A S Jaeger
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Hospital, Duesseldorf, Germany
| | - J Neugebauer
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - U Andergassen
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - C Melcher
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Hospital, Duesseldorf, Germany
| | - F Schochter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - D Mouarrawy
- Hospital Bremerhaven-Reinkenheide, Bremerhaven, Germany
| | | | - M Clemens
- Krankenanstalten Mutterhaus der Borromäerinnen, Trier, Germany
| | - E V Abel
- Hospital Schwäbisch Gmuend, Mutlangen, Germany
| | - G Heinrich
- Praxis Dr. Heinrich, Fuerstenwalde, Germany
| | - K Schueller
- Stat-up Statistische Beratung und Dienstleistung, Munich, Germany
| | - A Schneeweiss
- Department of Gynecology and Obstetrics in the National Center for Tumor Disease, University Hospital Heidelberg, Heidelberg, Germany
| | - P Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Ch Scholz
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - T W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - K Friese
- Hospital Bad Trissl, Bad Trissl, Germany
| | - K Pantel
- Institute for Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Hospital, Duesseldorf, Germany
| | - W Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - B Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Hospital, Munich, Germany
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32
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Polasik A, Schramm A, Friedl TWP, Rack B, Trapp E, Tzschaschel M, Fasching PA, Taran FA, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Pantel K, Meier-Stiegen F, Wimberger P, Janni W, Fehm T. Abstract OT1-02-04: The DETECT V-study – Comparison of dual HER2-targeted therapy with trastuzumab plus pertuzumab in combination with chemo- or endocrine therapy in patients with HER2-positive and hormone-receptor positive metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-02-04] [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: 11/16/2022]
Abstract
Abstract
Background: Maintenance of quality of life (QoL) is one of the main aims of treatment of incurable diseases such as metastatic breast cancer (MBC). In patients with HER2-positive MBC, taxan-based chemotherapy in combination with dual HER2 targeted therapy with trastuzumab and pertuzumab has shown promising efficacy results in terms of prolonged survival. However, cytostatic treatment is often accompanied by adverse events of grade 3 or higher, seriously impacting the patients' QoL. In patients with HER2-positive and hormone-receptor positive MBC, the combination of trastuzumab with aromatase inhibitors was shown to be a safe and effective treatment option. The synergistic combination of dual HER2-targeted therapy with trastuzumab and pertuzumab plus endocrine therapy might offer an even better treatment option for these patients. DETECT V is the first prospective randomized phase III clinical trial comparing the safety and efficacy of the dual HER2-targeted therapy in combination with either endocrine therapy or chemotherapy.
Trial design and eligibility criteria: Women with HER2-positive and hormone-receptor positive MBC with first to third line therapy are 1:1 randomized either to a dual HER2-targeted therapy with Pertuzumab and Trastuzumab plus endocrine therapy or to the dual HER2-targeted therapy plus chemotherapy.
Specific aims: The primary objective of this study is to compare the safety and QoL in both arms, as assessed by the occurrence of AEs during the treatment period. We developed a modified adverse event score - including all adverse events grade 3 or higher, except neutropenia, which is included only if rated grade 4, and alopecia, rash, hand-foot-syndrome and peripheral neuropathy which are included if rated grade 2 or higher – in order to better reflect the clinical, physiological and psychological impact of AEs on patients' QoL. Key secondary endpoint, besides the efficacy endpoints progression free survival (PFS) and overall survival, is to compare quality-adjusted survival (QAS), as measured using the quality-adjusted time without symptoms and toxicity (Q-TWiST) method, between both treatment arms. QAS as measured using the Q-TWiST method provides a single metric value that is a composite measure of quantity of survival time and quality of survival as assessed by the patients themselves. Q-TWiST analyses account for possible trade-offs between quantity and quality of life (e.g. prolonged time to progression at the cost of higher toxicity, which adversely affects QoL), and provide an excellent tool to evaluate whether two treatment options differ with regard to the overall perceived value to the patients.
Translational research projects focus on Circulating Tumor Cell(CTC)-enumeration (the presence of CTCs is not obligatory in DETECT V), prognostic role of CTC dynamics, and the assessment of marker expression on CTCs in order to calculate an endocrine responsiveness score which will be evaluated regarding its suitability to predict treatment success.
Contact: For further information on the DETECT V study please contact www.detect-studien.de or studienzentrale.ufk@uniklinik-ulm.de.
Citation Format: Polasik A, Schramm A, Friedl TWP, Rack B, Trapp E, Tzschaschel M, Fasching PA, Taran F-A, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Pantel K, Meier-Stiegen F, Wimberger P, Janni W, Fehm T. The DETECT V-study – Comparison of dual HER2-targeted therapy with trastuzumab plus pertuzumab in combination with chemo- or endocrine therapy in patients with HER2-positive and hormone-receptor positive metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-02-04.
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Affiliation(s)
- A Polasik
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - A Schramm
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - TWP Friedl
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - B Rack
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - E Trapp
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - M Tzschaschel
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - PA Fasching
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - F-A Taran
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - A Hartkopf
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - A Schneeweiss
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - V Müller
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - B Aktas
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - K Pantel
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - F Meier-Stiegen
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - P Wimberger
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - W Janni
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
| | - T Fehm
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität; Du¨sseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Germany
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Janni W, Rack B, Häberle L, Friedl TWP, Tesch H, Lorenz R, Jäger B, Fehm T, Müller V, Schneeweiß A, Lichtenegger W, Blohmer J, Beckmann MW, Scholz C, Pantel K, Trapp E, Fasching PA. Abstract P2-05-02: Active surveillance with a combination of tumor marker CA27.29 and detection of circulating tumor cells two year after primary diagnosis strongly predicts subsequent prognosis. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-02] [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: 11/16/2022]
Abstract
Abstract
Introduction
The prognosis of patients with early breast cancer is commonly estimated by prognostic factors obtained at the time of the initial diagnosis. However, patients and physicians alike are seeking for factors evaluating the prognosis years thereafter during follow-up. The identification of a patient group with an unfavourable prognosis could lead to secondary treatment intervention, potentially improving outcome. Aim of the study was to assess the added prognostic value of circulating tumor cells (CTCs) and CA27.29 beyond established predictors.
Materials and Methods
Patients of the phase III SUCCESS-A study were included into this analysis (n=1005). SUCCESS-A is a chemotherapy study for high risk patients with a comprehensive translational research program, which included the determination of CTCs and CA27.29 two years after the initial diagnosis. A Cox regression model with disease-free survival (DFS) as outcome and well-established predictors (age, BMI, pT, pN, histology, grading, ER, PR, Her2neu) was compared with an extended Cox model with the well-established predictors and additionally CTC (>0 versus 0) two years after randomization, and CA27.29 (in U/mL) measured after chemotherapy and again two years after randomization using a likelihood ratio test. In case of significance, the extended model was applied to predict for each patient the risk of disease recurrence within the next 12 months (0 to 100%). Cross-validated AUC, sensitivity and specificity values were determined to assess clinical usefulness of risk prediction.
Results
The markers CA27.29 and CTC were both significantly associated with subsequent prognosis (p < 0.000001). The detection of CTCs increased the risk of subsequent DFS events (HR=2.14, 95%CI: 1.31-3.48), while CA27.29 after two years increased the risk for DFS events with a HR of 1.12 per U/mL increase (95%CI: 1.09-1.15). The combination of the two markers significantly empowered the prognostic relevance, with a HR of 6.64 for patients with CTCs and an elevated CA27.29 by 10 U/mL compared to patients without CTCs and without CA27.29 elevation. The mean risk of disease recurrence in the third year after randomization was 2.38%. Discrimination of patients with and without disease recurrence based on risk prediction from the extended Cox model (AUC: 0.80) was better than discrimination based on the clinical model without the markers CTC and CA27.29 (AUC: 0.64). Sensitivity with regard to decision thresholds 1%, 2%, 3%, and 4% predicted risk was 0.89, 0.77, 0.65, and 0.55, respectively. The corresponding specificity was 0.42, 0.69, 0.81, and 0.88.
Discussion
Both CTCs and CA29.27 values determined 2 years after primary diagnosis are clinically relevant predictors of subsequent prognosis for those patients. This study extends evidence for active surveillance of breast cancer survivors. Identifying a group of women with a high recurrence risk after two years could be the basis for the development of secondary adjuvant treatment.
Citation Format: Janni W, Rack B, Häberle L, Friedl TWP, Tesch H, Lorenz R, Jäger B, Fehm T, Müller V, Schneeweiß A, Lichtenegger W, Blohmer J, Beckmann MW, Scholz C, Pantel K, Trapp E, Fasching PA. Active surveillance with a combination of tumor marker CA27.29 and detection of circulating tumor cells two year after primary diagnosis strongly predicts subsequent prognosis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-02.
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Affiliation(s)
- W Janni
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - B Rack
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - L Häberle
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - TWP Friedl
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - H Tesch
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - R Lorenz
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - B Jäger
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - T Fehm
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - V Müller
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - A Schneeweiß
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - W Lichtenegger
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - J Blohmer
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - MW Beckmann
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - C Scholz
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - K Pantel
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - E Trapp
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - PA Fasching
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
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Polasik A, Schramm A, Friedl TWP, Rack B, Trapp E, Fasching PA, Taran FA, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Pantel K, Meier-Stiegen F, Wimberger P, Janni W, Fehm T. Abstract OT3-04-02: DETECT III and IV – Individualized CTC-based therapy of metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot3-04-02] [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: 11/16/2022]
Abstract
Abstract
Background: Circulating tumor cells (CTCs) are found in patients with early and metastatic breast cancer (MBC), and both their prognostic and predictive value has been described already. There is growing evidence that CTC phenotype may differ from the primary tumor. However, CTC targeted therapy is not used in clinical routine, and treatment decisions often still are based on the primary tumor's phenotype without considering CTC-characteristics. The aim of the DETECT studies is to investigate and evaluate the role of presence and phenotype of CTC for guiding therapeutic decisions in women with HER2-negative MBC.
Trial design and eligibility criteria: In a joint screening for DETECT III and IV, women with HER2-negative MBC are tested for CTCs and their HER2-phenotype. CTC detection is performed by the FDA-approved CellSearch System® (Janssen Diagnostics, Raritan, USA).
Patients with HER2-positive CTCs are randomized in the multicenter Phase III study DETECT III to a physician's choice chemo- or endocrine therapy with or without additional HER2-targeted treatment with lapatinib.
Women with only HER2-negative CTCs are recruited to the multicenter open-label phase II study DETECT IV. Postmenopausal women with hormone-receptor positive MBC are treated with everolimus and a physician's choice endocrine therapy in DETECT IVa. Patients with hormone-receptor positive MBC and an indication for chemotherapy and patients with triple-negative MBC receive mono-chemotherapy with eribulin in DETECT IVb.
Treatment efficacy will be evaluated based on the early available CTC clearance rate (in DETECT III and DETECT IVa) and progression-free survival (in DETECT IVb) respectively, as the primary endpoint; secondary objectives will be to estimate disease control rate, progression-free (DETECT III and IVa) and overall survival, toxicity and tolerability of treatments with lapatinib, everolimus and eribulin, and quality of life.
Specific aims: Changes in CTC-dynamics during therapy and their HER2-phenotype may influence following therapy decisions. The DETECT studies evaluate the prognostic and predictive role of CTCs as well as the efficacy of CTC based therapy to enable the establishment of a more personalized therapy for patients with MBC that might lead to prolonged progressive free survival and/or improved quality of life. The accompanying translational research programs investigate various markers for molecular characterization of CTCs and prediction of therapy response.
Present accrual and target accrual: More than 1550 patients with HER2-negative MBC have already been screened within the DETECT study program. Thus, it is the worldwide largest study concept with therapy decisions resulting from CTC-testing and CTC-phenotypization.
Contact: For further information on the DETECT study program please contact www.detect-studien.de or studienzentrale.ufk@uniklinik-ulm.de.
Citation Format: Polasik A, Schramm A, Friedl TWP, Rack B, Trapp E, Fasching PA, Taran F-A, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Pantel K, Meier-Stiegen F, Wimberger P, Janni W, Fehm T. DETECT III and IV – Individualized CTC-based therapy of metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-04-02.
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Affiliation(s)
- A Polasik
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - A Schramm
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - TWP Friedl
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - B Rack
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - E Trapp
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - PA Fasching
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - F-A Taran
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - A Hartkopf
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - A Schneeweiss
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - V Müller
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - B Aktas
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - K Pantel
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - F Meier-Stiegen
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - P Wimberger
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - W Janni
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
| | - T Fehm
- Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany; University Hospital Heidelberg, Ulm, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-Universität, Düsseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany
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Tzschaschel MLJ, Rack B, Andergassen U, Friedl TWP, Schneeweiss A, Mueller V, Tanja F, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Soeling U, Polasik A, Alunni-Fabbroni M, Trapp EK, Mahner S, Schindlbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W. Abstract P1-01-03: Dynamics of circulating tumor cells during the course of chemotherapy and prognostic relevance across molecular subtypes in high-risk early breast cancer patients – Results from the adjuvant SUCCESS A trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The presence of circulating tumor cells (CTCs) before chemotherapy is known to be associated with reduced disease free survival (DFS) and overall survival (OS) in early breast cancer (EBC). In addition, recent findings suggest that CTCs persisting after adjuvant chemotherapy indicate poor prognosis. In an explorative analysis of the SUCCESS A trial, we evaluated the prognostic relevance of changes in CTC counts during the course of adjuvant chemotherapy across molecular subtypes to assess whether the prognostic role of persisting CTCs varies according to tumor biology.
Methods: The SUCCESS A trial is a phase III study, where patients with high-risk EBC (stage pN1-3 or pT2-4 or grade 3 or age ≤ 35 or hormone-receptor negative) were randomized to adjuvant chemotherapy with 3 cycles of epirubicin-fluorouracil-cyclophosphamide followed by either 3 cycles of docetaxel or 3 cycles of gemcitabine-docetaxel. CTC enumeration was performed before and after chemotherapy using the FDA-approved CellSearch® System (Janssen Diagnostics, LLC), and CTC positivity was defined as ≥ 1 CTC in 23 ml blood. Molecular subtypes were defined as luminal A like (hormone-receptor positive, grading 1 or 2), luminal B like (hormone-receptor positive, grading 3), triple-negative or HER2-positive. Patient outcome in terms of DFS and OS was analyzed using univariate log-rank tests and Cox regression models (median follow-up time 65.2 months).
Results: Data on both molecular subtypes and CTC status before and after chemotherapy were available for 1485 (39.6%) of 3754 patients randomized. This cohort contained 577 (38.9%) luminal A like, 236 (15.9%) luminal B like, 379 (25.5%) HER2-positive and 293 (19.7%) triple negative tumors. Overall, 917 (61.8%) patients were CTC negative before and after chemotherapy (neg/neg), 260 (17.5%) patients had a negative CTC status before and a positive CTC status after chemotherapy (neg/pos), 229 (15.4%) patients converted from positive to negative CTC status (pos/neg), and 79 (5.3%) patients were positive for CTCs at both time points (pos/pos). There were significant differences in DFS and OS among these four groups in patients with luminal A like tumors (log rank test, both p < 0.003) and patients with luminal B like tumors (log rank test, both p < 0.001). In both patients with luminal A like or luminal B like tumors, persistently CTC positive patients had the worst outcome (relative to persistently CTC-negative patients) in terms of DFS and OS. In contrast to luminal-like tumors, no significant differences with regard to DFS or OS were found among the four groups (neg/neg, neg/pos, pos/neg, pos/pos) in patients with HER2-positive or triple-negative tumors (log rank test, all p > 0.13).
Conclusion: The presence of CTCs both before and after adjuvant chemotherapy was associated with poor survival in luminal A like and luminal B like tumors, but not in HER2-positive or triple-negative tumors. Further research is needed to evaluate the effect of chemotherapy on CTC prevalence in different molecular subtypes of EBC.
Citation Format: Tzschaschel MLJ, Rack B, Andergassen U, Friedl TWP, Schneeweiss A, Mueller V, Tanja F, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Soeling U, Polasik A, Alunni-Fabbroni M, Trapp EK, Mahner S, Schindlbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W. Dynamics of circulating tumor cells during the course of chemotherapy and prognostic relevance across molecular subtypes in high-risk early breast cancer patients – Results from the adjuvant SUCCESS A trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-01-03.
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Affiliation(s)
- MLJ Tzschaschel
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - B Rack
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - U Andergassen
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - TWP Friedl
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - A Schneeweiss
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - V Mueller
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - F Tanja
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - K Pantel
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - J Gade
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - R Lorenz
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - M Rezai
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - H Tesch
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - U Soeling
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - A Polasik
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - M Alunni-Fabbroni
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - EK Trapp
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - S Mahner
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - C Schindlbeck
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - W Lichtenegger
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - MW Beckmann
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - PA Fasching
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - W Janni
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
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Tzschaschel M, Rack B, Andergassen U, Trapp E, Alunni-Fabbroni M, Schneeweiss A, Müller V, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Söling U, Fehm T, Mahner S, Schindelbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W, Friedl TWP. Prognostischer Effekt von Änderungen der Anzahl zirkulierender Tumorzellen unter Chemotherapie bei Patientinnen mit frühem Mammakarzinom (EBC). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592733] [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: 10/20/2022] Open
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Polasik A, Schramm A, Friedl TW, Rack B, Trapp E, Fasching PA, Taran FA, Hartkopf A, Schneeweiß A, Müller V, Aktas B, Pantel K, Meier-Stiegen F, Wimberger P, Janni W, Fehm T. Das DETECT-Studienkonzept – Therapie des metastasierten Mammakarzinoms auf der Grundlage zirkulierender Tumorzellen. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592965] [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: 10/20/2022] Open
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Jäger B, Andergassen U, Neugebauer J, Alunni-Fabbroni M, Melcher C, Hagenbeck C, Albrecht S, Lorenz R, Decker T, Heinrich G, Fehm T, Schneeweiss A, Beckmann MW, Pantel K, Friese K, Fasching PA, Friedl TWP, Janni W, Rack BK. Persistenz zirkulierender Tumorzellen direkt nach und zwei Jahre nach adjuvanter Chemotherapie bei Patientinnen mit früher Brustkrebserkrankung – Ergebnisse der SUCCESS Studien. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593026] [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: 10/20/2022] Open
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Polasik A, Schramm A, Friedl TW, Huober J, Janni W, Rack B, Alunni-Fabbroni M, Fasching PA, Taran FA, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Krawczyk N, Pantel K, Fehm T. Prädiktive Faktoren für die Diskordanz des HER2-Phänotyps zwischen Primärtumor und zirkulierenden Tumorzellen beim metastasierten Mammakarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592698] [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: 10/20/2022] Open
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40
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de Wit R, Fizazi K, Efstathiou E, Dittamore R, Hitier S, Pantel K, Sternberg C, Tombal B, Wülfing C, de Bono J. CARD: A randomized phase 4 trial comparing cabazitaxel and an androgen receptor (AR)-targeted agent in men with metastatic castration-resistant prostate cancer (mCRPC) progressing after docetaxel and an alternative AR-targeted agent. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.50] [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: 11/13/2022] Open
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41
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Pantano F, Croset M, Driouch K, Iuliani M, Fioramonti M, Santini D, Tonini G, Bednarz-Knoll N, Pantel K, Clézardin P. Integrin a5 is an independent prognosis factor and a potential therapeutic target for breast cancer bone metastasis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.06] [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: 11/13/2022] Open
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42
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Ghadban T, Miro JT, Trump F, Tsui TY, Uzunoglu FG, Reeh M, Gebauer F, Bachmann K, Wellner U, Kalinin V, Pantel K, Izbicki JR, Vashist YK. Diverse prognostic value of the GTn promoter polymorphism in squamous cell and adeno carcinoma of the oesophagus. Clin Genet 2016; 90:343-50. [PMID: 26916598 DOI: 10.1111/cge.12765] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/05/2016] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
The basal transcription of heme oxygenase-1 (HO-1) regulation is dependent upon a GT repeat germ line polymorphism (GTn) in the promoter of the HO-1 gene. We determined the prognostic value of HO-1 promoter polymorphism on the natural postoperative course of complete resected oesophageal cancer. Genomic DNA from 297 patients was amplified by polymerase chain reaction and sequenced. The results were correlated with clinicopathological parameters, disseminated tumour cells in bone marrow (DTC) and clinical outcome. Depending on short allele with <25 and long allele with ≥25, GTn repeats three genotypes (SS, SL and LL) were defined. A diverse role of GTn was evident in squamous cell carcinoma (SCC) and adenocarcinoma (AC). In SCC, the SS genotype presented less advanced tumours with lower rate DTC in bone marrow and relapse compared with L-allele carriers. In contrast, AC patients with the SS genotype displayed a complete opposing tumour characteristic. The disease-free (DFS) and overall survival (OS) in SCC patients was markedly reduced in LL genotypes (p < 0.001). In AC contrarily the SS genotype patients displayed the worst DFS and OS (p < 0.001). GTn is a strong prognostic factor with diverse prognostic value for recurrence and survival in AC and SCC.
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Affiliation(s)
- T Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J T Miro
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Trump
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Y Tsui
- Department of Surgery, University Medical College Rostock, Rostock, Germany
| | - F G Uzunoglu
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Gebauer
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Bachmann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U Wellner
- Clinic for Surgery, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - V Kalinin
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y K Vashist
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Hvichia GE, Parveen Z, Wagner C, Janning M, Quidde J, Stein A, Müller V, Loges S, Neves RPL, Stoecklein NH, Wikman H, Riethdorf S, Pantel K, Gorges TM. A novel microfluidic platform for size and deformability based separation and the subsequent molecular characterization of viable circulating tumor cells. Int J Cancer 2016; 138:2894-904. [PMID: 26789903 PMCID: PMC5069649 DOI: 10.1002/ijc.30007] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [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: 09/22/2015] [Revised: 12/04/2015] [Accepted: 12/16/2015] [Indexed: 12/14/2022]
Abstract
Circulating tumor cells (CTCs) were introduced as biomarkers more than 10 years ago, but capture of viable CTCs at high purity from peripheral blood of cancer patients is still a major technical challenge. Here, we report a novel microfluidic platform designed for marker independent capture of CTCs. The Parsortix™ cell separation system provides size and deformability-based enrichment with automated staining for cell identification, and subsequent recovery (harvesting) of cells from the device. Using the Parsortix™ system, average cell capture inside the device ranged between 42% and 70%. Subsequent harvest of cells from the device ranged between 54% and 69% of cells captured. Most importantly, 99% of the isolated tumor cells were viable after processing in spiking experiments as well as after harvesting from patient samples and still functional for downstream molecular analysis as demonstrated by mRNA characterization and array-based comparative genomic hybridization. Analyzing clinical blood samples from metastatic (n = 20) and nonmetastatic (n = 6) cancer patients in parallel with CellSearch(®) system, we found that there was no statistically significant difference between the quantitative behavior of the two systems in this set of twenty six paired separations. In conclusion, the epitope independent Parsortix™ system enables the isolation of viable CTCs at a very high purity. Using this system, viable tumor cells are easily accessible and ready for molecular and functional analysis. The system's ability for enumeration and molecular characterization of EpCAM-negative CTCs will help to broaden research into the mechanisms of cancer as well as facilitating the use of CTCs as "liquid biopsies."
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Affiliation(s)
| | - Z Parveen
- ANGLE North America Inc, Philadelphia, PA
| | - C Wagner
- ANGLE North America Inc, Philadelphia, PA
| | - M Janning
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Hematology/Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, Hamburg, Germany
| | - J Quidde
- Department of Hematology/Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, Hamburg, Germany
| | - A Stein
- Department of Hematology/Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, Hamburg, Germany
| | - V Müller
- Gynecology Department and Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Loges
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Hematology/Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, Hamburg, Germany
| | - R P L Neves
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - N H Stoecklein
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - H Wikman
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Riethdorf
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T M Gorges
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wallwiener M, Deutsch TM, Riethdorf S, Hartkopf AD, Taran FA, Trumpp A, Brucker S, Schütz F, Rom J, Pantel K, Schneeweiss A. Abstract P2-02-06: Impact of apoptotic circulating tumor cells in metastatic breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-02-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Circulating tumor cells (CTC) are a heterogeneous cell population and an independent negative prognostic factor for progression-free (PFS) and overall survival (OS) in patients with metastatic breast cancer (MBC). The study aimed to prospectively assess CTC status for the subtypes apoptotic CTC (aCTC) and intact CTC (iCTC) at baseline (CTCBL) and after one cycle of a new line of systemic therapy (CTC1C). Changes from CTCBL to CTC1C (CTC kinetics, CTCKIN) were evaluated for their utility in predicting response, progression-free (PFS) and overall survival (OS).
Methods
423 MBC patients were included in a prospective trial prior to a new regimen of treatment. Intact and apoptotic CTC were analyzed at baseline (CTCBL) and after one cycle of systemic therapy (CTC1C) using CellSearch™ (Veridex) and morphologic criteria. Samples with ≥5 CTC/7.5ml blood were regarded as positive. Therapy response was assessed using the RECIST-criteria on three-monthly radiological controls. CTCKIN were characterized by ≥25% change from CTCBL to CTC1C to differentiate stable, increased and decreased CTC kinetic.
Results
35% of patients were iCTCBL-positive and 28% aCTCBL-positive at baseline (CTCBL). PFS and OS differ significantly between the iCTCBL-positive and the iCTCBL-negative group (PFS 4.5 vs. 8.0; OS 12.5 vs. 27.2 (months)). Positive aCTC in conjunction with positive iCTCBL at baseline has worst prognostic impact (PFS 6.3; OS 8.7).
Regarding the CTCKIN (BL to 1C), aCTC-decrease (≥25%) is a positive prognostic factor compared to aCTC-stable and aCTC-increase (PFS 7.6 vs. 3.7; 3.3 and OS 21.0 vs. 4.8; 5.7). Decreasing aCTCKIN shows favorable prognostic impact versus decreasing iCTCKIN (PFS 7.6 vs. 5.9 and OS 21.0 vs 16.4).
Conclusion
Elevated aCTC levels at baseline have an unfavorable prognostic impact on both OS and PFS in conjunction with elevated iCTC. Additionally, the decrease of aCTC is a relevant prognostic value for systemic therapy response. aCTCKIN allows better differentiation for therapy response in patients with positive CTC-status at baseline. Differentiated enumeration of intact and apoptotic CTC should be considered in clinical application.
Citation Format: Wallwiener M, Deutsch TM, Riethdorf S, Hartkopf AD, Taran F-A, Trumpp A, Brucker S, Schütz F, Rom J, Pantel K, Schneeweiss A. Impact of apoptotic circulating tumor cells in metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-02-06.
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Affiliation(s)
- M Wallwiener
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - TM Deutsch
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Riethdorf
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - AD Hartkopf
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F-A Taran
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Trumpp
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Brucker
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Schütz
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Rom
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Pantel
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Schneeweiss
- University of Heidelberg, Heidelberg, Baden Württemberg, Germany; National Center for Tumor Diseases, Heidelberg, Baden Württemberg, Germany; University of Tuebingen, Tuebingen, Baden Württemberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Baden Württemberg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Janni W, Schramm A, Friedl TWP, Schochter F, Huober J, Rack B, Alunni-Fabbroni M, Fasching PA, Taran FA, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Krawczyk N, Pantel K, Fehm T. Abstract P2-02-02: Predictors for discordance in HER2 phenotype between primary tumor and circulating tumor cells in women with metastatic breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-02-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim: The DETECT study program evaluates whether treatment efficacy in women with metastatic breast cancer (MBC) is increased by taking into account the molecular characteristics of circulating tumor cells (CTCs). Here, we present data on both prevalence and HER2 phenotype of CTCs in patients with HER2 negative MBC screened within the DETECT program. The aim of this study is to evaluate the rate of discordance in HER2 phenotype between primary tumor and CTCs and to analyze whether primary tumor and/or patient characteristics can predict discordance in HER2-status.
Methods: The number of CTCs in 7.5 ml of peripheral blood (using the FDA-cleared CellSearch® System; Janssen Diagnostics, LLC) and their HER2 status were evaluated. Patients were defined as having a positive HER2-status on CTCs if at least 1 CTC with a strong (+++) immunocytochemical HER2 staining intensity was found. To assess which factors predict discordance of HER2 phenotype between primary tumor and CTCs, we used a multivariate binary logistic regression model with backward selection procedure. Patient and primary tumor characteristics included as independent factors were patient age, time since primary diagnosis, tumor stage, nodal stage, grading, histological type, and hormone receptor status (HRS).
Results: 1123 women with HER2-negative MBC were screened for CTCs. Based on a cutoff of ≥ 1 CTC, 711 (63.3%) of 1123 screened patients were positive for CTCs, while 412 (36.7%) of the 1123 screened patients were categorized as CTC positive if a cutoff of ≥ 5 CTCs was used.
At least one HER2-positive CTC was found in 134 of the 711 HER2-negative MBC patients with one or more CTCs (median 2 HER2-positive CTCs, range 1 – 80), indicating a discordance between primary tumor and CTCs with regard to HER2-status in 18.8% of patients. If the analysis was restricted to the 412 patients with 5 or more CTCs, at least one HER2-positive CTC was found in 121 patients, resulting in 29.4% discordance rate.
A multivariate logistic regression with discordance in HER2 phenotype (yes/no) as binary response variable, including number of CTCs (1 – 4 CTCs vs. 5 or more CTCs) to account for the difference in discordance rate observed at different cutoff values for CTC positivity, showed that histological type (lobular vs. ductal, odds ratio OR 2.66, 95% confidence interval CI 1.62 – 4.37, p < 0.001), HRS (positive vs. negative, OR 2.89, 95% CI 1.16 – 7.19, p = 0.022) and CTC number (5 or more CTCs vs. 1 – 4 CTCs, OR 7.57, 95% CI 3.93 – 14.89, p < 0.001) significantly predicted discordance in HER2 phenotype between primary tumor and CTCs.
Conclusion: Our data revealed discordance in HER2 status between primary tumor and CTCs in 19% to 29% of patients with HER2 negative MBC. Discordance in HER2 status was predicted by histological type and HRS of the primary tumor, as well as by the number of CTCs detected. Individualized breast cancer treatment based on CTC phenotype is currently investigated in Phase III trials and not part of clinical routine yet. However, the knowledge of factors associated with discordance in HER2 status may be incorporated in today's clinical practice by guiding the decision process for performing a biopsy to characterize a metastatic relapse.
Citation Format: Janni W, Schramm A, Friedl TWP, Schochter F, Huober J, Rack B, Alunni-Fabbroni M, Fasching PA, Taran F-A, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Krawczyk N, Pantel K, Fehm T. Predictors for discordance in HER2 phenotype between primary tumor and circulating tumor cells in women with metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-02-02.
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Affiliation(s)
- W Janni
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Schramm
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - TWP Friedl
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Schochter
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Huober
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Rack
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Alunni-Fabbroni
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - PA Fasching
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F-A Taran
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Hartkopf
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Schneeweiss
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Müller
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Aktas
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Krawczyk
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Pantel
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Fehm
- University Hospital Ulm, Ulm, Germany; Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; University Hospital Erlangen, Erlangen, Germany; University Hospital Tuebingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany; Heinrich-Heine-University, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bidard FC, Peeters D, Fehm T, Nole F, Gisbert-Criado R, Mavroudis D, Grisanti S, Generali D, Garcia-Saenz JA, Stebbing J, Caldas C, Gazzaniga P, Manso L, Zamarchi R, Fernandez de Lascoiti A, de Mattos-Arruda L, Ignatiadis M, van Laere SJ, Meier-Stiegen F, Sandri MT, Vidal-Martinez J, Politaki E, Consoli F, Bottini A, Diaz-Rubio E, Krell J, Dawson SJ, Raimondi C, Rutten A, Janni W, Munzone E, Carañana V, Agelaki S, Almici C, Dirix L, Solomayer E, Zorzino L, Reis-Filho JS, Squifflet P, Pantel K, Beije N, Sleijfers S, Pierga JY, Michiels S. Abstract P2-08-08: Circulating tumor cells count-based nomograms to predict survival of metastatic breast cancer patients: Results from the European pooled analysis. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-08] [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 European Pooled Analysis of CTC (EPAC) in metastatic breast cancer, based on 1,944 individual data from patients with various tumor types and clinical settings (Bidard et al, Lancet Oncol 2014), has established CTC count (CellSearch) at baseline and during therapy as a level of evidence 1 independent prognostic biomarker and demonstrated its superiority over serum blood markers. As part of the study pre-planned objectives, we sought to establish nomograms allowing accurate individual survival predictions.
Methods: Using individual data from 17 centers, we built simplified multivariate prognostic models taking into account the independent prognostic clinico-pathological (CP) characteristics including CTC count, dichotomized using the 5CTC/7.5ml threshold, at baseline and at 3-5 weeks after the start of a new treatment regimen, and derived nomograms for progression-free survival (PFS) and overall survival (OS) prediction at baseline and after 3-5 weeks of treatment. We report here the internal validation of these nomograms. Discrimination of the models was assessed using the c-index estimated by a jackknife procedure and the calibration was visually assessed through 10-fold crossvalidated calibration plots at 1,2,3 years for OS and 1,2 years for PFS.
Results: Multivariate models at baseline for PFS and OS were fitted on 1501 and 568 individual patient data with CTC count at baseline and CTC count at baseline and after 3-5 weeks, respectively. Models include tumor subtype, the number of previous chemotherapy lines (0/1/≥2), PS, age (<=50/>50-65/>65 years), metastasis-free intervals (0/>0-3/>3 years), metastatic sites (liver and CNS) and CTC count at baseline and eventually at 3-5 weeks of treatment. The C-index increased from 0.722 to 0.755 (increase in C-index:0.033, 95% CI [0.019;0.045]) when adding baseline CTC to the CP only model for OS (n=1501). For those patients with CTC values at 3-5 weeks (n=568), there was an additional increase in the C-index when adding CTC at 3-5 weeks to a model with already CP and baseline CTC from 0.731 to 0.743 (increase in C-index 0.013, 95% CI [-0.004;0.025]). The model with CP and baseline CTC counts showed a good calibration for OS at 1,2,3 years and the model with CP, baseline CTC and CTC count at 3-5 weeks a moderately good calibration. Similar results were obtained for PFS.
Conclusion: From the largest database with individual CTC data, we were able to build PFS and OS survival nomograms, with satisfactory discrimination and calibration. Our planned next step is to validate the nomogram in an additional cohort.
Citation Format: Bidard F-C, Peeters D, Fehm T, Nole F, Gisbert-Criado R, Mavroudis D, Grisanti S, Generali D, Garcia-Saenz JA, Stebbing J, Caldas C, Gazzaniga P, Manso L, Zamarchi R, Fernandez de Lascoiti A, de Mattos-Arruda L, Ignatiadis M, van Laere SJ, Meier-Stiegen F, Sandri M-T, Vidal-Martinez J, Politaki E, Consoli F, Bottini A, Diaz-Rubio E, Krell J, Dawson S-J, Raimondi C, Rutten A, Janni W, Munzone E, Carañana V, Agelaki S, Almici C, Dirix L, Solomayer E, Zorzino L, Reis-Filho JS, Squifflet P, Pantel K, Beije N, Sleijfers S, Pierga J-Y, Michiels S. Circulating tumor cells count-based nomograms to predict survival of metastatic breast cancer patients: Results from the European pooled analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-08.
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Affiliation(s)
- F-C Bidard
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - D Peeters
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - T Fehm
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - F Nole
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - R Gisbert-Criado
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - D Mavroudis
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Grisanti
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - D Generali
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - JA Garcia-Saenz
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J Stebbing
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - C Caldas
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - P Gazzaniga
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L Manso
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - R Zamarchi
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - A Fernandez de Lascoiti
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L de Mattos-Arruda
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - M Ignatiadis
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - SJ van Laere
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - F Meier-Stiegen
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - M-T Sandri
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J Vidal-Martinez
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Politaki
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - F Consoli
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - A Bottini
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Diaz-Rubio
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J Krell
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S-J Dawson
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - C Raimondi
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - A Rutten
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - W Janni
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Munzone
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - V Carañana
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Agelaki
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - C Almici
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L Dirix
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Solomayer
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L Zorzino
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - JS Reis-Filho
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - P Squifflet
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - K Pantel
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - N Beije
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Sleijfers
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J-Y Pierga
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Michiels
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
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Schramm A, Friedl TWP, Huober J, Jäger B, Rack B, Trapp E, Fasching PA, Taran FA, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Pantel K, Meier-Stiegen F, Wimberger P, Kümmel S, Gebauer G, Müller L, Janni W, Fehm T. Abstract OT1-02-02: The DETECT study program – Personalized treatment in metastatic breast cancer based on circulating tumor cells. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot1-02-02] [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: 11/16/2022]
Abstract
Abstract
Circulating tumor cells (CTCs) are found in patients with primary and metastatic breast cancer (MBC), respectively, and discordance in HER2 and hormone-receptor status between primary tumor, metastases and CTCs is well described. Treatment decisions are still based on the expression profile of solid tumor samples whereas CTCs are thought to cause tumor progression by blood-derived metastases. Nevertheless, targeted therapy based on expression profile of CTCs is not established in clinical routine. Individualized treatment decisions based on presence and phenotype of CTCs will be analyzed within the DETECT study program.
Metastatic breast cancer patients with HER2-negative MBC are screened in DETECT III and IV for presence of CTCs by using the CellSearch System (Janssen Diagnostics) which is FDA approved for enumeration of CTCs. Patients are enrolled into the different cohorts according to HER2-phenotype of CTCs. Since February 2012, women with HER2-negative MBC and HER2-positive CTCs are treated in the multicenter randomized Phase III study DETECT III with standard therapy with or without additional HER2-targeted therapy with Lapatinib. For standard therapy, physicians can choose between exemestane, letrozole and anastrozole for endocrine therapy, or docetaxel, paclitaxel, capecitabine, vinorelbine and non-pegylated liposomal doxorubicin for chemotherapy. Efficacy of CTC-based anti-HER2 treatment is evaluated by analyzing CTC-clearance rate after treatment.
Patients with only HER2-negative CTCs are recruited for the multicenter open-label phase II study DETECT IV. Since December 2013, women with hormone-receptor positive MBC receive endocrine therapy (tamoxifen, exemestane, letrozole or anastrozole) plus everolimus in DETECT IVa. In February 2015, DETECT IV was extended by the eribulin-cohort which offers a cytotoxic treatment with eribulin for women with triple-negative or hormone-receptor positive, chemotherapy demanding MBC (DETECT IVb). Progression free survival is used for assessment of clinical efficacy with overall survival and disease control rate as secondary objectives.
DETECT V, a multicenter open-label phase III study starting in summer 2015, randomizes patients with hormone-receptor positive, HER2-positive MBC to a dual HER2 targeted therapy (Trastuzumab and Pertuzumab) combined with either endocrine therapy or cytotoxic treatment. Quality of life determined by occurrence of adverse events is compared between both treatment arms. For prediction of endocrine treatment response, an "Endocrine Responsiveness Score" is calculated based on expression of estrogen-receptor and HER2 on detected CTCs.
More than 1200 patients are already screened in the DETECT study concept. Thus, it is the worldwide largest study concept with therapy decisions resulting from CTC-testing and CTC-phenotypization. The accompanying translational research programs evaluates further markers for molecular characterization of CTCs and prediction of therapy response.
Conclusion and Contact
The value of CTC phenotypes for making decisions on therapy interventions and predicting treatment responses in patients with MBC is tested in the DETECT study concept. The findings will help to move a step forward towards a more personalized anti-cancer therapy.
Citation Format: Schramm A, Friedl TWP, Huober J, Jäger B, Rack B, Trapp E, Fasching PA, Taran F-A, Hartkopf A, Schneeweiss A, Müller V, Aktas B, Pantel K, Meier-Stiegen F, Wimberger P, Kümmel S, Gebauer G, Müller L, Janni W, Fehm T. The DETECT study program – Personalized treatment in metastatic breast cancer based on circulating tumor cells. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT1-02-02.
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Affiliation(s)
- A Schramm
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - TWP Friedl
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - J Huober
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - B Jäger
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - B Rack
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - E Trapp
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - PA Fasching
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - F-A Taran
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - A Hartkopf
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - A Schneeweiss
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - V Müller
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - B Aktas
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - K Pantel
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - F Meier-Stiegen
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - P Wimberger
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - S Kümmel
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - G Gebauer
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - L Müller
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - W Janni
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
| | - T Fehm
- University Hospital Ulm, Ulm, Germany; Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany; Gynecology and Obstetrics, University Hospital Tübingen, Tuebingen, Germany; University Hospital Heidelberg, Heidelberg, Germany; Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Gynecology and Obstetrics, University Hospital Essen, Essen, Germany; University Hospital Hamburg-Eppendor, Hamburg, Germany; Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany; Interdisciplinary Breast Center Unit Kliniken-Essen-Mitte, Essen, Germany; Gynecology Marienhospital Hamburg, Hamburg, Germany; Private Practice Onkologie UnterEms, Leer Ostfriesland Leer, Leer, Germany
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Abstract
Metastasis is a biologically complex process consisting of numerous stochastic events which may tremendously differ across various cancer types. Circulating tumor cells (CTCs) are cells that are shed from primary tumors and metastatic deposits into the blood stream. CTCs bear a tremendous potential to improve our understanding of steps involved in the metastatic cascade, starting from intravasation of tumor cells into the circulation until the formation of clinically detectable metastasis. These efforts were propelled by novel high-resolution approaches to dissect the genomes and transcriptomes of CTCs. Furthermore, capturing of viable CTCs has paved the way for innovative culturing technologies to study fundamental characteristics of CTCs such as invasiveness, their kinetics and responses to selection barriers, such as given therapies. Hence the study of CTCs is not only instrumental as a basic research tool, but also allows the serial monitoring of tumor genotypes and may therefore provide predictive and prognostic biomarkers for clinicians. Here, we review how CTCs have contributed to significant insights into the metastatic process and how they may be utilized in clinical practice.
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Affiliation(s)
- K Pantel
- Institute of Tumor Biology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - M R Speicher
- Institute of Human Genetics, Medical University of Graz, Graz, Austria
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Milde-Langosch K, Oliveira-Ferrer L, Schütze D, Wikman H, Witzel I, Schröder C, Pantel K, Schumacher U, Müller V. Relevance of &bgr;ß-Gal-ß-GalNAc-containing O-glycans and the enzymes involved in their synthesis for vascular and lymphatic invasion and survival in breast cancer patients. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv120.04] [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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50
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Wikman H, Hohensee I, Riebensahm C, Witzel I, Matschke J, Glatzel M, Lamszus K, Riehtdorf S, Müller V, Pantel K. Molecular characterization of breast cancer brain metastases and circulating tumor cells. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv116.10] [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: 11/13/2022] Open
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