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Lüftner D, Lux MP, Fehm TN, Welslau M, Müller V, Schütz F, Fasching PA, Janni W, Thomssen C, Witzel I, Beierlein M, Belleville E, Untch M, Thill M, Ditsch N, Aktas B, Banys-Paluchowski M, Kolberg-Liedtke C, Wöckel A, Kolberg HC, Harbeck N, Stickeler E, Tesch H, Hartkopf AD. Update Breast Cancer 2022 Part 6 - Advanced-Stage Breast Cancer. Geburtshilfe Frauenheilkd 2023; 83:299-309. [PMID: 36908287 PMCID: PMC9998183 DOI: 10.1055/a-2018-9184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/23/2023] [Indexed: 03/12/2023] Open
Abstract
Large-scale study programs on CDK4/6 inhibitors, targeted therapies, and antibody-drug conjugates launched in recent years have yielded results from current studies which are now being published in journals and presented at international conferences. In this context, new results are available from the major CDK4/6 inhibitor studies. Also, an increasing amount of data is being published from large-scale genomic studies on efficacy and resistance mechanisms in patients treated with CDK4/6 inhibitors. These results now form the basis for further research plans to investigate combination therapies and treatment sequencing. Based on the latest published results, sacituzumab govitecan is now available as a second antibody-drug conjugate; this brings an advantage in terms of overall survival for patients with hormone receptor-positive (HRpos)/HER2-negative (HER2neg) breast cancer. In this review article, we summarize the latest developments and place them in context according to the current status of research.
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Affiliation(s)
- Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow; Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
| | - Michael P Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Isabell Witzel
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Milena Beierlein
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Bahriye Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | | | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Andreas D Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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Circulating Tumor-Derived Endothelial Cells: An Effective Biomarker for Breast Cancer Screening and Prognosis Prediction. JOURNAL OF ONCOLOGY 2022; 2022:5247423. [PMID: 36072971 PMCID: PMC9441390 DOI: 10.1155/2022/5247423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022]
Abstract
Background Circulating tumor-derived endothelial cell (CTEC) is a new potential tumor biomarker to be associated with cancer development and treatment efficacy. However, few evidences are available for breast cancer. Methods Eighty-nine breast cancer patients were recruited, and preoperative and postoperative blood samples were collected. Besides, 20 noncancer persons were enrolled as controls. An improved subtraction enrichment and immunostaining-fluorescence in situ hybridization (SE-iFISH) method was adopted to codetect CD31+ aneuploid CTEC and CD31− aneuploid circulating tumor cell (CTC). Then, the clinical significance of CTCs and CTECs on breast cancer screening and prognosis prediction was evaluated and compared. Results The positive rate of CTCs and CTECs in newly diagnosed breast cancer patients was 68.75% and 71.88%. Among detected aneuploid circulating rare cells, CTEC accounts for a greater proportion than CTC in breast cancer patients. CTEC-positive rate and level were significantly higher in breast cancer patients with lymph node metastasis (LNM) than those without LNM (P=0.043), while there was no significant difference in CTC. CTEC (area under the curve, AUC = 0.859) had better performance than CTC (AUC = 0.795) to distinguish breast cancer patients from controls by receiver operator characteristic curve analysis. Preoperative CTEC count ≥ 2 was a significant risk factor for reducing PFS of breast cancer patients. Conclusions CTECs may function as a reliable supplementary biomarker in breast cancer screening and prognosis prediction.
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Variable Expression of the Disialoganglioside GD2 in Breast Cancer Molecular Subtypes. Cancers (Basel) 2021; 13:cancers13215577. [PMID: 34771738 PMCID: PMC8582848 DOI: 10.3390/cancers13215577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/22/2021] [Accepted: 11/03/2021] [Indexed: 02/03/2023] Open
Abstract
Simple Summary GD2 is an antigen that is tumor-specific and can be used as a target for specific immunotherapies. Since the knowledge about GD2 in breast cancer is limited, we analyzed the frequency of GD2 expression in breast cancer using two different staining methods and the impact of GD2 expression on the survival of breast cancer patients. GD2 expression was found in more than 50% of breast cancer cases, with the highest frequency in hormone receptor-positive tumors. GD2 expression was not significantly associated with patient outcome. Unlike previous studies with smaller sample sizes that lacked correlation with clinical data, this study includes a larger cohort and associations with survival data and shows that GD2 is expressed on human breast cancer cells, providing a potential target for immunotherapies (e.g., anti-GD2 antibodies or GD2 CAR T cells), that are currently undergoing clinical testing. Abstract The disialoganglioside GD2 is a tumor-associated antigen that may allow for the application of targeted immunotherapies (anti-GD2 antibodies, GD2 CAR T cells) in patients with neuroblastoma and other solid tumors. We retrospectively investigated GD2 expression in a breast cancer cohort, using immunohistochemistry (IHC) and immunofluorescence (IF) on tissue microarrays (TMAs), and its impact on survival. GD2 expression on IHC (n = 568) and IF (n = 503) was investigated in relation to subtypes and patient outcome. Overall, 50.2% of the 568 IHC-assessed samples and 69.8% of the 503 IF-assessed samples were GD2-positive. The highest proportion of GD2-positive tumors was observed in luminal tumors. Significantly fewer GD2-positive cases were detected in triple-negative breast cancer (TNBC) compared with other subtypes. The proportion of GD2-expressing tumors were significantly lower in HER2-positive breast cancer in comparison with luminal tumors on IF staining (but not IHC). GD2 expression of IHC or IF was not significantly associated with disease-free or overall survival, in either the overall cohort or in individual subtypes. However, GD2 expression can be seen in more than 50% of breast cancer cases, with the highest frequency in hormone receptor-positive tumors. With this high expression frequency, patients with GD2-positive advanced breast cancer of all subtypes may benefit from GD2-targeting immunotherapies, which are currently subject to clinical testing.
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Lux MP, Schneeweiss A, Hartkopf AD, Müller V, Janni W, Belleville E, Stickeler E, Thill M, Fasching PA, Kolberg HC, Untch M, Harbeck N, Wöckel A, Thomssen C, Schulmeyer CE, Welslau M, Overkamp F, Schütz F, Lüftner D, Ditsch N. Update Breast Cancer 2020 Part 5 - Moving Therapies From Advanced to Early Breast Cancer Patients. Geburtshilfe Frauenheilkd 2021; 81:469-480. [PMID: 33867564 PMCID: PMC8046519 DOI: 10.1055/a-1397-7170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/20/2021] [Indexed: 12/17/2022] Open
Abstract
In recent years, significant progress has been made in new therapeutic approaches to breast cancer, particularly in patients with HER2-positive and HER2-negative/hormone receptor-positive (HR+) breast cancer. In the case of HER2-positive tumours, these approaches have included, in particular, treatment with pertuzumab, T-DM1, neratinib and, soon, also tucatinib and trastuzumab deruxtecan (neither of which has yet been authorised in Europe). In patients with HER2-/HR+ breast cancer, CDK4/6 inhibitors and the PIK3CA inhibitor alpelisib are of particular importance. Further novel therapies, such as Akt kinase inhibitors and oral SERDs (selective estrogen receptor down regulators), are already being investigated in ongoing clinical trials. These therapeutic agents are not only being introduced into curative, (neo-)adjuvant therapeutic settings for HER2-positive tumours; a first favourable study on abemaciclib as an adjuvant therapy has now also been published. In patients with triple-negative breast cancer, after many years of negative study results with the Trop-2 antibody drug conjugate (ADC) sacituzumab govitecan, a randomised study has been published that may represent a significant therapeutic advance. This review describes the latest developments in breast cancer subsequent to the ESMO Congress 2020.
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Affiliation(s)
- Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Andreas D. Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | | | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin Buch, Berlin, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, CCC Munich, LMU University Hospital, Munich, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Carla E. Schulmeyer
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Diana Lüftner
- Charité University Hospital, Department of Hematology, Oncology and Tumour Immunology, University Medicine Berlin, Berlin, Germany
| | - Nina Ditsch
- Frauenklinik, Universitätsklinikum Augsburg, Augsburg, Germany
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Schmidt M, Lenhard H, Hoenig A, Zimmerman Y, Krijgh J, Jansen M, Coelingh Bennink HJT. Tumor suppression, dose-limiting toxicity and wellbeing with the fetal estrogen estetrol in patients with advanced breast cancer. J Cancer Res Clin Oncol 2020; 147:1833-1842. [PMID: 33242131 PMCID: PMC8076125 DOI: 10.1007/s00432-020-03472-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/13/2020] [Indexed: 02/07/2023]
Abstract
Purpose The aim of this study (the ABCE4 study) was to assess dose-limiting toxicity (DLT), safety, tolerability and preliminary efficacy of high doses of the fetal estrogen estetrol (E4) in postmenopausal patients with heavily pretreated, locally advanced and/or metastatic ER+/HER2−breast cancer, resistant to anti-estrogens. Methods This was a multicenter, open-label, phase IB/IIA, dose-escalation study with a 3 + 3 cohort design, whereby successive cohorts of three patients received 20 mg, 40 mg or 60 mg E4 per day for 12 weeks by oral administration. DLTs, safety and wellbeing were evaluated after 4, 8 and 12 weeks of treatment. Anti-tumor effects were investigated by computer tomography scanning and evaluated according to RECIST criteria before and after 12 weeks of treatment. Wellbeing was judged weekly by the investigator and by quality-of-life questionnaires by the patients. In view of the small number of patients, no statistical testing was performed. Results All 12 patients enrolled had progressive, heavily pre-treated advanced breast cancer. No treatment-related serious adverse events or DLTs occurred during the first 4 weeks of E4 treatment allowing the investigation of all three doses. Five of nine patients completing 12 weeks of E4 treatment showed objective anti-tumor effects and six of nine patients reported improved wellbeing. Conclusion High doses of estetrol seem to be safe and are well tolerated during 12 weeks of treatment without dose-limiting toxicity and with anti-tumor effects in five of nine heavily treated patients with progressive, anti-estrogen resistant, advanced breast cancer.
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Affiliation(s)
- Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55122, Mainz, Germany
| | - Hans Lenhard
- Department of Obstetrics and Gynecology, Katholisches Klinikum Mainz, 55131, Mainz, Germany
| | - Arnd Hoenig
- Department of Obstetrics and Gynecology, Katholisches Klinikum Mainz, 55131, Mainz, Germany
| | - Yvette Zimmerman
- Pantarhei Oncology BV, Boulevard 17, 3707 BK, Zeist, The Netherlands
| | - Jan Krijgh
- Pantarhei Oncology BV, Boulevard 17, 3707 BK, Zeist, The Netherlands
| | - Monique Jansen
- Pantarhei Oncology BV, Boulevard 17, 3707 BK, Zeist, The Netherlands
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Tesch H, Müller V, Wöckel A, Ettl J, Belleville E, Schütz F, Hartkopf A, Thill M, Huober J, Fasching PA, Kolberg HC, Schulmeyer CE, Welslau M, Overkamp F, Fehm TN, Lux MP, Schneeweiss A, Lüftner D, Janni W. Update Breast Cancer 2020 Part 4 - Advanced Breast Cancer. Geburtshilfe Frauenheilkd 2020; 80:1115-1122. [PMID: 33173239 PMCID: PMC7647717 DOI: 10.1055/a-1270-7481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Substances with good effectiveness that intervene in specific signalling pathways have been used increasingly in recent years in the treatment of patients with advanced breast cancer, and new therapies and approaches have now been added, which actually relate to quite specific changes, such as the treatment of patients with HR+/HER2 tumours with a PIK3CA mutation. The treatment of patients with a BRCA1 or BRCA2 mutation has also been improved by the introduction of PARP inhibitors. Attempts are now being made increasingly to extend treatment indications based on molecular patterns, to identify other patients who could benefit from a treatment and to integrate the newly established treatment methods in existing therapy sequences. This review articles summarises the latest information in this connection.
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Affiliation(s)
- Hans Tesch
- Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Florian Schütz
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Carla E. Schulmeyer
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Diana Lüftner
- Charité University Hospital, Department of Hematology, Oncology and Tumour Immunology, Berlin, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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Hester A, Gaß P, Fasching PA, Krämer AK, Ettl J, Diessner J, Wöckel A, Egger T, Stock K, Redlin J, Andraschko M, Harbeck N, Würstlein R. Trastuzumab Biosimilars in the Therapy of Breast Cancer - "Real World" Experiences from four Bavarian University Breast Centres. Geburtshilfe Frauenheilkd 2020; 80:924-931. [PMID: 32905322 PMCID: PMC7467805 DOI: 10.1055/a-1226-6666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction With the introduction of the first trastuzumab biosimilar in the summer of 2018, biosimilar antibodies for breast cancer have found their way into the area of gynaecological oncology. The switch of anti-human epidermal growth factor receptor 2 (HER2) therapy from the reference drug Herceptin ® to a biosimilar has presented challenges to the clinics. In addition to structural and organisational measures, training of employees as well as patient briefing and acceptance were major challenges. The study presented here records - within the context of quality assurance - how the switch to a trastuzumab biosimilar was implemented at four Bavarian university clinics in the Purchasing Association of Bavarian University Pharmacies. Materials/Methods Questionnaires on treatment figures and the switching process were sent to breast centres and pharmacies of four Bavarian university clinics between July and December 2019. The neoadjuvant, adjuvant and metastasised anti-HER2 therapy with trastuzumab with or without pertuzumab was recorded, evaluated and summarised. Results In the anti-HER2-therapy, trastuzumab was used intravenously (i. v.) and subcutaneously. Between July and December 2018, all four clinics in the Purchasing Association switched the i. v. trastuzumab therapy from the reference drug (Herceptin) to a biosimilar (for 2018: Kanjinti ® ). Over 200 patients were treated with trastuzumab i. v. in each of the two half-years of 2018 (before and after the switch). The spectrum of side effects and pCR rates under therapy with the biosimilar were comparable to the experiences made with the reference drug. Three out of four clinics provided training to employees and informed patients by means of a defined information leaflet. Patient acceptance was high. Summary The anti-HER2 therapy could be switched successfully and safely to trastuzumab biosimilars at the Bavarian university hospitals. This may serve as guideline for the further implementation of biosimilars. The structures necessary for this initial switching process have been prepared with trastuzumab as an example.
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Affiliation(s)
- Anna Hester
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Brustzentrum und CCC München, Klinikum der Universität München, LMU München, München
| | - Paul Gaß
- Frauenklinik des Universitätsklinikums Erlangen, Erlangen
| | | | - Anne Katrin Krämer
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Technischen Universität München und CCC München, München
| | - Johannes Ettl
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Technischen Universität München und CCC München, München
| | - Joachim Diessner
- Frauenklinik und Poliklinik des Universitätsklinikums Würzburg, Würzburg
| | - Achim Wöckel
- Frauenklinik und Poliklinik des Universitätsklinikums Würzburg, Würzburg
| | - Tobias Egger
- Apotheke des Universitätsklinikums Würzburg, Würzburg
| | - Katja Stock
- Apotheke des Universitätsklinikums Erlangen, Erlangen
| | - Jutta Redlin
- Krankenhausapotheke des Klinikums Rechts der Isar der Technischen Universität, München
| | | | - Nadia Harbeck
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Brustzentrum und CCC München, Klinikum der Universität München, LMU München, München
| | - Rachel Würstlein
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Brustzentrum und CCC München, Klinikum der Universität München, LMU München, München
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8
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Lux MP, Wasner S, Meyer J, Häberle L, Hack CC, Jud S, Hein A, Wunderle M, Emons J, Gass P, Fasching PA, Egloffstein S, Krebs J, Erim Y, Beckmann MW, Loehberg CR. Analysis of Oncological Second Opinions in a Certified University Breast and Gynecological Cancer Center Regarding Consensus between the First and Second Opinion and Conformity with the Guidelines. Breast Care (Basel) 2020; 16:291-298. [PMID: 34248471 DOI: 10.1159/000509127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Oncological second opinions are becoming increasingly important in the era of complex treatments and established certified cancer centers. Oncological guidelines with the highest levels of evidence are available, but these can only be effective to the extent that they are implemented. Therefore, we analyzed the effects of second opinions with regard to their agreement with first opinions and conformity with guidelines. Methods In 164 patients with a diagnosis of breast cancer or gynecological malignancy who requested a second opinion, the first and second opinions, established at the interdisciplinary tumor conference, and conformity with the guidelines were evaluated. Results The first opinion was not in agreement with the guidelines in 34.8% (15.2% diagnosis, 12.8% surgical therapy, 13.4% systemic therapy, and 5.5% radiotherapy), and the recommendations were optimized in the second opinion in 56.7% (28.7% diagnosis, 15.9% surgical therapy, 30.5% systemic therapy, and 8.5% radiotherapy). Conclusions Oncological second opinions showed significant effects and one-third of first opinions were not in conformity with the guidelines. In a significant proportion of cases, the existing treatment plan was changed or supplemented to allow modern and individualized treatment approaches.
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Affiliation(s)
- Michael P Lux
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Breast and Gynecological Cancer Center, Women's Hospital St. Louise, and St. Josefs-Krankenhaus Salzkotten, St. Vincenz Hospital GmbH Paderborn, Paderborn, Germany
| | - Sonja Wasner
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Meyer
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sainab Egloffstein
- Comprehensive Cancer Center Erlangen - European Metropolitan Region Nürnberg (CCC Erlangen-EMN), Erlangen, Germany
| | - Jessica Krebs
- Department of Psychosomatic and Psychotherapeutic, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic and Psychotherapeutic, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen - European Metropolitan Region Nürnberg (CCC Erlangen-EMN), Erlangen, Germany
| | - Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Schönthal AH, Swenson SD, Chen TC, Markland FS. Preclinical studies of a novel snake venom-derived recombinant disintegrin with antitumor activity: A review. Biochem Pharmacol 2020; 181:114149. [PMID: 32663453 DOI: 10.1016/j.bcp.2020.114149] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022]
Abstract
Snake venoms consist of a complex mixture of many bioactive molecules. Among them are disintegrins, which are peptides without enzymatic activity, but with high binding affinity for integrins, transmembrane receptors that function to connect cells with components of the extracellular matrix. Integrin-mediated cell attachment is critical for cell migration and dissemination, as well as for signal transduction pathways involved in cell growth. During tumor development, integrins play key roles by supporting cancer cell proliferation, angiogenesis, and metastasis. The recognition that snake venom disintegrins can block integrin functions has spawned a number of studies to explore their cancer therapeutic potential. While dozens of different disintegrins have been isolated, none of them as yet has undergone clinical evaluation in cancer patients. Among the best-characterized and preclinically most advanced disintegrins is vicrostatin (VCN), a recombinant disintegrin that was rationally designed by fusing 62 N-terminal amino acids derived from the disintegrin contortrostatin with 6 C-terminal amino acids from echistatin, the disintegrins from another snake species. Bacterially produced VCN was shown to target multiple tumor-associated integrins, achieving potent anti-tumor and anti-angiogenic effects in in vitro and in vivo models in the absence of noticeable toxicity. This review will introduce the field of snake venom disintegrins as potential anticancer agents and illustrate the translational development and cancer-therapeutic potential of VCN as an example.
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Affiliation(s)
- Axel H Schönthal
- Department of Molecular Microbiology and Immunology, Keck School of Medicine (KSOM), University of Southern California (USC), Los Angeles, CA 90089, USA
| | - Stephen D Swenson
- Department of Neurological Surgery, KSOM, USC, Los Angeles, CA 90089, USA; Department of Biochemistry and Molecular Medicine, KSOM, USC, Los Angeles, CA 90089, USA
| | - Thomas C Chen
- Department of Neurological Surgery, KSOM, USC, Los Angeles, CA 90089, USA
| | - Francis S Markland
- Department of Biochemistry and Molecular Medicine, KSOM, USC, Los Angeles, CA 90089, USA.
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Hack CC, Wasner S, Meyer J, Häberle L, Jud S, Hein A, Wunderle M, Emons J, Gass P, Fasching PA, Egloffstein S, Beckmann MW, Lux MP, Loehberg CR. Analysis of Oncological Second Opinions in a Certified University Breast and Gynecological Cancer Center in Relation to Complementary and Alternative Medicine. Complement Med Res 2020; 27:431-439. [PMID: 32544918 DOI: 10.1159/000508235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Oncological second opinions are becoming increasingly important given more complex treatment strategies, simultaneously more patients use complementary and alternative medicine (CAM), and many comprehensive cancer centers initiate integrative medicine programs. The present study focuses on analyzing the effects of a second opinion in relation to attitudes toward CAM. METHODS In this prospective study patients (n = 97) with a diagnosis of breast cancer or gynecological malignancies who had requested a second opinion received a questionnaire before and after the second opinion concerning their attitudes toward CAM. RESULTS The majority of patients had breast cancer (72.2%, n = 70). Only 6.2% (n = 6) stated that they had been informed about CAM by the doctors who treated them first, 21.6% (n = 21) had received information about it when seeking the second opinion. After the first opinion, 42.3% (n = 41) wanted to try CAM, the same proportion trusted orthodox medicine alone. After the second opinion, 24 patients (24.7%) wanted to try CAM, while 38.1% (n = 37) relied exclusively on orthodox medicine. There was a significant correlation between an increased patients' need for information and interest in CAM (p = 0.02). CONCLUSIONS Today, aspects of CAM still are very often no part of oncological first and second opinions. This might hence lead to discouraging patients to try out CAM and therefore integrative medicine programs in comprehensive cancer centers might be problem-solving.
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Affiliation(s)
- Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Sonja Wasner
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Julia Meyer
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Sainab Egloffstein
- Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany.,Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany.,Breast and Gynecological Cancer Center, Women's Hospital St. Louise, Paderborn, Women's Hospital St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, St. Vincenz Hospital, Paderborn, Germany
| | - Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany,
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11
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Loehberg CR, Meyer J, Häberle L, Hack CC, Jud S, Hein A, Wunderle M, Emons J, Gass P, Fasching PA, Egloffstein S, Krebs J, Erim Y, Beckmann MW, Lux MP, Wasner S. Analysis of motives and patient satisfaction in oncological second opinions provided by a certified university breast and gynecological cancer center. Arch Gynecol Obstet 2020; 301:1299-1306. [PMID: 32274639 PMCID: PMC7181428 DOI: 10.1007/s00404-020-05525-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/28/2020] [Indexed: 01/08/2023]
Abstract
Purpose Second opinions in oncology are becoming increasingly important in an era of more complex treatments and a growing demand for information by patients. Therefore, we analyzed their effects and influencing factors like patients’ motives, subjective extent of information and satisfaction with communications. Methods This prospective study evaluated second opinions for patients with breast cancer or gynecological malignancy. The patients received a questionnaire before and two months after, which inquired expectations, reasons, and satisfaction with the second opinion and the attending physicians. Results A total of 164 patients were included and the majority had breast cancer (75.0%). Receiving the second opinion made 89.7% feel better informed, their need for information decreased (from 75.3% to 39.2%, P < 0.0001), and satisfaction with doctor–patient communications increased (from 61.9 to 91.8%, P = 0.0002). There were various reasons for requesting a second opinion, e.g., the extremely stressful situation of a cancer diagnosis, hope for change in the treatment recommendation or dissatisfaction with the initial physicians. Conclusions Second opinions can lead to significantly greater patient satisfaction, meeting the need for information and leading to better management of patients in the extremely stressful situation of a cancer diagnosis. Doctor–patient communications play a key role. Electronic supplementary material The online version of this article (10.1007/s00404-020-05525-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany.
| | - Julia Meyer
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Sainab Egloffstein
- Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Jessica Krebs
- Psychosomatic and Psychotherapeutic Department, Erlangen University Hospital, Erlangen, Germany
| | - Yesim Erim
- Psychosomatic and Psychotherapeutic Department, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany.,Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany.,Breast and Gynecological Cancer Center, Women´s Hospital St. Louise, Paderborn, Women´s Hospital St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, St. Vincenz Hospital, Paderborn, Germany
| | - Sonja Wasner
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
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Banys-Paluchowski M, Fehm T, Janni W, Solomayer EF, Hartkopf A. Circulating and Disseminated Tumor Cells in Breast Carcinoma: Report from the Consensus Conference on Tumor Cell Dissemination during the 39th Annual Meeting of the German Society of Senology, Berlin, 27 June 2019. Geburtshilfe Frauenheilkd 2019; 79:1320-1327. [PMID: 31875861 PMCID: PMC6924333 DOI: 10.1055/a-1031-1120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023] Open
Abstract
Hematogenous dissemination of single tumor cells from the primary tumor is a common phenomenon in most solid malignancies. In breast cancer, presence of circulating tumor cells (CTCs) in the peripheral blood and disseminated tumor cells (DTCs) in bone marrow predicts poor clinical outcome, both in early and metastatic setting. Beyond that, persistence of CTCs/DTCs is associated with shorter relapse-free interval as well. Numerous studies have shown that these cells differ from tumor cells in the primary tumor with regard to hormone and HER2 receptor status and it has been hypothesized that some of them might be in fact cancer stem cells. Recently, the first positive study on CTC-based therapy interventions has been presented at the San Antonio Breast Cancer Symposium 2018, demonstrating that detection of CTCs may guide treatment decisions in metastatic HR-positive HER2-negative disease. In this review, we present the current state of evidence of tumor cell dissemination and discuss the implications for future trials.
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Affiliation(s)
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Andreas Hartkopf
- Universitäts-Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
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