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Meyer-Wilmes P, Huober J, Untch M, Blohmer JU, Janni W, Denkert C, Klare P, Link T, Rhiem K, Bayer C, Reinisch M, Bjelic-Radisic V, Zahm DM, Hanusch C, Solbach C, Heinrich G, Hartkopf AD, Schneeweiss A, Fasching P, Filmann N, Nekljudova V, Holtschmidt J, Stickeler E, Loibl S. Long-term outcomes of a randomized, open-label, phase II study comparing cabazitaxel versus paclitaxel as neoadjuvant treatment in patients with triple-negative or luminal B/HER2-negative breast cancer (GENEVIEVE). ESMO Open 2024; 9:103009. [PMID: 38663168 PMCID: PMC11061217 DOI: 10.1016/j.esmoop.2024.103009] [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: 03/04/2024] [Accepted: 03/23/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The GENEVIEVE study, comparing neoadjuvant cabazitaxel versus paclitaxel in triple-negative breast cancer (TNBC) and luminal B/human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC), previously reported significant differences in pathological complete response (pCR) rates. Effects on long-term outcome are unknown. PATIENTS AND METHODS GENEVIEVE randomized patients with cT2-3, any cN or cT1, cN+/pNSLN+, centrally confirmed TNBC or luminal B/HER2-negative BC (latter defined as estrogen/progesterone receptor-positive and >14% Ki-67-stained cells) to receive either cabazitaxel 25 mg/m2 q3w for four cycles or paclitaxel 80 mg/m2 weekly for 12 weeks. Anthracycline-containing chemotherapy was allowed in case of histologically proven invasive residuals as neoadjuvant treatment or after surgery as adjuvant treatment. Here we report the secondary endpoints invasive disease-free survival (iDFS), distant disease-free survival (DDFS), and overall survival (OS). RESULTS Of the 333 patients randomized, 74.7% and 83.2% completed treatment in the cabazitaxel and paclitaxel arms, respectively. After a median follow-up of 89.3 months (interquartile range 68.8-97.3 months), 80 iDFS events (43 after cabazitaxel and 37 after paclitaxel) and 47 deaths (23 after cabazitaxel and 24 after paclitaxel) were reported. IDFS rates were not significantly different between the cabazitaxel and paclitaxel arms after a 3-year (83.6% versus 85.0%) and 5-year follow-up (76.2% versus 78.3%) [hazard ratio (HR) = 1.27, 95% confidence interval 0.82-1.96, P = 0.294], respectively. DDFS rates at 3 years (88.6% versus 87.8%) and 5 years (82.1% versus 82.8%) for cabazitaxel and paclitaxel were comparable (HR = 1.15, P = 0.573). Similarly, OS rates at 3 years (91.6% versus 91.8%) and 5 years (89.2% versus 86.8%) showed no significant differences (HR = 1.05, P = 0.872). Subgroup analysis for TNBC and luminal B/HER2-negative BCs indicated no significant variations in 3- or 5-year iDFS, DDFS, or OS. CONCLUSIONS The significant differences in pCR rates observed in both treatment arms did not significantly impact long-term outcomes for patients treated with cabazitaxel versus paclitaxel in the GENEVIEVE trial.
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Affiliation(s)
- P Meyer-Wilmes
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik Aachen, Aachen, Germany
| | - J Huober
- Department of Interdisciplinary Medical Services, University Hospital Ulm & Cantonal Hospital St. Gallen, Breast Center, St. Gallen, Switzerland
| | - M Untch
- Helios Kliniken Berlin-Buch, Berlin
| | - J-U Blohmer
- Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Berlin
| | | | - C Denkert
- Institut für Pathologie, Philipps-University Marburg and University Hospital Marburg (UKGM)-Universitätsklinikum Marburg, Marburg
| | - P Klare
- MediOnko-Institut GbR Berlin, Berlin
| | - T Link
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - K Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln
| | - C Bayer
- Universitätsklinikum Erlangen, Erlangen
| | - M Reinisch
- Department of Gynecology with Breast Center, Evang. Kliniken Essen-Mitte, Charité - Universitätsmedizin Berlin, Berlin
| | - V Bjelic-Radisic
- Breast Unit, University Hospital Helios, University Witten Herdecke, Wuppertal
| | - D M Zahm
- SRH Waldklinikum Gera GmbH, Gera
| | | | - C Solbach
- Department of Gynecology and Obstetrics, Goethe University Frankfurt, University Hospital, Frankfurt
| | - G Heinrich
- Schwerpunktpraxis der Gynäkologie und Onkologie Fürstenwalde, Klinikum Offenbach
| | - A D Hartkopf
- AGO Study Group and Department of Women's Health, University Hospital Tübingen, Tübingen
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg
| | | | - N Filmann
- German Breast Group, Neu-Isenburg, Germany
| | | | | | - E Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik Aachen, Aachen, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany.
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Marmé F, Krieghoff-Henning E, Gerber B, Schmitt M, Zahm DM, Bauerschlag D, Forstbauer H, Hildebrandt G, Ataseven B, Brodkorb T, Denkert C, Stachs A, Krug D, Heil J, Golatta M, Kühn T, Nekljudova V, Gaiser T, Schönmehl R, Brochhausen C, Loibl S, Reimer T, Brinker TJ. Deep learning to predict breast cancer sentinel lymph node status on INSEMA histological images. Eur J Cancer 2023; 195:113390. [PMID: 37890350 DOI: 10.1016/j.ejca.2023.113390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) status is a clinically important prognostic biomarker in breast cancer and is used to guide therapy, especially for hormone receptor-positive, HER2-negative cases. However, invasive lymph node staging is increasingly omitted before therapy, and studies such as the randomised Intergroup Sentinel Mamma (INSEMA) trial address the potential for further de-escalation of axillary surgery. Therefore, it would be helpful to accurately predict the pretherapeutic sentinel status using medical images. METHODS Using a ResNet 50 architecture pretrained on ImageNet and a previously successful strategy, we trained deep learning (DL)-based image analysis algorithms to predict sentinel status on hematoxylin/eosin-stained images of predominantly luminal, primary breast tumours from the INSEMA trial and three additional, independent cohorts (The Cancer Genome Atlas (TCGA) and cohorts from the University hospitals of Mannheim and Regensburg), and compared their performance with that of a logistic regression using clinical data only. Performance on an INSEMA hold-out set was investigated in a blinded manner. RESULTS None of the generated image analysis algorithms yielded significantly better than random areas under the receiver operating characteristic curves on the test sets, including the hold-out test set from INSEMA. In contrast, the logistic regression fitted on the Mannheim cohort retained a better than random performance on INSEMA and Regensburg. Including the image analysis model output in the logistic regression did not improve performance further on INSEMA. CONCLUSIONS Employing DL-based image analysis on histological slides, we could not predict SLN status for unseen cases in the INSEMA trial and other predominantly luminal cohorts.
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Affiliation(s)
- Frederik Marmé
- Department of Obstetrics and Gynaecology, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany
| | - Eva Krieghoff-Henning
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, University Hospital of Rostock, Rostock, Germany
| | - Max Schmitt
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Dirk Bauerschlag
- Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | | | - Guido Hildebrandt
- Department of Radiotherapy, University Medicine Rostock, Rostock, Germany
| | - Beyhan Ataseven
- Department of Gynecology, Gynecologic Oncology and Obstetrics, Klinikum Lippe, Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Bielefeld, Germany
| | - Tobias Brodkorb
- Department of Obstetrics and Gynaecology, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany
| | - Carsten Denkert
- Institute of Pathology, University Clinic Marburg, Marburg, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, University Hospital of Rostock, Rostock, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jörg Heil
- Brustzentrum Heidelberg - Klinik St. Elisabeth, Heidelberg, Germany; Department of Obstetrics and Gynecology, Uniklinikum Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- Brustzentrum Heidelberg - Klinik St. Elisabeth, Heidelberg, Germany; Department of Obstetrics and Gynecology, Uniklinikum Heidelberg, Heidelberg, Germany
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Klinikum Esslingen, Neckar, Germany
| | | | - Timo Gaiser
- Institute of Pathology, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany
| | - Rebecca Schönmehl
- Institute of Pathology, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany
| | - Christoph Brochhausen
- Institute of Pathology, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany; Institute of Pathology, University Regensburg, Regensburg, Germany
| | - Sibylle Loibl
- German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - Toralf Reimer
- Department of Obstetrics and Gynecology, University Hospital of Rostock, Rostock, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Decker T, Lüdtke-Heckenkamp K, Melnichuk L, Hirmas N, Lübbe K, Zahn MO, Schmidt M, Denkert C, Lorenz R, Müller V, Zahm DM, Mundhenke C, Bauer S, Thill M, Seropian P, Filmann N, Loibl S. Anti-hormonal maintenance treatment with the CDK4/6 inhibitor ribociclib after 1st line chemotherapy in hormone receptor positive / HER2 negative metastatic breast cancer: A phase II trial (AMICA). Breast 2023; 72:103575. [PMID: 37690320 PMCID: PMC10507224 DOI: 10.1016/j.breast.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023] Open
Abstract
PURPOSE This phase II study evaluated the impact of adding ribociclib to maintenance endocrine therapy (ET) treatment of physicians' choice following the first palliative chemotherapy in pre- and post-menopausal women with hormone receptor positive (HR+)/human epidermal growth factor 2 negative (HER2-) metastatic breast cancer (mBC). PATIENTS AND METHODS The initial randomized study design was later amended into a single-arm study, and all subsequent patients received ribociclib and ET. The primary end point was locally assessed progression-free survival (PFS). Secondary end points included overall survival (OS), clinical benefit rate (CBR), safety, compliance, and quality of life (QoL). RESULTS A total of 43 patients received ribociclib + ET and 10 patients received ET only. Median PFS was 12.4 months [95% CI 8.7-24.4] for patients who received ribociclib + ET and 4.75 months [95% CI 1.0-10.3] for those who received ET only. Median OS was not reached for patients who received ribociclib + ET, and 28 (65.1%) patients experienced clinical benefit [95% CI 49.1-79.0]. For patients who received ribociclib + ET, grade 3-4 hematological adverse events (AEs) occurred in 25 (58.1%) patients, and grade 3-4 non-hematological AEs occurred in 17 (39.5%) patients. During the study, 15 patients died - 14 of whom due to tumor-related reasons, and one patient due to pneumonia, which was not treatment-related. CONCLUSION The results of the AMICA study show a promising efficacy and safety of maintenance treatment with ribociclib added to ET after at least stable disease following the first metastatic chemotherapy in patients with HR+/HER2-mBC. TRIAL REGISTRATION Anti-hormonal Therapy With Ribociclib in HR-positive/HER2- Negative Metastatic Breast Cancer (AMICA), NCT03555877, https://clinicaltrials.gov/ct2/show/NCT03555877.
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Affiliation(s)
| | | | | | - Nader Hirmas
- German Breast Group (GBG) Forschungs GmbH, Neu-Isenburg, Germany
| | - Kristina Lübbe
- Diakovere Henriettenstift, Breast Center, Hannover, Germany
| | | | | | - Carsten Denkert
- Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
| | - Ralf Lorenz
- Frauenärztliche Gemeinschaftspraxis Braunschweig, Germany
| | - Volkmar Müller
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Stefan Bauer
- Gemeinschaftspraxis für Hämatologie und Onkologie, Lebach, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology, Agaplesion Markus Krankenhaus Frankfurt, Germany
| | | | - Natalie Filmann
- German Breast Group (GBG) Forschungs GmbH, Neu-Isenburg, Germany
| | - Sibylle Loibl
- German Breast Group (GBG) Forschungs GmbH, Neu-Isenburg, Germany; Centre for Haematology and Oncology/Bethanien Frankfurt/M Freudenstadt, Germany.
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Denkert C, Schneeweiss A, Rey J, Hattesohl A, Karn T, Braun M, Jank P, Huober J, Sinn HP, Zahm DM, Hanusch C, Marmé F, Furlanetto J, Thomalla J, Blohmer JU, van Mackelenbergh M, Stiewe T, Staib P, Jackisch C, Teply-Szymanski J, Fasching PA, Sinn BV, Untch M, Weber K, Loibl S. Abstract PD4-02: PD4-02 Spatial and temporal heterogeneity of predictive and prognostic signatures in triple-negative breast cancer treated with neoadjuvant combination immune-chemotherapy. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd4-02] [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: 03/06/2023]
Abstract
Abstract
Background: It is well known that immunological pathways are relevant for response to classical neoadjuvant chemotherapy as well as combined chemo-immunotherapy. In addition, it has been shown that combined chemo-immunotherapy significantly improves survival, even in the context of only moderate effects on pCR. Due to the window therapy with durvalumab-alone and the option to analyze multiple consecutive biopsies, the GeparNuevo trial offers the opportunity to 1) determine gene expression patterns for pCR and DDFS endpoints 2) identify pathways most relevant for pCR and DDFS 3) identify genes specifically regulated by immunotherapy (comparison of samples pre-and post-window) 4) identify genes specifically regulated by chemotherapy (comparison of samples pre-Tx and after 4 cycles of chemotherapy 5) identify longitudinal patterns of gene expression by comparison of up to four time points and 6) identify changes in the tumor microenvironment by spatial sequencing of tumor cell and stroma areas. Methods: 292 tumor samples were evaluated by gene expression analysis: 162 pretherapeutic core biopsies, 79 post-window biopsies, 32 biopsies during chemotherapy and 19 biopsies of the residual tumor after therapy. These samples were analyzed by HTG OBP panel targeting 2549 genes which are assigned to 25 different biological mechanisms or cellular pathways. In addition, spatial profiling was compared in a subset of pre-and post-window samples using Nanostring GeoMx spatial profiling system. Endpoints were pCR and DDFS. Results: A total of more than 600 genes were significantly associated with either the pCR or the DDFS endpoint in either the complete GeparNuevo cohort or one of the two therapy arms. Interestingly, there was a large number of predictive or prognostic genes (n=247 for pCR and n=179 for DDFS) in the durvalumab arm, while the number of genes in the placebo arm was considerably lower (n=113 for pCR and n=61 for DDFS). We used existing pathway information for HTG OBP panel to analyze the contribution of different cellular processes to pCR and DDFS signatures in different therapy arms. Immune pathways were particularly relevant for durvalumab signatures (pCR and DDFS), while cell cycle related gene expression patterns were particularly involved in signatures predictive of pCR in both therapy arms. To further assign genes to the cellular response to durvalumab-alone or chemotherapy-alone, we compared gene expression patterns in durvalumab arm before and after the window phase (gene expression patterns induced by one dose of durvalumab) with gene expression patterns in placebo arm before and after 4 cycles of chemotherapy. Further longitudinal alterations were analyzed by comparison of longitudinal samples for 4 different time-points (a: before NACT, n=162; b: after window phase, n=79; c: after 4 cycles, n=31 and d: at surgery, n=19). Using the Nanostring GeoMx spatial RNA profiling system guided by cytokeratine immunofluorescence, we compared areas with high tumor cell content with stromal areas with or without TILs. In combination with the HTG gene expression data, we were able allocate the changes induced by durvalumab vs chemotherapy to the stromal cell and tumor cell compartment, indicating a re-organization of the tumor-microenvironment. Conclusions: In our analysis, we show that immune gene signatures are particularly relevant for neoadjuvant response to durvalumab as well as prognosis after durvalumab treatment, while proliferation signatures are involved in pCR-signatures after durvalumab as well as chemotherapy. The spatial analysis showed that relevant changes occur in the stromal compartment, indicating a re-organization of the tumor microenvironment. The parallel targeting of immune- and proliferation pathways might explain why a combined immunotherapy-chemotherapy approach is more successful than each single therapy strategy alone.
Citation Format: Carsten Denkert, Andreas Schneeweiss, Julia Rey, Akira Hattesohl, Thomas Karn, Michael Braun, Paul Jank, Jens Huober, Hans-Peter Sinn, Dirk-Michael Zahm, Claus Hanusch, Frederik Marmé, Jenny Furlanetto, Jörg Thomalla, Jens-Uwe Blohmer, Marion van Mackelenbergh, Thorsten Stiewe, Peter Staib, Christian Jackisch, Julia Teply-Szymanski, Peter A. Fasching, Bruno V. Sinn, Michael Untch, Karsten Weber, Sibylle Loibl. PD4-02 Spatial and temporal heterogeneity of predictive and prognostic signatures in triple-negative breast cancer treated with neoadjuvant combination immune-chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD4-02.
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Affiliation(s)
- Carsten Denkert
- 1Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
| | - Andreas Schneeweiss
- 2National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | | | - Akira Hattesohl
- 4Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
| | - Thomas Karn
- 5Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Michael Braun
- 6Abteilung für Senologie Leiter Interdisziplinäres Brustzentrum - Rotkreuzklinikum München, Germany
| | - Paul Jank
- 7Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
| | - Jens Huober
- 8Kantonsspital St.Gallen, Brustzentrum, Departement Interdisziplinäre medizinische Dienste, St. Gallen, Switzerland
| | - Hans-Peter Sinn
- 9Pathologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | | | - Frederik Marmé
- 12Med. Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | | | - Jörg Thomalla
- 14Institut für Versorgungsforschung in der Oncologie Koblenz am Rhein, Germany
| | | | - Marion van Mackelenbergh
- 16Universitätsklinikum Schleswig-Holstein, Klinik für Gynäkologie und Geburtshilfe, Schleswig-Holstein, Germany
| | - Thorsten Stiewe
- 17Institut für Molekulare Onkologie, Genomics Core Facility, Philipps Universität Marburg, Germany
| | | | - Christian Jackisch
- 19Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Germany
| | - Julia Teply-Szymanski
- 20Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
| | - Peter A. Fasching
- 21Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
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Massa C, Karn T, Weber K, Schneeweiss A, Hanusch C, Blohmer JU, Zahm DM, Jackisch C, van Mackelenbergh M, Thomalla J, Marmé F, Huober J, Müller V, Schem C, Müller A, Stickeler E, Biehl K, Fasching PA, Untch M, Loibl S, Denkert C, Seliger B. Abstract PD9-04: Immunological and clinical consequences of durvalumab treatment in combination to neoadjuvant chemotherapy in triple-negative breast cancer patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd9-04] [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: 03/06/2023]
Abstract
Abstract
Background: The implementation of immune checkpoint inhibitors in the therapy of different cancer types has provided promising results, but only a limited number of patients respond. Therefore, biomarkers to identify these responding patients are urgently needed. Methods: The GeparNuevo was a randomized, double-blind phase II trial in which triple-negative breast cancer (TNBC) patients were treated with neoadjuvant chemotherapy (NACT) consisting of nanoparticle albumin-bound paclitaxel in an initial phase followed by treatment with epirubicin and cyclophosphamide. Placebo or durvalumab were given throughout the neo-adjuvant treatment and in the “window” sub-cohort also prior to chemotherapy. Primary objective of this report was to evaluate changes in the blood immune cell repertoires of TNBC patients receiving durvalumab (anti-PD-L1) versus placebo in combination with NACT. At up to 4 different time points during therapy, blood samples were taken and underwent immunomonitoring using multicolor flow cytometry. The absolute counts of the major immune cell subtypes in the blood as well as the frequencies of different immune cell subpopulations and their functional phenotypes along treatment were determined and correlated to clinico-pathologic characteristics of the patients and to treatment response. Results: 120 out of 174 patients included in the GeparNuevo trial underwent blood immunomonitoring; 63 patients belonged to the “window” sub-cohort. Durvalumab administration almost completely blocked the detection of the inhibitory ligand PD-L1 and induced changes in the composition of the immune cell subpopulations. Evaluation of the “window” sub-cohort, in which an enhanced, but not significant pathological clinical response was observed within the immunomonitored patients, identified different markers correlating with clinical response to durvalumab. Higher frequencies of CD4+ T cells at recruitment as well as increased frequencies of T cells bearing the gamma delta TCR along treatment were some of the characteristics of patients responding to durvalumab treatment. Conclusions: The flow cytometry-based immunomonitoring of the clinical trial identified different immune-relevant biomarkers at recruitment as well as during treatment that predict clinical response to durvalumab. After validation of this data in an independent patient cohort, these markers could be implemented for an improved patient stratification to immunotherapy.
Citation Format: Chiara Massa, Thomas Karn, Karsten Weber, Andreas Schneeweiss, Claus Hanusch, Jens-Uwe Blohmer, Dirk-Michael Zahm, Christian Jackisch, Marion van Mackelenbergh, Jörg Thomalla, Frederik Marmé, Jens Huober, Volkmar Müller, Christian Schem, Anja Müller, Elmar Stickeler, Katharina Biehl, Peter A. Fasching, Michael Untch, Sibylle Loibl, Carsten Denkert, Barbara Seliger. Immunological and clinical consequences of durvalumab treatment in combination to neoadjuvant chemotherapy in triple-negative breast cancer patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD9-04.
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Affiliation(s)
- Chiara Massa
- 1Institute of Medical Immunology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Karn
- 2Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | | | - Andreas Schneeweiss
- 4National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | | | | | | | - Christian Jackisch
- 8Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Germany
| | - Marion van Mackelenbergh
- 9Universitätsklinikum Schleswig-Holstein, Klinik für Gynäkologie und Geburtshilfe, Schleswig-Holstein, Germany
| | - Jörg Thomalla
- 10Institut für Versorgungsforschung in der Oncologie Koblenz am Rhein, Germany
| | - Frederik Marmé
- 11Med. Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Jens Huober
- 12Kantonsspital St.Gallen, Brustzentrum, Departement Interdisziplinäre medizinische Dienste, St. Gallen, Switzerland
| | - Volkmar Müller
- 13Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Anja Müller
- 15Institute of Medical Immunology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Elmar Stickeler
- 16Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Germany
| | - Katharina Biehl
- 17Institute of Medical Immunology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Peter A. Fasching
- 18Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Carsten Denkert
- 21Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
| | - Barbara Seliger
- 22Institute of Medical Immunology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Reimer T, Stachs A, Veselinovic K, Polata S, Müller T, Kühn T, Heil J, Ataseven B, Reitsamer R, Hildebrandt G, Knauer M, Golatta M, Stefek A, Zahm DM, Thill M, Nekljudova V, Krug D, Loibl S, Gerber B. Patient-reported outcomes for the Intergroup Sentinel Mamma study (INSEMA): A randomised trial with persistent impact of axillary surgery on arm and breast symptoms in patients with early breast cancer. EClinicalMedicine 2023; 55:101756. [PMID: 36457648 PMCID: PMC9706517 DOI: 10.1016/j.eclinm.2022.101756] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In clinically node-negative breast cancer patients, the INSEMA trial (NCT02466737) assessed the non-inferiority of avoiding sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Here we present patient-reported outcomes (PROs) as a secondary endpoint. METHODS PROs were assessed for patients with no axillary surgery, SLNB alone, and ALND. Quality of life (QoL) questionnaire EORTC QLQ-C30 and its breast cancer module (BR23) were used at baseline (pre-surgery) and 1, 3, 6, 12, and 18 months after surgery. The QoL scores were compared using repeated measures mixed models based on the safety set. FINDINGS Between 2015 and 2019, 5502 patients were recruited for the first randomization, and 5154 were included in the intent-to-treat set (4124 SLNB versus 1030 no SLNB). In the case of one to three macrometastases after SLNB, 485 patients underwent second randomization (242 SLNB alone versus 243 ALND). Questionnaire completion response remained high throughout the trial: over 70% at all time points for the first randomization. There were significant differences for the BRBS (breast symptoms) and BRAS (arm symptoms) scores favoring the no SLNB group in all post-baseline assessments. Patients in the SLNB group showed significantly and clinically relevant higher scores for BRAS (differences in mean values ≥5.0 points at all times), including pain, arm swelling, and impaired mobility in all postoperative visits, with the highest difference at one month after surgery. Scoring of the QLQ-C30 questionnaire revealed no relevant differences between the treatment groups, although some comparisons were statistically significant. INTERPRETATION This is one of the first randomized trials investigating the omission of SLNB in clinically node-negative patients and the first to report comprehensive QoL data. Patients with no SLNB benefitted regarding arm symptoms/functioning, while no relevant differences in other scales were seen. FUNDING Supported by German Cancer Aid (Deutsche Krebshilfe, Bonn, Germany), Grant No. 110580 and Grant No. 70110580 to University Medicine Rostock.
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Affiliation(s)
- Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany
- Corresponding author. Department of Obstetrics and Gynecology, The University of Rostock, Suedring 81, 18059 Rostock, Germany.
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany
| | - Kristina Veselinovic
- Department of Obstetrics and Gynecology, University of Ulm, Prittwitzstr. 43, 89075 Ulm, Germany
| | - Silke Polata
- Breast Center, Evangelisches Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589 Berlin, Germany
| | - Thomas Müller
- Women's Hospital, Klinikum Hanau GmbH, Leimenstr. 20, 63450 Hanau, Germany
| | - Thorsten Kühn
- Women's Hospital, Klinikum Esslingen, Hirschlandstr. 97, 73730 Esslingen, Germany
| | - Jörg Heil
- Breast Unit, University Hospital, University of Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany
- Department of Obstetrics and Gynecology, LMU University Hospital, Marchioninistr. 15, 81377 Munich, Germany
| | - Roland Reitsamer
- Breast Center, LKH Salzburg, Paracelsus Medical University Clinics, Müllner Hauptstr. 48, A-5020 Salzburg, Austria
| | - Guido Hildebrandt
- Department of Radiotherapy, University of Rostock, Südring 75, 18059 Rostock, Germany
| | - Michael Knauer
- Brustzentrum Ost, Rohrschacher Str. 286, CH-9016 St. Gallen, Switzerland
| | - Michael Golatta
- Breast Unit, Sankt Elisabeth Hospital, Max-Reger-Str. 5-7, 69121 Heidelberg, Germany
| | - Andrea Stefek
- Women's Hospital, Johanniter-Hospital Stendal, Wendstr. 31, 39576 Stendal, Germany
| | - Dirk-Michael Zahm
- Breast Center, SRH Waldklinikum Gera, Str. des Friedens 122, 07548 Gera, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology, Agaplesion Markus Hospital, W.-Epstein-Str. 4, 60431 Frankfurt/Main, Germany
| | | | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Str., 24105 Kiel, Germany
| | - Sibylle Loibl
- German Breast Group, Dornhofstr. 10, 63263 Neu-Isenburg, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany
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Gerber B, Stachs A, Veselinovic K, Polata S, Müller T, Kühn T, Heil J, Ataseven B, Reitsamer R, Hildebrandt G, Knauer M, Golatta M, Stefek A, Zahm DM, Thill M, Nekljudova V, Krug D, Seither F, Loibl S, Reimer T. Abstract GS4-03: Patient-reported outcomes (PROs) for the intergroup sentinel mamma study (INSEMA, GBG75, ABCSG43): Persistent impact of axillary surgery on arm and breast symptoms in early breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs4-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Despite increasing evidence disfavoring axillary lymph node dissection (ALND) for locoregional control, it remains part of guidelines for breast cancer (BC) treatment. In an attempt to re-evaluate standard local therapy, the INSEMA trial was designed to assess non-inferiority of avoiding sentinel lymph node biopsy (SLNB) or completion ALND (cALND) in early-stage clinically node-negative BC patients. Here we present PROs from the INSEMA trial. Methods: INSEMA (NCT02466737) investigates non-inferiority of invasive disease-free survival (iDFS) after no axillary surgical staging versus SLNB (first randomization 1:4) in patients with clinically node-negative BC (tumor size ≤5 cm) and primary breast-conserving surgery (BCS). In case of pN1a(sn) in the SLNB arm, patients underwent a second randomization to either SLNB alone or cALND (1:1). PROs were assessed at baseline (pre-surgery) and at 1, 3, 6, 12, and 18 months after final axillary surgery using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) and its breast cancer (BR23) module. Higher scores of C30 and BR23 (range 0-100) indicate better functioning and global health status (GHS)/quality of life (QoL) or worse symptom severity, respectively. The QoL scores were compared using the Mann-Whitney U test based on the safety set. Results: Between September 2015 and April 2019, 5,502 patients were recruited for the 1st randomization and 5,173 of them were included in the intent-to-treat set (4,138 SLNB vs 1,035 no SLNB). Patient and tumor characteristics were well-balanced between treatment arms. Median age at diagnosis was 62.0 years (range 24.0 - 89.0). Overall, recruited patients presented with low-risk BC marked by 85.6% clinically stage T1, 98.5% hormone-receptor positivity, 2.4% HER2-positivity, and 3.7% G3 tumors. The majority (73.5%) had an invasive carcinoma of no special type (72.8% in SLNB vs 76.0% in no SLNB arm) and 87.0% had Ki-67 ≤ 20%. Questionnaire completion response remained high throughout the trial: n=3,915 (75.7%) returned questionnaires at 1 month after final axillary surgery, n=3,938 (76.1%) at 3 months, n=4,024 (77.8%) at 6 months, n=3,907 (75.5%) at 12 months, and n=3,637 (70.3%) at 18 months. All QoL baseline parameters regarding GHS, functional scales, and symptom scales/items were well-balanced between arms (total 4,117 SLNB vs 1,056 no SLNB as treated; 270 of 4,117 received cALND). There were significant differences for the BRBS (breast symptoms) and BRAS (arm symptoms) scores favoring the no SLNB group in all post-baseline assessments Patients in the SLNB group showed persistent higher scores for BRAS (differences in mean values ≥5.0 points at all times of assessment) including pain, arm swelling, and impaired mobility in all postoperative visits with the highest difference at 1 month after final surgery (mean scores, 23.6 vs. 12.8, p<0.001). Differences between treatment arms regarding BRBS including pain, breast swelling, hypersensitivity, and other skin problems showed a smaller range, but still a continuous trend for improved QoL in the no SLNB arm. Scoring of the QLQ-C30 questionnaire revealed no relevant differences between the treatment groups postoperatively. Conclusions: This is one of the first randomized trials investigating the omission of SLNB in clinically node-negative patients and the first to report QoL data. Patients with no SLNB benefitted regarding arm symptoms/functioning while no relevant differences in other QoL scales were seen. Data for the primary outcome of the study (iDFS) are expected for the end of 2024.
Citation Format: Bernd Gerber, Angrit Stachs, Kristina Veselinovic, Silke Polata, Thomas Müller, Thorsten Kühn, Jörg Heil, Beyhan Ataseven, Roland Reitsamer, Guido Hildebrandt, Michael Knauer, Michael Golatta, Andrea Stefek, Dirk-Michael Zahm, Marc Thill, Valentina Nekljudova, David Krug, Fenja Seither, Sibylle Loibl, Toralf Reimer. Patient-reported outcomes (PROs) for the intergroup sentinel mamma study (INSEMA, GBG75, ABCSG43): Persistent impact of axillary surgery on arm and breast symptoms in early breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS4-03.
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Affiliation(s)
- Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | | | - Silke Polata
- Breast Center, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
| | - Thomas Müller
- Women’s Hospital, Klinikum Hanau GmbH, Hanau, Germany
| | - Thorsten Kühn
- Women’s Hospital, Klinikum Esslingen, Esslingen, Germany
| | - Jörg Heil
- Department of Obstetrics and Gynecology, Universitäsklinikum Heidelberg, Heidelberg, Germany
| | | | - Roland Reitsamer
- Breast Center, Gemeinnützige Salzburger Landeskliniken Betriebsgesellschaft, Salzburg, Austria
| | | | | | - Michael Golatta
- Department of Obstetrics and Gynecology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Andrea Stefek
- Women’s Hospital, Johanniter-Krankenhaus Stendal, Stendal, Germany
| | | | - Marc Thill
- Breast Center, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
| | | | - David Krug
- Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | | | - Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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Jank P, Gehlhaar C, Lederer B, Fontanella C, Schneeweiss A, Karn T, Marmé F, Sinn HP, van Mackelenbergh M, Sinn B, Zahm DM, Ingold-Heppner B, Schem C, Stickeler E, Fasching PA, Nekljudova V, Taube ET, Heppner F, Müller V, Denkert C, Loibl S. Correction: MGMT promoter methylation in triple negative breast cancer of the GeparSixto trial. PLoS One 2021; 16:e0257142. [PMID: 34469495 PMCID: PMC8409660 DOI: 10.1371/journal.pone.0257142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0238021.].
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Reinisch M, Seiler S, Hauzenberger T, Kamischke A, Schmatloch S, Strittmatter HJ, Zahm DM, Thode C, Furlanetto J, Strik D, Möbus V, Reimer T, Sinn BV, Stickeler E, Marmé F, Janni W, Schmidt M, Rudlowski C, Untch M, Nekljudova V, Loibl S. Efficacy of Endocrine Therapy for the Treatment of Breast Cancer in Men: Results from the MALE Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:565-572. [PMID: 33538790 DOI: 10.1001/jamaoncol.2020.7442] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance The extent of changes in estradiol levels in male patients with hormone receptor-positive breast cancer receiving standard endocrine therapies is unknown. The sexual function and quality of life related to those changes have not been adequately evaluated. Objective To assess the changes in estradiol levels in male patients with breast cancer after 3 months of therapy. Design, Setting, and Participants This multicenter, phase 2 randomized clinical trial assessed 56 male patients with hormone receptor-positive breast cancer. Patients were recruited from 24 breast units across Germany between October 2012 and May 2017. The last patient completed 6 months of treatment in December 2017. The analysis data set was locked on August 24, 2018, and analysis was completed on December 19, 2018. Interventions Patients were randomized to 1 of 3 arms: tamoxifen alone or tamoxifen plus gonadotropin-releasing hormone analogue (GnRHa) or aromatase inhibitor (AI) plus GnRHa for 6 months. Main Outcomes and Measures The primary end point was the change in estradiol levels from baseline to 3 months. Secondary end points were changes of estradiol levels after 6 months, changes of additional hormonal parameters, adverse effects, sexual function, and quality of life after 3 and 6 months. Results In this phase 2 randomized clinical trial, a total of 52 of 56 male patients with a median (range) age of 61.5 (37-83) years started treatment. A total of 3 patients discontinued study treatment prematurely, 1 in each arm. A total of 50 patients were evaluable for the primary end point. After 3 months the patients' median estradiol levels increased by 67% (a change of +17.0 ng/L) with tamoxifen, decreased by 85% (-23.0 ng/L) with tamoxifen plus GnRHa, and decreased by 72% (-18.5 ng/L) with AI plus GnRHa (P < .001). After 6 months, median estradiol levels increased by 41% (a change of +12 ng/L) with tamoxifen, decreased by 61% (-19.5 ng/L) with tamoxifen plus GnRHa, and decreased by 64% (-17.0 ng/L) with AI plus GnRHa (P < .001). Sexual function and quality of life decreased when GnRHa was added but were unchanged with tamoxifen alone. Conclusions and Relevance This phase 2 randomized clinical trial found that AI or tamoxifen plus GnRHa vs tamoxifen alone led to a sustained decrease of estradiol levels. The decreased hormonal parameters were associated with impaired sexual function and quality of life. Trial Registration ClinicalTrials.gov Identifier: NCT01638247.
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Affiliation(s)
| | - Sabine Seiler
- German Breast Group, GBG Forschungs GmbH Neu-Isenburg, Germany
| | | | | | | | | | | | - Christian Thode
- Amedes MVZ Wagnerstibbe für Laboratoriumsmedizin, medizinische Mikrobiologie und Immunologie, Göttingen, Germany
| | | | | | - Volker Möbus
- Department of Medicine II, Hematology and Oncology, Goethe University of Frankfurt, Germany
| | | | | | | | | | | | | | | | | | | | - Sibylle Loibl
- German Breast Group, GBG Forschungs GmbH Neu-Isenburg, Germany.,Centre for Haematology and Oncology Bethanien, Frankfurt/Main, Germany
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10
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Sinn BV, Loibl S, Hanusch CA, Zahm DM, Sinn HP, Untch M, Weber K, Karn T, Becker C, Marmé F, Schmitt WD, Müller V, Schem C, Treue D, Stickeler E, Klauschen F, Burchardi N, Furlanetto J, van Mackelenbergh M, Fasching PA, Schneeweiss A, Denkert C. Immune-related Gene Expression Predicts Response to Neoadjuvant Chemotherapy but not Additional Benefit from PD-L1 Inhibition in Women with Early Triple-negative Breast Cancer. Clin Cancer Res 2021; 27:2584-2591. [PMID: 33593886 DOI: 10.1158/1078-0432.ccr-20-3113] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/05/2020] [Accepted: 02/11/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE We evaluated mRNA signatures to predict response to neoadjuvant PD-L1 inhibition in combination with chemotherapy in early triple-negative breast cancer. EXPERIMENTAL DESIGN Targeted mRNA sequencing of 2,559 transcripts was performed in formalin-fixed, paraffin-embedded samples from 162 patients of the GeparNuevo trial. We focused on validation of four predefined gene signatures and differential gene expression analyses for new predictive markers. RESULTS Two signatures [GeparSixto signature (G6-Sig) and IFN signature (IFN-Sig)] were predictive for treatment response in a multivariate model including treatment arm [G6-Sig: OR, 1.558; 95% confidence interval (CI), 1.130-2.182; P = 0.008 and IFN-Sig: OR, 1.695; 95% CI, 1.234-2.376; P = 0.002), while the CYT metric predicted pathologic complete response (pCR) in the durvalumab arm, and the proliferation-associated gene signature in the placebo arm. Expression of PD-L1 mRNA was associated with better response in both arms, indicating that increased levels of PD-L1 are a general predictor of neoadjuvant therapy response. In an exploratory analysis, we identified seven genes that were higher expressed in responders in the durvalumab arm, but not the placebo arm: HLA-A, HLA-B, TAP1, GBP1, CXCL10, STAT1, and CD38. These genes were associated with cellular antigen processing and presentation and IFN signaling. CONCLUSIONS Immune-associated signatures are associated with pCR after chemotherapy, but might be of limited use for the prediction of response to additional immune checkpoint blockade. Gene expressions related to antigen presentation and IFN signaling might be interesting candidates for further evaluation.
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Affiliation(s)
- Bruno V Sinn
- Department of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institut of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Claus A Hanusch
- Department of Gynecology, Rotkreuzklinikum München, Munich, Germany
| | - Dirk-Michael Zahm
- Department of Gynecology and Obstetrics, SRH Waldklinikum Gera GmbH, Gera, Germany
| | - Hans-Peter Sinn
- Department of Pathology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael Untch
- Department of Gynecology, Helios Kliniken Berlin-Buch, Berlin, Germany
| | - Karsten Weber
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Thomas Karn
- Department of Gynecology and Obstetrics, Goethe-University, Frankfurt, Germany
| | - Clemens Becker
- Department of Pathology, Rotkreuzklinikum München, Munich, Germany
| | - Frederik Marmé
- Department of Gynecology, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Wolfgang D Schmitt
- Department of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institut of Health, Berlin, Germany
| | - Volkmar Müller
- Department of Gynecology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Denise Treue
- Department of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institut of Health, Berlin, Germany
| | - Elmar Stickeler
- Department of Gynecology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Frederik Klauschen
- Department of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institut of Health, Berlin, Germany
| | | | | | | | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - Carsten Denkert
- Department of Pathology, Philipps-University Marburg and University Hospital Marburg (UKGM), Marburg, Germany.
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Massa C, Karn T, Denkert C, Schneeweiss A, Hanusch C, Blohmer JU, Zahm DM, Jackisch C, van Mackelenbergh M, Thomalla J, Marme F, Huober J, Müller V, Schem C, Mueller A, Stickeler E, Biehl K, Fasching PA, Untch M, Loibl S, Weber K, Seliger B. Differential effect on different immune subsets of neoadjuvant chemotherapy in patients with TNBC. J Immunother Cancer 2020; 8:jitc-2020-001261. [PMID: 33199511 PMCID: PMC7670944 DOI: 10.1136/jitc-2020-001261] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 01/03/2023] Open
Abstract
Background Triple-negative breast cancer (TNBC) is the most aggressive form of breast cancer (BC). Due to the absence of targets such as HER2 or hormone receptors, early TNBC is treated with surgery and chemotherapy. Since TNBC is also considered the most immunogenic type of BC with tumor infiltrating lymphocytes that are predictive for chemotherapy response and prognostic for patients′ survival, many different immunotherapeutic strategies are currently explored in clinical trials for the treatment of this disease. In order to efficiently combine chemotherapy with immunotherapy, it is important to evaluate the effect of chemotherapy on immune cells in vivo. Methods Peripheral blood was taken from 56 patients with TNBC undergoing neoadjuvant chemotherapy with nanoparticle albumin-bound paclitaxel (Nab-Pac) followed by epirubicin and cyclophosphamide (EC) at three different time points. Multicolor flow cytometry was used to characterize the immune cell composition and functional properties along neoadjuvant chemotherapy. Results Whereas the first phase of the neoadjuvant chemotherapy did not significantly alter the patients′ immune cell composition, after the second phase of chemotherapeutic administration most B cells (>90%) were lost and the frequency of natural killer (NK) cells and CD4+ T lymphocytes decreased approximately to 50%. In contrast, the frequency of CD8+ T cells were less affected. Conclusions Despite late consequences of Nab-Pac cannot be ruled out, these data suggest that different chemotherapeutics might have distinct effects on the immune cell repertoire and that different immune cell populations exhibit a specific susceptibility to these chemotherapies with B and NK cells being more affected than T cells. This might also have an impact on the combination of chemotherapies with immunotherapies. Trial registration number NCT02685059.
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Affiliation(s)
- Chiara Massa
- Insitute of Medical Immunology, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Thomas Karn
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Carsten Denkert
- Institute of Pathology, Philipps-Universitat Marburg, Marburg, Hessen, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Deutsches Krebsforschungszentrum, Heidelberg, Baden-Württemberg, Germany
| | | | - Jens-Uwe Blohmer
- Brustzentrum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Christian Jackisch
- Department of Obstetrics and Gynecology, Sana Klinikum Offenbach GmbH, Offenbach, Hessen, Germany
| | - Marion van Mackelenbergh
- Department of Obstetrics and Gynecology, Universitätsklinikum Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | - Jörg Thomalla
- Praxis für Hämatologie und Onkologie Koblenz, Koblenz, Germany
| | - Frederik Marme
- Universitätsfrauenklinik, Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Jens Huober
- Universitätsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | - Volkmar Müller
- Department of Obstetrics and Gynecology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | | | - Anja Mueller
- Insitute of Medical Immunology, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, Uniklinik RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Katharina Biehl
- Insitute of Medical Immunology, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Michael Untch
- Department of Obstetrics and Gynecology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Sibylle Loibl
- Department of Medicine and Research, German Breast Group, Neu-Isenburg, Hessen, Germany
| | - Karsten Weber
- Department of Medicine and Research, German Breast Group, Neu-Isenburg, Hessen, Germany
| | - Barbara Seliger
- Insitute of Medical Immunology, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
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Furlanetto J, Möbus V, Schneeweiss A, Rhiem K, Tesch H, Blohmer JU, Lübbe K, Untch M, Salat C, Huober J, Klare P, Schmutzler R, Couch FJ, Lederer B, Gerber B, Zahm DM, Bauerfeind I, Nekljudova V, Hanusch C, Jackisch C, Link T, Loibl S, Fasching PA. Abstract P6-10-03: Germline (g)BRCA1/2 mutations (m) and hematological toxicities in patients (pts) with triple negative breast cancer (TNBC) treated with neoadjuvant chemotherapy (NACT). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p6-10-03] [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: BRCA1/2 genes play a central role in DNA repair. Therefore, pts harboring gBRCA1/2m treated with chemotherapy might be at higher risk of acute hematological toxicities due to the lower level of functional BRCA1/2 protein potentially resulting in more toxicity. Published results are discordant, further data are needed.
Methods: Pts with early TNBC and known gBRCA1/2m treated with anthracycline-taxane based NACT in the GeparQuinto (n=487), GeparSixto (n=291) and GeparOcto (n=393) studies were included. Primary G-CSF prophylaxis was foreseen only for the iddETC arm in GeparOcto. Primary objective was the rate of neutropenia grade (G)3-4 after cycle 1; secondary objectives were the rate of other hematological toxicities G3-4 and the overall toxicity rate after cycle 1 as well as hematological toxicities in gBRCA1/2 pts during the taxane part of chemotherapy.
Results: 209/1171 evaluated pts (17.8%) had a gBRCA1/2m (177 gBRCA1m, 33 gBRCA2m). Median age was 48yrs [21-78].
The rate of neutropenia G3-4 after cycle 1 in gBRCA1/2 wildtype (wt) pts was 35.7% vs 37.4% in gBRCA1/2m (p=0.683), 35.9% in gBRCA1m (p=1.000), 44.8% in gBRCA2m (p=0.330).
gBRCA1/2 mutational status did not predict neutropenia G3-4 at univariate (OR=1.08, 95%CI 0.78-1.48 p=0.658) or multivariate analysis adjusted for age, BMI and treatment (OR=1.26, 95%CI 0.87-1.82 p=0.226).
The overall rate and the rates of other hematological toxicities are shown in the table.
gBRCA1/2 mutational status did also not predict for any other hematological toxicities G3-4 (univariate OR=0.94, 95%CI 0.64-1.40 p=0.773; multivariate OR=0.94, 95%CI 0.62-1.43 p=0.779).
gBRCA1/2 mutational status predicted for hematological toxicities G3-4 under taxane treatment (univariate OR=1.94, 95%CI 1.35-2.77 p<0.001; multivariate OR=2.91, 95%CI 1.55-5.45 p=0.001).
During taxane treatment, the overall rate of hematological toxicities G3-4 in wt pts was 43.1% (n=270) vs 59.5% (n=91) in gBRCA1/2m, p<0.001; anemia G3-4 2.6% (n=16) vs 3.3% (n=5), p=0.584; leucopenia G3-4 32.7% (n=203) vs 47.1% (n=72), p=0.001; neutropenia G3-4 35.8% (n=219) vs 49.3% (n=73), p=0.003; thrombopenia G3-4 1.4% (n=9) vs 4.6% (n=7), p=0.024; febrile neutropenia 5.9% (n=37) vs 4.6% (n=7), p=0.696.
Conclusions: Overall, gBRCA1/2 mutation is not associated with a significantly higher risk of severe hematological toxicities. Under taxane therapy, pts with gBRCA1/2 demonstrate a higher rate of hematological toxicities G3-4, especially neutropenia, compared to wildtype pts, and should therefore be carefully monitored.
Hematological toxicities after cycle 1wildtypegBRCA1/2mp-valuegBRCA1mp-valuegBRCA2mp-valueN%N%N%N%neutropenia G3-432635.77437.40.6836135.91.0001344.80.330febrile neutropenia171.831.41.00010.60.33726.10.130leucopenia G3-424425.83818.20.0212815.80.0041030.30.548anemia G3-420.200.01.00000.01.00000.01.000thrombopenia G3-4111.210.50.70510.60.70400.01.000any hematological toxicities G1-477782.617081.70.76314180.10.4533090.90.344any hematological toxicities G3-442846.38843.60.5337241.90.3171651.60.587
Citation Format: Jenny Furlanetto, Volker Möbus, Andreas Schneeweiss, Kerstin Rhiem, Hans Tesch, Jens-Uwe Blohmer, Kristina Lübbe, Michael Untch, Christoph Salat, Jens Huober, Peter Klare, Rita Schmutzler, Fergus J Couch, Bianca Lederer, Bernd Gerber, Dirk-Michael Zahm, Ingo Bauerfeind, Valentina Nekljudova, Claus Hanusch, Christian Jackisch, Theresa Link, Sibylle Loibl, Peter A Fasching. Germline (g)BRCA1/2 mutations (m) and hematological toxicities in patients (pts) with triple negative breast cancer (TNBC) treated with neoadjuvant chemotherapy (NACT) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-10-03.
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Affiliation(s)
| | | | | | - Kerstin Rhiem
- 4Zentrum Familiärer Brust- und Eierstockkrebs, Köln, Germany
| | - Hans Tesch
- 5Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | - Kristina Lübbe
- 7DIAKOVERE Henriettenstift, Klinik für Gynäkologische Chirurgie, Senologie und Onkologie, Hannover, Germany
| | | | - Christoph Salat
- 9Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany
| | | | - Peter Klare
- 11MediOnko-Institut GbR Berlin, Berlin, Germany
| | - Rita Schmutzler
- 4Zentrum Familiärer Brust- und Eierstockkrebs, Köln, Germany
| | - Fergus J Couch
- 12Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Bernd Gerber
- 13Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | | | | | | | | | | | - Theresa Link
- 18Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Peter A Fasching
- 19Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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13
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Loibl S, Weber KE, Timms KM, Elkin EP, Hahnen E, Fasching PA, Lederer B, Denkert C, Schneeweiss A, Braun S, Salat CT, Rezai M, Blohmer JU, Zahm DM, Jackisch C, Gerber B, Klare P, Kümmel S, Schem C, Paepke S, Schmutzler R, Rhiem K, Penn S, Reid J, Nekljudova V, Hartman AR, von Minckwitz G, Untch M. Survival analysis of carboplatin added to an anthracycline/taxane-based neoadjuvant chemotherapy and HRD score as predictor of response-final results from GeparSixto. Ann Oncol 2019; 29:2341-2347. [PMID: 30335131 DOI: 10.1093/annonc/mdy460] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In the neoadjuvant GeparSixto study, adding carboplatin to taxane- and anthracycline-based chemotherapy improved pathological complete response (pCR) rates in patients with triple-negative breast cancer (TNBC). Here, we present survival data and the potential prognostic and predictive role of homologous recombination deficiency (HRD). Patients and methods Patients were randomized to paclitaxel plus nonpegylated liposomal doxorubicin (Myocet®) (PM) or PM plus carboplatin (PMCb). The secondary study end points disease-free survival (DFS) and overall survival (OS) were analyzed. Median follow-up was 47.3 months. HRD was among the exploratory analyses in GeparSixto and was successfully measured in formalin-fixed, paraffin-embedded tumor samples of 193/315 (61.3%) participants with TNBC. Homologous recombination (HR) deficiency was defined as HRD score ≥42 and/or presence of tumor BRCA mutations (tmBRCA). Results A significantly better DFS (hazard ratio 0.56, 95% CI 0.34-0.93; P = 0.022) was observed in patients with TNBC when treated with PMCb. The improvement of OS with PMCb was not statistically significant. Additional carboplatin did not improve DFS or OS in patients with HER2-positive tumors. HR deficiency was detected in 136 (70.5%) of 193 triple-negative tumors, of which 82 (60.3%) showed high HRD score without tmBRCA. HR deficiency independently predicted pCR (ypT0 ypN0) [odds ratio (OR) 2.60, 95% CI 1.26-5.37, P = 0.008]. Adding carboplatin to PM significantly increased the pCR rate from 33.9% to 63.5% in HR deficient tumors (P = 0.001), but only marginally in HR nondeficient tumors (from 20.0% to 29.6%, P = 0.540; test for interaction P = 0.327). pCR rates with carboplatin were also higher (63.2%) than without carboplatin (31.7%; OR 3.69, 1.46-9.37, P = 0.005) in patients with high HRD score but no tmBRCA. DFS rates were improved with addition of carboplatin, both in HR nondeficient (hazard ratio 0.44, 0.17-1.17, P = 0.086) and HR deficient tumors (hazard ratio 0.49, 0.23-1.04, P = 0.059). Conclusions The addition of carboplatin to neoadjuvant PM improved DFS significantly in TNBC. Long-term survival analyses support the neoadjuvant use of carboplatin in TNBC. HR deficiency in TNBC and HRD score in non-tmBRCA TNBC are predictors of response. HRD does not predict for carboplatin benefit.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, Germany.
| | - K E Weber
- German Breast Group, Neu-Isenburg, Germany
| | - K M Timms
- Myriad Genetics Inc, Salt Lake City, USA
| | - E P Elkin
- The Permanente Medical Group Inc, Oakland, USA
| | - E Hahnen
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - B Lederer
- German Breast Group, Neu-Isenburg, Germany
| | - C Denkert
- Institute of Pathology, Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - S Braun
- Brustzentrum, Sana Kliniken Offenbach, Offenbach, Germany
| | - C T Salat
- Hämatoonkologische Schwerpunktpraxis, Munich, Germany
| | - M Rezai
- Luisenkrankenhaus, Düsseldorf, Germany
| | - J U Blohmer
- Klinik für Gynäkologie mit Brustzentrum Charité, Berlin, Germany
| | - D M Zahm
- Brustzentrum SRH Waldklinikum, Gera, Germany
| | - C Jackisch
- Brustzentrum, Sana Kliniken Offenbach, Offenbach, Germany
| | - B Gerber
- Frauenklinik, Universität Rostock, Rostock, Germany
| | - P Klare
- Praxisklinik, Berlin, Germany
| | - S Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - C Schem
- Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - S Paepke
- Klinikum rechts der Isar der Technischen Universität München, Frauenklinik, München, Germany
| | - R Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - S Penn
- Myriad Genetics Inc, Salt Lake City, USA
| | - J Reid
- Myriad Genetics Inc, Salt Lake City, USA
| | | | | | | | - M Untch
- Helios-Klinikum Berlin-Buch, Berlin, Germany
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Laakmann E, Witzel I, Fasching PA, Rezai M, Schem C, Solbach C, Tesch H, Klare P, Schneeweiss A, Salat C, Zahm DM, Blohmer JU, Ingold-Heppner B, Huober J, Hanusch C, Jackisch C, Reinisch M, Untch M, von Minckwitz G, Nekljudova V, Müller V, Loibl S. Development of central nervous system metastases as a first site of metastatic disease in breast cancer patients treated in the neoadjuvant trials GeparQuinto and GeparSixto. Breast Cancer Res 2019; 21:60. [PMID: 31077239 PMCID: PMC6509843 DOI: 10.1186/s13058-019-1144-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 04/17/2019] [Indexed: 11/28/2022] Open
Abstract
Background The incidence of central nervous system (CNS) metastases in breast cancer patients is rising and has become a major clinical challenge. Only few data are published concerning risk factors for the development of CNS metastases as a first site of metastatic disease in breast cancer patients. Moreover, the incidence of CNS metastases after modern neoadjuvant treatment is not clear. Methods We analyzed clinical factors associated with the occurrence of CNS metastases as the first site of metastatic disease in breast cancer patients after neoadjuvant treatment in the trials GeparQuinto and GeparSixto (n = 3160) where patients received targeted treatment in addition to taxane and anthracycline-based chemotherapy. Results After a median follow-up of 61 months, 108 (3%) of a total of 3160 patients developed CNS metastases as the first site of recurrence and 411 (13%) patients had metastatic disease outside the CNS. Thirty-six patients (1%) developed both CNS metastases and other distant metastases as the first site of metastatic disease. Regarding subtypes of the primary tumor, 1% of luminal A-like (11/954), 2% of luminal B-like (7/381), 4% of HER2-positive (34/809), and 6% of triple-negative patients (56/1008) developed CNS metastases as the first site of metastatic disease. In multivariate analysis, risk factors for the development of CNS metastases were larger tumor size (cT3–4; HR 1.63, 95% CI 1.08–2.46, p = 0.021), node-positive disease (HR 2.57, 95% CI 1.64–4.04, p < 0.001), no pCR after neoadjuvant chemotherapy (HR 2.29, 95% CI 1.32–3.97, p = 0.003), and HER2-positive (HR 3.80, 95% CI 1.89–7.64, p < 0.001) or triple-negative subtype (HR 6.38, 95% CI 3.28–12.44, p < 0.001). Conclusions Especially patients with HER2-positive and triple-negative tumors are at risk of developing CNS metastases despite effective systemic treatment. A better understanding of the underlying mechanisms is required in order to develop potential preventive strategies.
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Affiliation(s)
- Elena Laakmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Mahdi Rezai
- European Breast Center Duesseldorf, Luise-Rainer-Str. 6-10, 40235, Duesseldorf, Germany
| | - Christian Schem
- Department of Gynecology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105, Kiel, Germany.,Breastcancer Center Hamburg, Moorkamp 2-6, 20357, Hamburg, Germany
| | - Christine Solbach
- Department of Gynecology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Hans Tesch
- Center for Hematology und Oncology Bethanien Frankfurt, Im Prüfling 17-19, 60389, Frankfurt/Main, Germany
| | - Peter Klare
- Medical Center, Lichtenberg, Möllendorffstraße 52, 10367, Berlin, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Christoph Salat
- Medical Center for Hematology and Oncology, Winthirstr. 7, 80639, Munich, Germany
| | - Dirk-Michael Zahm
- Department of Gynecology, SRH Wald-Klinikum Gera gGmbH, Strasse des Friedens 122, 07548, Gera, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Cancer, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Jens Huober
- Department of Gynecology, University of Ulm, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Claus Hanusch
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - Christian Jackisch
- Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - Mattea Reinisch
- Breast Unit, Kliniken Essen-Mitte Evang. Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany
| | - Michael Untch
- Department of Gynecology, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Gunter von Minckwitz
- German Breast Group GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
| | - Valentina Nekljudova
- German Breast Group GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Sibylle Loibl
- German Breast Group GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
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Böttcher J, Renz DM, Zahm DM, Pfeil A, Fallenberg EM, Streitparth F, Maurer MH, Hamm B, Engelken FJ. Response to neoadjuvant treatment of invasive ductal breast carcinomas including outcome evaluation: MRI analysis by an automatic CAD system in comparison to visual evaluation. Acta Oncol 2014; 53:759-68. [PMID: 24299492 DOI: 10.3109/0284186x.2013.852688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate imaging-based response to standardized neoadjuvant chemotherapy (NACT) regimen by dynamic contrast-enhanced magnetic resonance mammography (DCE-MRM), whereas MR images were analyzed by an automatic computer-assisted diagnosis (CAD) system in comparison to visual evaluation. MRI findings were correlated with histopathologic response to NACT and also with the occurrence of metastases in a follow-up analysis. PATIENTS AND METHODS Fifty-four patients with invasive ductal breast carcinomas received two identical MRI examinations (before and after NACT; 1.5T, contrast medium gadoteric acid). Pre-therapeutic images were compared with post-therapeutic examinations by CAD and two blinded human observers, considering morphologic and dynamic MRI parameters as well as tumor size measurements. Imaging-assessed response to NACT was compared with histopathologically verified response. All clinical, histopathologic, and DCE-MRM parameters were correlated with the occurrence of distant metastases. RESULTS Initial and post-initial dynamic parameters significantly changed between pre- and post-therapeutic DCE-MRM. Visually evaluated DCE-MRM revealed sensitivity of 85.7%, specificity of 91.7%, and diagnostic accuracy of 87.0% in evaluating the response to NACT compared to histopathology. CAD analysis led to more false-negative findings (37.0%) compared to visual evaluation (11.1%), resulting in sensitivity of 52.4%, specificity of 100.0%, and diagnostic accuracy of 63.0%. The following dynamic MRI parameters showed significant associations to occurring metastases: Post-initial curve type before NACT (entire lesions, calculated by CAD) and post-initial curve type of the most enhancing tumor parts after NACT (calculated by CAD and manually). CONCLUSIONS In the accurate evaluation of response to neoadjuvant treatment, CAD systems can provide useful additional information due to the high specificity; however, they cannot replace visual imaging evaluation. Besides traditional prognostic factors, contrast medium-induced dynamic MRI parameters reveal significant associations to patient outcome, i.e. occurrence of distant metastases.
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Affiliation(s)
- Joachim Böttcher
- Institute of Diagnostic and Interventional Radiology, SRH Clinic Gera , Gera , Germany
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Renz DM, Zahm DM, Engelken FJ, Pfeil A, Fallenberg EM, Streitparth F, Maurer MH, Hamm B, Böttcher J. Diagnostischer Stellenwert computerassistierter Auswertungen von MR-Mammografien für die Beurteilung des Erfolgs einer neoadjuvanten Chemotherapie. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Darb-Esfahani S, Kronenwett R, von Minckwitz G, Denkert C, Gehrmann M, Rody A, Budczies J, Brase JC, Mehta MK, Bojar H, Ataseven B, Karn T, Weiss E, Zahm DM, Khandan F, Dietel M, Loibl S. Thymosin beta 15A (TMSB15A) is a predictor of chemotherapy response in triple-negative breast cancer. Br J Cancer 2012; 107:1892-900. [PMID: 23079573 PMCID: PMC3504944 DOI: 10.1038/bjc.2012.475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Biomarkers predictive of pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) of breast cancer are urgently needed. Methods: Using a training/validation approach for detection of predictive biomarkers in HER2-negative breast cancer, pre-therapeutic core biopsies from four independent cohorts were investigated: Gene array data were analysed in fresh frozen samples of two cohorts (n=86 and n=55). Quantitative reverse transcription polymerase chain reaction (qRT–PCR) was performed in formalin-fixed, paraffin-embedded (FFPE) samples from two neoadjuvant phase III trials (GeparTrio, n=212, and GeparQuattro, n=383). Results: A strong predictive capacity of thymosin beta 15 (TMSB15A) gene expression was evident in both fresh frozen cohorts (P<0.0001; P<0.0042). In the GeparTrio FFPE training cohort, a significant linear correlation between TMSB15A expression and pCR was apparent in triple-negative breast cancer (TNBC) (n=61, P=0.040). A cutoff point was then defined that divided TNBC into a low and a high expression group (pCR rate 16.0% vs 47.2%). Both linear correlation of TMSB15A mRNA levels (P=0.017) and the pre-defined cutoff point were validated in 134 TNBC from GeparQuattro (pCR rate 36.8% vs 17.0%, P=0.020). No significant predictive capacity was observed in luminal carcinomas from GeparTrio and GeparQuattro. Conclusion: In TNBC, TMSB15A gene expression analysis might help to select patients with a high chance for pCR after NACT.
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Affiliation(s)
- S Darb-Esfahani
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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von Minckwitz G, Müller BM, Loibl S, Budczies J, Hanusch C, Darb-Esfahani S, Hilfrich J, Weiss E, Huober J, Blohmer JU, du Bois A, Zahm DM, Khandan F, Hoffmann G, Gerber B, Eidtmann H, Fend F, Dietel M, Mehta K, Denkert C. Cytoplasmic Poly(Adenosine Diphosphate–Ribose) Polymerase Expression Is Predictive and Prognostic in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy. J Clin Oncol 2011; 29:2150-7. [DOI: 10.1200/jco.2010.31.9079] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose Poly(adenosine diphosphate–ribose) polymerase (PARP) plays a key role in DNA repair and cellular stress response. Inhibitors of PARP show promising clinical activity in metastatic, triple-negative or BRCA-mutated breast cancer. Patients and Methods We investigated cytoplasmic PARP (cPARP) and nuclear PARP (nPARP) expression by immunohistochemistry in 638 pretreatment biopsies from patients on the GeparTrio study and evaluated its predictive and prognostic value after neoadjuvant anthracycline/taxane-based chemotherapy. Results cPARP expression was high in 23.7%, intermediate in 50.9%, and negative in 25.4% of tumors. High cPARP expression was significantly correlated with nonlobular histology (P < .001), undifferentiated grade (P < .001), positive nodal status (P = .049), and negative hormone receptor (HR) status (P < .001) but not with human epidermal growth factor receptor 2 (HER2) status. Expression was high in 35.5% of triple-negative tumors, 24.6% of HER2-positive tumors, and 18.0% of HR-positive/HER2-negative tumors (P < .001). Pathologic complete response (pCR) rates were 26.5%, 19.1%, and 8.0% in patients with high, intermediate, or negative expression, respectively (P < .001). This predictive effect was most prominent in HR-positive tumors (P = .035) or HER2-negative tumors (P < .001). High cPARP expression was a negative, but not independent, prognostic factor for disease-free survival (DFS; P = .0025) and overall survival (OS; P = .0022). cPARP expression was highly prognostic in patients without a pCR (DFS, P < .001; OS, P < .001) and in patients with HR-positive tumors (DFS, P < .001; OS, P < .001). No such correlations were found for nPARP expression. Conclusion High cPARP expression correlates with aggressive tumor pattern and predicts high sensitivity to neoadjuvant taxane/anthracycline-based chemotherapy but also unfavorable long-term prognosis. As a potential target for PARP inhibitors, cPARP-positive breast cancer might become a new, clinically relevant entity.
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Affiliation(s)
- Gunter von Minckwitz
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Berit Maria Müller
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Sibylle Loibl
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Jan Budczies
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Claus Hanusch
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Silvia Darb-Esfahani
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Jörn Hilfrich
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Erich Weiss
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Jens Huober
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Jens Uwe Blohmer
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Andreas du Bois
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Dirk-Michael Zahm
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Fariba Khandan
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Gerald Hoffmann
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Bernd Gerber
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Holger Eidtmann
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Falko Fend
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Manfred Dietel
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Keyur Mehta
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
| | - Carsten Denkert
- From the German Breast Group, Neu- Isenburg; Institut für Pathologie, Charité-Universitätsmedizin Berlin; St Gertrauden Krankenhaus, Berlin; Frauenklinik, Rotkreuzklinikum, München; Frauenklinik, Henriettenstiftung, Hannover; Frauenklinik, Krankenhaus Böblingen, Böblingen; Universitäts-Frauenklinik Tübingen; Institut für Pathologie, Universitätsklinikum, Tübingen, Tübingen; Kantonsspital St Gallen, St Gallen; Dr Horst Schmidt Klinik; Frauenklinik, St Josef Krankenhaus, Wiesbaden; Frauenklinik,
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Costa SD, Loibl S, Kaufmann M, Zahm DM, Hilfrich J, Huober J, Eidtmann H, du Bois A, Blohmer JU, Ataseven B, Weiss E, Tesch H, Gerber B, Baumann KH, Thomssen C, Breitbach GP, Ibishi S, Jackisch C, Mehta K, von Minckwitz G. Neoadjuvant chemotherapy shows similar response in patients with inflammatory or locally advanced breast cancer when compared with operable breast cancer: a secondary analysis of the GeparTrio trial data. J Clin Oncol 2009; 28:83-91. [PMID: 19901111 DOI: 10.1200/jco.2009.23.5101] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Neoadjuvant chemotherapy followed by mastectomy is the treatment of choice in patients with inflammatory breast cancer (IBC) or locally advanced breast cancer (LABC), but it is considered less effective in these diseases than in operable breast cancer (OBC). We report a prospective comparison of the GeparTrio trial of patients with IBC (cT4 days) or LABC (cT4a-c or cN3; stage IIIB or IIIC) and patients with OBC (cT2-3). PATIENTS AND METHODS Participants were stratified by stage and were randomly assigned to six or eight cycles of docetaxel/doxorubicin/cyclophosphamide (TAC) or to two cycles of TAC followed by four cycles of vinorelbine/capecitabine. We present results of a secondary aim of the study, which was to compare pathologic complete response (pCR; ie, no remaining invasive/noninvasive tumor in breast and lymph nodes) in different stage groups. Results A total of 287 patients with IBC (n = 93) or LABC (n = 194) and 1,777 patients with OBC were entered onto the trial. At baseline, parameters were as follows for the three types of cancer, respectively: median tumor sizes: 8.0 cm, 7.0 cm, and 4.0 cm (P < .001); multiple lesions: 31.2%, 27.3%, and 19.6% (P < .001); nodal involvement: 86.6%, 71.2%, and 51.6% (P < .001); grade 3: 44.4%, 30.4%, and 39.9% (P = .178); lobular-invasive type: 7.5%, 17.5%, and 13.3% (P = .673); negative hormone receptor status: 38.0%, 20.0%, and 36.4% (P = .008); and positive human growth factor receptor 2 status: 45.1%, 38.9%, and 35.7% (P = .158). Response rates for IBC, LABC, and OBC, respectively, were 8.6%, 11.3%, and 17.7% for pCR (P = .002); 71.0%, 69.6%, and 83.4% for overall response by physical or sonographic examination (P < .001); and 12.9%, 33.0%, and 69.9% for breast conservation (P < .001). All P values were for IBC and LABC versus OBC. However, tumor stage itself was not an independent predictor for pCR in multivariable analysis (odds ratio, 1.51; 95% CI, 0.88 to 2.59; P = .13). CONCLUSION No evidence of a difference in response to neoadjuvant chemotherapy was found by tumor stage when analysis was adjusted for baseline characteristics.
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Abstract
OBJECTIVE We investigated to determine whether colposcopic, histologic, and virologic parameters of cervical intraepithelial neoplasia are influenced by a patient's age. STUDY DESIGN A cohort of 967 women with a mean age of 37.1 years underwent screening for detection of cervical intraepithelial neoplasia by colposcopy, cytologic examination, and testing for high-risk human papillomaviruses with the Hybrid Capture System (Digene, Silver Springs, Md) and a general primer and type-specific primer polymerase chain reaction system. Cervicography was used for documentation and reproducible evaluation of the colposcopic appearance of the cervix. In 86% of patients with trivial colposcopic changes of doubtful significance (100/116) and 89% of patients with colposcopic changes consistent with cervical intraepithelial neoplasia (89/99), punch biopsy specimens were taken for histologic evaluation. RESULTS In patients with trivial colposcopic changes of doubtful significance, histologically confirmed cervical intraepithelial neoplasia was almost as frequent (32%, 37/116) as in patients with colposcopic changes consistent with cervical intraepithelial neoplasia (43%, 43/99, difference not significant). The ratio between colposcopic evidence of cervical intraepithelial neoplasia and trivial colposcopic changes was 1.9 in patients <35 years old with cervical intraepithelial neoplasia, versus 0.5 in patients >/=35 years old with cervical intra-epithelial neoplasia (P =.005). Patients with trivial colposcopic changes of doubtful significance were older (median age 36 years) than were patients with colposcopic changes consistent with cervical intraepithelial neoplasia (median age 29 years, P =. 008). In patients with cervical intraepithelial neoplasia who had no or trivial colposcopic changes, the thickness of neoplastic epithelium was smaller (P =.008) and the number of cellular layers was lower (P =.01) than in patients with cervical intraepithelial neoplasia who had colposcopic changes consistent with cervical intraepithelial neoplasia. In patients <35 years old the rate of positive results for a high-risk human papillomavirus (P <.005) and the viral load (difference not significant) were higher than in women >/=35 years old. The rate of positive results for high-risk human papillomaviruses differed independently of age among patients with normal colposcopic findings, patients with trivial colposcopic changes of doubtful significance, and patients with colposcopic changes consistent with cervical intraepithelial neoplasia (P <.005). CONCLUSIONS In women >/=35 years old cervical lesions associated with intraepithelial neoplasia are thinner and thus less colposcopically conspicuous than those in women <35 years old. Patients >/=35 years old with acetowhite cervical lesions consistent with trivial changes of doubtful significance should therefore undergo punch biopsy for histologic evaluation.
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Affiliation(s)
- D M Zahm
- Department of Gynecology and the Institute of Medical Statistics, Informatics and Documentation, Friedrich Schiller University, Jena, Germany
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Nindl I, Greinke C, Zahm DM, Stockfleth E, Hoyer H, Schneider A. Human papillomavirus distribution in cervical tissues of different morphology as determined by hybrid capture assay and PCR. Int J Gynecol Pathol 1997; 16:197-204. [PMID: 9421083 DOI: 10.1097/00004347-199707000-00002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [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: 02/05/2023]
Abstract
Distribution of various types of genital human Papillomavirus (HPV) in smears from histologically classified cervical lesions was determined by hybrid capture assay (HCA) and was compared with a polymerase chain reaction (PCR) system using general primers (GP) in first and type specific primers (TS) in a second step. The overall agreement of high-risk HPV by HCA and the more sensitive GP/TS PCR was 80.6% (204 of 253, kappa value 0.6). Human Papillomavirus frequency by GP/TS PCR was 14-20% higher compared with HCA (p = 0.02-0.004) independent of morphology. Only one sample was positive by HCA and negative by GP/TS PCR. A significantly higher frequency was found using HCA and GP/TS PCR in smears from histologically proven cervical intraepithelial lesions (CIN) II/III compared with CIN I, tissues with minimal changes (metaplasia, cervicitis, or lack of glycogenization), or normal morphology (61% and 81% vs 8-15% and 24-34%, p < or = 0.001). Semi-quantitative estimate of HPV DNA copies by GP-PCR coincided with estimated virus load by quantitative HCA and was significantly higher in patients with CIN II/III compared with CIN I (p < 0.001). Thus, the GP-PCR may be used to monitor the amount of HPV DNA copies in clinical samples. A direct correlation between morphologic changes and HPV detection as well as virus load was found by HCA and the more sensitive GP/TS PCR.
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Affiliation(s)
- I Nindl
- Department of Gynecology, Friedrich Schiller University, Jena, Federal Republic of Germany
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Schneider A, Zahm DM, Greinke C, Kirchmayr R, Nindl I. Different detectability of high-risk HPV in smears from incident and prevalent high-grade squamous intraepithelial lesions of the cervix. Gynecol Oncol 1997; 65:399-404. [PMID: 9190964 DOI: 10.1006/gyno.1997.4693] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 02/04/2023]
Abstract
Human papillomavirus (HPV) status in cervical smears from cervical intraepithelial neoplasia (CIN) 2/3 diagnosed in 36 of 892 women with a history of normal cytology and colposcopy (incident CIN 2/3) was compared with CIN 2/3 in 40 patients with a history of abnormal cytology (prevalent CIN 2/3). In all patients cervical smears for HPV testing and cytology and two cervigrams were taken. The scrapes were collected in hybrid capture assay solution and analyzed with the hybrid capture and general primer/type-specific primer polymerase chain reaction system (GP/TS-PCR) after DNA extraction. Patients with incident and prevalent CIN 2/3 were similar with respect to age. By GP/TS-PCR carried out under suboptimal conditions due to DNA extraction, HPV DNA was detected in 69.4% (25 of 36) of smears from incident CIN 2/3 compared to 95% (38 of 40) in prevalent CIN 2/3 (P = 0.003). Using hybrid capture, smears of incident CIN 2/3 were HPV positive in 50% (18 of 36) compared to 80% (32 of 40) in prevalent CIN 2/3 (P = 0.006). High-risk HPVs were significantly less common in smears from incident CIN 2/3 compared with prevalent CIN 2/3: 36.1% vs 72.5% by GP/TS-PCR (P = 0.001) and 47.2% vs 80% by hybrid capture assay (P = 0.003), respectively. Virus load in HPV-positive smears of prevalent CIN 2/3 was significantly higher than of incident CIN 2/3 using semiquantitative PCR (P = 0.0005). Thus, high-risk HPV types were detected less frequently and in lower concentration in smears from incident CIN 2/3 than in smears from prevalent CIN 2/3.
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Affiliation(s)
- A Schneider
- Department of Gynecology, Friedrich Schiller University, Jena, Germany
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Schneider A, Zahm DM. New adjunctive methods for cervical cancer screening. Obstet Gynecol Clin North Am 1996; 23:657-73. [PMID: 8869951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The sensitivity of cytology for detection of cervical intraepithelial neoplasia (CIN) is effectively augmented by cervicography with the disadvantage of lower specificity. However, the combination of cytology and cervicography can decrease the number of recalls, biopsies, and unnecessary treatments, which reduces cost. Down-staging of invasive cancer by visual inspection seems a cost-effective alternative to the introduction of cytology in countries with limited health facilities. Other methods such as speculoscopy, polarprobe, laser-induced fluorescence, computerized digital imaging colposcopy, or computer imaging have a potential to be used for future screening or triaging; however, so far, insufficient data are available to evaluate the validity of these techniques.
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Affiliation(s)
- A Schneider
- Department of Gynecology, Friedrich Schiller University, Jena, Germany
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Schneider A, Zahm DM, Kirchmayr R, Schneider VL. Screening for cervical intraepithelial neoplasia grade 2/3: validity of cytologic study, cervicography, and human papillomavirus detection. Am J Obstet Gynecol 1996; 174:1534-41. [PMID: 9065125 DOI: 10.1016/s0002-9378(96)70602-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.3] [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: 02/03/2023]
Abstract
OBJECTIVE A commercial test for human papillomavirus detection (hybrid capture assay) was examined for its potential value to augment the sensitivity of cytologic study or cervicography for screening for cervical intraepithelial neoplasia grade 2/3. STUDY DESIGN In a cohort of 967 women with a mean age of 37.1 years who underwent routine cytologic screening, cytologic examination, cervicography, and testing for high-risk human papillomavirus by the hybrid capture assay were compared for their ability to detect cervical intraepithelial neoplasia grade 2/3. Cervical punch biopsy specimens were taken in 20.5% (198/967) patients because they had an atypical or positive cervigram or abnormal cytologic results in the primary screening smears. The data were analyzed by two-tailed chi(2) and Fisher's exact test. RESULTS Thirty-eight patients were diagnosed with cervical intraepithelial neoplasia grade 2/3 (prevalence 3.9%) by histologic study. Cytologic study identified 29%, cervicography 45%, and testing for high-risk human papillomavirus 50% of cervical intraepithelial neoplasia grade 2/3. When combined, detection of high-risk human papillomavirus or cervicography augmented sensitivity of cytologic study to 58% (p = 0.01) with positive predictive values of 23% and 17%, respectively. Results of the different techniques should be interpreted in relationship to each other and not as absolute values because collection of specimens for cytologic study was done with cotton swabs, which may be suboptimal for screening but is general practice in Germany. CONCLUSIONS Screening for cervical intraepithelial neoplasia grade 2/3 can significantly be improved by human papillomavirus testing with the hybrid capture assay.
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Affiliation(s)
- A Schneider
- Department of Gynecology, Friedrich Schiller University, Jena, Germany
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Zahm DM, Greinke C, Nöschel H. [MSA--a new sensitive tumor marker in breast carcinoma]. Zentralbl Gynakol 1996; 118:659-64. [PMID: 9082702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mammary serum antigen (MSA) serum levels were evaluated for its association with histopathologic outcome of breast biopsies. 212 women were undergoing a diagnostic extirpation for suspicious lesions of the breast. Invasive breast cancer was found in 24.5%, in-situ-carcinomas in 7.1% respectively. 56.1% of the women were diagnosed with proliferating benign breast diseases and normal breast tissue was found in 12.3% of the patients. In all women pretherapeutic MSA-serum levels were measured by Inhibition-ELISA using the monoclonal antibody 3E1.2. The positivity-rates of MSA, CA15-3, TPA and CEA were compared separately and in combination. MSA was positive in 25% of breast cancer patients when a cut-off level of 55 U/ml was applied. The addition of CA15-3, TPA or CEA increased the sensitivity to 42.3% and the increment of the positivity-rate was smaller by addition of CA15-3, when compared with TPA or CEA. The highest MSA serum levels and positivity-rates were associated with malignant tumours, but there was no significant difference compared with benign epithelial proliferations (19.5% positivity rate). The lowest positivity-rate was detected in mesenchymal proliferations of the breast (4.8%, p = 0.02). To sum up one can say that MSA serum levels do not allow to discriminate benign from malignant breast diseases and MSA is 2.5 to 3 times more sensitive for the prediction of early stages breast cancer compared to CA15-3, TPA and CEA.
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Affiliation(s)
- D M Zahm
- Abteilung Frauenheilkunde, Klinik für Frauenheilkunde und Geburtshilfe der Friedrich-Schiller-Universtät Jena
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Nindl I, Zahm DM, Meijer CJ, Walboomers JM, Schneider A. Human papillomavirus detection in high-grade squamous intraepithelial lesions. Comparison of hybrid capture assay with a polymerase chain reaction system. Diagn Microbiol Infect Dis 1995; 23:161-4. [PMID: 9407223 DOI: 10.1016/0732-8893(95)00187-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 02/05/2023]
Abstract
The validity of human papillomavirus (HPV) detection using the hybrid capture assay (HCA) was compared with the polymerase chain reaction (PCR) in 38 patients with high-grade squamous intraepithelial lesions (HSILs). HCA and PCR showed 84% agreement for HPV detection. HCA missed a significant higher proportion of HSIL compared with PCR (21% vs. 5%; P = .04). Thus, the sensitivity of HCA should be increased before this test can be recommended for HSIL.
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Affiliation(s)
- I Nindl
- Department of Gynecology, Friedrich Schiller University, Jena, Federal Republic of Germany
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