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Gluz O, Kuemmel S, Nitz U, Braun M, Lüdtke-Heckenkamp K, von Schumann R, Darsow M, Forstbauer H, Potenberg J, Uleer C, Grischke EM, Aktas B, Schumacher C, Zu Eulenburg C, Kates R, Jóźwiak K, Graeser M, Wuerstlein R, Baehner R, Christgen M, Kreipe HH, Harbeck N. Nab-paclitaxel weekly versus dose-dense solvent-based paclitaxel followed by dose-dense epirubicin plus cyclophosphamide in high-risk HR+/HER2- early breast cancer: results from the neoadjuvant part of the WSG-ADAPT-HR+/HER2- trial. Ann Oncol 2023; 34:531-542. [PMID: 37062416 DOI: 10.1016/j.annonc.2023.04.002] [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: 12/02/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND In high-risk hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) early breast cancer (EBC), nanoparticle albumin-bound (nab)-paclitaxel showed promising efficacy versus solvent-based (sb)-paclitaxel in neoadjuvant trials; however, optimal patient and therapy selection remains a topic of ongoing research. Here, we investigate the potential of Oncotype DX® recurrence score (RS) and endocrine therapy (ET) response (low post-endocrine Ki67) for therapy selection. PATIENTS AND METHODS Within the WSG-ADAPT trial (NCT01779206), high-risk HR+/HER2- EBC patients were randomized to (neo)adjuvant 4× sb-paclitaxel 175 mg/m2 q2w or 8× nab-paclitaxel 125 mg/m2 q1w, followed by 4× epirubicin + cyclophosphamide (90 mg + 600 mg) q2w; inclusion criteria: (i) cN0-1, RS 12-25, and post-ET Ki67 >10%; (ii) cN0-1 with RS >25. Patients with cN2-3 or (G3, baseline Ki67 ≥40%, and tumor size >1 cm) were allowed to be included without RS and/or ET response testing. Associations of key factors with pathological complete response (pCR) (primary) and survival (secondary) endpoints were analyzed using statistical mediation and moderation models. RESULTS Eight hundred and sixty-four patients received neoadjuvant nab-paclitaxel (n= 437) or sb-paclitaxel (n = 427); nab-paclitaxel was superior for pCR (20.8% versus 12.9%, P = 0.002). pCR was higher for RS >25 versus RS ≤25 (16.0% versus 8.4%, P = 0.021) and for ET non-response versus ET response (15.1% versus 6.0%, P = 0.027); no factors were predictive for the relative efficacy of nab-paclitaxel versus sb-paclitaxel. Patients with pCR had longer distant disease-free survival [dDFS; hazard ratio 0.42, 95% confidence interval (CI) 0.20-0.91, P = 0.024]. Despite favorable prognostic association of RS >25 versus RS ≤25 with pCR (odds ratio 3.11, 95% CI 1.71-5.63, P ≤ 0.001), higher RS was unfavorably associated with dDFS (hazard ratio 1.03, 95% CI 1.01-1.05, P = 0.010). CONCLUSIONS In high-risk HR+/HER2- EBC, neoadjuvant nab-paclitaxel q1w appears superior to sb-paclitaxel q2w regarding pCR. Combining RS and ET response assessment appears to select patients with highest pCR rates. The disadvantage of higher RS for dDFS is reduced in patients with pCR. These are the first results from a large neoadjuvant randomized trial supporting the use of RS to help select patients for neoadjuvant chemotherapy in high-risk HR+/HER2- EBC.
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Affiliation(s)
- O Gluz
- West German Study Group, Moenchengladbach; Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach; University Clinics Cologne, Cologne.
| | - S Kuemmel
- West German Study Group, Moenchengladbach; Breast Unit, Kliniken Essen-Mitte, Essen; Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Berlin
| | - U Nitz
- West German Study Group, Moenchengladbach; Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach
| | - M Braun
- Breast Center, Rotkreuz Clinics Munich, Munich
| | - K Lüdtke-Heckenkamp
- Department of Oncology and Hematology, Niels Stensen-Kliniken, Georgsmarienhütte
| | - R von Schumann
- Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach
| | - M Darsow
- Breast Center, Luisenhospital, Duesseldorf; Practice for Senologic Oncology, Duesseldorf
| | | | | | - C Uleer
- Frauenaerzte am Bahnhofsplatz, Practice of Gynecology and Oncology, Hildesheim
| | - E M Grischke
- Women's Clinic, University Clinics Tuebingen, Tuebingen
| | - B Aktas
- Women's Clinic, University Clinics Essen, Essen; University Clinics Leipzig, Women's Clinic, Leipzig
| | - C Schumacher
- Breast Center, St. Elisabeth Hospital Cologne, Cologne
| | - C Zu Eulenburg
- West German Study Group, Moenchengladbach; Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg
| | - R Kates
- West German Study Group, Moenchengladbach
| | - K Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin
| | - M Graeser
- West German Study Group, Moenchengladbach; Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach; Department of Gynecology, University Medical Center Hamburg, Hamburg
| | - R Wuerstlein
- West German Study Group, Moenchengladbach; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, Munich, Germany
| | | | - M Christgen
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - H H Kreipe
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - N Harbeck
- West German Study Group, Moenchengladbach; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, Munich, Germany
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Nitz U, Gluz O, Christgen M, Grischke EM, Augustin D, Kuemmel S, Braun M, Potenberg J, Kohls A, Krauss K, Stefek A, Schumacher C, Forstbauer H, Reimer T, Fischer H, Liedtke C, Wuerstlein R, Schumacher J, Kates R, Kreipe H, Harbeck N. Corrigendum to “De-escalation strategies in HER2-positive early breast cancer (EBC): final analysis of the WSG-ADAPT HER2+/HR− phase II trial: efficacy, safety, and predictive markers for 12weeks of neoadjuvant dual blockade with trastuzumab and pertuzumab ± weekly paclitaxel”. Ann Oncol 2022; 33:355. [DOI: 10.1016/j.annonc.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Christgen M, Harbeck N, Gluz O, Raap M, Christgen H, Clemens M, Malter W, Nuding B, Aktas B, Kuemmel S, Reimer T, Stefek A, Krabisch P, Just M, Graeser M, Baehner R, Wuerstlein R, Nitz U, Kates R, Kreipe H. Differential impact of prognostic parameters in hormone receptor-positive lobular early breast cancer in the WSG PlanB trial. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30531-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Harbeck N, Nitz U, Christgen M, Kuemmel S, Braun M, Schumacher C, Potenberg J, Tio J, Aktas B, Malter W, Forstbauer H, von Schumann R, Just M, Jóźwiak K, Hauptmann M, Kates R, Gräser M, Wuerstlein R, Kreipe H. LBA14 De-escalated neoadjuvant T-DM1 with or without endocrine therapy (ET) vs trastuzumab+ET in early HR+/HER2+ breast cancer (BC): ADAPT-TP survival results. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Harbeck N, Gluz O, Christgen M, Graeser M, Hilpert F, Kreipe H, Nitz U, Kates R, Schinkoethe T, Kuemmel S. ADAPTcycle – adjuvant dynamic marker-adjusted personalized therapy comparing endocrine therapy plus ribociclib versus chemotherapy in intermediate risk HR+/HER2- early breast cancer. Breast 2019. [DOI: 10.1016/s0960-9776(19)30443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gluz O, Nitz U, Liedtke C, Prat A, Christgen M, Feuerhake F, Garke M, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Pelz E, Gebauer D, Paré L, Kates R, Wuerstlein R, Kreipe HH, Harbeck N. Abstract GS5-06: No survival benefit of chemotherapy escalation in patients with pCR and “high-immune” triple-negative early breast cancer in the neoadjuvant WSG-ADAPT-TN trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs5-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Immune markers such as tumor infiltrating lymphocytes (TILs), CD8, PDL1, PD1 and other protein or mRNA-based genomic markers have been identified as prognostic / predictive in TNBC regarding survival / chemotherapy (CTx) efficacy.
In the adjuvant WSG-PlanB trial, patients with high TILs and/or CD8 by mRNA had excellent outcome, irrespective of anthracycline use; in the neoadjuvant ADAPT-TN trial, high PDL1, PD1 and CD8 and/or TILs were predictive for pCR. Still, optimal markers for potential treatment de-escalation have yet to be determined. Here, we analyse for the first time impact of immune mRNA-based markers and TIL's as prognostic and predictive survival markers.
Methods: TNBC patients (ER/PR<1%, HER2-,) were randomized to neoadjuvant 4x nab-paclitaxel 125 mg/m2/gemcitabine 1000 mg/m2 d1/8 q3w (gem arm) or 4x nab-paclitaxel 125 mg/m2/carboplatin AUC2 day 1/8 3-weekly (q3w) (carbo arm). Primary endpoint of WSG-ADAPT-TN was pCR (ypT0/is/ypN0); secondary endpoints included translational analyses, e.g., TILs or expression of 119 genes by nCounter platform. Standard adjuvant chemotherapy (4xEC) was optional (not randomized) in patients achieving pCR after 12 weeks. According to protocol, 1st safety survival analysis was performed after 3y median follow-up.
Results: Present translational analysis included 306 of 336 TNBC patients (36 months median FU). pCR was associated with significantly better survival (3y EFS: 92% vs. 71%, p<.001), but despite substantially higher pCR in the carbo arm (46% vs. 29%), no significant EFS advantage was seen (p=.6) (gem: 78%; carbo: 80%; 3y-EFS).
Bivariate Spearman correlations among CD8, PD1, and PDL1 were strongly positive; their correlations with TILs were moderately positive.
Preliminary Cox analysis of EFS was performed with clinical variables (cN, cT, menopausal status); neoadjuvant study arm; pCR; TILs; proliferation markers (baseline Ki67 by IHC, scores derived from PAM50); baseline immune markers; risk scores; and individual gene expression scores previously identified as prognostic for pCR in one or both neoadjuvant arms. Independent prognostic factors included pCR, cN, Ki67, PD1, and CD8; these were entered into (prognostic) interaction analysis. The resulting model contained cN, high Ki67 and low TILs as (unfavorable) main effects and the interaction of (higher) PD1*pCR (favorable).
Among pCR patients, the groups with/without additional adjuvant CTX were similar with respect to explanatory factors. Baseline TILs, Ki67, cN, and PD1 were entered into exploratory predictive analysis; the model retained only the interaction [adjuvant CTx * (fractionally ranked) PD1]. In patients with pCR, those with low PD1 benefited from standard anthracycline-containing adjuvant CTx, whereas patients high PD1 did not with an 98% 3y-EFS.
Conclusions: Our exploratory results suggest independent prognostic impact of mRNA markers and TIL's in early TNBC. Patients with both pCR (after 12 weeks) and “high-immune” signature (defined here by PD1) had excellent 3y-EFS and may be candidates for treatment de-escalation (e.g. omission of anthracyclines), whereas “low-immune” pCR patients may benefit from standard adjuvant poly-chemotherapy.
Citation Format: Gluz O, Nitz U, Liedtke C, Prat A, Christgen M, Feuerhake F, Garke M, Grischke E-M, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Kuemmel S, Pelz E, Gebauer D, Paré L, Kates R, Wuerstlein R, Kreipe HH, Harbeck N. No survival benefit of chemotherapy escalation in patients with pCR and “high-immune” triple-negative early breast cancer in the neoadjuvant WSG-ADAPT-TN trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS5-06.
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Affiliation(s)
- O Gluz
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - U Nitz
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - C Liedtke
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - A Prat
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Christgen
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - F Feuerhake
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Garke
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - E-M Grischke
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - H Forstbauer
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Braun
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - M Warm
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - J Hackmann
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - C Uleer
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - B Aktas
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - C Schumacher
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - S Kuemmel
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - E Pelz
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - D Gebauer
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - L Paré
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - R Kates
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - R Wuerstlein
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - HH Kreipe
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
| | - N Harbeck
- West German Study Group, Moenchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Charité, Women's Clinic, Berlin, Germany; Hospital Clínic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hannover Medical School, Institute of Pathology, Hannover, Germany; University Hospital Luebeck, Luebeck, Germany; University Clinics Tuebingen, Women's Clinic, Tuebingen, Germany; Practice Network Troisdorf, Troisdorf, Germany; Rotkreuz Clinics Munich, Breast Center, Munich, Germany; City Hospital Holweide, Breast Center, Cologne, Germany; Marien Hospital, Breast Center, Witten, Germany; Practice of Gynecology and Oncology, Hildesheim, Germany; University Clinics Essen, Women's Clinic, Essen, Germany; University Clinics Leipzig, Women's Clinic, Leipzig, Germany; St. Elisabeth Hospital, Breast Center, Cologne, Germany; Clinics Essen
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Gluz O, Nitz U, Liedtke C, Christgen M, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Lindner C, Kümmel S, Kates R, Potenberg J, Staib P, Wuerstlein R, Kreipe H, Harbeck N. Prognostic impact of anthracyclines and immune/proliferation markers in TNBC according to pCR after de-escalated neoadjuvant chemotherapy with 12 weeks of nab-paclitaxel/carboplatin or gemcitabine: Survival results of WSG-ADAPT-TN phase II trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gluz O, Liedtke C, Prat A, Christgen M, Gebauer D, Kates R, Pelz E, Clemens M, Warm M, Aktas B, Kuemmel S, Pare L, Krabisch P, Kreipe HH, Wuerstlein R, Nitz U, Harbeck N. Abstract P2-10-03: Genomic markers but not molecular subtypes provide prognostic impact and predict anthracycline efficacy in early triple-negative breast cancer: Results from the prospective WSG PlanB trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-10-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Optimal treatment, particularly use of anthracyclines in aggressive triple-negative breast cancer (TNBC), is still a controversial issue in early BC management. However, TNBC exhibits substantial molecular heterogeneity: for example, the immune phenotype seems to be associated with better outcome. An important clinical issue in early TNBC is to quantify the impact of subtypes as well as individual genes on survival and especially on anthracycline benefit.
Methods: In PlanB, patients with ER and PR<1% (local or central lab), HER2- EBC were treated by TC (6 cycles Docetaxel/Cyclophosphamide) or EC-Doc (4xEpirubicin/Cyclophosphamideà4xDocetaxel) (overall n=2449, HER2-). RNA isolation was successfully performed in n=402/449 patients with available follow-up. Gene (n=119) expression data by Nanostring® platform were entered into univariate and multivariate Cox models for disease-free survival (DFS) to identify genes (and combinations) with potential prognostic and/or predictive impact. Median follow-up was 60 months.
Results: RNA expression results were available in n=394 (203 TC vs. 191 EC-Doc): PAM-50 subtype: basal-like 82%; HER2-enriched 7%; luminal (A or B) 3.5%; normal-like 7.4%. Median age was 54; 78% were node-negative. In patients with “discordant” tumors (HR positive by local or central assessment), 76% were still basal-like, compared to 86% in “concordant” TNBC. Of 27 patients with HER2-enriched subtype, HER2 status was positive by central assessment in only five cases (18%).
Within this TN cohort, 5y DFS was similar in TC (83%) and EC-Doc (79%) arms; positive nodal status and tumor size >2 cm were (unfavorable) clinical-pathological prognostic markers. Prognostic or predictive impacts of molecular subtype, risk of recurrence subgroups, or proliferation indices were not seen.
Twelve genes (incl. CD8, EGFR, GPR160, SPINT2) showed potential multivariate prognostic impact by entering the “forwards stepwise” multivariate Cox model for DFS. The upper half of patients according to the resulting “twelve-gene signature” had well over 90% 5y-DFS, whereas the lowest quartile had under 60% 5-y DFS. Several genes (incl. ERBB2, FOXC1) showed potential for a predictive impact regarding TC vs. EC-Doc by interaction analysis. Further details and perspectives for testing the robustness of these potential impacts will be presented at the meeting.
Conclusions
To our knowledge, these are the first results from a prospective, adjuvant taxane-based trial regarding molecular predictors of anthracycline efficacy and PAM-50-based prognostic factors in early TNBC. ERBB2 expression, but not HER2-enriched subtype, was predictive for A-benefit in HER2-negative BC. Molecular heterogeneity of TNBC beyond basal-like vs. non-basal-like subtype is clinically relevant and should be considered for patient stratification in ongoing trials with combination therapy. The identified prognostic gene signature should be validated in the WSG-ADAPT-TN and other TNBC trials.
Citation Format: Gluz O, Liedtke C, Prat A, Christgen M, Gebauer D, Kates R, Pelz E, Clemens M, Warm M, Aktas B, Kuemmel S, Pare L, Krabisch P, Kreipe HH, Wuerstlein R, Nitz U, Harbeck N. Genomic markers but not molecular subtypes provide prognostic impact and predict anthracycline efficacy in early triple-negative breast cancer: Results from the prospective WSG PlanB trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-10-03.
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Affiliation(s)
- O Gluz
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - C Liedtke
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - A Prat
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - M Christgen
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - D Gebauer
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - R Kates
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - E Pelz
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - M Clemens
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - M Warm
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - B Aktas
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - S Kuemmel
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - L Pare
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - P Krabisch
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - HH Kreipe
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - R Wuerstlein
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - U Nitz
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
| | - N Harbeck
- West German Study Group; Breast Center Niederrhein, Evangelical Hospital Bethesda, Moenchengladbach; University Hospital Clinics of Gynecology and Obstetrics, Luebeck; Vall d'Hebron Institute of Oncology, Barcelona; Medical School, Institue of Pathology, Hannover; Institute of Pathology, Viersen; Mutterhaus Clinics, Trier; City Hospital, Breast Center, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital, Clinics of Gynecology and Obstetrics, Essen; Clinics Essen-Mitte, Breast Center; City Hospital, Clinics of Gynecology and Obstetrics, Chemnitz; Univeristy Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center, CCCLMU, Munich
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Harbeck N, Gluz O, Wuerstlein R, Clemens M, Malter W, Reimer T, Nuding B, Stefek A, Pollmanns A, Augustin D, Uleer C, Lorenz-Salehi F, Shak S, Chao C, Christgen M, Kates R, Kreipe H, Nitz U. Abstract P1-06-06: No age-related outcome disparities according to 21-gene recurrence score groups in early breast cancer patients treated by adjuvant chemotherapy in the prospective WSG PlanB trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-06-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Elderly breast cancer (BC) patients (pts) have been reported to have worse BC-related outcome than younger pts, even within clinical trials such as TEAM. Shak et al. recently showed in a large SEER data analysis that in the high 21-gene recurrence score (RS) group, older pts (>70y) receive less chemotherapy (CT) and have a worse BC-specific mortality than younger pts. Here, we therefore aimed to see whether there are age-related outcome disparities according to RS groups in pts receiving state-of-the-art CT in the prospective WSG PlanB trial.
Material and Methods: PlanB compared 6 cycles of anthracycline-free TC vs. standard anthracycline-taxane based CT (4xECà4xDoc) in patients with high risk pN0 (T2-4, G2-3, <35 years, or high uPA/PAI-1) or pN+ HER2- early BC. 21-gene assay was performed in all HR+ tumors and omission of chemotherapy (CT) recommended in RS≤11 HR+ pN0-1 BC. Final analysis for the CT randomization for RS 12-25 after 60 months median follow-up revealed similar 5-year DFS and OS outcomes for both CT arms (ASCO 2017).
Results: In all pts with luminal cancer and RS results (n=2577), there was an age-related significant difference in RS risk group assignment (p<0.0001): in young pts (<40y), 9.1% had RS≤11, 52.7% RS 12-25, and 38.2% RS>25; in pts 40-69 years, 18.3% had RS≤11, 61% RS 12-25, and 20.7%% RS>25; in elderly pts (>70y), 19.5% had RS≤11, 55.3% RS 12-25, and 25.2% RS>25. Among patients receiving chemotherapy, RS>25 vs. RS<25 was associated with significantly poorer DFS separately within the elderly subgroup (HR=3.03, 95%-CI [1.15-7.96]) and in those aged 40-69 years (HR=3.14, 95%-CI [2.18-4.52]); there were only nine events among patients <40y. In particular, among pts receiving CT with RS>25, there were no significant differences in DFS between any two of these three age groups.
Conclusion: A substantial percentage of elderly patients (> 70y) presents with high-risk luminal disease; these patients are candidates for CT. In PlanB, about 25% of elderly luminal BC patients had high-risk (RS>25) tumors. Nevertheless, after receiving modern adjuvant CT, their DFS was comparable to that of non-elderly pts with high-risk RS tumors. Consequently, older BC pts with high-risk luminal tumors who are fit enough to receive adjuvant CT should be treated according to guidelines in order to overcome age-dependent survival disparities which have been observed in registries for high-RS tumors.
Citation Format: Harbeck N, Gluz O, Wuerstlein R, Clemens M, Malter W, Reimer T, Nuding B, Stefek A, Pollmanns A, Augustin D, Uleer C, Lorenz-Salehi F, Shak S, Chao C, Christgen M, Kates R, Kreipe H, Nitz U. No age-related outcome disparities according to 21-gene recurrence score groups in early breast cancer patients treated by adjuvant chemotherapy in the prospective WSG PlanB trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-06.
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Affiliation(s)
- N Harbeck
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - O Gluz
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - R Wuerstlein
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - M Clemens
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - W Malter
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - T Reimer
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - B Nuding
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - A Stefek
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - A Pollmanns
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - D Augustin
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - C Uleer
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - F Lorenz-Salehi
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - S Shak
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - C Chao
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - M Christgen
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - R Kates
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - H Kreipe
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
| | - U Nitz
- University Hospital LMU, Clinics of Gynecology and Obstetrics, Breast Center and CCCLMU, Munich; West German Study Group; Breast Center Niederrhein, Evangelical Bethesda Hospital, Moenchengladbach; Mutterhaus Clinics, Trier; University Hospital, Clinics of Gynecology and Obstetrics, Cologne; University Hospital Suedtsadt, Clinics of Gynecology and Obstetrics, Rostock; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Bergisch Gladbach; Johanniter Hospital, Breast Center, Stendal; Evangelical Hospital, Clinics of Gynecology and Obstetrics, Oberhausen; Breast Center Ostbayern, Deggendorf; Gynecological-Oncological Practice, Hildesheim; HSK, Clinics of Gynecology and Obstetrics, Wiesbaden; Genomic Health, Redwood City; Medical School, Institute of Pathology, Hannover
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Nitz UA, Gluz O, Christgen M, Grischke EM, Augustin D, Kuemmel S, Braun M, Potenberg J, Kohls A, Krauss K, Stefek A, Schumacher C, Forstbauer H, Reimer T, Fischer H, Liedtke C, Wuerstlein R, Schumacher J, Kates R, Kreipe H, Harbeck N. De-escalation strategies in HER2-positive early breast cancer (EBC): final analysis of the WSG-ADAPT HER2+/HR- phase II trial: efficacy, safety, and predictive markers for 12 weeks of neoadjuvant dual blockade with trastuzumab and pertuzumab ± weekly paclitaxel. Ann Oncol 2017; 28:2768-2772. [PMID: 28945833 DOI: 10.1093/annonc/mdx494] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Response rates in HER2-overexpressing EBC treated with neoadjuvant chemotherapy and trastuzumab (T) have been improved by addition of pertuzumab (P). The prospective, phase II, neoadjuvant WSG-ADAPT HER2+/HR- trial assessed whether patients with strong early response to dual blockade alone might achieve pathological complete response (pCR) comparable to that of patients receiving dual blockade and chemotherapy. PATIENTS AND METHODS Female patients with HER2+/HR- EBC (M0) were randomized (5:2) to 12 weeks of T + P ± weekly paclitaxel (pac) at 80 mg/m2. Early response was defined as proliferation decrease ≥30% of Ki-67 (versus baseline) or low cellularity (<500 invasive tumor cells) in the 3-week biopsy. The trial was designed to test non-inferiority for pCR in early responding patients of the T + P arm versus all chemotherapy-treated patients. RESULTS From February 2014 to December 2015, 160 patients were screened, 92 were randomized to T + P and 42 to T + P+pac. Baseline characteristics were well balanced (median age 54 versus 51.5 years, cT2 51.1 versus 52.4%, cN0 54.3 versus 61.9%); 91.3% of patients completed T + P per protocol and 92.9% T + P+pac. The pCR rate in the T + P+pac arm was 90.5%, compared with 36.3% in the T + P arm as a whole. In the T + P arm, 24/92 were classified as non-responders, and their pCR rate was only 8.3% compared with 44.7% in responders (38/92) and 42.9% in patients with unclassified early response (30/92). No new safety signals were observed in the study population. CONCLUSION Addition of taxane monotherapy to dual HER2 blockade in a 12-week neoadjuvant setting substantially increases pCR rates in HER2+/HR- EBC compared with dual blockade alone, even within early responders to dual blockade. Early non-response under dual blockade strongly predicts failure to achieve pCR.
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Affiliation(s)
- U A Nitz
- West German Study Group GmbH, Moenchengladabach; Evangelical Hospital Johanniter Bethesda, Breast Center Niederrhein, Moenchengladbach
| | - O Gluz
- West German Study Group GmbH, Moenchengladabach; Evangelical Hospital Johanniter Bethesda, Breast Center Niederrhein, Moenchengladbach; University of Cologne, Cologne.
| | - M Christgen
- Institute of Pathology, Medical School Hannover, Hannover
| | - E-M Grischke
- Department of Gynecology and Obstetrics, University Clinics Tuebingen, Tuebingen
| | | | - S Kuemmel
- Breast Center, Clinics Essen-Mitte, Essen
| | - M Braun
- Rotkreuz Clinics Munich Breast Center, Munich
| | - J Potenberg
- Department of Oncology Evangelical Waldkrankenhaus Berlin, Berlin
| | - A Kohls
- Department of Gynecology and Obstetrics, Evangelical Hospital, Ludwigsfelde
| | - K Krauss
- Department of Gynecology and Obstetrics, University Clinics RWTH, Aachen
| | - A Stefek
- Breast Center, Evangelical Hospital Johanniter, Stendal
| | - C Schumacher
- Breast Center, St. Elisabeth Hospital Cologne, Cologne
| | | | - T Reimer
- Department of Gynecology and Obstetrics, University Clinics Rostock, Suedstadt
| | - H Fischer
- Breast Center, Evangelical Hospital Gelsenkirchen, Gelsenkirchen
| | - C Liedtke
- Department of Gynecology and Obstetrics, University Clinics Schleswig-Holstein/Campus Luebeck, Luebeck; Charite Berlin
| | - R Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, University of Munich (LMU) and CCCLMU, Munich
| | - J Schumacher
- Palleos Healthcare, Statistics, Wiesbaden, Germany
| | - R Kates
- West German Study Group GmbH, Moenchengladabach
| | | | - N Harbeck
- West German Study Group GmbH, Moenchengladabach; Breast Center, Department of Gynecology and Obstetrics, University of Munich (LMU) and CCCLMU, Munich
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Gluz O, Nitz U, Christgen M, Malter W, Clemens M, Reimer T, Nuding B, Aktas B, Stefek A, Ppllmanns A, Lorenz-Salehi F, Uleer C, Krabisch P, Kümmel S, Liedtke C, Shak S, Kates R, Wurstlein R, Kreipe H, Harbeck N. Prognostic impact of recurrence score (RS), grade/Ki67 central pathological review, and acycline (A)-free vs. A-containing chemotherapy (CT) on distant and locoregional disease-free survival (DDFS/LRFS) in high clinical risk HER2- early breast cancer (EBC): WSG PlanB trial results. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
From a historical perspective, histological grading was the earliest cell-based method for assessing tumor biology and the prognosis of breast cancer. This review article provides detailed and practical instructions for grading of breast cancer in routine diagnostics. Furthermore, the increasing relevance of precise histological grading in the era of molecular pathology is discussed.
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Affiliation(s)
- M Christgen
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Deutschland.
| | - F Länger
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Deutschland
| | - H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Deutschland
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Degenhardt T, Kreipe HH, Gluz O, Kates RE, Liedtke C, Kraemer S, Clemens MR, Nuding B, Reimer T, Aktas B, Kuemmel S, Just M, Lorenz-Salehi F, Uleer C, Stefek A, Heyl V, Würstlein R, Nitz U, Christgen M, Harbeck N. Androgenrezeptor (AR) und Forkhead BoxA1 (FOXA1) als Prognosefaktoren beim frühen HER2-negativen Mammakarzinom – eine translationale Substudie im Rahmen der prospektiven Phase-III-WSG-Plan B Studie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Liedtke C, Gluz O, Heinisch F, Feuerhake F, Kreipe HH, Clemens M, Nuding B, Kraemer S, Reimer T, Svedman C, Shak S, Nitz U, Kates RE, Harbeck N, Christgen M. Abstract P2-07-01: Association of TILs with clinical parameters, recurrence score, and prognosis in patients with early HER2-negative breast cancer (BC) – A translational analysis of the prospective WSG planB trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-07-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
Tumor-infiltrating lymphocytes (TILs) have been associated with prognosis and with chemotherapy response among patients with BC, particularly in presence of high-risk features. The WSG planB trial randomized 2448 patients with HER2- N0/1 BC for comparison of anthracycline-free (6xTC) vs. standard anthracycline-taxane chemotherapy (4xEC-4xDoc). Recurrence Score® (RS) was incorporated for risk stratification in hormone receptor positive (HR+) BC. The present analysis focuses on the correlation of TILs with clinical/pathological parameters and their prognostic impact among planB patients.
Methods:
Stromal TILs were evaluated using a pathologist and two-observer approach. Three independent observers evaluated digital sections on H&E staining as previously suggested (Salgado et al., Ann Oncol. 2014); the median of the three values (TILmed) was used for statistical analysis. Spearman correlations of TILmed with clinical/pathological parameters (including central KI67 expression, quantitative ER measurements, nodal involvement, and RS) and univariate impact on event-free survival (EFS) were analyzed.
Results:
Our analysis included 300 patients with HR- and 1124 patients with HR+ HER2- BC. Both in HR- and HR+ BC, a significant association between TILmed and (i) central grading (correlation coefficient r=0.147, p=0.012 and r=0.195, p<0.001, respectively) and (ii) central Ki67 expression (r=0.202, p=0.001 and r=0.152 and p<0.001) was observed. Among HR+ cases, a significant association between TILmed and quantitative ER measurements (r=-0.412, p=0.041) and RS (r=0.190, p<0.001) was found. Furthermore, univariate Cox analysis revealed a significant association between TILmed (coded as fractional rank) and event-free survival (EFS). The hazard ratio of 75th to 25th percentile was 1.58 (95%CI: 1.06-2.36, p=0.025). This impact was not separately significant in HR subgroups due to lack of events
Conclusion:
In this dataset, presence of stromal TILs was moderately associated with clinical features of high-risk breast cancer (including RS) and decreased EFS. TILs will be evaluated as a prognostic or predictive factor (in multivariate and subgroup analyses) when the outcome results are evaluated after prolonged follow up. Furthermore, an updated analysis including the complete planB dataset will be presented.
Citation Format: Liedtke C, Gluz O, Heinisch F, Feuerhake F, Kreipe HH, Clemens M, Nuding B, Kraemer S, Reimer T, Svedman C, Shak S, Nitz U, Kates RE, Harbeck N, Christgen M. Association of TILs with clinical parameters, recurrence score, and prognosis in patients with early HER2-negative breast cancer (BC) – A translational analysis of the prospective WSG planB trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-07-01.
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Affiliation(s)
- C Liedtke
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - O Gluz
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - F Heinisch
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - F Feuerhake
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - HH Kreipe
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - M Clemens
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - B Nuding
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - S Kraemer
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - T Reimer
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - C Svedman
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - S Shak
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - U Nitz
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - RE Kates
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - N Harbeck
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
| | - M Christgen
- Westdeutsche Studiengruppe GmbH, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Ev. Hospital Bethesda, Breast Center Niederrhein; Medical School Hannover, Institute of Pathology; Mutterhaus der Borromäerinnen Trier; Ev. Hospital Bergisch Gladbach; University Clinics Cologne, Breast Center; Clinics Suedstadt Rostock; Genomic Health, Inc.; Palleos Healthcare Services, Statistics; Breast Center, University of Munich and CCCLMU
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Gluz O, Nitz U, Liedtke C, Christgen M, Sotlar K, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kuemmel S, Clemens M, Potenberg J, Staib P, Kohls A, Pelz E, Kates RE, Wuerstlein R, Kreipe HH, Harbeck N. Abstract P1-13-01: Comparison of 12 weeks neoadjuvant Nab-paclitaxel combined with carboplatinum vs. gemcitabine in triple- negative breast cancer: WSG-ADAPT TN randomized phase II trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-13-01] [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: Pathological complete response (pCR) is associated with improved prognosis in TNBC, but optimal chemotherapy remains unclear. Use of weekly nab- paclitaxel (Nab-Pac) vs. conventional paclitaxel and also addition of carboplatinum(Carbo) to anthracycline-taxane(A/T) containing chemotherapy results in significantly higher pCR rates in TNBC with unclear impact on survival and increased toxicity.
The ADAPT study seeks to compare Carbo vs. gemcitabine(Gem) added to nab- paclitaxel as a short 12-week A-free regimen. It also assesses efficacy in early responders vs. non-responders by 3-week proliferation and/or imaging response.
Methods: ADAPT TN compares 12-week neoadjuvant regimens: Carbo vs. Gem combined with Nab-Pac and aims to identify early-response markers for pCR (yPN0 and ypT0/is). TNBC patients (centrally confirmed ER/PR <1%, HER2 neg.), cT1c- cT4c, cN0/+ were randomized to arm A (Nab-Pac 125/Gem 1000 d1,8 q3w) vs. B (Nab-Pac 125/Carbo AUC2 d1,8 q3w). Randomization was stratified by center and nodal status. The trial is powered for pCR comparison by therapy arm and by presence vs. absence of early response markers. Pre-planned interim analysis aimed to identify a dynamic biomarker, e.g. drop of 3-week Ki-67, and to validate trial assumptions.
Results: 336 patients were enrolled from 47 centers between 06/13-02/15 (n=182 ArmA: Nab-Pac/Gem and n=154 ArmB: Nab-Pac/Carbo). 90% and 95% completed therapy according to protocol respectively (n.s.). Median age was 50y. At baseline: A/B: 73% and 74%% had G3 tumors, median Ki-67 of 70% and 75%; 62.6% and 62.9%% had cT2-4c tumors, pN0 status prior to chemotherapy was confirmed in 50.5% and 50%, respectively.
pCR (ypT0/is/ypN0) was A: 28.7% and B: 45.9% (p<0.001). Total pCR (ypT0/ypN0) was A: 25.8% and B: 45.2% respectively (p <0.001).
Nab/Gem arm was associated with significantly higher frequency of dose reductions (20.6% vs. 11.9% (p=0.03), treatment related SAE's (13% vs. 5%, p=0.02), grade 3-4 infections (6.1% vs. 1.3%, p=0.04) and ALAT elevations (11.7 vs. 3.3%, p=0.01) compared to the Nab-Carbo arm.
Within the planned interim analysis (n=130: A/B: 69/61), baseline Ki-67 (Nab- Pac/Carbo arm), age>50 years, and low cellularity (<500 tumor cells and/or Ki-67≤10% in the 3-week biopsy) (Nab-Pac/Gem arm) were positively associated with pCR by logistic regression analysis (separately by therapy arm). In all patients, therapy arm itself was significant for pCR.
Validation of responder definitions for the whole study will be presented at the meeting.
Conclusions:
This is the first large randomized study comparing two short 12-week anthracycline- free regimens in unselected TNBC. Our results suggest superior efficacy and excellent toxicity of Nab-Pac/Carbo vs. Gem. Longer A/T-Carbo containing regimens render quite comparable pCR rates, thus overtreatment by 4xEC in unselected TNBC may be present in some patients. Early response criteria seem to differ according to regimen; their assessment may be impaired by substantial tumor necrosis already after the first therapy cycle.
Citation Format: Gluz O, Nitz U, Liedtke C, Christgen M, Sotlar K, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kuemmel S, Clemens M, Potenberg J, Staib P, Kohls A, Pelz E, Kates RE, Wuerstlein R, Kreipe HH, Harbeck N. Comparison of 12 weeks neoadjuvant Nab-paclitaxel combined with carboplatinum vs. gemcitabine in triple- negative breast cancer: WSG-ADAPT TN randomized phase II trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-13-01.
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Affiliation(s)
- O Gluz
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - U Nitz
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - C Liedtke
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - M Christgen
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - K Sotlar
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - EM Grischke
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - H Forstbauer
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - M Braun
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - M Warm
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - J Hackmann
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - C Uleer
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - B Aktas
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - C Schumacher
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - N Bangemann
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - C Lindner
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - S Kuemmel
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - M Clemens
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - J Potenberg
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - P Staib
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - A Kohls
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - E Pelz
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - RE Kates
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - R Wuerstlein
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - HH Kreipe
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
| | - N Harbeck
- Westdeutsche Studiengruppe GmbH, Moenchengladabach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany; University Clinics Schleswig-Holstein/Campus Luebeck, Women's Clinic; Medical School Hannover, Institute of Pathology; University of Munich (LMU), Institue of Pathology; University Clinics Tuebingen, Women's Clinic; Practice Network Troisdorf; Rotkreuz Clinics Munich; Clinics of Cologne - Hospital Holweide; Marien-Hospital Witten; Gynecologic Oncologic Practice Hildesheim; University Clinics Essen, Women's Clinic; St. Elisabeth Hospital Cologne; Charité Berlin, Clinic of Gynecology; Agaplesion Diakonie Clinic; Clinics Essen-Mitte, Breast Center; Mutterhaus der Borromäerinnen Trier; Ev. Waldkrankenhaus; St. Antonius Hospital, Clinicsof Hematology and Oncology; Ev. Hospital Ludwigsfelde; Pathology Viersen; Palleos Healthcare Services, Statitistics; Breast Center, University of Munich and CCCLMU
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Gluz O, Nitz U, Kreipe H, Christgen M, Kates R, Hofmann D, Shak S, Clemens M, Kraemer S, Aktas B, Kuemmel S, Reimer T, Kusche M, Heyl V, Lorenz-Salehi F, Just M, Liedtke C, Wuerstlein R, Harbeck N. 1937 Clinical impact of risk classification by central/local grade or luminal-like subtype vs. Oncotype DX®: First prospective survival results from the WSG phase III planB trial. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30886-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Christgen M, Winkens W, Kreipe HH. [Determination of proliferation in breast cancer by immunohistochemical detection of Ki-67]. Pathologe 2014; 35:54-60. [PMID: 24414612 DOI: 10.1007/s00292-013-1843-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gene expression profiling has demonstrated the prognostic relevance of genes associated with proliferation in breast cancer. The immunohistochemical marker Ki-67 enables routine assessment of proliferation activity in pathology. In a number of retrospective but only few prospective studies the prognostic relevance of Ki-67 in breast cancer could be shown. Although there is no standardized approach with regard to which area of a histological section and how many cells should be counted in a quantitative or semiquantitative fashion as well as to the threshold, Ki-67 is broadly applied in breast pathology. This can be explained by the good reproducibility of the degree of proliferation assessed by Ki-67, at least in the low and high ranges, the possibility to substantiate grading and better practicability in core biopsies in comparison to mitotic counting. In neoadjuvant therapy of hormone receptor positive breast cancer, Ki-67 can probably predict the efficacy of pure hormone receptor blockade without chemotherapy.
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Affiliation(s)
- M Christgen
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Krauß K, Gluz O, Kümmel S, Schumann RV, Nuding B, Schumacher C, Maass N, Rezai M, Braun M, Aktas B, Forstbauer H, Kusche M, Krämer S, der Assen AV, Kreipe H, Christgen M, Hofmann D, Kates R, Shak S, Würstlein R, Nitz U, Harbeck N. Oncotype DX® und Proliferationsänderung durch kurzzeitige präoperative endokrine Induktionstherapie zur Therapieentscheidung beim frühen Mammakarzinom: Biomarkerdaten aus der prospektiven multi-zentrischen Phase II/III WSG-ADAPT Studie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388575] [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: 10/24/2022] Open
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Harbeck N, Gluz O, Kreipe HH, Christgen M, Svedman C, Shak S, Hofmann D, Kuemmel S, Nuding B, Rezai M, Schumacher C, Kusche M, Forstbauer H, Maass N, Kraemer S, Aktas B, Mohrmann S, Wuerstlein R, Kates RE, Nitz U. Abstract P6-05-11: Run-in phase of prospective WSG-ADAPT HR+/HER2- trial demonstrates feasibility of early endocrine sensitivity prediction by recurrence score and conventional parameters in clinical routine. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-05-11] [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: Despite promising evidence regarding outcome prediction, endocrine sensitivity, as determined by proliferation response to short-term preoperative endocrine therapy, is currently not included in adjuvant chemotherapy decisions in early HR+/HER2- breast cancer (BC).
Methods: The prospective WSG-ADAPT HR+/HER2- trial includes early BC patients with 0-3 positive LN who are candidates for adjuvant chemotherapy based on clinical-pathological criteria alone; it aims to spare chemotherapy in a substantial proportion utilizing a combination of genomic assessment by Oncotype DX and endocrine sensitivity testing. All patients received 3-week preoperative endocrine induction therapy (ET): aromatase inhibitors (AI) if postmenopausal, tamoxifen if premenopausal. Patients with low (0-11) Recurrence Score (RS) or intermediate RS (12-25) and ET response (centrally tested, post-therapy Ki-67 <10%) are recommended to forego adjuvant chemotherapy (“low-risk” patients). Distribution of RS, responder percentages in each group, and impacts of RS, ET regimen, and initial Ki-67 on post-therapy Ki-67 are reported here.
Results: As of 6/2013, 380 patients from 30 study centers had been enrolled in the ADAPT HR+/HER2- trial. Median age was 54 years. At first pre-planned analysis (5/2013), paired Ki-67 measurements (pre-/post-therapy) were available in 241 patients; RS was available in 208 cases (201 with paired Ki-67). RS was low in 21.6%, intermediate in 57.7%, and high in 20.7%; the respective risk group responder percentages (post-treatment Ki 67 <10%) were 84.1%, 73.9%, and 40.0% (p<0.001 when comparing low/intermediate vs. high, chi-square). In particular, these percentages support the pre-trial estimate of >70% endocrine responders in the intermediate genomic risk group, who could potentially be spared adjuvant chemotherapy. Median Ki 67 level decreases (as percentage of pre-treatment value) were 25% in premenopausal patients (tamoxifen, n = 101) vs. 75% in postmenopausal patients (AI, n = 115) (p<0.001, Mann-Whitney); median decreases by RS group were similar, 61% (low), 53% (intermediate) and 56% (high), respectively (p = 0.81, Kruskal-Wallis). In linear regression, pre-treatment Ki-67, endocrine regimen/menopausal status, and RS were all independent predictors for post-treatment Ki 67. Final run-in-phase analysis and validation will be presented after completion of endocrine induction therapy in 400 patients.
Conclusions: The Run-In Phase of the WSG ADAPT HR+/HER2- trial confirms trial design estimates of RS and proliferation response to induction ET. It indicates that the multicenter prospective ADAPT concept combining static and dynamic biomarker assessment for individualized therapy decisions in early BC is feasible. Proliferation response was strongly associated with therapy group (AI/post-menopausal vs. tamoxifen/pre-menopausal). Survival non-inferiority of intermediate Recurrence Score proliferation responders vs. low Recurrence Score patients (active control) will be tested in the ADAPT main phase to determine if adjuvant chemotherapy can be spared in 70% of patients with 0-3 positive LN classified as “intermediate risk” by conventional factors.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-11.
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Affiliation(s)
- N Harbeck
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - O Gluz
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - HH Kreipe
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - M Christgen
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - C Svedman
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - S Shak
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - D Hofmann
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - S Kuemmel
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - B Nuding
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - M Rezai
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - C Schumacher
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - M Kusche
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - H Forstbauer
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - N Maass
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - S Kraemer
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - B Aktas
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - S Mohrmann
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - R Wuerstlein
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - RE Kates
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
| | - U Nitz
- West German Study Group GmbH, Moenchengladbach, Germany; Breast Center of the University of Munich (LMU), Munich, Germany; Breast Center Niederrhein, Ev. Bethesda Hospital, Moenchengladbach, Germany; Institute of Pathology, Medical University Hannover, Hannover, Germany; Genomic Health, Inc., Redwood City; Clinics Essen-Mitte, Essen, Germany; Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany; Luisenhospital Duesseldorf, Duesseldorf, Germany; St. Elisabeth Hospital Cologne, Cologne, Germany; Marienhospital Aachen, Aachen, Germany; Oncologic Practive Network, Troisdorf, Germany; University Clinics Aachen, Aachen, Germany; University Clinics Cologne, Cologne, Germany; University Clinics Essen, Essen, Germany; University Clinics Duesseldorf, Duesseldorf, Germany
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Wuerstlein R, Gluz O, Degenhardt T, Kreipe HH, Kates R, Liedtke C, Shak S, Schumann RV, Clemens M, Markmann S, Christgen M, Svedman C, Aktas B, Salem M, Uleer C, Augustin D, Thomssen C, Nitz U, Harbeck N. Welche Prognosefaktoren sind geeignet für den klinischen Einsatz beim Mammakarzinom? Prospektiver Vergleich von Recurrence Score, uPA/PAI-1, Grading und molekularen Subtypen und Korrelationen aus der WSG-Plan B Studie. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1318581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Lehmann U, Hasemeier B, Christgen M, Müller M, Römermann D, Länger F, Kreipe H. Epigenetic inactivation of microRNA gene hsa-mir-9-1 in human breast cancer. J Pathol 2008; 214:17-24. [PMID: 17948228 DOI: 10.1002/path.2251] [Citation(s) in RCA: 335] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
MicroRNAs (miRNAs) represent a new class of small non-coding RNAs regulating gene expression by inducing RNA degradation or interfering with translation. Aberrant miRNA expression has been described for several human malignancies and tumour suppressor functions have been ascribed to this new class of small regulatory RNAs. Accordingly, inactivation due to deletion or mutation has been found in human malignancies. Here, we describe the role of aberrant hypermethylation as an additional mechanism for miRNA gene inactivation in human breast cancer. Aberrant hypermethylation was shown for mir-9-1, mir-124a3, mir-148, mir-152, and mir-663 in 34-86% of cases in a series of 71 primary human breast cancer specimens. For comprehensive methylation analysis, combined bisulphite restriction analysis, bisulphite sequencing, and Pyrosequencing were employed. miRNA gene hypermethylation correlated strongly with methylation of known tumour suppressor genes (p = 0.003). After treatment of various breast cancer cell lines with the demethylating agent 5-aza-2'-deoxycytidine, reduction of mir-9-1 gene methylation and concomitant reactivation of expression could be observed. For the mir-9-1 gene, which is already hypermethylated in pre-invasive intraductal lesions, a good correlation between quantitative methylation level and reduction of expression could be demonstrated in a subset of primary human breast cancer specimen (r = 0.8). In conclusion, this study demonstrates that various microRNA genes are also affected by epigenetic inactivation due to aberrant hypermethylation and that this is an early and frequent event in breast cancer development.
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Affiliation(s)
- U Lehmann
- Institute of Pathology, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, D-30625, Hannover, Germany.
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Trauzold A, Schmiedel S, Röder C, Tams C, Christgen M, Oestern S, Arlt A, Westphal S, Kapischke M, Ungefroren H, Kalthoff H. Multiple and synergistic deregulations of apoptosis-controlling genes in pancreatic carcinoma cells. Br J Cancer 2003; 89:1714-21. [PMID: 14583775 PMCID: PMC2394395 DOI: 10.1038/sj.bjc.6601330] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Inability to die by apoptosis is one of the reasons for the deregulated growth of tumour cells and the frequently observed failure of chemotherapy. In this study we thought to identify the common and functionally important characteristics responsible for the apoptosis resistance of pancreatic tumour cells. We analysed cell surface expression level of death receptors CD95 and TRAIL-R1-4 as well as the expression profile of sixteen apoptosis-relevant proteins in five pancreatic carcinoma cell lines Capan1, Colo357, PancTuI, Panc89 and Panc1. These data were evaluated in the context of sensitivity towards anti-CD95 and TRAIL-mediated apoptosis. Here we report that except for resistant Panc1 cells, which only marginally expressed CD95, all other cell lines showed comparable levels of CD95 and TRAIL receptors irrespectively of their apoptotic phenotype. Interestingly, we found that the elevated expression of FLIP, Bcl-xL and IAP in parallel with a downregulation of FADD and Bid was common for the resistant cell lines. Consequently, stable overexpression of XIAP, Bcl-xL or dominant negative FADD in sensitive cells significantly reduced the death receptor mediated apoptosis while the overexpression of Bid rendered the resistant cells sensitive.
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Affiliation(s)
- A Trauzold
- Molecular Oncology, Clinic for General Surgery
| | - S Schmiedel
- Molecular Oncology, Clinic for General Surgery
| | - C Röder
- Molecular Oncology, Clinic for General Surgery
| | - C Tams
- Molecular Oncology, Clinic for General Surgery
| | - M Christgen
- Molecular Oncology, Clinic for General Surgery
| | - S Oestern
- Molecular Oncology, Clinic for General Surgery
| | - A Arlt
- Laboratory of Molecular Gastroenterology, 1st Dept. of Medicine, UK S-H, Campus Kiel, Germany
| | - S Westphal
- Molecular Oncology, Clinic for General Surgery
| | - M Kapischke
- Molecular Oncology, Clinic for General Surgery
| | | | - H Kalthoff
- Molecular Oncology, Clinic for General Surgery
- Molecular Oncology, Clinic for General Surgery. E-mail:
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Schniewind B, Christgen M, Haye S, Ungefroren H, Kalthoff H. 49 Gemcitabine mediates cell death in human pancreatic cancer by recruitment of CD95 and the mitochondrial apoptosis pathway. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Yeung SC, Xu G, Pan J, Christgen M, Bamiagis A. Manumycin enhances the cytotoxic effect of paclitaxel on anaplastic thyroid carcinoma cells. Cancer Res 2000; 60:650-6. [PMID: 10676649] [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: 02/15/2023]
Abstract
Despite the current multimodal approach to treatment of anaplastic thyroid cancer (ATC), the prognosis for patients with the disease is poor. New effective therapy for ATC is desperately needed. Thus, we investigated the effects of manumycin (a farnesyl:protein transferase inhibitor), alone and in combination with other drugs frequently used to treat ATC, in six human ATC cell lines: ARO, C643, DRO, Hth-74, KAT-4, and KAT-18. By means of a formazan dye-based spectrophotometric assay of cell viability and light microscopy, manumycin was shown to decrease the number of viable cells in all six of the cell lines though to a lesser degree in DRO and C643 cells than in ARO, Hth-74, KAT-4, and KAT-18 cells. In combination, manumycin enhanced the effect of paclitaxel in all six of the cell lines. The mechanism of cell death was investigated by measuring caspase-3 activity, immunoblotting with anti-poly-(ADP-ribose)polymerase (PARP) antibody and electrophoresis of DNA. After an 18-h incubation, manumycin plus paclitaxel caused enhanced activation of caspase-3 activity, cleavage of PARP into Mr 89,000 and 28,000 fragments, and internucleosomal fragmentation of DNA (all of which are characteristic of apoptotic cell death). In contrast, neither manumycin alone, paclitaxel alone, doxorubicin alone, nor doxorubicin plus manumycin produced significant specific cleavage of PARP and internucleosomal DNA fragmentation after 18 h of incubation. The in vivo effect and toxicity of combined manumycin and paclitaxel treatments were evaluated in a nude mouse xenograft model using ARO and KAT-4 cells. Drugs were injected i.p. on days 1 and 3 of a 7-day cycle for three cycles. Both manumycin (7.5 mg/kg/dose) and paclitaxel (20 mg/kg/dose) had significant inhibitory effects on tumor growth. Combined manumycin and paclitaxel treatments seemed as effective as manumycin against ARO cells and more effective than either manumycin or paclitaxel alone against KAT-4 cells. No significant morbidity or mortality was caused by the treatments. In conclusion, manumycin can inhibit the growth of ATC both in vitro and in vivo. Manumycin plus paclitaxel has enhanced cytotoxic effects and increased apoptotic cell death in ATC cells in vitro compared with either drug by itself. The combination of manumycin and paclitaxel is also effective in vivo with no significant toxicity observed. The lack of synergy observed in this in vivo experiment may be due to a ceiling effect, and further experimentation is warranted to ascertain the optimal way to combine these two agents for maximal therapeutic effects.
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Affiliation(s)
- S C Yeung
- Section of General Internal Medicine, M.D. Anderson Cancer Center, University of Texas, Houston 77030, USA.
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