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Loibl S, Untch M, Burchardi N, Huober J, Sinn BV, Blohmer JU, Grischke EM, Furlanetto J, Tesch H, Hanusch C, Engels K, Rezai M, Jackisch C, Schmitt WD, von Minckwitz G, Thomalla J, Kümmel S, Rautenberg B, Fasching PA, Weber K, Rhiem K, Denkert C, Schneeweiss A. Corrigendum to "A randomised phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadjuvant therapy in early triple-negative breast cancer: clinical results and biomarker analysis of GeparNuevo study": [Annals of Oncology (2019), volume 30:1279-1288]. Ann Oncol 2022; 33:743-744. [PMID: 35595658 DOI: 10.1016/j.annonc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg; Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main.
| | - M Untch
- HELIOS Klinikum Berlin-Buch, Berlin
| | | | - J Huober
- Brustzentrum, Universitätsfrauenklinik Ulm, Ulm
| | - B V Sinn
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin; Berlin Institute of Health (BIH), Berlin
| | - J-U Blohmer
- Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Berlin
| | | | | | - H Tesch
- Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main
| | - C Hanusch
- Rotkreuzklinikum München Frauenklinik, München
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss
| | - M Rezai
- Medical Center, Luisenkrankenhaus Düsseldorf, Düsseldorf
| | - C Jackisch
- Brustzentrum, Sana-Klinikum Offenbach, Offenbach
| | - W D Schmitt
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | | | - J Thomalla
- Praxisklinik für Hämatologie und Onkologie Koblenz, Koblenz
| | - S Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen
| | - B Rautenberg
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg
| | - P A Fasching
- Brustzentrum, Universitätsklinikum Erlangen, Erlangen
| | - K Weber
- German Breast Group, Neu-Isenburg
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne
| | - C Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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Schaper T, Rezai M, Franzmann L, Groß B, Petruschke G, Darsow M. Die prophylaktische Nutzung der Hilotherapy® (gradgenaues Thermoheilverfahren) vermeidet die Entwicklung von schwerwiegender CIPN in der Chemotherapie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- T Schaper
- Luisenkrankenhaus Düsseldorf
- Internationale Senologie Initiative ISI e.V., Selbsthilfe
| | | | | | - B Groß
- Luisenkrankenhaus Düsseldorf
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Schaper T, Rezai M, Franzmann L, Groß B, Petruschke G, Darsow M. Die sekundäre, reaktive Hilotherapy® lindert Symptome der CIPN und vermeidet ihr Fortschreiten während der Chemotherapie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- T Schaper
- Luisenkrankenhaus Düsseldorf
- Internationale Senologie Initiative ISI e.V., Selbsthilfe
| | | | | | - B Groß
- Luisenkrankenhaus Düsseldorf
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4
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Loibl S, Untch M, Burchardi N, Huober J, Sinn BV, Blohmer JU, Grischke EM, Furlanetto J, Tesch H, Hanusch C, Engels K, Rezai M, Jackisch C, Schmitt WD, von Minckwitz G, Thomalla J, Kümmel S, Rautenberg B, Fasching PA, Weber K, Rhiem K, Denkert C, Schneeweiss A. A randomised phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadjuvant therapy in early triple-negative breast cancer: clinical results and biomarker analysis of GeparNuevo study. Ann Oncol 2020; 30:1279-1288. [PMID: 31095287 DOI: 10.1093/annonc/mdz158] [Citation(s) in RCA: 387] [Impact Index Per Article: 96.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Combining immune-checkpoint inhibitors with chemotherapy yielded an increased response rates in patients with metastatic triple-negative breast cancer (TNBC). Therefore, we evaluated the addition of durvalumab to standard neoadjuvant chemotherapy (NACT) in primary TNBC. PATIENTS AND METHODS GeparNuevo is a randomised phase II double-blind placebo-controlled study randomising patients with TNBC to durvalumab or placebo given every 4 weeks in addition to nab-paclitaxel followed by standard EC. In the window-phase durvalumab/placebo alone was given 2 weeks before start of nab-paclitaxel. Randomisation was stratified by stromal tumour-infiltrating lymphocyte (sTILs). Patients with primary cT1b-cT4a-d disease, centrally confirmed TNBC and sTILs were included. Primary objective was pathological complete response (pCR) (ypT0 ypN0). RESULTS A total of 174 patients were randomised, 117 participated in the window-phase. Median age was 49.5 years (range 23-76); 47 patients (27%) were younger than 40 years; 113 (65%) had stage ≥IIA disease, 25 (14%) high sTILs, 138 of 158 (87%) were PD-L1-positive. pCR rate with durvalumab was 53.4% (95% CI 42.5% to 61.4%) versus placebo 44.2% (95% CI 33.5% to 55.3%; unadjusted continuity corrected χ2P = 0.287), corresponding to OR = 1.45 (95% CI 0.80-2.63, unadjusted Wald P = 0.224). Durvalumab effect was seen only in the window cohort (pCR 61.0% versus 41.4%, OR = 2.22, 95% CI 1.06-4.64, P = 0.035; interaction P = 0.048). In both arms, significantly increased pCR (P < 0.01) were observed with higher sTILs. There was a trend for increased pCR rates in PD-L1-positive tumours, which was significant for PD-L1-tumour cell in durvalumab (P = 0.045) and for PD-L1-immune cell in placebo arm (P = 0.040). The most common immune-related adverse events were thyroid dysfunction any grade in 47%. CONCLUSIONS Our results suggest that the addition of durvalumab to anthracycline-/taxane-based NACT increases pCR rate particularly in patients treated with durvalumab alone before start of chemotherapy. TRIAL REGISTRATION ClinicalTrials.gov number: NCT02685059.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg; Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main.
| | - M Untch
- HELIOS Klinikum Berlin-Buch, Berlin
| | | | - J Huober
- Brustzentrum, Universitätsfrauenklinik Ulm, Ulm
| | - B V Sinn
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin; Berlin Institute of Health (BIH), Berlin
| | - J-U Blohmer
- Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Berlin
| | | | | | - H Tesch
- Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main
| | - C Hanusch
- Rotkreuzklinikum München Frauenklinik, München
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss
| | - M Rezai
- Medical Center, Luisenkrankenhaus Düsseldorf, Düsseldorf
| | - C Jackisch
- Brustzentrum, Sana-Klinikum Offenbach, Offenbach
| | - W D Schmitt
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | | | - J Thomalla
- Praxisklinik für Hämatologie und Onkologie Koblenz, Koblenz
| | - S Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen
| | - B Rautenberg
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg
| | - P A Fasching
- Brustzentrum, Universitätsklinikum Erlangen, Erlangen
| | - K Weber
- German Breast Group, Neu-Isenburg
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne
| | - C Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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5
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Loibl S, Weber KE, Timms KM, Elkin EP, Hahnen E, Fasching PA, Lederer B, Denkert C, Schneeweiss A, Braun S, Salat CT, Rezai M, Blohmer JU, Zahm DM, Jackisch C, Gerber B, Klare P, Kümmel S, Schem C, Paepke S, Schmutzler R, Rhiem K, Penn S, Reid J, Nekljudova V, Hartman AR, von Minckwitz G, Untch M. Survival analysis of carboplatin added to an anthracycline/taxane-based neoadjuvant chemotherapy and HRD score as predictor of response-final results from GeparSixto. Ann Oncol 2019; 29:2341-2347. [PMID: 30335131 DOI: 10.1093/annonc/mdy460] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In the neoadjuvant GeparSixto study, adding carboplatin to taxane- and anthracycline-based chemotherapy improved pathological complete response (pCR) rates in patients with triple-negative breast cancer (TNBC). Here, we present survival data and the potential prognostic and predictive role of homologous recombination deficiency (HRD). Patients and methods Patients were randomized to paclitaxel plus nonpegylated liposomal doxorubicin (Myocet®) (PM) or PM plus carboplatin (PMCb). The secondary study end points disease-free survival (DFS) and overall survival (OS) were analyzed. Median follow-up was 47.3 months. HRD was among the exploratory analyses in GeparSixto and was successfully measured in formalin-fixed, paraffin-embedded tumor samples of 193/315 (61.3%) participants with TNBC. Homologous recombination (HR) deficiency was defined as HRD score ≥42 and/or presence of tumor BRCA mutations (tmBRCA). Results A significantly better DFS (hazard ratio 0.56, 95% CI 0.34-0.93; P = 0.022) was observed in patients with TNBC when treated with PMCb. The improvement of OS with PMCb was not statistically significant. Additional carboplatin did not improve DFS or OS in patients with HER2-positive tumors. HR deficiency was detected in 136 (70.5%) of 193 triple-negative tumors, of which 82 (60.3%) showed high HRD score without tmBRCA. HR deficiency independently predicted pCR (ypT0 ypN0) [odds ratio (OR) 2.60, 95% CI 1.26-5.37, P = 0.008]. Adding carboplatin to PM significantly increased the pCR rate from 33.9% to 63.5% in HR deficient tumors (P = 0.001), but only marginally in HR nondeficient tumors (from 20.0% to 29.6%, P = 0.540; test for interaction P = 0.327). pCR rates with carboplatin were also higher (63.2%) than without carboplatin (31.7%; OR 3.69, 1.46-9.37, P = 0.005) in patients with high HRD score but no tmBRCA. DFS rates were improved with addition of carboplatin, both in HR nondeficient (hazard ratio 0.44, 0.17-1.17, P = 0.086) and HR deficient tumors (hazard ratio 0.49, 0.23-1.04, P = 0.059). Conclusions The addition of carboplatin to neoadjuvant PM improved DFS significantly in TNBC. Long-term survival analyses support the neoadjuvant use of carboplatin in TNBC. HR deficiency in TNBC and HRD score in non-tmBRCA TNBC are predictors of response. HRD does not predict for carboplatin benefit.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, Germany.
| | - K E Weber
- German Breast Group, Neu-Isenburg, Germany
| | - K M Timms
- Myriad Genetics Inc, Salt Lake City, USA
| | - E P Elkin
- The Permanente Medical Group Inc, Oakland, USA
| | - E Hahnen
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - B Lederer
- German Breast Group, Neu-Isenburg, Germany
| | - C Denkert
- Institute of Pathology, Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - S Braun
- Brustzentrum, Sana Kliniken Offenbach, Offenbach, Germany
| | - C T Salat
- Hämatoonkologische Schwerpunktpraxis, Munich, Germany
| | - M Rezai
- Luisenkrankenhaus, Düsseldorf, Germany
| | - J U Blohmer
- Klinik für Gynäkologie mit Brustzentrum Charité, Berlin, Germany
| | - D M Zahm
- Brustzentrum SRH Waldklinikum, Gera, Germany
| | - C Jackisch
- Brustzentrum, Sana Kliniken Offenbach, Offenbach, Germany
| | - B Gerber
- Frauenklinik, Universität Rostock, Rostock, Germany
| | - P Klare
- Praxisklinik, Berlin, Germany
| | - S Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - C Schem
- Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - S Paepke
- Klinikum rechts der Isar der Technischen Universität München, Frauenklinik, München, Germany
| | - R Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - S Penn
- Myriad Genetics Inc, Salt Lake City, USA
| | - J Reid
- Myriad Genetics Inc, Salt Lake City, USA
| | | | | | | | - M Untch
- Helios-Klinikum Berlin-Buch, Berlin, Germany
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6
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Marmé F, Solbach C, Michel L, Fasching P, Schneeweiss A, Blohmer JU, Rezai M, Huober J, Jackisch C, Nekljudova V, Link T, Rhiem K, Denkert C, Hanusch C, Tesch H, Lederer B, Loibl S, Untch M. Utility of the CPS+EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.008] [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: 11/12/2022] Open
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7
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Schaper T, Rezai M, Petruschke G, Gross B, Franzmann L, Darsow M. Efficiency of controlled cryotherapy in prevention of chemotherapy induced peripheral neuropathy (CIPN). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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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8
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Nava MB, Benson JR, Audretsch W, Blondeel P, Catanuto G, Clemens MW, Cordeiro PG, De Vita R, Hammond DC, Jassem J, Lozza L, Orecchia R, Pusic AL, Rancati A, Rezai M, Scaperrotta G, Spano A, Winters ZE, Rocco N. International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy. Br J Surg 2019; 106:1327-1340. [PMID: 31318456 DOI: 10.1002/bjs.11256] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/11/2018] [Accepted: 05/06/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Conflicting evidence challenges clinical decision-making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017. METHODS Studies on radiotherapy and breast reconstruction (1985 to September 2017) were screened using MEDLINE, Embase and CENTRAL. The literature review yielded 30 controversial key questions. A set of key statements was derived and the highest levels of clinical evidence (LoE) for each of these were summarized. Nineteen panellists convened for dedicated discussions at the International Oncoplastic Breast Surgery Meeting to express agreement, disagreement or abstention for the generated key statements. RESULTS The literature review identified 1522 peer-reviewed publications. A list of 22 key statements was produced, with the highest LoE recorded for each statement. These ranged from II to IV, with most statements (11 of 22, 50 per cent) supported by LoE III. There was full consensus for nine (41 per cent) of the 22 key statements, and more than 75 per cent agreement was reached for half (11 of 22). CONCLUSION Poor evidence exists on which to base patient-informed consent. Low-quality studies are conflicting with wide-ranging treatment options, precluding expert consensus regarding optimal type and timing of breast reconstruction in the context of radiotherapy. There is a need for high-quality evidence from prospective registries and randomized trials in this field.
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Affiliation(s)
- M B Nava
- Department of Plastic Surgery, University of Milan, Milan, Italy
| | - J R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK.,School of Medicine, Anglia Ruskin University, Cambridge and Chelmsford, UK
| | - W Audretsch
- Department of Senology and Breast Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - P Blondeel
- Department of Plastic Surgery, University Hospital Ghent, Ghent, Belgium
| | - G Catanuto
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - M W Clemens
- Plastic and Reconstructive Surgery Unit, MD Anderson Cancer Center, Houston, Texas
| | - P G Cordeiro
- Department of Plastic and Reconstructive Surgery, Weill Cornell Medicine and.,Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - R De Vita
- Department of Plastic Surgery, National Cancer Institute 'Regina Elena', Rome, Italy
| | - D C Hammond
- Partners in Plastic Surgery of West Michigan, Grand Rapids, Michigan, USA
| | - J Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - L Lozza
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Orecchia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - A Rancati
- Oncoplastic Surgery, Instituto Henry Moore, University of Buenos Aires, Buenos Aires, Argentina
| | - M Rezai
- European Breast Centre, Dusseldorf, Germany
| | - G Scaperrotta
- Radiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Spano
- Plastic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Z E Winters
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - N Rocco
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
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9
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Nabieva N, Kellner S, Fehm T, Häberle L, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Fersis N, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauss T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Rauh C, Bayer CM, Jacob A, Schmidt K, Belleville E, Brucker SY, Kümmel S, Beckmann MW, Wallwiener D, Hadji P, Fasching PA. Influence of patient and tumor characteristics on early therapy persistence with letrozole in postmenopausal women with early breast cancer: results of the prospective Evaluate-TM study with 3941 patients. Ann Oncol 2019; 29:186-192. [PMID: 29045642 DOI: 10.1093/annonc/mdx630] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Patients' compliance and persistence with endocrine treatment has a significant effect on the prognosis in early breast cancer (EBC). The purpose of this analysis was to identify possible reasons for non-persistence, defined as premature cessation of therapy, on the basis of patient and tumor characteristics in individuals receiving adjuvant treatment with letrozole. Patients and methods The EvAluate-TM study is a prospective, multicenter, noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor-positive EBC in the early therapy phase. Treatment persistence was evaluated at two pre-specified study visits after 6 and 12 months. As a measure of early therapy persistence the time from the start to the end of treatment (TTEOT) was analyzed. Cox regression analyses were carried out to identify patient characteristics and tumor characteristics predicting TTEOT. Results Out of the total population of 3941 patients with EBC, 540 (13.7%) events involving treatment cessation unrelated to disease progression were observed. This was due to drug-related toxicity in the majority of cases (73.5%). Persistence rates were 92.2%, 86.9%, and 86.3% after 6, 12, and 15 months, respectively. The main factors influencing premature treatment discontinuation were older age [hazard ratio (HR) 1.02/year], comorbidities (HR 1.06 per comorbidity), low body mass index, and lower tumor grade (HR 0.85 per grade unit). Conclusion These results support the view that older, multimorbid patients with low tumor grade and low body mass index are at the greatest risk for treatment discontinuation and might benefit from compliance and support programs.
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Affiliation(s)
- N Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - S Kellner
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.,Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - L Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - J de Waal
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - M Rezai
- Luisen-Hospital Düsseldorf, Düsseldorf, Germany
| | - B Baier
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | | | | | - M Warm
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Clinics of Cologne gGmbH, Holweide, Cologne, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - R Wuerstlein
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - J-U Deuker
- Vinzenz-Hospital Hannover GmbH, Hannover, Germany
| | - P Dall
- Department of Gynecology, Lüneburg Clinic, Lüneburg, Germany
| | - B Richter
- Elbland Clinics, Meissen-Radebeul, Germany
| | - G Wachsmann
- County Hospital of Böblingen, Böblingen, Germany
| | - C Brucker
- Department of Gynecology, University Hospital, Paracelsus Private Medical University of Nuremberg, Nuremberg, Germany
| | - J W Siebers
- Department of Gynecology, St. Josef's Hospital, Offenburg, Germany
| | - N Fersis
- Department of Gynecology, Bayreuth Clinic GmbH, CCC ER-EMN, Bayreuth, Germany
| | - T Kuhn
- Karl-Olga-Hospital Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - C Wolf
- Medical Center Ulm, Ulm, Germany
| | - H-W Vollert
- Friedrichshafen Clinic, Friedrichshafen, Germany
| | - G-P Breitbach
- Department of Gynecology, Neunkirchen Clinic, Neunkirchen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - R Landthaler
- Gynecological Medical Practice of the County Hospital of Krumbach, Krumbach, Germany
| | - A Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - D Rezek
- Marien-Hospital Wesel, Wesel, Germany
| | - T Noesselt
- Department of Gynecology of the County Hospital of Hameln, Hameln, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - S Henschen
- HELIOS Kliniken Schwerin GmbH, Schwerin, Germany
| | - T Praetz
- Caritas-Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - V Heyl
- Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - T Kühn
- Department of Gynecology, Esslingen Clinics a.N., Esslingen, Germany
| | - T Krauss
- Department of Gynecology Lippe-Detmold, Lippe-Detmold, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - A Hohn
- County Hospital of Rendsburg, Rendsburg, Germany
| | - H Tesch
- Oncology Bethanien Frankfurt, Frankfurt, Germany
| | - C Mundhenke
- Department of Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - A Jacob
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | - K Schmidt
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | | | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - S Kümmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - M W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - D Wallwiener
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - P Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - P A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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Janni W, Rack BK, Friedl TW, Müller V, Lorenz R, Rezai M, Tesch H, Heinrich G, Andergassen U, Harbeck N, Schochter F, De Gregorio A, Tzschaschel M, Huober J, Hepp P, Fehm TN, Schneeweiss A, Lichtenegger W, Blohmer J, Hauner D, Beckmann MW, Häberle L, Fasching PA, Hauner H. Abstract GS5-03: Lifestyle Intervention and Effect on Disease-free Survival in Early Breast Cancer Pts: Interim Analysis from the Randomized SUCCESS C Study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs5-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Recent trials have provided evidence that obesity and a low level of physical activity are not only associated with a higher risk of developing breast cancer, but also with an increased risk for recurrence and reduced survival in breast cancer patients (pts). The SUCCESS C study is the first randomized Phase III trial to evaluate the effect of an intensive lifestyle intervention program, focusing on both physical activity and healthy diet following adjuvant chemotherapy on disease-free survival in women with early breast cancer.
Methods:
SUCCESS C is a German multicenter, 2×2 factorial design, randomized phase III study comparing disease-free survival (DFS) in pts with HER2-negative early breast cancer treated with either 3 cycles of epirubicine, fluorouracil, cyclophosphamide chemotherapy followed by 3 cycles of docetaxel (FEC-D) or 6 cycles of docetaxel-cyclophosphamide (DC). The second randomization compares DFS in pts with a body mass index (BMI) of 24—40 kg/m2 receiving either a telephone-based individualized lifestyle intervention (LI) program aiming at moderate weight loss for 2 years (LI arm) or general recommendations for a healthy lifestyle alone (non-LI arm). DFS according to lifestyle intervention was analyzed using both univariable cox regressions and multivariable cox regressions adjusted for age (years, continuous), BMI (kg/m2, continuous), menopausal status (premenopausal, postmenopausal), tumor size (pT1, pT2, pT3/pT4), nodal stage (pN0, pN1, pN2, pN3), hormone receptor status (positive, negative), grading (G1, G2, G3), histological type (ductal, lobular, other) and chemotherapy randomization (FEC-D, DC). Median follow-up was 64.2 months.
Results:
Overall, 2292 of the 3643 pts recruited for the SUCCESS C study were randomized for the lifestyle intervention program (1146 pts in both the non-LI arm and the LI arm). The Intention-to-treat analysis revealed no difference in DFS between the two treatment arms (LI vs. non-LI) in univariable analysis (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.76 — 1.28, p = 0.922) and in adjusted multivariable cox regression (HR 0.91, 95% CI 0.70 — 1.18, p = 0.48). At the 2-year follow up, pts in the LI arm lost on average 1.0 kg weight compared to the start of the LI program, while pts in the non-LI arm gained on average 0.95 kg (p < 0.001). Overall, 1477 pts completed the 2-year LI program (non-LI arm: 80.7%, 925 of 1146 pts; LI arm: 48.2%, 552 of 1146 pts; p < 0.001). Pts that completed the 2-year LI program had a significant better DFS than non-completers (HR 0.35, 95% CI 0.27 — 0.45, p < 0.001). Among completers, pts in the LI arm had a significantly better DFS than pts in the non-LI arm both in univariable analysis (HR 0.53, 95% CI 0.35 — 0.82, p = 0.004) and in adjusted multivariable cox regression (HR 0.51, 95% CI 0.33 — 0.78, p = 0.002).
Conclusions:
This explorative and non-planned interim analysis indicates that the completion of a systematic telephone life style intervention program may positively impact patient outcome in early breast cancer.
Citation Format: Janni W, Rack BK, Friedl TW, Müller V, Lorenz R, Rezai M, Tesch H, Heinrich G, Andergassen U, Harbeck N, Schochter F, De Gregorio A, Tzschaschel M, Huober J, Hepp P, Fehm TN, Schneeweiss A, Lichtenegger W, Blohmer J, Hauner D, Beckmann MW, Häberle L, Fasching PA, Hauner H. Lifestyle Intervention and Effect on Disease-free Survival in Early Breast Cancer Pts: Interim Analysis from the Randomized SUCCESS C Study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS5-03.
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Affiliation(s)
- W Janni
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - BK Rack
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - TW Friedl
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - V Müller
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - R Lorenz
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - M Rezai
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - H Tesch
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - G Heinrich
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - U Andergassen
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - N Harbeck
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - F Schochter
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - A De Gregorio
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - M Tzschaschel
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - J Huober
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - P Hepp
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - TN Fehm
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - A Schneeweiss
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - W Lichtenegger
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - J Blohmer
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - D Hauner
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - MW Beckmann
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - L Häberle
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - PA Fasching
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - H Hauner
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
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Villegas SL, Lederer B, Untch M, Holms F, Ulmer HU, Diebold K, Fasching PA, Weber K, Schmitt WD, Tesch H, Rezai M, Marmé F, Sinn B, Hackmann J, Schneeweiss A, Tannapfel A, Nekljudova V, Denkert C, Loibl S. Abstract P2-08-10: Similarities between low hormone receptor positive and hormone receptor negative breast cancer: An analysis of 4366 patients from multicenter clinical trials. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-10] [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:
Currently, patients with breast cancer (BC) with hormone receptor (HR) immunohistochemical expression between 1-9% are eligible to receive endocrine therapy. However, recent data suggest that these tumors express a basal-like molecular phenotype associated with triple negative BC (TNBC) rather than luminal phenotype associated with HR positive BC. Here, we aimed to determine the differences between strong HR positive, low HR positive and negative HR BC, in regard to responsiveness to neoadjuvant chemotherapy (NACT) and disease free survival (DFS) in large cohorts from GBG clinical trials.
Methods:
In this retrospective analysis of data from women with BC treated in the neoadjuvant GeparQuinto (n=2572), GeparSixto (n=588) and GeparSepto (n=1206) clinical trials, we compared patients with three HR phenotypes: low positive (ER and/or PR= 1-9%), strong positive (ER or PR= 10-100%), and negative (ER and PR= <1%), regarding pathological complete response (pCR, ypT0 ypN0) and DFS. A logistic regression model for endpoint pCR was performed on pooled data from all trials. Cox regression was used to model DFS for patients participating in GeparQuinto and GeparSixto trial, including 71 with low HR positive phenotype. The models were adjusted by age, tumor and nodal status, grading, Her2 status, histological type, stromal and tumor infiltrating lymphocytes and clinical trial. The survival model was additionally adjusted by pCR after NACT.
Results:
Patients median age was 49 years, the majority had clinical tumor stage 2 (54.1%), negative nodal status (54.7%), and Her2 negative tumors (72.4%). 85.1% of women had BC classified as no special histological type. The pCR rate across the studies was 26.2%. 145 (3.4%) patients had low HR positive, 2417 (57.3%) strong HR positive and 1658 (39.3%) HR negative tumors. After NACT, 16.3% of patients with strong HR positive BC achieved a pCR, while among those with HR negative and low HR positive tumors, pCR rates were 40.2% and 37.9%, respectively (p<0.001). In the adjusted logistic regression model, there was no statistically significant difference between low HR positive and HR negative tumors (OR: 1.34, 95%-CI: (0.84-2.13), p=0.222). But strong HR positive tumors had a significantly lower chance of achieving a pCR compared to low HR positives (OR 0.48, 95%-CI: 0.30-0.76, p=0.002). Patients with strong HR positive BC had a better DFS than patients with low HR positive tumors (hazard ratio 0.35, 95%-CI: 0.18-0.70, p=0.003). DFS was not significantly different between patients with HR negative and low HR positive tumors (hazard ratio 0.74, 95%-CI: 0.38-1.43, p=0.370).
Conclusions:
Similarly to patients with negative HR tumors, patients with low HR positive tumors have a better responsiveness to NACT and worse survival rates, compared to patients with strongly HR positive BC. We suggest that studies on treatment options for basal-like/TNBC, should also consider including patients with low HR positive tumors.
Citation Format: Villegas SL, Lederer B, Untch M, Holms F, Ulmer H-U, Diebold K, Fasching PA, Weber K, Schmitt WD, Tesch H, Rezai M, Marmé F, Sinn B, Hackmann J, Schneeweiss A, Tannapfel A, Nekljudova V, Denkert C, Loibl S. Similarities between low hormone receptor positive and hormone receptor negative breast cancer: An analysis of 4366 patients from multicenter clinical trials [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 P2-08-10.
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Affiliation(s)
- SL Villegas
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - B Lederer
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - M Untch
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - F Holms
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - H-U Ulmer
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - K Diebold
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - PA Fasching
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - K Weber
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - WD Schmitt
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - H Tesch
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - M Rezai
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - F Marmé
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - B Sinn
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - J Hackmann
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - A Schneeweiss
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - A Tannapfel
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - V Nekljudova
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - C Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
| | - S Loibl
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; HELIOS Klinikum, Berlin, Germany; Institute of Pathology, St. Barbara Klinik, Hamm-Heessen, Germany; Mittelbaden Hospital, Karlsruhe, Germany; University Hospital Erlangen, Friedrich-Alexander University, Erlangen, Germany; Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt, Germany; Luisenkrankenhaus, Medical Center Düsseldorf, Düsseldorf, Germany; National Center for Tumour Diseases and University Hospital Heidelberg, Heidelberg, Germany; Marien Hospital, Witten, Germany; Institute for Pathology, Ruhr-University, Bochum, Germany
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Huober J, Schneeweiss A, Blohmer JU, Denkert C, Tesch H, Hanusch CA, Salat C, Rhiem K, Rezai M, Solbach C, Fasching PA, Jackisch C, Mehta K, Nekljudova V, Seither F, von Minckwitz G, Loibl S, Untch M. Abstract P2-08-01: Factors predicting relapse in early breast cancer patients with a pathological complete response after neoadjuvant therapy – Results of a pooled analysis based on the GBG meta-database. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Even though patients with a pCR following neoadjuvant chemotherapy have an excellent prognosis still some of these patients will eventually relapse. A better identification of pts with an increased risk of relapse despite a pCR would be helpful to select these patients for additional post-neoadjuvant treatment strategies. Thus, the rationale of this retrospective analysis was to identify factors predicting relapse despite a pCR.
Methods
This pooled retrospective analysis based on the GBG meta-database includes the neoadjuvant trials GeparTrio, GeparQuattro, GeparQuinto, GeparSixto and GeparSepto. In these trials 2188 (27%) of 7933 pts had a pCR according to ypT0/ypTis ypN0 Definition and were included. The primary endpoint was disease-free survival (DFS), secondary endpoints were distant DFS (DDFS) and overall survival (OS). A multivariate Cox proportional hazards model was used to report hazard ratios with 95% confidence interval (CI). The two-sided significance level was set to α=0.05. Endpoints were analysed for all pts and in subgroups defined by intrinsic subtypes. The potential risk factors intrinsic subtype (HER2 negative/hormone receptor (HR) positive, triple negative, HER2 positive/HR positive, HER2 positive/HR negative), histological tumor type (lobular vs other), grade (G1/G2 vs G3), KI67 (≤20% vs higher), initial cT and cN stadium (cT1 vs cT2 vs cT3/4; cN0 vs cN+), age (≤40 vs 41-59 vs ≥60), BMI (< 25 vs 25-29 vs ≥ 30), planned number of cycles of chemotherapy (≤6 vs > 6), menopausal status (pre- vs postmenopausal) and clinical response after 2-4 cycles (SD vs PR vs CR vs PD) were included as covariates in multivariate Cox regression models as well as study identification.
Results
From 2188 evaluable patients DFS, DDFS and OS events were observed in 290/197/130 pts respectively; the median follow-up over all studies was 59 months. In multivariate analysis including study and all potential risk factors DFS was significantly different with regard to the initial cN status (cN+ vs cN0, hazard ratio (HR) 1.70; 95% CI [1.2, 2.4], p=0.002). Of borderline significance was histological type (non-lobular vs lobular, HR 0.52 95% CI [0.3, 1.1]; p=0.076) and initial tumor stage (cT3/4 vs cT1, HR 1.61 95% CI [1.0, 2.7]; p=0.064). In terms of DDFS significant differences were seen for the initial cN status (cN+ vs cN0, HR 2.34; 95% CI [1.5, 3.6], p<0.001) and initial tumor stage (cT3/4 vs cT1, HR 1.83 95% CI [1.0, 3.3]; p=0.044); histological type was again close to significance (non-lobular vs lobular, HR 0.46 95% CI [0.2, 1.1]; p=0.067). Multivariate analysis showed significantly worse OS with initial cT3/4 tumors (cT3/4 vs cT1, HR 2.48 95%CI [1.1, 5.7]; p=0.030), and the lobular type (non-lobular vs lobular, HR 0.35 95% CI [0.1, 0.9]; p=0.026) and a trend for worse OS in pts with cN+ (cN+ vs cN0, HR 1.67 95% CI [1.0, 2.9]; p=0.067).
Conclusions
Initial tumor load before start of neoadjuvant chemotherapy (tumor stage and nodal status) and lobular subtype were predictors of long term outcome after a pCR following neoadjuvant chemotherapy. Intrinsic subtype, KI67, grade and planned number of cycles were not predictive for a relapse.
Citation Format: Huober J, Schneeweiss A, Blohmer J-U, Denkert C, Tesch H, Hanusch CA, Salat C, Rhiem K, Rezai M, Solbach C, Fasching PA, Jackisch C, Mehta K, Nekljudova V, Seither F, von Minckwitz G, Loibl S, Untch M. Factors predicting relapse in early breast cancer patients with a pathological complete response after neoadjuvant therapy – Results of a pooled analysis based on the GBG meta-database [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 P2-08-01.
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Affiliation(s)
- J Huober
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - A Schneeweiss
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - J-U Blohmer
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Denkert
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - H Tesch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - CA Hanusch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Salat
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - K Rhiem
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - M Rezai
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Solbach
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - PA Fasching
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Jackisch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - K Mehta
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - V Nekljudova
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - F Seither
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - G von Minckwitz
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - S Loibl
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - M Untch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
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Tzschaschel M, Westernhagen U, Rack B, Schneweiss A, Müller V, Fehm T, Gade J, Lorenz R, Rezai M, Tesch H, Söling U, Polasik A, Schochter F, De Gregorio A, Mahner S, Schindlbeck C, Beckmann M, Fasching P, Janni W, Friedl TW. Gibt es einen Zusammenhang zwischen BMI und dem Nachweis von CTCs bei Patientinnen mit frühem Hochrisiko Mammakarzinom? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | | | - B Rack
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - A Schneweiss
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - V Müller
- Universitätsklinikum Hamburg Eppendorf, Klinik und Poliklinik für Gynäkologie, Hamburg, Deutschland
| | - T Fehm
- Klinikum der Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - J Gade
- Diakoniekrankenhaus Friederikenstift, Klinik für Gynäkologie, Hannover, Deutschland
| | - R Lorenz
- Gemeinschaftspraxis Dr. Lorenz, Hecker und Wesche, Braunschweig, Deutschland
| | - M Rezai
- Luisenkrankenhaus Düsseldorf, Klinik für Gynäkologie und Geburtshilfe, Düsseldorf, Deutschland
| | - H Tesch
- Onkologische Gemeinschaftspraxis, Frankfurt, Deutschland
| | - U Söling
- Gemeinschaftspraxis Siehl und Soeling, Kassel, Deutschland
| | - A Polasik
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - F Schochter
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | | | - S Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - C Schindlbeck
- Klinikum Traunstein, Frauenklinik, Traunstein, Deutschland
| | - M Beckmann
- Friedrich-Alexander Universität Erlangen-Nürnberg, Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - P Fasching
- Friedrich-Alexander Universität Erlangen-Nürnberg, Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - W Janni
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - TW Friedl
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
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14
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Köpke M, Feißt M, Rezai M, Nitz U, Moderow M, Riedel F, Golatta M, Sohn C, Schneeweiss A, Heil J, Hennigs A. Veränderung des axillären Managements bei Brustkrebspatientinnen mit 1 – 2 tumorbefallenen Sentinel-Lymphknoten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Köpke
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Feißt
- Medizinische Biometrie und Informatik, Heidelberg, Deutschland
| | - M Rezai
- Europäisches Brustzentrum Dr. Mahdi Rezai, Luisenkrankenhaus, Düsseldorf, Deutschland
| | - U Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum Niederrhein, Mönchengladbach, Deutschland
| | - M Moderow
- Westdeutsches Brust-Centrum GmbH, Düsseldorf, Deutschland
| | - F Riedel
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Golatta
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Sohn
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - J Heil
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
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Nabieva N, Fehm T, Häberle L, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Popovic M, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauss T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Hack CC, Schmidt K, Belleville E, Brucker SY, Kümmel S, Beckmann MW, Wallwiener D, Hadji P, Fasching PA. Influence of side-effects on early therapy persistence with letrozole in post-menopausal patients with early breast cancer: Results of the prospective EvAluate-TM study. Eur J Cancer 2018; 96:82-90. [PMID: 29679775 DOI: 10.1016/j.ejca.2018.03.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endocrine treatment (ET) with an aromatase inhibitor (AI) is the treatment of choice in post-menopausal patients with hormone receptor-positive early breast cancer (EBC). However, adverse events (AEs) often lead to treatment discontinuation. This analysis aimed to identify side-effects that lead to patients failing to persist with letrozole treatment. PATIENTS AND METHODS Post-menopausal hormone receptor-positive EBC patients starting ET with letrozole were enroled in EvAluate-TM, a non-interventional study. Information regarding treatment compliance and persistence was gathered in months 6 and 12. Persistence was defined as the time from 30 d after the start to the end of treatment. The influence on persistence of musculoskeletal syndrome, menopausal disorder, sleep disorder and other AEs within the first 30 d was analysed using Cox regression analyses. RESULTS Among 3887 patients analysed, the persistence rate after 12 months was >85%. In all, 568 patients (14.6%) discontinued the treatment, 358 of whom (63.0%) did so only because of side-effects. The main AEs influencing persistence were musculoskeletal symptoms (hazard ratio [HR] 2.55; 95% confidence interval [CI], 1.90-3.42), sleep disorders (HR 1.95; 95% CI, 1.41-2.70) and other AEs (HR 2.03; 95% CI, 1.51-2.73). Menopausal disorder was not associated with non-persistence (HR 1.17; 95% CI, 0.74-1.84). CONCLUSIONS These results suggest that side-effects of AIs such as musculoskeletal syndrome and sleep disorder lead to ET discontinuation within the first treatment year in significant numbers of EBC patients. Compliance programmes adapted for subgroups that are at risk for early non-persistence might help to ensure the recommended therapy duration. CLINICAL TRIALS NUMBER CFEM345DDE19.
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Affiliation(s)
- N Nabieva
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - L Häberle
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - J de Waal
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - M Rezai
- Luisen-Hospital Düsseldorf, Düsseldorf, Germany
| | - B Baier
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | | | | | - M Warm
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; Breast Center, Clinics of Cologne GmbH, Holweide, Cologne, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - R Wuerstlein
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - J-U Deuker
- Vinzenz-Hospital Hannover GmbH, Hannover, Germany
| | - P Dall
- Department of Gynecology, Lüneburg Clinic, Lüneburg, Germany
| | - B Richter
- Elbland Clinics, Meissen-Radebeul, Germany
| | - G Wachsmann
- County Hospital of Böblingen, Böblingen, Germany
| | - C Brucker
- Department of Gynecology, University Hospital, Paracelsus Private Medical University of Nuremberg, Nuremberg, Germany
| | - J W Siebers
- Department of Gynecology, St. Josef's Hospital, Offenburg, Germany
| | - M Popovic
- Department of Gynecology, Bayreuth Clinic GmbH, CCC ER-EMN, Bayreuth, Germany
| | - T Kuhn
- Karl-Olga-Hospital Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - C Wolf
- Medical Center Ulm, Ulm, Germany
| | - H-W Vollert
- Friedrichshafen Clinic, Friedrichshafen, Germany
| | - G-P Breitbach
- Department of Gynecology, Neunkirchen Clinic, Neunkirchen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - R Landthaler
- Gynecological Medical Practice of the County Hospital of Krumbach, Krumbach, Germany
| | - A Kohls
- Evangelic County Hospital Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - D Rezek
- Marien-Hospital Wesel, Wesel, Germany
| | - T Noesselt
- Department of Gynecology of the County Hospital of Hameln, Hameln, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - S Henschen
- Johanniter Hospital Genthin Stendal gGmbH, Hansestadt Stendal, Germany
| | - T Praetz
- Caritas-Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - V Heyl
- Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - T Kühn
- Department of Gynecology, Esslingen Clinics a.N., Esslingen, Germany
| | - T Krauss
- Department of Gynecology Passau, Passau, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - A Hohn
- County Hospital Kiel GmbH, Kiel, Germany
| | - H Tesch
- Oncology Bethanien Frankfurt, Frankfurt, Germany
| | - C Mundhenke
- Department of Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Hein
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C C Hack
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - K Schmidt
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | | | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - S Kümmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - M W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - D Wallwiener
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - P Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - P A Fasching
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
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Rezai M, Farrokhnia T, Vatanpour M, Lesan S, Yazdipour SH. Evaluation of Multiple Choice Questions of Oral and Maxillofacial Medicine Courses 1, 2, and 3 in the First Semester of Academic Year 2014-2015. J Res Dentomaxillofac Sci 2018. [DOI: 10.29252/jrdms.3.2.24] [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: 10/31/2022] Open
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Kern P, Kimmig R, Rezai M, Hoffmann O, Bücker I, Braun M. Abstract OT2-01-05: Sentinel lymphnode biopsy (SLNB) and targeted axillary surgery (TAS) by indocyaningreen (ICG) and a novel near-infrared color camera system - a prospectively randomised, multicenter study to avoid radioactivity in a time-/cost-saving procedure in primary breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-01-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Sentinel lymph node biopsy (SLNB) by radioactively labelled 99mTechnetium +/- patent blue is so far the current standard in SLN detection. However, it remains a time- and cost-consuming procedure requiring the availability of a nuclear medicine department and a precise coordination with the subsequent surgery. It could be desirable to empower surgeons to be independent from availability of a nuclear source and to spare patients from radioactivity. Indocyanine green (ICG) as a fluorescent coloring agent is already known as safe in diagnostics for heart, circulation, liver and eye disease and may represent a valid alternative to 99mTc and patent blue (PBD), especially as it does not cause aesthetic impairment of the breast, with ICG being only visible with near infra-red light.
Methods: This prospective, randomized study is a non-inferiority trial to evaluate ICG-fluorescence as an alternative to either 99mTc and/or patent blue dye for sentinel lymph node detection of primary breast cancer with and without neoadjuvant chemotherapy.
Patients, aged 18 - 80 years, with unilateral or bilateral, unifocal or multifocal/ multicentric primary breast cancer without signs of metastases and written consent are eligible for this study. ECOG status of 0-2 and life expectancy > 1 year is required. All BMI classes are admitted to the study, with predefined subgroups of a) <= 20 b) >20-30 c) >30-40 d) >40. Tumor stages included are a) Tis (>= 4 cm) b) T1 c) T2 and d) T3. ICG-guided SLNB may be applied in patients in the following settings: a) before neoadjuvant, b) after neoadjuvant chemotherapy.
Primary Endpoints: Rate of SLN detection by either of the methods in the following 3 arms of the trial:
Arm A: 99mTc + patent blue dye (PBD)
Arm B: 99mTc + indocyanine green (ICG)
Arm C: Indocyanine green (ICG)
Secondary Endpoints:
- Time to identify (TTI) sentinel lymph node(s) (min)
- Number of sentinel lymph nodes (SLN) and non-sentinel lymph nodes (non-SLN)
- Rate of concordance of detection by 99mTc+patent blue dye (PBD) vs. 99mTc + ICG
- Dose of radioactivity omitted in Arm C vs. Arm A & B
Results: This trial is in progress.
Citation Format: Kern P, Kimmig R, Rezai M, Hoffmann O, Bücker I, Braun M. Sentinel lymphnode biopsy (SLNB) and targeted axillary surgery (TAS) by indocyaningreen (ICG) and a novel near-infrared color camera system - a prospectively randomised, multicenter study to avoid radioactivity in a time-/cost-saving procedure in primary breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-01-05.
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Affiliation(s)
- P Kern
- University of Bochum, Teaching Hospital St.Elisabeth´s Hospital, Bochum, Northrhine-Westfalia, Germany; University of Duisburg-Essen, University Hospital of Essen, Essen, Northrhine-Westfalia, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Northrhine-Westfalia, Germany; Rotkreuzklinikum München, München, Bavaria, Germany
| | - R Kimmig
- University of Bochum, Teaching Hospital St.Elisabeth´s Hospital, Bochum, Northrhine-Westfalia, Germany; University of Duisburg-Essen, University Hospital of Essen, Essen, Northrhine-Westfalia, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Northrhine-Westfalia, Germany; Rotkreuzklinikum München, München, Bavaria, Germany
| | - M Rezai
- University of Bochum, Teaching Hospital St.Elisabeth´s Hospital, Bochum, Northrhine-Westfalia, Germany; University of Duisburg-Essen, University Hospital of Essen, Essen, Northrhine-Westfalia, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Northrhine-Westfalia, Germany; Rotkreuzklinikum München, München, Bavaria, Germany
| | - O Hoffmann
- University of Bochum, Teaching Hospital St.Elisabeth´s Hospital, Bochum, Northrhine-Westfalia, Germany; University of Duisburg-Essen, University Hospital of Essen, Essen, Northrhine-Westfalia, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Northrhine-Westfalia, Germany; Rotkreuzklinikum München, München, Bavaria, Germany
| | - I Bücker
- University of Bochum, Teaching Hospital St.Elisabeth´s Hospital, Bochum, Northrhine-Westfalia, Germany; University of Duisburg-Essen, University Hospital of Essen, Essen, Northrhine-Westfalia, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Northrhine-Westfalia, Germany; Rotkreuzklinikum München, München, Bavaria, Germany
| | - M Braun
- University of Bochum, Teaching Hospital St.Elisabeth´s Hospital, Bochum, Northrhine-Westfalia, Germany; University of Duisburg-Essen, University Hospital of Essen, Essen, Northrhine-Westfalia, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Northrhine-Westfalia, Germany; Rotkreuzklinikum München, München, Bavaria, Germany
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Witzel ID, Laakmann E, Fasching PA, Rezai M, Schem C, Solbach C, Tesch H, Klare P, Schneeweiss A, Zahm D, Blohmer J, Ingold-Heppner B, Huober J, Hanusch C, Jackisch C, Reinisch M, Untch M, von Minckwitz G, Müller V, Loibl S. Abstract P1-17-01: Development of brain metastases in breast cancer patients treated in the neoadjuvant trials Geparquinto and Geparsixto. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-17-01] [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: The incidence of brain metastases (BM) in breast cancer patients is rising and has become a major clinical challenge. So far, the incidence of BM after modern neoadjuvant treatment is not clear.
Materials and Methods: In Geparquinto, patients with untreated HER2-positive breast cancer (n=615) received either lapatinib or trastuzumab, patients with HER2 negative breast cancer (n=1925) received bevacizumab in addition to an anthracycline and taxane-containing regimen and those not responding paclitaxel and everolimus (n=32). In Geparsixto, patients with HER2-positive tumors (n=273) received trastuzumab and lapatinib and patients with triple-negative tumors (n=315) received bevacizumab in addition to chemotherapy. We analyzed clinical factors associated with the occurrence of BM as first site of metastatic relapse after neoadjuvant treatment in both trials (n=3160).
Results: After a median follow-up of 61 months, 108 (3%) of a total of 3160 patients developed BM as first site of recurrence and 411 (13%) patients had distant metastases outside the brain. Brain metastases as first site of recurrence occurred later than other metastases (3--year-relapse free-rate 96.7% for patients who developed BM and 89.5% for patients who developed metastases outside the brain). Regarding subtypes of the primary tumor, 1% of luminal A (11/954), 2% of luminal B (7/381), 4% of HER2 positive (34/809) and 6% of triple-negative patients (56/1008) developed BM as first site of recurrence. In multivariate analysis, risk factors for the development of BM were larger tumor size (cT3-4; HR 1.9, 95%-CI 1.3-2.8, p=0.0022), node positive disease (HR 2.8, 95% CI 1.8-4.4, p<0.0001), no pCR after neoadjuvant chemotherapy (HR 2.7, 95% CI 1.6-4.7, p=0.0003) and HER2 positive (HR 3.8, 95% CI 1.9-7.8, p=0.0002) or triple-negative subtype (HR 8.1, 95% CI 4.2 – 15.8, p< 0.0001). Breast cancer subtype remained the most relevant risk factor for BM. Patients who developed BM were more often HER2 positive or triple-negative tumors compared with patients who developed metastases outside the brain (HER2 positive subtype 32 vs. 19%, triple-negative subtype 52 vs. 40%, p< 0.001).
Conclusion: Especially patients with HER2-positive and triple negative tumors are at risk of developing BM despite active systemic treatment. A better understanding of the underlying mechanisms is required in order to develop potential preventive strategies.
Citation Format: Witzel ID, Laakmann E, Fasching PA, Rezai M, Schem C, Solbach C, Tesch H, Klare P, Schneeweiss A, Zahm D, Blohmer J, Ingold-Heppner B, Huober J, Hanusch C, Jackisch C, Reinisch M, Untch M, von Minckwitz G, Müller V, Loibl S. Development of brain metastases in breast cancer patients treated in the neoadjuvant trials Geparquinto and Geparsixto [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 P1-17-01.
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Affiliation(s)
- ID Witzel
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - E Laakmann
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - PA Fasching
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - M Rezai
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - C Schem
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - C Solbach
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - H Tesch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - P Klare
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - A Schneeweiss
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - D Zahm
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - J Blohmer
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - B Ingold-Heppner
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - J Huober
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - C Hanusch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - C Jackisch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - M Reinisch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - M Untch
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - G von Minckwitz
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - V Müller
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
| | - S Loibl
- University Medical Center, Hamburg, Germany; German Breast Group, Neu Isenburg, Germany; University Medical Center, Erlangen, Germany; Medical Center Luisenkrankenhaus, Düsseldorf, Germany; University Medical Center, Kiel, Germany; University Medical Center, Frankfurt, Germany; Center for Hematology und Oncology Bethanien, Frankfurt, Germany; Praxisklinik, Standort Lichtenberg, Berlin, Germany; Medical Center for Hematology and Oncology, Munich, Germany; University Medical Center, Heidelberg, Germany; Breast Center Ostthüringen, Gera, Germany; University Medical Center, Charité- Campus Mitte, Berlin, Germany; University Medical Center, Institute for Pathology, Charité, Berlin, Germany; University Medical Center, Ulm, Germany; Rotkreuzklinikum, Munich, Germany; Hospital Offenbach, Offenbach, Germany; Kliniken Essen-Mitte, Essen, Germany; Klinikum Berlin-Buch, Berlin, Germany
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19
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Loibl S, Untch M, Denkert C, Huober J, Blohmer JU, Grischke EM, Furlanetto J, Tesch H, Hanusch C, Rezai M, Jackisch C, Schmitt WD, von Minckwitz G, Thomalla J, Kümmel S, Rautenberg B, Fasching PA, Rhiem K, Burchardi N, Schneeweiss A. Abstract P6-15-01: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-15-01] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- S Loibl
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - M Untch
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - C Denkert
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - J Huober
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - JU Blohmer
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - E-M Grischke
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - J Furlanetto
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - H Tesch
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - C Hanusch
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - M Rezai
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - C Jackisch
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - WD Schmitt
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - G von Minckwitz
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - J Thomalla
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - S Kümmel
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - B Rautenberg
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - PA Fasching
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - K Rhiem
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - N Burchardi
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
| | - A Schneeweiss
- German Breast Group; Centrum für Hämatologie und Onkologie Bethanien Frankfurt; HELIOS Klinikum Berlin Buch; Universitätsfrauenklinik Ulm; Brustzentrum Charité; Universitätsfrauenklinik Tübingen; Klinikum zum Roten Kreuz München; Medical Center, Luisenkrankenhaus; Sana-Clinic, Offenbach; Praxisklinik für Hämatologie und Onkologie, Koblenz; Brustzentrum, Kliniken Essen-Mitte; Universitätsklinikum Freiburg; Brustzentrum Universitätsklinikum Erlangen; Uniklinik Köln; Charité University Hospital Berlin; National Center for Tumor Diseases (NCT), Heidelberg
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Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Schmidt M, Klare P, Rezai M, Rautenberg B, Klutinus N, Rhein U, Mousa K, Ricardo-Vitorino S, von Minckwitz G, Bliss J. Abstract GS3-03: A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib trial). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs3-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Inhibition of COX-2 has been shown to attenuate the metastatic process in pre-clinical models of human breast cancer (BC). The primary aim of this study was to assess the effect of 2 years adjuvant therapy with the COX-2 inhibitor celecoxib compared with placebo in HER2-ve primary BC patients.
Patients & Methods
Patients were randomised in a 2:1 ratio to receive celecoxib 400mg once daily or placebo for 2 years. Patients had to have completely resected BC with prior local and systemic adjuvant treatment according to local practice. Concurrent radiotherapy was permitted and hormone receptor +ve patients received endocrine therapy according to local practice. Patients with HER2+ or node negative, T1 and grade 1 disease were excluded. Median age of patients was 55 years (IQR: 49-63). 50% of patients had tumours >2cm; 42% were grade 3; 48% had node +ve disease. According to local assessment 73% were ER/PgR +ve. Primary endpoint was Disease Free Survival (DFS); defined as time from randomisation to date of first event, with events contributing to analysis defined as recurrence (distant/local), new primary BC (ipsilateral/contralateral) and death. Secondary endpoints included Overall Survival (OS), toxicity, cardiovascular mortality and incidence of second primaries. Subgroup analysis by hormone receptor status was pre-planned. Survival endpoints are analysed using Cox-proportional hazards and log-rank tests; restricted mean survival is used where proportional hazards do not hold.
Results
Between January 2007 and November 2012, 2639 patients were randomised (1763 celecoxib; 876 placebo) from 181 centres across the UK and Germany. At 13th April 2017, median follow up was 60 months (IQR: 48-72) with 428 DFS events reported. Unadjusted survival analysis results are presented below, with hazard ratio<1 favouring celecoxib:
5 year survival estimate (95% CI)Hazard ratio (95% CI)p-valueDFS (all patients) Celecoxib83% (81, 85)1.02 (0.83 – 1.24)0.88Placebo83% (80, 86)1- DFS within ER+ Celecoxib87% (85, 89)0.89 (0.69 – 1.16)0.40Placebo86% (83, 89)1- DFS within ER- Celecoxib72% (68, 76)1.17 (0.85 – 1.61)0.33Placebo75% (69, 80)1- OS (all patients) Celecoxib90% (88, 91)0.97 (0.75 – 1.25)0.81Placebo90% (88, 92)1-
The interaction between ER status and treatment was not significant; p=0.36.
In the celecoxib and placebo groups there were 17 and 8 deaths respectively in patients who had not relapsed. These were due to cardiac (n=3; 2) and other (n=14; 6) in the celecoxib and placebo groups respectively; none were GI related. In total 304 serious adverse events were observed in 265 patients (186/1763 celecoxib; 79/876 placebo). In the celecoxib and placebo groups respectively these were related to cardiac (n=12; 7), GI (n=9; 2) and other (n=193; 81). Work is ongoing to determine whether a subset of ER+ patients whose primary tumours show the characteristics of a COX-2 signature receive greater benefit from celecoxib.
Conclusions
There is no benefit of celecoxib in the ITT population. Further exploratory studies focussing on the ER+ subpopulation are ongoing. Celecoxib treatment is not associated with significant toxicity when compared to placebo in this population of BC patients.
Citation Format: Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Schmidt M, Klare P, Rezai M, Rautenberg B, Klutinus N, Rhein U, Mousa K, Ricardo-Vitorino S, von Minckwitz G, Bliss J. A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib 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 GS3-03.
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Affiliation(s)
- RC Coombes
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - H Tovey
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - L Kilburn
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Mansi
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - C Palmieri
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Bartlett
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Hicks
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - A Makris
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - A Evans
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - S Loibl
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - C Denkert
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - E Murray
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - R Grieve
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - R Coleman
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - M Schmidt
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - P Klare
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - M Rezai
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - B Rautenberg
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - N Klutinus
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - U Rhein
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - K Mousa
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - S Ricardo-Vitorino
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - G von Minckwitz
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Bliss
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
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21
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Assadi T, Mofidi M, Rezai M, Hafezimoghadam P, Maghsoudi M, Mosaddegh R, Aghdam H. The Comparison between two Methods of Basic Life Support Instruction: Video Self-Instruction versus Traditional Method. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Medical education is changing and evolving. Teachers need to re-evaluate their medical teaching practice to enhance student learning. The data about the ideal training method of Basic Life Support (BLS) is lacking. The goal of this study was to analyse the use and performance of video self-instruction (VSI) method in BLS, in order to develop an efficient BLS training method. Methods Eighty-one undergraduate medical interns were enrolled in a prospective clinical study in 2011. They were divided into VSI group and traditional group. We provided the first group with a DVD containing a 20-minute training video while the second group took part in a 4-hour training class of BLS. Subjects participated in a pre-test and post-test based on 2010 American Heart Association Resuscitation guideline. Results The average scores of VSI group and the traditional group before training were 8.85±2.42 and 8.57±2.22 respectively (p=0.592). After training, the average scores of the VSI and the traditional group were 20.24±0.83 and 18.05±1.86 respectively. VSI group achieved slightly better scores compared with the traditional group (p<0.001). Conclusions Training through VSI achieves more satisfying results than the traditional lecture method. VSI method can be considered a useful technique in undergraduate educational programs. Developing VSI can increase significantly the access to the BLS training. (Hong Kong j.emerg.med. 2015;22:291-296)
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Affiliation(s)
- T Assadi
- Shahrood University of Medical Sciences, Emergency Medicine Department, Iran
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22
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Untch M, Schneeweiss A, Salat C, Rezai M, Zahm DM, Klare P, Blohmer JU, Tesch H, Khandan F, Fasching P, Jackisch C, Nekljudova V, von Minckwitz G, Loibl S. Long-term survival analysis of the randomized phase II trial investigating the addition of carboplatin to neoadjuvant therapy for triple-negative (TNBC) and HER2-positive early breast cancer (GeparSixto). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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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23
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Hein A, Rack B, Li L, Ekici AB, Reis A, Lux MP, Cunningham JM, Rübner M, Fridley BL, Schneeweiss A, Tesch H, Lichtenegger W, Fehm T, Heinrich G, Rezai M, Beckmann MW, Janni W, Weinshilboum RM, Wang L, Fasching PA, Häberle L. Genetic Breast Cancer Susceptibility Variants and Prognosis in the Prospectively Randomized SUCCESS A Study. Geburtshilfe Frauenheilkd 2017; 77:651-659. [PMID: 28757652 DOI: 10.1055/s-0042-113189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/13/2022] Open
Abstract
Large-scale genotyping studies have identified over 70 single nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk. However, knowledge regarding genetic risk factors associated with the prognosis is limited. The aim of this study was therefore to investigate the prognostic effect of nine known breast cancer risk SNPs. BC patients (n = 1687) randomly sampled in an adjuvant, randomized phase III trial (SUCCESS A study) were genotyped for nine BC risk SNPs: rs17468277 (CASP8) , rs2981582 (FGFR2) , rs13281615(8q24), rs3817198 (LSP1) , rs889312 (MAP3K1) , rs3803662 (TOX3) , rs13387042(2q35), rs4973768 (SLC4A7) , rs6504950 (COX11) . Cox proportional hazards models were used to test the SNPs' association with overall survival (OS) and progression-free survival (PFS). Additional analyses were carried out for molecular subgroups. rs3817198 in LSP1 (lymphocyte-specific protein 1) was the only SNP that significantly influenced OS (p = 0.01) and PFS (p < 0.01) in the likelihood ratio test comparing the genetic survival model with the clinical survival model. In the molecular subgroups, triple-negative patients with two minor alleles in rs3817198 had a much better prognosis relative to OS (adjusted HR 0.03; 95% CI 0.002 - 0.279) and PFS (HR 0.09; 95% CI 0.02 - 0.36) than patients with the common alleles. The same effect on PFS was shown for patients with luminal A tumors (HR 0.19; 95% CI 0.05 - 0.84), whereas patients with luminal B tumors had a poorer PFS with two minor alleles (HR 2.13; 95% CI 1.02 - 4.40). The variant in rs3817198 has a prognostic effect particularly in the subgroup of patients with triple-negative BC, suggesting a possible link with immunomodulation and BC.
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Affiliation(s)
- A Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - B Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - L Li
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Mayo Medical School-Mayo Foundation, Rochester, MN, USA.,Department of Oncology; Institute of Medicinal Biotechnology; Chinese Academy of Medical Sciences & Peking Union Medical College; Tiantan Xili, Beijing, 100050, China
| | - A B Ekici
- Institute of Human Genetics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - A Reis
- Institute of Human Genetics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - J M Cunningham
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | - M Rübner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - B L Fridley
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.,Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - A Schneeweiss
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, National Center for Tumor Diseases, Heidelberg, Germany
| | - H Tesch
- Department of Oncology, Onkologie Bethanien, Frankfurt am Main, Germany
| | - W Lichtenegger
- Department of Gynecology and Obstetrics, Charité University Hospital Campus Virchow, Berlin, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Duesseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - G Heinrich
- Department of Gynecologic Oncology, Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany
| | - M Rezai
- Department of Breast Diseases, Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - W Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - R M Weinshilboum
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Mayo Medical School-Mayo Foundation, Rochester, MN, USA
| | - L Wang
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Mayo Medical School-Mayo Foundation, Rochester, MN, USA
| | - P A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Department of Medicine, Division of Hematology/Oncology, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - L Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Farahmand Rad H, Ziaei T, Rezai M, Roshandel G. PS-01-011 Effect of counselling based on sexual self-concept on sexual health of women in reproductive age. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.03.080] [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: 10/19/2022]
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25
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Schneeweiss A, Möbus V, Tesch H, Hanusch C, Denkert C, Lübbe K, Huober J, Klare P, Kümmel S, Untch M, Kast K, Jackisch C, Ingold-Heppner B, Thomalla J, Blohmer JU, Rezai M, Nekljudova V, von Minckwitz G, Loibl S. Abstract P5-16-01: A randomised phase III trial comparing two dose-dense, dose-intensified approaches (ETC and PM(Cb)) for neoadjuvant treatment of patients with high-risk early breast cancer (GeparOcto). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-16-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- A Schneeweiss
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - V Möbus
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - H Tesch
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - C Hanusch
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - C Denkert
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - K Lübbe
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - J Huober
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - P Klare
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - S Kümmel
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - M Untch
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - K Kast
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - C Jackisch
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - B Ingold-Heppner
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - J Thomalla
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - J-U Blohmer
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - M Rezai
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - V Nekljudova
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - G von Minckwitz
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
| | - S Loibl
- Universitätsklinikum Heidelberg; Klinikum Frankfurt-Höchst; Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt; Klinikum zum Roten Kreuz, München; Charite Berlin; Diakovere Henriettenstift Hannover; Universitätsklinikum Ulm; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin; Kliniken Essen- Mitte, Essen; Helios Kliniken Berlin-Buch; Universitätsklinikum Dresden; Sana Klinikum Offenbach; Praxisklinik für Hämatologie und Onkologie Koblenz; Luisenkrankenhaus Düsseldorf; German Breast Group, Neu-Isenburg
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Tzschaschel MLJ, Rack B, Andergassen U, Friedl TWP, Schneeweiss A, Mueller V, Tanja F, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Soeling U, Polasik A, Alunni-Fabbroni M, Trapp EK, Mahner S, Schindlbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W. Abstract P1-01-03: Dynamics of circulating tumor cells during the course of chemotherapy and prognostic relevance across molecular subtypes in high-risk early breast cancer patients – Results from the adjuvant SUCCESS A trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The presence of circulating tumor cells (CTCs) before chemotherapy is known to be associated with reduced disease free survival (DFS) and overall survival (OS) in early breast cancer (EBC). In addition, recent findings suggest that CTCs persisting after adjuvant chemotherapy indicate poor prognosis. In an explorative analysis of the SUCCESS A trial, we evaluated the prognostic relevance of changes in CTC counts during the course of adjuvant chemotherapy across molecular subtypes to assess whether the prognostic role of persisting CTCs varies according to tumor biology.
Methods: The SUCCESS A trial is a phase III study, where patients with high-risk EBC (stage pN1-3 or pT2-4 or grade 3 or age ≤ 35 or hormone-receptor negative) were randomized to adjuvant chemotherapy with 3 cycles of epirubicin-fluorouracil-cyclophosphamide followed by either 3 cycles of docetaxel or 3 cycles of gemcitabine-docetaxel. CTC enumeration was performed before and after chemotherapy using the FDA-approved CellSearch® System (Janssen Diagnostics, LLC), and CTC positivity was defined as ≥ 1 CTC in 23 ml blood. Molecular subtypes were defined as luminal A like (hormone-receptor positive, grading 1 or 2), luminal B like (hormone-receptor positive, grading 3), triple-negative or HER2-positive. Patient outcome in terms of DFS and OS was analyzed using univariate log-rank tests and Cox regression models (median follow-up time 65.2 months).
Results: Data on both molecular subtypes and CTC status before and after chemotherapy were available for 1485 (39.6%) of 3754 patients randomized. This cohort contained 577 (38.9%) luminal A like, 236 (15.9%) luminal B like, 379 (25.5%) HER2-positive and 293 (19.7%) triple negative tumors. Overall, 917 (61.8%) patients were CTC negative before and after chemotherapy (neg/neg), 260 (17.5%) patients had a negative CTC status before and a positive CTC status after chemotherapy (neg/pos), 229 (15.4%) patients converted from positive to negative CTC status (pos/neg), and 79 (5.3%) patients were positive for CTCs at both time points (pos/pos). There were significant differences in DFS and OS among these four groups in patients with luminal A like tumors (log rank test, both p < 0.003) and patients with luminal B like tumors (log rank test, both p < 0.001). In both patients with luminal A like or luminal B like tumors, persistently CTC positive patients had the worst outcome (relative to persistently CTC-negative patients) in terms of DFS and OS. In contrast to luminal-like tumors, no significant differences with regard to DFS or OS were found among the four groups (neg/neg, neg/pos, pos/neg, pos/pos) in patients with HER2-positive or triple-negative tumors (log rank test, all p > 0.13).
Conclusion: The presence of CTCs both before and after adjuvant chemotherapy was associated with poor survival in luminal A like and luminal B like tumors, but not in HER2-positive or triple-negative tumors. Further research is needed to evaluate the effect of chemotherapy on CTC prevalence in different molecular subtypes of EBC.
Citation Format: Tzschaschel MLJ, Rack B, Andergassen U, Friedl TWP, Schneeweiss A, Mueller V, Tanja F, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Soeling U, Polasik A, Alunni-Fabbroni M, Trapp EK, Mahner S, Schindlbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W. Dynamics of circulating tumor cells during the course of chemotherapy and prognostic relevance across molecular subtypes in high-risk early breast cancer patients – Results from the adjuvant SUCCESS A trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-01-03.
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Affiliation(s)
- MLJ Tzschaschel
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - B Rack
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - U Andergassen
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - TWP Friedl
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - A Schneeweiss
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - V Mueller
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - F Tanja
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - K Pantel
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - J Gade
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - R Lorenz
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - M Rezai
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - H Tesch
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - U Soeling
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - A Polasik
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - M Alunni-Fabbroni
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - EK Trapp
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - S Mahner
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - C Schindlbeck
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - W Lichtenegger
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - MW Beckmann
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - PA Fasching
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - W Janni
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
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von Minckwitz G, Timms K, Untch M, Elkin EP, Hahnen E, Fasching PA, Schneeweiss A, Salat CT, Rezai M, Blohmer JU, Zahm DM, Jackisch C, Gerber B, Klare P, Kümmel S, Paepke S, Schmutzler R, Chau S, Reid J, Hartman AR, Nekljudova V, Weber KE, Loibl S. Abstract P1-09-02: Homologous repair deficiency (HRD) as measure to predict the effect of carboplatin on survival in the neoadjuvant phase II trial GeparSixto in triple-negative early breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Addition of carboplatin to anthracycline/taxane-based neoadjuvant chemotherapy has shown to improve pathological complete response (pCR; ypT0 ypN0) rates in patients with triple-negative breast cancer (TNBC) in two large phase II studies (GeparSixto: von Minckwitz et al, Lancet Oncol 2014, CALGB 40603: Sikov WM, J Clin Oncol 2015). Participants of the GeparSixto study showed an improvement of pCR rate from 36.9 to 53.2% (p=0.005) and DFS by absolute 9% (HR 0.56 95% CI 0.33-0.96] p=0.035) with the addition of carboplatin in the TNBC subgroup. No effect was observed in the HER2-positive subgroup. We here report results on homologous repair deficiency (HRD) status in relation to pCR and DFS in the TNBC subgroup.
Patients and Methods
In the GeparSixto trial (NCT01426880), patients were treated for 18 weeks with paclitaxel 80mg/m2 q1w and non-pegylated-liposomal doxorubicin (NPLD) 20mg/m2 q1w. Patients with TNBC (N=315) received concurrently bevacizumab 15mg/kg i.v. q2w until surgery. All patients were randomized 1:1 to receive concurrently carboplatin AUC 1.5-2 q1w vs no carboplatin. Carboplatin dose was reduced from AUC 2.0 to 1.5 by an amendment after 330 patients. Primary objective is pCR rate (ypT0 ypN0). Event free survival (EFS), and overall survival (OS) were secondary objectives. HR Deficiency status was assessed on FFPE material from pretherapeutic core biopsies. HR Deficiency was defined as either HRD score high or a BRCA mutation.
Results
HRD status was measurable in 193 of 315 TNBC patients. 101 patients of them were randomly assigned to receive carboplatin and 92 to no additional carboplatin. After median follow-up of 34.3 months 43 event free survival (EFS) events have been reported.
HR deficiency was detected in 136 (70.5%) tumors of which 79 (58.1%) showed high HRD score with intact tBRCA. HR deficiency independently predicted pCR (ypT0is ypN0) (odds ratio (OR) 2.506, CI 1.243-5.051, p=0.009). Adding carboplatin to PM significantly increased the pCR rate from 36.6% to 63.2% in HR deficient tumors with intact tBRCA (p=0.018), only marginally from 61.9% to 72.7% in BRCA mutated tumors (p=0.406), and moderately from 20.0% to 40.7% in HR non-deficient tumors (p=0.086). In general, patients with HRD deficient tumors had a better ESF than non HRD deficient ones (HR 1.805 (0.985-3.309); p=0.0526). Patients with high HRD score had an insignificant trend towards an improved EFS compared to those with low HRD score (HR 1.546 (0.764-3.127) p=0.2223). HRD deficiency did not predict carboplatin effect in patients without BRCA mutation (HR 0.8617). In multivariable analysis, only therapy, clinical nodal status before treatment, and lymphocyte predominant breast cancer were significant prognostic on EFS.
Conclusion
Within the GeparSixto study HR deficiency (either HRD score high or BRCA mutation) was associated with a higher pCR in general and an improved EFS. The effect of carboplatin could not be predicted by HR deficiency in this relatively small study. However, the results will help to understand the role of HR deficiency and the value of the HRD score in TNBC especially in patients without BRCA mutation.
Citation Format: von Minckwitz G, Timms K, Untch M, Elkin EP, Hahnen E, Fasching PA, Schneeweiss A, Salat CT, Rezai M, Blohmer J-U, Zahm D-M, Jackisch C, Gerber B, Klare P, Kümmel S, Paepke S, Schmutzler R, Chau S, Reid J, Hartman A-R, Nekljudova V, Weber KE, Loibl S. Homologous repair deficiency (HRD) as measure to predict the effect of carboplatin on survival in the neoadjuvant phase II trial GeparSixto in triple-negative early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-02.
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Affiliation(s)
- G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - K Timms
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - EP Elkin
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - E Hahnen
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - PA Fasching
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - CT Salat
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - M Rezai
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - D-M Zahm
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - C Jackisch
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - B Gerber
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - P Klare
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - S Kümmel
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - S Paepke
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - R Schmutzler
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - S Chau
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - J Reid
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - A-R Hartman
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - V Nekljudova
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - KE Weber
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany; Myriad Genetic Laboratories, Salt Lake City; Helios Kliniken Berlin-Buch, Berlin, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Germany; Universitätsklinikum Erlangen, Germany; Universitätsklinikum Heidelberg, Germany; Hämatologisch-Onkologische Schwerpunktpraxis Salat/Stötzer, München, Germany; Luisenkrankenhaus, Düsseldorf, Germany; Charité, Brustzentrum, Berlin, Germany; SRH Wald-Klinikum Gera, Germany; SANA Klinikum Offenbach, Germany; Universitätsfrauenklinik Rostock, Germany; Praxisklinik Krebsheilkunde für Frauen/Brustzentrum Berlin, Germany; Kliniken Essen-Mitte, Essen, Germany
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Tzschaschel M, Rack B, Andergassen U, Trapp E, Alunni-Fabbroni M, Schneeweiss A, Müller V, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Söling U, Fehm T, Mahner S, Schindelbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W, Friedl TWP. Prognostischer Effekt von Änderungen der Anzahl zirkulierender Tumorzellen unter Chemotherapie bei Patientinnen mit frühem Mammakarzinom (EBC). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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von Minckwitz G, Rezai M, Tesch H, Huober J, Gerber B, Zahm D, Hilfrich J, Costa S, Dubsky P, Blohmer J, Denkert C, Hanusch C, Jackisch C, Kümmel S, Fasching P, Schneeweiss A, Paepke S, Untch M, Burchardi N, Mehta K, Loibl S. Zoledronate for patients with invasive residual disease after anthracyclines-taxane-based chemotherapy for early breast cancer – The Phase III NeoAdjuvant Trial Add-oN (NaTaN) study (GBG 36/ABCSG 29). Eur J Cancer 2016; 64:12-21. [DOI: 10.1016/j.ejca.2016.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/27/2016] [Accepted: 05/14/2016] [Indexed: 11/25/2022]
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Schröder L, Rack B, Sommer H, Koch JG, Weissenbacher T, Janni W, Schneeweiss A, Rezai M, Lorenz R, Jäger B, Schramm A, Häberle L, Fasching PA, Friedl TWP, Beckmann MW, Scholz C. Toxicity Assessment of a Phase III Study Evaluating FEC-Doc and FEC-Doc Combined with Gemcitabine as an Adjuvant Treatment for High-Risk Early Breast Cancer: the SUCCESS-A Trial. Geburtshilfe Frauenheilkd 2016; 76:542-550. [PMID: 27239063 PMCID: PMC4873296 DOI: 10.1055/s-0042-106209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 02/07/2023] Open
Abstract
Introduction: This paper aims to evaluate the toxicity profile of additive gemcitabine to adjuvant taxane-based chemotherapy in breast cancer patients. Methods: Patients enrolled in this open-label randomized controlled Phase III study were treated with 3 cycles of epirubicin-fluorouracil-cyclophosphamide (FEC) chemotherapy followed by 3 cycles of docetaxel with those receiving 3 cycles of FEC followed by 3 cycles of gemcitabine-docetaxel (FEC-DG). 3690 patients were evaluated according to National Cancer Institute (NCI) toxicity criteria (CTCAE). The study medications were assessed by the occurrence of grade 3-4 adverse events, dose reductions, postponements of treatment cycles and granulocyte colony-stimulating factor (G-CSF) support. Results: No differences in neutropenia or febrile neutropenia were demonstrated. However, thrombocytopenia was significantly increased with FEC-DG treatment (2.0 vs. 0.5 %, p < 0.001), as was leukopenia (64.1 vs. 58.5 %, p < 0.001). With FEC-DG significantly more G-CSF support in cycles 4 to 6 (FEC-DG: 57.8 %, FEC-D: 36.3 %, p < 0.001) was provided. Transaminase elevation was significantly more common with FEC-DG (SGPT: 6.3 %, SGOT: 2 %), whereas neuropathy (1.2 %), arthralgia (1.6 %) and bone pain (2.6 %) were more common using FEC-D. Dose reductions > 20 % (4 vs. 2.4 %) and postponement of treatment cycles (0.9 vs. 0.4 %) were significantly more frequent in the FEC-DG arm. Eight deaths occurred during treatment in the FEC-DG arm and four in the FEC-D arm. Conclusion: The addition of gemcitabine increased hematological toxicity and was associated with more dose reductions and postponements of treatment cycles.
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Affiliation(s)
- L Schröder
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - B Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - H Sommer
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - J G Koch
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - T Weissenbacher
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich
| | - W Janni
- Department of Gynecology and Obstetrics, University of Ulm, Ulm
| | - A Schneeweiss
- Head of Division Gynecologic Oncology National Center for Tumor Diseases, Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg
| | - M Rezai
- Luisenkrankenhaus Düsseldorf, Düsseldorf
| | - R Lorenz
- Gemeinschaftspraxis Dr. R. Lorenz/N. Hecker, Braunschweig
| | - B Jäger
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Düsseldorf
| | - A Schramm
- Department of Gynecology and Obstetrics, University of Ulm, Ulm
| | - L Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - T W P Friedl
- Department of Gynecology and Obstetrics, University of Ulm, Ulm
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - C Scholz
- Department of Gynecology and Obstetrics, University of Ulm, Ulm
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Untch M, Von Minckwitz G, Gerber B, Eidtmann H, Rezai M, Fasching P, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer J, Hauschild M, Fehm T, Nekljudova V, Loibl S. 1801 Neoadjuvant chemotherapy with trastuzumab or lapatinib: Survival analysis of the HER2-positive cohort of the GeparQuinto study (GBG 44). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30755-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kern P, Zarth F, Kimmig R, Rezai M. Impact of Age, Obesity and Smoking on Patient Satisfaction with Breast Implant Surgery - A Unicentric Analysis of 318 Implant Reconstructions after Mastectomy. Geburtshilfe Frauenheilkd 2015; 75:597-604. [PMID: 26166841 DOI: 10.1055/s-0035-1546171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 12/11/2022] Open
Abstract
Aim: Breast reconstruction has become increasingly important for the body image of women with breast cancer. We conducted a study to investigate how patient characteristics correlate with surgical outcome after breast reconstruction with implant after mastectomy and to identify risk factors which could facilitate patient selection for reconstruction. Patients and Methods: For this case cohort analysis (n = 257 patients with 318 heterologous reconstructions), we analyzed BMI, smoking, pre-existing disease, chemotherapy and radiotherapy, one-stage/two-stage reconstruction, immediate/delayed reconstruction, antibiotic therapy and complications, partner interaction and adherence to the decision for reconstruction using a customized questionnaire. Results: 257 patients with 318 implant reconstructions (196 unilateral, 61 bilateral) were eligible for inclusion in the study. Median follow-up time was 3.1 years (range: 1 month to 10 years). Response rate to the questionnaire was 71.8 %. Median age was 49 years (range 24-79 years), median BMI was 22.44 (range 16.33-40.09). A BMI > 30 was inversely correlated with positive self-image (p = 0.004), and implant loss/rotation was more frequent in this group (p < 0.05). Smoking > 10 cigarettes/day had a negative impact on surgical outcome. A positive self-image had a positive impact on partner interaction (p < 0.001) and was correlated with a lower perception of pain. Aesthetic results did not vary with age (p = 0.054). Titanized polypropylene meshes were used to protect against implant rotation (p = 0.034). Rates of capsular fibrosis were low in our cohort (< 10 %), and implant loss rate was less than 2 %. Conclusions: This study offers a differentiated approach for the pre-surgical counselling of patients and shows that patients up to 80 years of age are highly satisfied with implant reconstruction. A high BMI and smoking > 10 cigarettes/day are unfavorable preconditions for implant reconstruction. The use of prophylactic antibiotics was confirmed as beneficial for surgical outcome. A positive self-image after reconstruction strongly influences partner interaction.
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Affiliation(s)
- P Kern
- Department of Gynecology and Obstetrics; University Hospital Essen, Essen ; Breast Center Düsseldorf, Luisenkrankenhaus, Düsseldorf
| | - F Zarth
- Department of Gynecology and Obstetrics; University Hospital Essen, Essen
| | - R Kimmig
- Department of Gynecology and Obstetrics; University Hospital Essen, Essen
| | - M Rezai
- Breast Center Düsseldorf, Luisenkrankenhaus, Düsseldorf
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Rezai M, Kellersmann S, Knispel S, Lax H, Kimmig R, Kern P. Translating the concept of intrinsic subtypes into an oncoplastic cohort of more than 1000 patients - predictors of recurrence and survival. Breast 2015; 24:384-90. [PMID: 25987488 DOI: 10.1016/j.breast.2015.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 02/01/2015] [Accepted: 02/22/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION A paradigm shift in breast cancer was introduced by Sørlie's concept of intrinsic subtypes [1]. We validated this concept - which was originally based on 84 individuals - in a large cohort study of 1035 patients with oncoplastic surgery and analyzed if early and late recurrences are linked to a specific intrinsic tumor subtype or resection margins. MATERIALS AND METHODS 1035 patients with oncoplastic surgery (2004-2009) were analyzed with regard to treatment characteristics and patterns of early (<5 years) and late recurrence (>5 years) and survival related to the intrinsic subtypes. Data was retrieved from patient's charts, customized patients questionnaires and cancer registries. RESULTS 944 patients with primary, unilateral breast cancer, median age 58 years, were eligible for analysis. At a median FU of 5.2 years, LRR was 4.0%, 5-year-OS 94.5% and DFS 90.9%. Intrinsic subtypes, but not T-size, nodal-status, resections margins nor histopathology, governed local control and survival. There was no signal for prevelance of unclear margins in any of intrinsic subgroups and no preference of any oncoplastic technique attributed to them. TNBC and Her2 non-luminal breast cancer had highest recurrence and lowest survival rates. Although sentinel involvement (SLN+) was prevailing in the Luminal-B-Her 2 negative subtype at 34.3%, this did not translate into a higher axillary dissection rate. CONCLUSION This study confirmed the intrinsic subtype concept on a large clinical basis and describes the patterns of early and late recurrence in oncoplastic surgery, concluding that bigger risk may not be overcome by bigger surgery.
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Affiliation(s)
- M Rezai
- Breast Center Düsseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Günther-Sohl-Str.6-10, 40235 Düsseldorf, Germany
| | - S Kellersmann
- Breast Center Düsseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Günther-Sohl-Str.6-10, 40235 Düsseldorf, Germany; University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany
| | - S Knispel
- Breast Center Düsseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Günther-Sohl-Str.6-10, 40235 Düsseldorf, Germany; University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany
| | - H Lax
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Zweigertstr. 37, D-45130 Essen, Germany
| | - R Kimmig
- University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany
| | - P Kern
- Breast Center Düsseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Günther-Sohl-Str.6-10, 40235 Düsseldorf, Germany; University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany
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Rezai M, Kellersmann S, Knispel S, Kimmig R, Kern P. PG 9.05 Breast conservative surgery and local recurrence. Breast 2015. [DOI: 10.1016/s0960-9776(15)70038-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fasching PA, Fehm T, Kellner S, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Würstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Fersis N, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesslet T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauß T, Thomssen C, Kümmel S, Hohn A, Tesch H, Mundhenke C, Hein A, Rauh C, Bayer CM, Jacob A, Schmidt K, Belleville E, Hadji P, Wallwiener D, Grischke EM, Beckmann MW, Brucker SY. Evaluation of Therapy Management and Patient Compliance in Postmenopausal Patients with Hormone Receptor-positive Breast Cancer Receiving Letrozole Treatment: The EvaluateTM Study. Geburtshilfe Frauenheilkd 2014; 74:1137-1143. [PMID: 25568468 DOI: 10.1055/s-0034-1383401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022] Open
Abstract
Introduction: The EvaluateTM study (Evaluation of therapy management and patient compliance in postmenopausal hormone receptor-positive breast cancer patients receiving letrozole treatment) is a prospective, non-interventional study for the assessment of therapy management and compliance in the routine care of postmenopausal women with invasive hormone receptor-positive breast cancer receiving letrozole. The parameters for inclusion in the study are presented and discussed here. Material and Methods: Between January 2008 and December 2009 a total of 5045 patients in 310 study centers were recruited to the EvaluateTM study. Inclusion criteria were hormone receptor-positive breast cancer and adjuvant treatment or metastasis. 373 patients were excluded from the analysis for various reasons. Results: A total of 4420 patients receiving adjuvant treatment and 252 patients with metastasis receiving palliative treatment were included in the study. For 4181 patients receiving adjuvant treatment, treatment with the aromatase inhibitor letrozole commenced immediately after surgery (upfront). Two hundred patients had initially received tamoxifen and started aromatase inhibitor treatment with letrozole at 1-5 years after diagnosis (switch), und 39 patients only commenced letrozole treatment 5-10 years after diagnosis (extended endocrine therapy). Patient and tumor characteristics were within expected ranges, as were comorbidities and concurrent medication. Conclusion: The data from the EvaluateTM study will offer a good overview of therapy management in the routine care of postmenopausal women with hormone receptor-positive breast cancer. Planned analyses will look at therapy compliance and patient satisfaction with how information is conveyed and the contents of the conveyed information.
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Affiliation(s)
- P A Fasching
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - T Fehm
- Universitäts-Frauenklinik Düsseldorf, Düsseldorf ; Universitätsfrauenklinik Tübingen, Tübingen
| | - S Kellner
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - J de Waal
- Frauenklinik im Klinikum Dachau, Dachau
| | - M Rezai
- Luisenkrankenhaus Düsseldorf, Düsseldorf
| | - B Baier
- Frauenklinik im Klinikum Dachau, Dachau
| | - G Baake
- Klinikum Pinneberg, Pinneberg
| | | | | | - M Warm
- Brustzentrum, Universitäts-Frauenklinik Köln, Köln ; Brustzentrum, Klinken der Stadt Köln gGmbH Holweide, Köln
| | - N Harbeck
- Brustzentrum, Universitäts-Frauenklinik Köln, Köln ; Brustzentrum der Universität München, Frauenkliniken Großhadern und Maistrasse-Innenstadt, München
| | - R Würstlein
- Brustzentrum, Universitäts-Frauenklinik Köln, Köln ; Brustzentrum der Universität München, Frauenkliniken Großhadern und Maistrasse-Innenstadt, München
| | - J-U Deuker
- Vinzenzkrankenhaus Hannover gGmbH, Hannover
| | - P Dall
- Frauenklinik, Klinikum Lüneburg, Lüneburg
| | - B Richter
- Elblandkliniken Meißen-Radebeul Standort Radebeul, Radebeul
| | | | - C Brucker
- Universitätsklinik für Frauenheilkunde, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - J W Siebers
- Frauenklinik des St. Josefsklinik Offenburg, Offenburg
| | - N Fersis
- Frauenklinik, Klinikum Bayreuth GmbH, Comprehensive Cancer Center Erlangen-EMN, Bayreuth
| | - T Kuhn
- Karl-Olga-Krankenhaus, Stuttgart
| | - C Wolf
- Medizinisches Zentrum Ulm, Ulm
| | | | - G-P Breitbach
- Städtisches Klinikum Neunkirchen Gynäkologie und Geburtshilfe, Neunkirchen
| | - W Janni
- Frauenklinik des Universitätsklinikums Ulm, Ulm
| | - R Landthaler
- Gynäkologische Praxis in der Kreisklinik, Krumbach
| | - A Kohls
- Evangelisches Krankenhaus Ludwigsfelde-Teltow, Ludwigsfelde
| | - D Rezek
- Marien-Hospital Wesel, Wesel
| | - T Noesslet
- Frauenklinik am Kreiskrankenhaus Hameln, Hameln
| | - G Fischer
- Landkreis Mittweida Krankenhaus gGmbH, Mittweida
| | - S Henschen
- Johanniter Krankenhaus Genthin Stendal gGmbH, Stendal
| | - T Praetz
- Praxis Dr. Praetz, Bad Mergentheim
| | - V Heyl
- Asklepios Paulinen Klinik Wiesbaden, Wiesbaden
| | - T Kühn
- Frauenklinik, Städtische Kliniken Esslingen a. N., Esslingen
| | | | - C Thomssen
- Frauenklinik, Universitätsklinik Halle Wittenberg, Halle
| | - S Kümmel
- Brustzentrum, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen
| | - A Hohn
- Kreiskrankenhaus Rendsburg, Rendsburg
| | - H Tesch
- Onkologie Bethanien, Frankfurt
| | - C Mundhenke
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - A Hein
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - C Rauh
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - C M Bayer
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - A Jacob
- Novartis Pharma GmbH, Nürnberg
| | | | | | - P Hadji
- Krankenhaus Nordwest, Klinik für Gynäkologie und Gebursthilfe, Frankfurt
| | | | | | - M W Beckmann
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
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von Minckwitz G, Loibl S, Untch M, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, Gerber B, Gnauert K, Heinrich B, Prätz T, Groh U, Tanzer H, Villena C, Tulusan A, Liedtke B, Blohmer JU, Kittel K, Mau C, Potenberg J, Schilling J, Just M, Weiss E, Bückner U, Wolfgarten M, Lorenz R, Doering G, Feidicker S, Krabisch P, Deichert U, Augustin D, Kunz G, Kast K, von Minckwitz G, Nestle-Krämling C, Rezai M, Höß C, Terhaag J, Fasching P, Staib P, Aktas B, Kühn T, Khandan F, Möbus V, Solbach C, Tesch H, Stickeler E, Heinrich G, Wagner H, Abdallah A, Dewitz T, Emons G, Belau A, Rethwisch V, Lantzsch T, Thomssen C, Mattner U, Nugent A, Müller V, Noesselt T, Holms F, Müller T, Deuker JU, Schrader I, Strumberg D, Uleer C, Solomayer E, Runnebaum I, Link H, Tomé O, Ulmer HU, Conrad B, Feisel-Schwickardi G, Eidtmann H, Schumacher C, Steinmetz T, Bauerfeind I, Kremers S, Langanke D, Kullmer U, Ober A, Fischer D, Kohls A, Weikel W, Bischoff J, Freese K, Schmidt M, Wiest W, Sütterlin M, Dietrich M, Grießhammer M, Burgmann DM, Hanusch C, Rack B, Salat C, Sattler D, Tio J, von Abel E, Christensen B, Burkamp U, Köhne CH, Meinerz W, Graßhoff ST, Decker T, Overkamp F, Thalmann I, Sallmann A, Beck T, Reimer T, Bartzke G, Deryal M, Weigel M, Huober J, Weder P, Steffens CC, Lemster S, Stefek A, Ruhland F, Hofmann M, Schuster J, Simon W, Kronawitter U, Clemens M, Fehm T, Janni W, Latos K, Bauer W, Roßmann A, Bauer L, Lampe D, Heyl V, Hoffmann G, Lorenz-Salehi F, Hackmann J, Schlag R. Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†. Ann Oncol 2014; 25:2363-2372. [PMID: 25223482 DOI: 10.1093/annonc/mdu455] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, β = 0.8) 379 events had to be observed in the bevacizumab arms. RESULTS With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups. CONCLUSIONS Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients. CLINICAL TRIAL NUMBER NCT 00567554, www.clinicaltrials.gov.
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Affiliation(s)
- G von Minckwitz
- Headquarter, German Breast Group, Neu-Isenburg; Department of Gynaecology and Obstetrics, University Hospital, Frankfurt.
| | - S Loibl
- Headquarter, German Breast Group, Neu-Isenburg
| | - M Untch
- Department of Gynaecology and Obstetrics, Klinikum Berlin-Buch, Berlin
| | - H Eidtmann
- Department of Gynaecology and Obstetrics, University Hospital, Kiel
| | - M Rezai
- Breast Center, Luisenkrankenhaus, Düsseldorf
| | - P A Fasching
- Department of Gynaecology and Obstetrics, University Hospital, Erlangen
| | - H Tesch
- Department of Medical Oncology, Chop GmbH, Frankfurt
| | - H Eggemann
- Department of Gynaecology and Obstetrics, University Hospital, Magdeburg
| | - I Schrader
- Department of Gynaecology and Obstetrics, Henriettenstiftung, Hannover
| | - K Kittel
- Department of Gynaecology and Obstetrics, Praxisklinik, Berlin
| | - C Hanusch
- Department of Gynaecology and Obstetrics, Rot-Kreuz-Klinikum, München
| | - J Huober
- Department of Gynaecology and Obstetrics, University Hospital, Ulm
| | - C Solbach
- Department of Gynaecology and Obstetrics, University Hospital, Frankfurt
| | - C Jackisch
- Department of Gynaecology and Obstetrics, Sana-Klinikum, Offenbach
| | - G Kunz
- Department of Gynaecology and Obstetrics, St Johannes Hospital, Dortmund
| | - J U Blohmer
- Department of Gynaecology and Obstetrics, St Gertrauden-Hospital, Berlin
| | - M Hauschild
- Department of Gynaecology and Obstetrics, Hospital, Rheinfelden
| | - T Fehm
- Department of Gynaecology and Obstetrics, University Hospital, Tübingen
| | | | - B Gerber
- Department of Gynaecology and Obstetrics, University Hospital, Rostock, Germany
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Hein A, Häberle L, Ekici AB, Lux MP, Rack B, Weissenbacher T, Andergassen U, Scholz C, Schwentner L, Schneeweiss A, Lorenz R, Forstbauer H, Tesch H, Schrader I, Rezai M, Janni W, Beckmann MW, Weinshilboum RM, Wang L, Fasching PA. Genetic breast cancer susceptibility variants and prognosis in the prospectively randomized SUCCESS A trial. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388571] [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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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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von Minckwitz G, Rezai M, Eidtmann H, Tesch H, Huober J, Gerber B, Zahn DM, Costa S, Gnant M, Blohmer JU, Denkert C, Hanusch C, Jackisch C, Kümmel S, Fasching PA, Schneeweiss A, Paepke S, Untch M, Nekljudova V, Mehta K, Loibl S. Abstract S5-05: Postneoadjuvant treatment with zoledronate in patients with tumor residuals after anthracyclines-taxane-based chemotherapy for primary breast cancer – The phase III NATAN study (GBG 36/ABCSG XX). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s5-05] [Citation(s) in RCA: 4] [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: Patients with residual disease after neoadjuvant chemotherapy (NACT) are considered to have chemoresistant breast cancer. Adjuvant treatment with bisphosphonates is considered to reduce the relapse risk predominantly in estrogen-deprivated patients.
Methods: Patients who had invasive tumor residuals (ypT1-4 or ypN+) after a minimum of 4 cycles of anthracycline-taxane-containing NACT were eligible to the NATAN study. Patients were randomized within 3 years after surgery to receive zoledronate 4 mg i.v. (plus 1000 mg Ca2+ and 880 I.U. vitamin D daily) for 5 years vs. observation. Zoledronate was given q 4 weeks for the first 6 months, q 3 months the following 2 years, and q 6 months for the last 2.5 years. Patients with hormone receptor (HR)-positive disease received letrozole for 5 years if postmenopausal, or tamoxifen, if premenopausal. Adjuvant trastuzumab for HER2-positive disease was allowed since an amendment in 2007. Stratification factors were HR, time since surgery, age, and center. Primary objective was event-free survival (EFS). 654 patients and 316 events were required to observe an increase of 5yr EFS from 58% to 67.2% (hazard ratio 0.73). Secondary objectives were to determine overall survival, EFS with respect to the interval between surgery and randomization, bone-metastasis-free-survival, toxicity of and compliance to zoledronate, the predictive value of breast tumor response to NACT on the effect of postoperative treatment and the prognostic impact of chemotherapy induced amenorrhea in premenopausal patients. An interim analysis for high efficacy at 158 observed events was planned in the protocol; in agreement with study IDMC a Bayesian analysis for futility with futility boundary of 15% will be performed at the same time.
Results: Between 2/2005 and 5/2009 693 patients were enrolled. Time between surgery and randomization was <4 months in 48.4%, 4-12 months in 34.5%, and 13-36 months in 17.1% of patients. The median age was 50.9 yrs (range 33.7-88.2), 72.3% of patients were postmenopausal. 82% had HR-positive and 19% HER2-positive disease. During a median follow up of 48 months 154 events were observed so far.
Conclusion: This is the first post-neoadjuvant phase III study. Analysis of the primary endpoint will be presented in case the IDMC will release of the results of the futility analysis.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S5-05.
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Affiliation(s)
- G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - M Rezai
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - H Eidtmann
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - H Tesch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - J Huober
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - B Gerber
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - DM Zahn
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Costa
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - M Gnant
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - JU Blohmer
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - C Denkert
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - C Hanusch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - C Jackisch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Kümmel
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - PA Fasching
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Paepke
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - V Nekljudova
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - K Mehta
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
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Kern PA, von Minckwitz G, Rietkoetter E, Kimmig R, Rezai M, Otterbach F. Abstract P6-06-23: Glycogen-rich, clear cell breast cancer - An underestimated histopathological risk factor? Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-06-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
Glycogen-rich clear cell carcinoma (GRCCC) is a rare tumour and there is only few data on the prognosis of this subtype, the largest cases series ever published in literature comprising of 21 cases only. (1)
Patients and methods:
In a case-control study of 56 GRCCC early breast cancer cases with matched pairs we analyzed the features of this subtype and survival data regarding DFS and OS.
56 patients with GRCCC have been identified from the period 1992 until 2010 in a multicenter retrospective case cohort trial. To determine the incidence of glycogen-rich clear cell carcinoma in various age groups were stratified in 3 age groups: < 45 years, < 65 years and > 65 years. This was compared to incidence of all breast cancer subtypes due to epidemiological data of Robert-Koch-Institute of the German Ministry of Health.
Results:
Patients were in a range of 33-87 years, median 59,5 years, distributed to the following age groups: 14% (n = 8) of patients were < 45 years, 71,4% (n = 40) < 65 years and 28,6% (n = 16) > 65 years. In the epidemiological data set 10% were < 45 years, 50% < 65 years and 50% > 65 years. Thus patients with glycogen-rich clear cell carcinoma were younger compared to the epidemiological data of all breast cancers registered nationally (< 65 years: 71,4% vs. 50%; p < 0,002).
Stage distribution was as follows: Stage T1 a: no cases, T1b: 2, T1c: 19, T2: 20, T3: 4, T4: 4, unknown T-stage in 7 cases.
Nodal status was in 22 nodal-positive, 23 nodal-negative and 11 with unknown nodal status. The Grading was in G1 none, G2 24 and G3 29 and unknown in 3 cases. Approximated intrinsic tumour subtype was: Luminal A: 10, Luminal B 3, Luminal Her2 positive 16, non-luminal Her2 negative: 14, Triple-Negative Breast Cancer: 7; not further specified: 6.
Chemotherapy was applied in 35 out of 56 patients (62,5%) in our study cohort.
5-years-(OS) was 84% and 5-years (DFS) was 80%. Recurrence rates at a mean time of follow-up of 8,5 years were significantly higher (11 recurrences out of 56 cases) in this specific subtype than in the matched control group (p<0,005).
OS was significantly lower in the group with a local recurrence, dropping down from a 5-years OS-rate of 92% in the recurrence-free group to 48% in the group with a loco-regional recurrence.
Conclusion:
GRCCC of the breast is associated with a highly proliferative and aggressive receptor profile and unfavourable course of disease with significantly higher risk of recurrence (p< 0,005).
This is - to our best knowledge - the largest cohort published in literature on this rare histological subtype of human early breast cancer. Evidence derived from this analysis suggests effective chemotherapy treatment to reduce the risk of recurrence and mortality from this aggressive tumour subtype.
The poor prognosis of 48% in 5-years-overall-survival in case of a loco-regional recurrences of glycogen-rich clear cell carcinom also endorses a role of chemo-therapy in case of recurrence, with regards to the fact that survival rates in this tumor subtype of our cohort were even lower than in the cohort of the CALOR trial.(2)
Literature:
1) Hayes MMM, Am J Surg Pathol. 1995;19:904-911.
2)Aebi S, S3-2. San Antonio Breast Cancer Symposium 2012.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-23.
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Affiliation(s)
- PA Kern
- University Hospital of Essen, Essen, North-Rhine Westfalia, Germany; Breast Center Düsseldorf, Düsseldorf, North-Rhine-Westfalia, Germany; GermanBreastGroup, Neu-Isenburg, Hessen, Germany; Institute of Pathology, Soest, North-Rhine Westfalia, Germany
| | - G von Minckwitz
- University Hospital of Essen, Essen, North-Rhine Westfalia, Germany; Breast Center Düsseldorf, Düsseldorf, North-Rhine-Westfalia, Germany; GermanBreastGroup, Neu-Isenburg, Hessen, Germany; Institute of Pathology, Soest, North-Rhine Westfalia, Germany
| | - E Rietkoetter
- University Hospital of Essen, Essen, North-Rhine Westfalia, Germany; Breast Center Düsseldorf, Düsseldorf, North-Rhine-Westfalia, Germany; GermanBreastGroup, Neu-Isenburg, Hessen, Germany; Institute of Pathology, Soest, North-Rhine Westfalia, Germany
| | - R Kimmig
- University Hospital of Essen, Essen, North-Rhine Westfalia, Germany; Breast Center Düsseldorf, Düsseldorf, North-Rhine-Westfalia, Germany; GermanBreastGroup, Neu-Isenburg, Hessen, Germany; Institute of Pathology, Soest, North-Rhine Westfalia, Germany
| | - M Rezai
- University Hospital of Essen, Essen, North-Rhine Westfalia, Germany; Breast Center Düsseldorf, Düsseldorf, North-Rhine-Westfalia, Germany; GermanBreastGroup, Neu-Isenburg, Hessen, Germany; Institute of Pathology, Soest, North-Rhine Westfalia, Germany
| | - F Otterbach
- University Hospital of Essen, Essen, North-Rhine Westfalia, Germany; Breast Center Düsseldorf, Düsseldorf, North-Rhine-Westfalia, Germany; GermanBreastGroup, Neu-Isenburg, Hessen, Germany; Institute of Pathology, Soest, North-Rhine Westfalia, Germany
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von Minckwitz G, Kern P, Schneeweiss A, Gluz O, Harbeck N, Neumann M, Badiian M, Fries H, Rezai M. Abstract P3-14-01: Features of neoadjuvant and adjuvant chemotherapy in breast cancer – A population-based study on 39404 patients. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-14-01] [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: Neoadjuvant chemotherapy (NACT) is increasingly used globally in clinical trials for breast cancer patients. In Germany, NACT has been implemented as a standard option of care for almost a decade. In a population-based benchmark cohort study, the West German Breast Center (WBC) recorded approximately 50% of all breast cancer cases diagnosed in Germany between 2007 and 2010. We compare baseline and treatment pattern of patients treated either with adjuvant (ACT) or NACT.
Methods: Approx. 200 accredited breast centers treated 115169 primary breast cancer patients of whom 32609 received ACT and 6795 NACT. Pathological complete response (pCR) was stated if no invasive and no non-invasive tumor residues (ypT0 ypN0) were detected. Follow up information was available for 55% of patients.
Results: Use of NACT increased from 16.4% in 2007 to 19.1% in 2010 (p<.0001). Patients treated with NACT were younger, had higher clinical nodal involvement, fewer lobular-invasive cancers, more undifferentiated, hormone-receptor-negative, and HER2-positive cancers, and more multicentric tumors compared to patients treated with ACT (all p<0.002). 34% of patients in the NACT group had cT3/4 tumors compared to 7.7% of pT3/4 tumors in the ACT group. cN0 status was twice as frequent (70.6% vs 37.7%, p<.0001) whereas pN0 status was reported less frequently (47.4% vs 51.4%, p<0.0001) in the ACT and NACT group, respectively. Time between diagnosis and start of systemic treatment or surgery was in median 12 (range 1-902) and 22 (range 1-721) days in the ACT and NACT group, respectively (p<.0001). 66.2% and 91.4% of patients received ACT and NACT with a taxane, respectively (p<.0001). 9.7% and 37.5% of patients receiving treatment for > = 18 weeks, respectively. 35.2% and 69.9% of patients with HER2-positive tumors received adjuvant or neoadjuvant trastuzumab, respectively (p<.0001). 21.7% and 31.4% of patients were treated in ACT or NACT clinical trials, respectively (p<.0001). Breast conservation was possible in 69.4% and 55.2% in the ACT and NACT group, respectively (p<.0001). 30.5% and 37.5% needed two or more surgical interventions in the ACT and NACT group, respectively (p<.0001).
Multivariable logistic regression analysis confirmed taxane- and trastuzumab-based treatment, study participation, age, histologic type, grading, and hormone-receptor status as independent predictors of pCR. pCR rate was not dependent on the time between diagnosis and start of treatment or the time between end of chemotherapy and surgery.
In univariate analysis patients receiving NACT showed a 4-year overall survival rate of 78%, compared to 92% in patients receiving ACT (p<.0001). However, patients with a pCR after NACT showed a comparable survival to patients in the ACT group, whereas patients without a pCR showed a 4-year overall survival rate of 76%. In the hormone-receptor-positive/HER2-positive and even more in the triple-negative subgroup, survival of patients with a pCR appeared better than in patients with ACT.
Conclusion: In this population-based study, NACT was used in patients with unfavorable risk factors and was more intense than ACT. Outcome of patients with pCR after NACT was similar and in aggressive tumor subtypes even better than after ACT.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-01.
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Affiliation(s)
- G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Univ. Women's Hospital, Frankfurt, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany; University Hospital of Essen, Germany; Universitätsklinikum Heidelberg, Germany; West German Study Group, Monchengladbach, Germany; Universität München, Germany; Universitätsklinikum Düsseldorf, Germany
| | - P Kern
- German Breast Group, Neu-Isenburg, Germany; Univ. Women's Hospital, Frankfurt, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany; University Hospital of Essen, Germany; Universitätsklinikum Heidelberg, Germany; West German Study Group, Monchengladbach, Germany; Universität München, Germany; Universitätsklinikum Düsseldorf, Germany
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg, Germany; Univ. Women's Hospital, Frankfurt, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany; University Hospital of Essen, Germany; Universitätsklinikum Heidelberg, Germany; West German Study Group, Monchengladbach, Germany; Universität München, Germany; Universitätsklinikum Düsseldorf, Germany
| | - O Gluz
- German Breast Group, Neu-Isenburg, Germany; Univ. Women's Hospital, Frankfurt, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany; University Hospital of Essen, Germany; Universitätsklinikum Heidelberg, Germany; West German Study Group, Monchengladbach, Germany; Universität München, Germany; Universitätsklinikum Düsseldorf, Germany
| | - N Harbeck
- German Breast Group, Neu-Isenburg, Germany; Univ. Women's Hospital, Frankfurt, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany; University Hospital of Essen, Germany; Universitätsklinikum Heidelberg, Germany; West German Study Group, Monchengladbach, Germany; Universität München, Germany; Universitätsklinikum Düsseldorf, Germany
| | - M Neumann
- German Breast Group, Neu-Isenburg, Germany; Univ. Women's Hospital, Frankfurt, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany; University Hospital of Essen, Germany; Universitätsklinikum Heidelberg, Germany; West German Study Group, Monchengladbach, Germany; Universität München, Germany; Universitätsklinikum Düsseldorf, Germany
| | - M Badiian
- German Breast Group, Neu-Isenburg, Germany; Univ. Women's Hospital, Frankfurt, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany; University Hospital of Essen, Germany; Universitätsklinikum Heidelberg, Germany; West German Study Group, Monchengladbach, Germany; Universität München, Germany; Universitätsklinikum Düsseldorf, Germany
| | - H Fries
- German Breast Group, Neu-Isenburg, Germany; Univ. Women's Hospital, Frankfurt, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany; University Hospital of Essen, Germany; Universitätsklinikum Heidelberg, Germany; West German Study Group, Monchengladbach, Germany; Universität München, Germany; Universitätsklinikum Düsseldorf, Germany
| | - M Rezai
- German Breast Group, Neu-Isenburg, Germany; Univ. Women's Hospital, Frankfurt, Germany; Breast Center Düsseldorf Luisenkrankenhaus, Düsseldorf, Germany; University Hospital of Essen, Germany; Universitätsklinikum Heidelberg, Germany; West German Study Group, Monchengladbach, Germany; Universität München, Germany; Universitätsklinikum Düsseldorf, Germany
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Loibl S, Mergler B, Eppel A, Solbach C, Lübbe KM, Eidtmann H, Rezai M, Hanusch C, Fehm T, Bartzke G, Burgmann DM, Krabisch P, Untch M, Nekljudova V, von Minckwitz G. Abstract P3-14-04: The choice of the indicator lesion impacts on the pCR rate – An analysis of 114 bilateral breast cancer patients treated within neoadjuvant trials. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-14-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients with bilateral breast cancer are usually excluded from participating in clinical trials. The German Breast Group has traditionally included these patients into their neoadjuvant trials. However, little is known about the outcome of the non-indicator lesion.
Methods: We prospectively captured the information on bilateral breast cancer in our database and collected retrospectively the information from the original histological and surgical reports on tumor size, nodal status, histology, grading, hormone receptor and HER2 status as well as type of surgery and pathological complete response defined as ypT0 ypN0 and ypT0/is ypN0 because both definitions have been used in our clinical studies. The treating physician decided on clinical presentation, which side to be the indicator lesion on which response was assessed for the purpose of the study. The synchronous carcinoma in the contralateral breast is considered as the non-indicator lesion.
Results: From the 6727 patients treated within the Gepartrio, Geparquattro, Geparquinto, and Geparsixto study 157 (2.3%) patients have been identified with the diagnosis of bilateral carcinoma. From the 114 bilateral patients with any information on the non indicator lesion 104 with information on pCR on both sides were used for further analysis. The median age was 51 (range 29-74) years. There were more cT1 (48.5% vs 9.6%, p<0.001) and cN0 (60.0% vs 38.4%, p = 0.004) tumors in the group of the non-indicator lesion compared to the indicator lesion group. In 56% the molecular subtype was identical 86% had a luminal A like tumor of indicator as well as the non-indicator lesion, none of the luminal B-like indicator lesions were identical, 27% of the HER2+/ HR +, 58% in the HER2+/ HR- group and 66% of the triple negative indicator lesions had an identical non indicator lesion. In general the tumor tended to be of lower malignant potential in the non- indicator lesion. Lobular carcinomas (23.4% vs 16.7%, p = 0.205); grade 3 (26% vs 36.7%, p = 0.101), ER positive (72% vs 67%, p = 0.427), HER2-positive (23.9 vs. 35.7%, p = 0.068). Overall the pCR rate (ypT0 ypN) was 20.2% in the non-indicator lesion group vs 13.9% the indicator lesion group (p = 0.276) and ypT0/is ypN0 was 30.8% and 17.6%, respectively (p = 0.0388). 64.4% had no pCR in the indicator as well as the non-indicator lesion, 11.5% had a pCR in the indicator as well as the non-indicator lesion, 4.8% in the indicator alone and 19.2% in the non-indicator alone. Breast conserving surgery was performed more often for non-indicator lesions than for indicator lesions (59% vs 44.4%, p = 0.144).
Conclusion: In general the selection for the indicator lesion was based on tumor size, nodal status and inclusion criteria. Probably, some of the indicator lesions would not have qualified for trial participation. The pCR rate including non-invasive residuals was significantly higher for the non-indicator lesions probably due to smaller tumors and less nodal involvement at baseline. However, based on our data bilateral breast carcinomas should not be excluded from neoadjuvant clinical trials.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-04.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - B Mergler
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - A Eppel
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - C Solbach
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - KM Lübbe
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - H Eidtmann
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - M Rezai
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - C Hanusch
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - T Fehm
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - G Bartzke
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - D-M Burgmann
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - P Krabisch
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - M Untch
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - V Nekljudova
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
| | - G von Minckwitz
- German Breast Group, Neu-Isenburg; Universität Mainz; Brustzentrum Universität Mainz; Henriettenstiftung, Düsseldorf; Luisenkrankenhaus Düsseldorf; Rotkreuzklinikum München gGmbH, Frauenklinik, München; Universitätsfrauenklinik Düsseldorf; Helios Kliniken Berlin; Universitätsfrauenklinik München; Klinik für Frauenheilkunde und Geburtshilfe, Chemnitz; Universitätsfrauenklinik Frankfurt
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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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von Minckwitz G, Rezai M, Fasching PA, Huober J, Tesch H, Bauerfeind I, Hilfrich J, Eidtmann H, Gerber B, Hanusch C, Blohmer JU, Costa SD, Jackisch C, Paepke S, Schneeweiss A, Kümmel S, Denkert C, Mehta K, Loibl S, Untch M. Survival after adding capecitabine and trastuzumab to neoadjuvant anthracycline-taxane-based chemotherapy for primary breast cancer (GBG 40--GeparQuattro). Ann Oncol 2013; 25:81-9. [PMID: 24273046 DOI: 10.1093/annonc/mdt410] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The GeparQuattro study showed that adding capecitabine or prolonging the duration of anthracycline-taxane-based neoadjuvant chemotherapy from 24 to 36 weeks did not increase pathological complete response (pCR) rates. Trastuzumab-treated patients with HER2-positive disease showed a higher pCR rate than patients with HER2-negative disease treated with chemotherapy alone. We here present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1495) with cT ≥ 3 tumors, or negative hormone-receptor status, or positive hormone-receptor and clinically node-positive disease received four times epirubicin/cyclophosphamide and were thereafter randomly assigned to four times docetaxel (Taxotere), or four times docetaxel/capecitabine over 24 weeks, or four times docetaxel followed by capecitabine over 36 weeks. Patients with HER2-positive tumors received 1 year of trastuzumab, starting with the first chemotherapy cycle. Follow-up was available for a median of 5.4 years. RESULTS Outcome was not improved for patients receiving capecitabine (HR 0.92; P = 0.463 for DFS and HR 93; P = 0.618 for OS) as well as for patients receiving 36 weeks of chemotherapy (HR 0.97; P = 0.818 for DFS and HR 0.97; P = 0.825 for OS). Trastuzumab-treated patients with HER2-positive disease showed similar DFS (P = 0.305) but a significantly better adjusted OS (P = 0.040) when compared with patients with HER2-negative disease treated with chemotherapy alone. Recorded long-term cardiac toxicity was low. CONCLUSIONS Long-term results, similar to the results of pCR, do not support the use of capecitabine in the neoadjuvant setting in addition to an anthracycline-taxane-based chemotherapy. However, the results support previous data showing a benefit of trastuzumab as predicted by higher pCR rates.
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Gerber B, Loibl S, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Kreienberg R, Solbach C, Jackisch C, Kunz G, Blohmer JU, Huober J, Hauschild M, Nekljudova V, Untch M, von Minckwitz G. Neoadjuvant bevacizumab and anthracycline-taxane-based chemotherapy in 678 triple-negative primary breast cancers; results from the geparquinto study (GBG 44). Ann Oncol 2013; 24:2978-84. [PMID: 24136883 DOI: 10.1093/annonc/mdt361] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We evaluated the pathological complete response (pCR) rate after neoadjuvant epirubicin, (E) cyclophosphamide (C) and docetaxel containing chemotherapy with and without the addition of bevacizumab in patients with triple-negative breast cancer (TNBC). PATIENTS AND METHODS Patients with untreated cT1c-4d TNBC represented a stratified subset of the 1948 participants of the HER2-negative part of the GeparQuinto trial. Patients were randomized to receive four cycles EC (90/600 mg/m(2); q3w) followed by four cycles docetaxel (100 mg/m(2); q3w) each with or without bevacizumab (15 mg/kg; q3w) added to chemotherapy. RESULTS TNBC patients were randomized to chemotherapy without (n = 340) or with bevacizumab (n = 323). pCR (ypT0 ypN0, primary end point) rates were 27.9% without and 39.3% with bevacizumab (P = 0.003). According to other pCR definitions, the addition of bevacizumab increased the pCR rate from 30.9% to 41.8% (ypT0 ypN0/+; P = 0.004), 36.2% to 46.4% (ypT0/is ypN0/+; P = 0.009) and 32.9% to 43.3% (ypT0/is ypN0; P = 0.007). Bevacizumab treatment [OR 1.73, 95% confidence interval (CI) 1.23-2.42; P = 0.002], lower tumor stage (OR 2.38, 95% CI 1.24-4.54; P = 0.009) and grade 3 tumors (OR 1.68, 95% CI 1.14-2.48; P = 0.009) were confirmed as independent predictors of higher pCR in multivariate logistic regression analysis. CONCLUSIONS The addition of bevacizumab to chemotherapy in TNBC significantly increases pCR rates.
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Affiliation(s)
- B Gerber
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock
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50
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Blohmer JU, Rezai M, Kümmel S, Kühn T, Warm M, Friedrichs K, Benkow A, Valentine WJ, Eiermann W. Using the 21-gene assay to guide adjuvant chemotherapy decision-making in early-stage breast cancer: a cost-effectiveness evaluation in the German setting. J Med Econ 2013; 16:30-40. [PMID: 22966753 DOI: 10.3111/13696998.2012.722572] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The 21-gene assay (Oncotype DX Breast Cancer Test (Genomic Health Inc., Redwood City, CA)) is a well validated test that predicts the likelihood of adjuvant chemotherapy benefit and the 10-year risk of distant recurrence in patients with ER+, HER2- early-stage breast cancer. The aim of this analysis was to evaluate the cost-effectiveness of using the assay to inform adjuvant chemotherapy decisions in Germany. METHODS A Markov model was developed to make long-term projections of distant recurrence, survival, quality-adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative, or up to 3 node-positive early-stage breast cancer. Scenarios using conventional diagnostic procedures or the 21-gene assay to inform treatment recommendations for adjuvant chemotherapy were modeled based on a prospective, multi-center trial in 366 patients. Transition probabilities and risk adjustment were based on published landmark trials. Costs (2011 Euros (€)) were estimated from a sick fund perspective based on resource use in patients receiving chemotherapy. Future costs and clinical benefits were discounted at 3% annually. RESULTS The 21-gene assay was projected to increase mean life expectancy by 0.06 years and quality-adjusted life expectancy by 0.06 quality-adjusted life years (QALYs) compared with current clinical practice over a 30-year time horizon. Clinical benefits were driven by optimized allocation of adjuvant chemotherapy. Costs from a healthcare payer perspective were lower with the 21-gene assay by ∼€561 vs standard of care. Probabilistic sensitivity analysis indicated that there was an 87% probability that the 21-gene assay would be dominant (cost and life saving) to standard of care. LIMITATIONS Country-specific data on the risk of distant recurrence and quality-of-life were not available. CONCLUSIONS Guiding decision-making on adjuvant chemotherapy using the 21-gene assay was projected to improve survival, quality-adjusted life expectancy, and be cost saving vs the current standard of care women with ER+, HER2- early-stage breast cancer.
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Affiliation(s)
- J U Blohmer
- St. Gertrauden-Krankenhaus, Berlin, Germany.
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