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Abbasi S, Garjani N, Mahshidfar B, Farsi D, Mofidi M, Hafezimoghadam P, Rezai M, Javan A. Comparative Study of Radial and Median Nerve Blocks with Hematoma Block under Ultrasound Guide in Distal Radius Fracture Reduction: A Randomized Clinical Trial. Med J Islam Repub Iran 2023; 37:113. [PMID: 38145179 PMCID: PMC10744119 DOI: 10.47176/mjiri.37.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 12/26/2023] Open
Abstract
Background Distal radius fractures are one of the most common upper extremity fractures, and their incidence continues to increase due to an aging population and an increase in osteoporosis. Various methods of analgesia for distal radius fractures have been described-including hematoma blocks and nerve blocks. Hematoma blocks are a simple and effective method of providing analgesia; nonetheless, their efficacy may be limited in some cases. On the other hand, nerve blocks provide more targeted analgesia and may be more effective in reducing pain during fracture reduction. This study aimed to compare the analgesic effectiveness of radial and median nerve blocks with hematoma blocks under ultrasound guidance in treating distal radius fractures. Also, this study aimed to compare the analgesia of radial and median nerve blocks with hematoma blocks under ultrasound guidance to reduce distal radius fractures. Methods In this prospective trial, patients with distal radius fractures referring to 2 academic centers were placed into 2 randomized groups, including hematoma block, and radial median block, both of which were ultrasound-guided. The patient's pain levels were measured and recorded based on the visual analog scale before the block, 5, 10, and 15 minutes after the block, at the start of reduction, during reduction, and 5, 10, and 15 minutes after reduction. Patient satisfaction and physician satisfaction rates were assessed, and side effects were also observed for 1 week. Quantitative variables were reported as mean ± standard deviation, and number and frequency percentages were reported for qualitative variables. The Student t test and the chi-square test were used on a case-by-case basis. The significance level was set at P ˂ 0.05. Results In this study, 120 patients were included. The groups had no significant differences in pain reduction during the procedure. Analgesic medication was needed during the procedure for 17 patients; nerve blocks were applied for 6 patients, and hematoma blocks for 11 patients, which was statistically significant (P = 0.041). Satisfaction rates for patients and physicians performing the procedure were significantly higher in the nerve block group than in the hematoma block group ( P = 0.001; P ˂ 0.001, respectively). Conclusion The results of this study suggest that ultrasound-guided radial and median nerve blocks can be used as alternative methods of analgesia with other techniques in the reduction of distal radius fractures in emergency departments.
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Affiliation(s)
- Saeed Abbasi
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Nayyereh Garjani
- Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran
University of Medical Sciences, Tehran, Iran
| | - Babak Mahshidfar
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Davood Farsi
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Mani Mofidi
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Peyman Hafezimoghadam
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Alireza Javan
- Student Research Committee, School of Medicine, Iran University of Medical
Sciences, Tehran, Iran
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Yasinzadeh M, Shahriari H, Rezai M, Eslami M, Banijamal M, Amiri H. A survey on the knowledge of patients’ companions about the concept and application of hospital triage. J Res Clin Med 2022. [DOI: 10.34172/jrcm.2022.032] [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: 01/09/2023] Open
Abstract
Introduction: Given the importance of the subject and the knowledge gap, we decided to perform this survey. Methods: In this descriptive cross-sectional study, the knowledge levels of patients’ companions about the concept and application of hospital triage were evaluated in 202 subjects. The research population included patient companions referred to the emergency department (ED). The exclusion criterion was the failure to complete the questionnaire. Convenience sampling was done. Questionnaires were delivered to the companions of the patients. In this study, the data gathering tool was a questionnaire consisting of two parts. The final questionnaire included 13 questions, 10 and 3 of which were closed (multiple choice) and open questions, respectively. Finally, the age, level of education, and gender were also asked from participants. The level of patient triage was also determined in this research. Results: 202 questionnaires were completed by companions of patients admitted to the ED. The mean age of those who completed the questionnaire was 39.95±17.92 years, and 192 individuals expressed their gender, of which 123 (64.1%) and 69 (35.9%) persons were male and female, respectively. The level of education was also reported in 180 people. Moreover, diploma and postgraduate diplomas, bachelor’s degrees, and postgraduate or doctoral degrees were observed in 59 (32.77%), 90 (50%), and 31 (17.22%) patients’ companions respectively. Conclusion: According to the results, it seems that the knowledge about the concept of triage among ordinary people of the society is lower than the desired level.
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Affiliation(s)
- Mohammadreza Yasinzadeh
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hila Shahriari
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Eslami
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Banijamal
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Amiri
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
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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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Sadeghzadeh‐Bazargan A, Rezai M, Najar Nobari N, Mozafarpoor S, Goodarzi A. Skin manifestations as potential symptoms of diffuse vascular injury in critical COVID-19 patients. J Cutan Pathol 2021; 48:1266-1276. [PMID: 33978234 PMCID: PMC8239514 DOI: 10.1111/cup.14059] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 01/08/2023]
Abstract
As a respiratory viral infection caused by a novel coronavirus, COVID-19 became rapidly pandemic within a few months. Despite the wide range of manifestations and organ involvement in COVID-19 patients, the exact pathogenesis of severe and fatal types of COVID-19 and causes involved with the individual base of the disease is not yet understood. Several studies have reported clinical, laboratory, and histopathological data in favor of vascular injury in multiple organs of critically ill patients with COVID-19 as a result of hyperactive immune response, inflammation, and cytokine storm. Also, both clinical and histopathological evidence points to such vascular involvements in the skin. Given the ease of clinical examinations and skin biopsy and the lower risks of transmission of COVID-19 to healthcare workers, the present review article was conducted to investigate the vascular skin manifestations of COVID-19 patients clinically and/or histopathologically as helpful clues for better understanding the pathogenesis and predicting the prognosis of the disease, especially in severe cases.
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Affiliation(s)
| | - Mahdi Rezai
- Department of Emergency Medicine Management Research Center, Rasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| | - Niloufar Najar Nobari
- Department of Dermatology, Rasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| | - Samaneh Mozafarpoor
- Dermatologist, Skin Disease and Leishmaniasis Research Center, Department of DermatologyIsfahan University of Medical SciencesIsfahanIran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
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5
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Villegas SL, Nekljudova V, Pfarr N, Engel J, Untch M, Schrodi S, Holms F, Ulmer HU, Fasching PA, Weber KE, Albig C, Heinrichs C, Marmé F, Hartmann A, Hanusch C, Schmitt WD, Huober J, Lederer B, van Mackelenbergh M, Tesch H, Jackisch C, Rezai M, Sinn P, Sinn BV, Hackmann J, Kiechle M, Schneeweiss A, Weichert W, Denkert C, Loibl S. Therapy response and prognosis of patients with early breast cancer with low positivity for hormone receptors - An analysis of 2765 patients from neoadjuvant clinical trials. Eur J Cancer 2021; 148:159-170. [PMID: 33743484 DOI: 10.1016/j.ejca.2021.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 12/11/2022]
Abstract
AIM To evaluate HER2-negative breast cancer (BC) with a low hormone receptor (HR) expression, with regard to pathological complete response (pCR) and survival, in comparison to triple-negative BC (TNBC) and strong HR-positive BC. METHODS We compared negative [oestrogen (ER) and progesterone receptor (PR) <1%], low-positive (ER and/or PR 1-9%) and strong-positive (ER or PR 10-100%) HR-expression in neoadjuvant clinical trial cohorts (n = 2765) of BC patients. End-points were disease-free survival (DFS), distant-disease free survival (DDFS) and overall survival (OS). We performed RNA sequencing on available tumour tissue samples from patients with low-HR expression (n = 38). RESULTS Ninety-four (3.4%) patients had low HR-positive tumours, 1769 (64.0%) had strong HR-positive tumours, and 902 (32.6%) had TNBC. There were no significant differences in pCR rates between women with low HR-positive tumours (27.7%) and women with TNBC (35.5%). DFS and DDFS were also not different [for DFS, hazard ratio 1.26, 95%-CI (confidence interval) : 0.87-1.83, log-rank test p = 0.951; for DDFS, hazard ratio 1.17, 95%-CI: 0.78-1.76, log-rank test p = 0.774]. Patients with strong HR-positive tumours had a significantly lower pCR rate (pCR 9.4%; odds ratio 0.38, 95%-CI: 0.23-0.63), but better DFS (hazard ratio 0.48, 95%-CI: 0.33-0.70) and DDFS (hazard ratio 0.49, 95%-CI: 0.33-0.74) than patients with low HR-positive tumours. Molecular subtyping (RNA sequencing) of low HR-positive tumours classified these predominantly into a basal subtype (86.8%). CONCLUSION Low HR-positive, HER2-negative tumours have a similar clinical behaviour to TNBC showing high pCR rates and poor survival and also a basal-like gene expression signature. Patients with low HR-positive tumours should be regarded as candidates for therapy strategies targeting TNBC.
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Affiliation(s)
- Sonia L Villegas
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Nicole Pfarr
- Institute of General and Surgical Pathology of the Technical University of Munich, Technische Universität München, Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR), Bavarian Cancer Registry - Regional Centre Munich (LGL) at the University Hospital of Munich, Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Michael Untch
- Breast Cancer Center, HELIOS Klinikum, Berlin, Germany
| | - Simone Schrodi
- Munich Cancer Registry (MCR), Bavarian Cancer Registry - Regional Centre Munich (LGL) at the University Hospital of Munich, Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | | | - Peter A Fasching
- Department of Gynecology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Karsten E Weber
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany
| | - Christian Albig
- Institute of General and Surgical Pathology of the Technical University of Munich, Technische Universität München, Munich, Germany
| | | | - Frederik Marmé
- Department of Gynecology, University Hospital Mannheim, Mannheim, Germany
| | - Arndt Hartmann
- Institute of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Wolfgang D Schmitt
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jens Huober
- Department of Gynecology, University of Ulm, Ulm, Germany
| | - Bianca Lederer
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany
| | | | - Hans Tesch
- Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Peter Sinn
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Bruno V Sinn
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - John Hackmann
- Department of Gynecology, Marien Hospital Witten, Witten, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich (CCCM), Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universität Heidelberg, Heidelberg, Germany
| | - Wilko Weichert
- Institute of General and Surgical Pathology of the Technical University of Munich, Technische Universität München, Munich, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - Sibylle Loibl
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany.
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Kern P, Hoffmann O, Bittner AK, Kimmig R, Rezai M, Bücker I, Kessel A. Abstract PS1-11: Natural transition targeted surgery. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps1-11] [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: Breast conserving surgery is the standard in T1-T3 primary breast cancer. The cosmetic result is very much depending on the surgeon´s experience, the tumor-size/breast ratio and the technique applied. To improve cosmetic outcome and reduce repeated surgery, we have proposed a nomogram earlier (1) which has been cited by the American Society of Breast Surgeons Consensus Conference (2). In this nomogram, we proposed 5 simple oncoplastic techniques to handle the vast majority of breast cancer cases with a good cosmetic result. However, these techniques used direct access to the mammary gland, leaving scars in the visible skin of the breast. To avoid this, we chose a more natural access to the mammary gland at the natural transitions. Methods: We conducted a prospective open-arm study including all primary invasive and non-invasive breast cancer cases of tumor stages AJCC 0-III A (Version 8.0). Access to the tumor was chosen according to the proximity of the tumor to one of the following natural transitions (Areola, Lateral Insertion of the breast, inframmary fold): Non-palpable tumors and those undergoing neoadjuvant chemotherapy had to be marked by a wireand clippes before. Intraoperative ultrasound was applied before skin incision and after removal of the tumour (ultrasound of the specimen to confirm clear margins). Resection was performed as a segmentectomy and SLN biopsy and axillary clearance was done according to current guidelines.Results: 84 patients with breast conserving NTT-surgery have been enrolled so far. 76 patients had primary surgery with stage distribution as follows: Tis (1), T1a (3), T1b (8), T1c (30), T2 (30), T3 (4) and T4b(1). 8 patients had neoadjuvant chemotherapy with stage distribution as follows: ypT0 (3), ypT1a(2), ypT1c(1) and ypT2 (2). Histopathology was predominantly invasive-ductal breast cancer (70), followed by invasive-lobular (6), ductulo-lobular (5), invasive-ductal and DCIS (1),invasive-ductal and mucinous (1) and mucinous only (1). After first surgery 77 patients had a tumor resection according to the nomogramm of NTT-surgery with free margins and 7 with involved margins, thus 91,6 % tumors were resected with free margins at first surgery. The remaining 8,4 % were margin-free after second surgery. Conclusion: Scars were not visible on the surface of the breast outside of natural transitions and rate of free margins was high at 91,6 % without impairment due to the remote access to the mammary gland. We report a high patient satisfaction. Patient-reported outcome in detail has been evaluated by validated questionnaires and will be presented onsite. References:1. Rezai M., Knispel S., Kellersmann S., Lax H., Kimmig R., Kern P: Systematization of Oncoplastic Surgery: Selection of Surgical Techniques and Patient-Reported Outcome in a Cohort of 1,035 Patients, Ann Surg Oncol (2015) 22:3730-37372. Landercasper J. et al.: Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients: The America Society of Breast Surgeons Consensus Conference, Ann Surg Oncol 22, 3174-3183 (2015)
Citation Format: Peter Kern, Oliver Hoffmann, Ann-Kathrin Bittner, Rainer Kimmig, Mahdi Rezai, Ines Bücker, Alina Kessel. Natural transition targeted surgery [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-11.
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Affiliation(s)
- Peter Kern
- 1Ruhr-University of Bochum & University Hospital of Essen, Bochum & Essen, Germany
| | | | | | | | - Mahdi Rezai
- 3Malteser Hospital of Duisburg, Duisburg, Germany
| | - Ines Bücker
- 1Ruhr-University of Bochum & University Hospital of Essen, Bochum & Essen, 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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Masoomi GR, Rastegar Chupani Z, Heidari Beigvand H, Rezai M, Hasan Pour SD. Comparison of serum lead level of opium dependent patients with a healthy control group. J Prev Epidemiol 2020. [DOI: 10.34172/jpe.2020.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: The prevalence of multiple symptoms, including mental illness, symptoms that mimic diseases such as pancreatitis, nonspecific abdominal pain and cholecystitis, are high in drug-dependent patients. Objectives: The aim of this study was to consider the clinical signs and serum lead levels of individuals referred to four university hospitals with various complaints. Patients and Methods: In this study, 128 sample cases in two groups, the case group and control group, have been examined. The case group included 64 persons using oral opium who were suffering from various complaints and referred to emergency department of mentioned hospitals. The control group included 64 patients without any history of addiction. Results: Mean of blood serum lead level in opium users and control group was 76.34±17.82 mg/dL and 7.68±3.72 mg/dL respectively, and the difference between these groups was significantly meaningful (P<0.001). The most prevalent complaints were abdominal pain and pulmonary complaints. Conclusion: Findings of the current study showed high levels for an average serum lead level for oral opium addicts among the studied statistical population. In addition, results show that ultimate diagnosis of lead poisoning is a factor justifying symptoms for addicts with nonspecific symptoms, the subject that confirms several previous reports. This finding asserts the necessity of screening of serum lead level for patients addicted to opium compounds in order to prevent more severe side effects.
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Affiliation(s)
- Gholam Reza Masoomi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
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Keshmiri F, Rezai M, Tavakoli N. The effect of interprofessional education on healthcare providers' intentions to engage in interprofessional shared decision-making: Perspectives from the theory of planned behaviour. J Eval Clin Pract 2020; 26:1153-1161. [PMID: 32114699 DOI: 10.1111/jep.13379] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/31/2022]
Abstract
AIMS AND OBJECTIVES The present study aimed to investigate the effects of interprofessional education on healthcare providers' intentions to engage in an interprofessional shared decision-making (IP-SDM) process at emergency department and exploring the affecting factors on their intentions. METHODS We conducted the study through a sequential explanatory mixed method (quantitative-qualitative) design. All ED residents and nurses from two university hospitals were invited and assigned to the intervention and control groups. The intervention group was exposed to case-based learning sessions conducted by applying interprofessional strategies. The intentions of the participants engaged in IP-SDM were assessed before and 2 weeks after the intervention by a questionnaire designed based on the theory of planned behaviour. The questionnaire scores were compared between the intervention and control groups using analysis of covariance (ANCOVA). Partial eta-squared (η2 ) was used for effect size calculations in ANCOVA. Subsequently, to explore the affecting factors in engagement in IP-SDM, qualitative data were collected through semi-structured individual interviews. The inductive content analysis approach by Elo and Kyngas was employed to analyze the qualitative data. RESULTS Out of 117 potentially eligible healthcare professionals, 113 completed the study in the intervention (n = 55) and control (n = 58) groups. The results showed that the difference between the mean scores of the learners in the intervention (1.41 ± 0.27) and control (0.80 ± 0.52) groups was statistically significant (P-value = .00001). The main effect of the intervention and a large educational effect size for the intervention were found to be statistically significant F (1, 11) = 180.54, P-value = .00001, η2 = 0.62. The qualitative data analysis showed two main categories of "team-based facilitators" and "contextual challenges" as the main affecting factors in the engagement of participant in IP-SDM. CONCLUSION Our findings suggested that applying interprofessional education strategies could improve the learners' intention to engage in IP-SDM. Moreover, the results showed that the interprofessional collaboration among team members, adherence to the team-based care principles, and administrative support at different levels could be the influential factors the intentions of the participants to engage in IP-SDM.
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Affiliation(s)
- Fatemeh Keshmiri
- Medical Education Department, Educational Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Emergency Medicine Department, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
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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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12
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Mofidi M, Dashti A, Rezai M, Ghodrati N, Ameli H, Amiri H. Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management. J Res Clin Med 2020. [DOI: 10.34172/jrcm.2020.021] [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: 11/09/2022] Open
Abstract
Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.
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Affiliation(s)
- Mani Mofidi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Dashti
- Student Research Committee, School of medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Ghodrati
- Hematology and Oncology, Alborz University of Medical Sciences, Karaj, Iran
| | - Hoorolnesa Ameli
- Emergency Medicine Department, Qom University of Medical Sciences, Qom, Iran
| | - hassan Amiri
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
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13
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Loibl S, Weber KE, Timms KM, Elkin EP, Hahnen E, Fasching PA, Lederer B, Denkert C, Schneeweiss A, Braun S, Salat CT, Rezai M, Blohmer JU, Zahm DM, Jackisch C, Gerber B, Klare P, Kümmel S, Schem C, Paepke S, Schmutzler R, Rhiem K, Penn S, Reid J, Nekljudova V, Hartman AR, von Minckwitz G, Untch M. Survival analysis of carboplatin added to an anthracycline/taxane-based neoadjuvant chemotherapy and HRD score as predictor of response-final results from GeparSixto. Ann Oncol 2019; 29:2341-2347. [PMID: 30335131 DOI: 10.1093/annonc/mdy460] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In the neoadjuvant GeparSixto study, adding carboplatin to taxane- and anthracycline-based chemotherapy improved pathological complete response (pCR) rates in patients with triple-negative breast cancer (TNBC). Here, we present survival data and the potential prognostic and predictive role of homologous recombination deficiency (HRD). Patients and methods Patients were randomized to paclitaxel plus nonpegylated liposomal doxorubicin (Myocet®) (PM) or PM plus carboplatin (PMCb). The secondary study end points disease-free survival (DFS) and overall survival (OS) were analyzed. Median follow-up was 47.3 months. HRD was among the exploratory analyses in GeparSixto and was successfully measured in formalin-fixed, paraffin-embedded tumor samples of 193/315 (61.3%) participants with TNBC. Homologous recombination (HR) deficiency was defined as HRD score ≥42 and/or presence of tumor BRCA mutations (tmBRCA). Results A significantly better DFS (hazard ratio 0.56, 95% CI 0.34-0.93; P = 0.022) was observed in patients with TNBC when treated with PMCb. The improvement of OS with PMCb was not statistically significant. Additional carboplatin did not improve DFS or OS in patients with HER2-positive tumors. HR deficiency was detected in 136 (70.5%) of 193 triple-negative tumors, of which 82 (60.3%) showed high HRD score without tmBRCA. HR deficiency independently predicted pCR (ypT0 ypN0) [odds ratio (OR) 2.60, 95% CI 1.26-5.37, P = 0.008]. Adding carboplatin to PM significantly increased the pCR rate from 33.9% to 63.5% in HR deficient tumors (P = 0.001), but only marginally in HR nondeficient tumors (from 20.0% to 29.6%, P = 0.540; test for interaction P = 0.327). pCR rates with carboplatin were also higher (63.2%) than without carboplatin (31.7%; OR 3.69, 1.46-9.37, P = 0.005) in patients with high HRD score but no tmBRCA. DFS rates were improved with addition of carboplatin, both in HR nondeficient (hazard ratio 0.44, 0.17-1.17, P = 0.086) and HR deficient tumors (hazard ratio 0.49, 0.23-1.04, P = 0.059). Conclusions The addition of carboplatin to neoadjuvant PM improved DFS significantly in TNBC. Long-term survival analyses support the neoadjuvant use of carboplatin in TNBC. HR deficiency in TNBC and HRD score in non-tmBRCA TNBC are predictors of response. HRD does not predict for carboplatin benefit.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, Germany.
| | - K E Weber
- German Breast Group, Neu-Isenburg, Germany
| | - K M Timms
- Myriad Genetics Inc, Salt Lake City, USA
| | - E P Elkin
- The Permanente Medical Group Inc, Oakland, USA
| | - E Hahnen
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - B Lederer
- German Breast Group, Neu-Isenburg, Germany
| | - C Denkert
- Institute of Pathology, Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - S Braun
- Brustzentrum, Sana Kliniken Offenbach, Offenbach, Germany
| | - C T Salat
- Hämatoonkologische Schwerpunktpraxis, Munich, Germany
| | - M Rezai
- Luisenkrankenhaus, Düsseldorf, Germany
| | - J U Blohmer
- Klinik für Gynäkologie mit Brustzentrum Charité, Berlin, Germany
| | - D M Zahm
- Brustzentrum SRH Waldklinikum, Gera, Germany
| | - C Jackisch
- Brustzentrum, Sana Kliniken Offenbach, Offenbach, Germany
| | - B Gerber
- Frauenklinik, Universität Rostock, Rostock, Germany
| | - P Klare
- Praxisklinik, Berlin, Germany
| | - S Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - C Schem
- Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - S Paepke
- Klinikum rechts der Isar der Technischen Universität München, Frauenklinik, München, Germany
| | - R Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - S Penn
- Myriad Genetics Inc, Salt Lake City, USA
| | - J Reid
- Myriad Genetics Inc, Salt Lake City, USA
| | | | | | | | - M Untch
- Helios-Klinikum Berlin-Buch, Berlin, Germany
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14
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Mosaddegh R, Nabi S, Daei S, Mohammadi F, Masoumi G, Vaziri S, Rezai M. Combination of liver enzymes, amylase and abdominal ultrasound tests have acceptable diagnostic values as an alternative test for abdominopelvic CT scan in blunt abdominal trauma. Open Access Emerg Med 2019; 11:205-210. [PMID: 31686923 PMCID: PMC6709808 DOI: 10.2147/oaem.s207066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/05/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Abdominal trauma accounts for 15–20% of all-cause mortality of trauma. Abdominopelvic CT scan with intravenous contrast is considered the most accurate non-invasive diagnostic tool in detecting intra-abdominal injuries. In previous studies, rise in liver enzymes and amylase was associated with intra-abdominal injuries but the studies were not sufficient. Our aim was to assess the diagnostic values of liver enzymes and amylase for intra-abdominal injuries in blunt trauma patients. Methods We included blunt abdominal trauma patients who referred to three teaching hospitals in 2018. The patients who had 14 years old or more and Glasgow Coma Scale above 8 were enrolled the study if the treating physician had high index of suspicion for intra-abdominal injuries and sent the patients for abdominopelvic CT scan with intravenous contrast. Sensitivity, specificity, positive and negative predictive values are calculated for results of liver enzymes, amylase and abdominal ultrasound. Results Eventually, 300 patients with blunt abdominal trauma entered the study. Sensitivity, specificity, positive and negative predictive values of concurrent positive results of abdominal ultrasound, amylase and liver enzymes were 81.73 (95% CI, 73.2–88.1), 63.78 (95% CI, 65.36–70.61), 58.38 (95% CI, 56.36–70.61) and 84.89 (95% CI, 77.6–90.19), respectively. Conclusion Considering findings of the present study, the combination of liver enzymes, amylase and abdominal ultrasound results can be an alternative method for detecting intra-abdominal injuries in patients in whom treating physicians have limitations such as overweight, instability of hemodynamic and lack of CT scan facility.
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Affiliation(s)
- Reza Mosaddegh
- Emergency Medicine Management Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samane Nabi
- Trauma and Injury Research Centre, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sogand Daei
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mohammadi
- Emergency Medicine Management Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Masoumi
- Trauma and Injury Research Centre, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Vaziri
- Emergency Medicine Management Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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15
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Amirhajlou L, Bidari A, Alipour F, Yaseri M, Vaziri S, Rezai M, Tavakoli N, Farsi D, Yasinzadeh MR, Mosaddegh R, Hashemi A. Validity, reliability and acceptability of Professionalism Mini-Evaluation Exercise (P-MEX) for emergency medicine residency training. J Med Ethics Hist Med 2019; 12:12. [PMID: 32328225 PMCID: PMC7166245 DOI: 10.18502/jmehm.v12i12.1641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 09/15/2019] [Indexed: 01/08/2023] Open
Abstract
Professionalism is a core competency in the medical profession. In this paper, we aimed to confirm the validity, reliability and acceptability of the Professionalism Mini-Evaluation Exercise (P-MEX) instrument for the emergency medicine (EM) residency program. Twenty-two EM attending physicians completed 383 P-MEX forms (the Persian version) for 90 EM residents. Construct validity was assessed via structural equation modeling (SEM). The reliability coefficient was estimated by the generalizability theory, and acceptability was assessed using two researcher-made questionnaires to evaluate the perspectives of residents and assessors. There was a consensus among the participants regarding the content of P-MEX. According to the results of SEM, the first implementation of the original model was associated with a moderate fit and high item loadings. The model modified with correlated error variances for two pairs of items showed an appropriate fit. The reliability of P-MEX was 0.81 for 14 occasions. The perception survey indicated high acceptability for P-MEX from the viewpoint of the residents and increasing satisfaction with P-MEX among the assessors over time. According to the results of the research, P-MEX is a reliable, valid, and acceptable instrument for assessing professionalism in EM residents.
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Affiliation(s)
- Leila Amirhajlou
- Researcher, Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Bidari
- Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fateme Alipour
- Associate Professor, Department of Ophthalmology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Associate Professor, Department of Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Vaziri
- Assistant Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Rezai
- Assistant Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Associate Professor, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Davood Farsi
- Associate Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Yasinzadeh
- Assistant Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mosaddegh
- Assistant Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Hashemi
- Assistant Professor, Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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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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17
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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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18
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Mofidi M, Kianmehr N, Qomi YF, Zaim SN, Moghadam PH, Rezai M, Farsi D, Abbasi S, Mahshidfar B. Daylight saving time and incidence ratio of acute myocardial infarction among Iranian people. J Med Life 2019; 12:123-127. [PMID: 31406512 PMCID: PMC6685301 DOI: 10.25122/jml-2017-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Iran is among the countries which change official time, every year according to their constitutions. Studies have shown an increase of incidence ratio (IR) of acute myocardial infarction by these time transitions. Despite annual time changes in Iran, there is no published data to prove this among the Iranian. This retrospective study examined the IR of patients with AMI, who were admitted to the Emergency Department (ED) of 5 teaching hospitals during the week just after the time transitions (observed period), with two weeks before and after the time transitions (expected period), both in spring and fall. In total, 11051 patients were admitted during the ten weeks (observed and expected), in both spring and fall time transitions. The IR of AMI during both observed and expected period did not show any significant difference (p > 0.05); however, the incidence of AMI was increased during the first week after the transition in spring (p > 0.05). Although the results of the present study did not prove the relation between time transitions and incidence of AMI, a slight increase existed for IR of AMI during three days after spring shift. This increase in IR of AMI can be due to Nowrooz, the national holidays which lasts four days after turning clocks forward in Iran.
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Affiliation(s)
- Mani Mofidi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Kianmehr
- Iran University of Medical Sciences, Department of Rheumatology, Hazrat Rasoul Akram Complex, Tehran, Iran
| | | | - Sonia N Zaim
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Peyman Hafezi Moghadam
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Davood Farsi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Abbasi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Mahshidfar
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
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19
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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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20
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Riedel F, Heil J, Feißt M, Rezai M, Moderow M, Sohn C, Schütz F, Golatta M, Hennigs A. Non-sentinel axillary tumor burden applying the ACOSOG Z0011 eligibility criteria to a large routine cohort. Breast Cancer Res Treat 2019; 177:457-467. [DOI: 10.1007/s10549-019-05327-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022]
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21
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Wallwiener M, Nabieva N, Feisst M, Fehm T, 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, Rauh C, Bayer CM, Schmidt K, Belleville E, Brucker SY, Hadji P, Beckmann MW, Wallwiener D, Kümmel S, Hartkopf A, Fasching PA. Influence of patient and tumor characteristics on therapy persistence with letrozole in postmenopausal women with advanced breast cancer: results of the prospective observational EvAluate-TM study. BMC Cancer 2019; 19:611. [PMID: 31227025 PMCID: PMC6588890 DOI: 10.1186/s12885-019-5806-y] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background Treatment of postmenopausal, hormone receptor-positive metastatic breast cancer (MBC) patients varies despite clear therapy guidelines, favoring endocrine treatment (ET). Aim of this study was to analyze persistence of palliative aromatase inhibitor (AI) monotherapy in MBC patients. Methods EvAluate-TM is a prospective, multicenter, noninterventional study to evaluate treatment with letrozole in postmenopausal women with hormone receptor–positive breast cancer. To assess therapy persistence, defined as the time from therapy start to the end of the therapy (TTEOT), two pre-specified study visits took place after 6 and 12 months. Competing risk survival analyses were performed to identify patient and tumor characteristics that predict TTEOT. Results Out of 200 patients, 66 patients terminated treatment prematurely, 26 (13%) of them due to causes other than disease progression. Persistence rate for reasons other than progression at 12 months was 77.7%. Persistence was lower in patients who reported any adverse event (AE) in the first 30 days of ET (89.5% with no AE and 56% with AE). Furthermore, patients had a lower persistence if they reported compliance problems in the past before letrozole treatment. Conclusions Despite suffering from a life-threatening disease, AEs of an AI will result in a relevant number of treatment terminations that are not related to progression. Some subgroups of patients have very low persistence rates. Especially with regard to novel endocrine combination therapies, these data imply that some groups of patients will need special attention to guide them through the therapy process. Trial registration Clinical Trials Number: CFEM345DDE19 Electronic supplementary material The online version of this article (10.1186/s12885-019-5806-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Markus Wallwiener
- Department of Gynecology, University of Tübingen, Tübingen, Germany.,Department of Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Naiba Nabieva
- Department of Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Tanja Fehm
- Department of Gynecology, Heinrich Heine University of Dusseldorf, Dusseldorf, Germany
| | - Johann de Waal
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - Mahdi Rezai
- Luisen-Hospital Dusseldorf, Dusseldorf, Germany
| | - Bernd Baier
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - Gerold Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | | | | | - Mathias Warm
- Breast center, Department of Gynecology, University Hospital Cologne, Cologne, Germany.,Breast Center, Clinics of Cologne gGmbH Holweide, Cologne, Germany
| | - Nadia Harbeck
- Breast center, Department of Gynecology, University Hospital Cologne, Cologne, Germany.,Department of Gynecology and Obstetrics, Breast Center and CCC Munich, University Hospital Munich, Munich, Germany
| | - Rachel Wuerstlein
- Breast center, Department of Gynecology, University Hospital Cologne, Cologne, Germany.,Department of Gynecology and Obstetrics, Breast Center and CCC Munich, University Hospital Munich, Munich, Germany
| | | | - Peter Dall
- Department of Gynecology, Lüneburg Clinic, Lüneburg, Germany
| | | | | | - Cosima Brucker
- Department of Gynecology and Obstetrics, Paracelsus Medical University, Nuremberg, Germany
| | - Jan Willem Siebers
- Department of Gynecology of the St. Josef's Clinic Offenburg, Offenburg, Germany
| | - Milos Popovic
- Department of Gynecology, Bayreuth clinic GmbH, CCC ER-EMN, Bayreuth, Germany
| | - Thomas Kuhn
- Brustzentrum am Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | | | | | | | - Wolfgang Janni
- Department of Gynecology, University Hospital Ulm, Ulm, Germany
| | - Robert Landthaler
- Gynecological Medical Practice of the County Hospital Krumbach, Krumbach, Germany
| | - Andreas Kohls
- Evangelic County Hospital Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | | | - Thomas Noesselt
- Department of Gynecology of the Sana hospital Hameln, Hameln, Germany
| | | | - Stephan Henschen
- Johanniter Hospital Genthin Stendal gGmbH, Hansestadt Stendal, Germany
| | - Thomas Praetz
- Caritas-Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - Volker Heyl
- Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - Thorsten Kühn
- Department of Gynecology, Esslingen Clinics a.N, Esslingen, Germany
| | | | - Christoph Thomssen
- Department of Gynecology, Martin-Luther-University Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Andre Hohn
- Städtisches Krankenhaus Kiel GmbH, Kiel, Germany
| | - Hans Tesch
- Oncology Bethanien Frankfurt, Frankfurt, Germany
| | - Christoph Mundhenke
- Department of Gynecology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Alexander Hein
- Department of Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Christian M Bayer
- Department of Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | | | | | - Sara Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - Peyman Hadji
- Department of Gynecology, Nordwest Hospital, Frankfurt, Germany
| | - Matthias W Beckmann
- Department of Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | | | - Sherko Kümmel
- Breast center, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Andreas Hartkopf
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - Peter A Fasching
- Department of Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
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22
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Kuemmel S, Holtschmidt J, Gerber B, Von der Assen A, Heil J, Thill M, Krug D, Schem C, Denkert C, Lubitz J, Blohmer JU, Reinisch M, Hötzeldt M, Seither F, Nekljudova V, Schwidde I, Uhrhan K, Von Minckwitz G, Rezai M, Mulowski J, Loibl S, Kuehn T. Prospective, Multicenter, Randomized Phase III Trial Evaluating the Impact of Lymphoscintigraphy as Part of Sentinel Node Biopsy in Early Breast Cancer: SenSzi (GBG80) Trial. J Clin Oncol 2019; 37:1490-1498. [DOI: 10.1200/jco.18.02092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of the current work was to clarify whether a preoperative lymphoscintigraphy (LSG) enhances staging accuracy of sentinel lymph node biopsy (SLNB). PATIENTS AND METHODS In a prospective, multicenter, randomized phase III trial, patients with cN0 early breast cancer or extensive/high-grade ductal carcinoma in situ planned for standard radioactive-labeled colloid LSG with subsequent SLNB were randomly assigned 1:1 to receive SLNB either with knowledge of the LSG findings or without. As the false-negative rate of SLNB correlates with the number of resected sentinel lymph nodes (SLNs), our primary end point was the mean number of histologically detected SLNs per patient. One thousand one hundred two evaluable patients were necessary to demonstrate noninferiority of SLNB without LSG. Stratified one-sided 95% CI for the difference (without LSG − with LSG) in the mean number of histologically detected SLNs had to be greater than −0.27 (10% noninferiority margin). Stratification was performed according to tumor focality and trial site. Additional predefined secondary end points (rates of node-positive patients and of completion axillary lymph node dissection) were analyzed to rule out differences in the reliable detection of nodal metastases. RESULTS Between May 2014 and October 2015, 1,198 patients were randomly assigned in 23 German and Swiss breast centers. Modified intention-to-treat analysis (n = 1,163) showed a mean number of histologically detected SLNs of 2.21 with LSG and 2.26 without LSG (difference 0.05; stratified 95% CI, −0.18 to infinity), thus establishing noninferiority of omitting preoperative LSG. Secondary end points displayed no statistically significant differences. CONCLUSION We show that SLNB is equally effective irrespective of the surgeon’s knowledge of preoperative LSG results. SLNB without LSG will speed up the preoperative workflow and reduce cost.
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Affiliation(s)
| | | | | | | | - Joerg Heil
- University Hospital Heidelberg, Heidelberg, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - David Krug
- University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Schem
- University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- Mammazentrum Hamburg, Hamburg, Germany
| | | | | | | | - Mattea Reinisch
- Kliniken Essen-Mitte, Essen, Germany
- German Breast Group, Neu-Isenburg, Germany
| | | | | | | | - Ilka Schwidde
- Die Frauenärztinnen Mülheim an der Ruhr, Mülheim, Germany
| | - Klara Uhrhan
- Zentrum für Nuklearmedizin und Molekulare Bildgebung Essen, Essen, Germany
| | | | - Mahdi Rezai
- Luisenkrankenhaus Düsseldorf, Düsseldorf, Germany
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23
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Laakmann E, Witzel I, Fasching PA, Rezai M, Schem C, Solbach C, Tesch H, Klare P, Schneeweiss A, Salat C, Zahm DM, Blohmer JU, Ingold-Heppner B, Huober J, Hanusch C, Jackisch C, Reinisch M, Untch M, von Minckwitz G, Nekljudova V, Müller V, Loibl S. Development of central nervous system metastases as a first site of metastatic disease in breast cancer patients treated in the neoadjuvant trials GeparQuinto and GeparSixto. Breast Cancer Res 2019; 21:60. [PMID: 31077239 PMCID: PMC6509843 DOI: 10.1186/s13058-019-1144-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 04/17/2019] [Indexed: 11/28/2022] Open
Abstract
Background The incidence of central nervous system (CNS) metastases in breast cancer patients is rising and has become a major clinical challenge. Only few data are published concerning risk factors for the development of CNS metastases as a first site of metastatic disease in breast cancer patients. Moreover, the incidence of CNS metastases after modern neoadjuvant treatment is not clear. Methods We analyzed clinical factors associated with the occurrence of CNS metastases as the first site of metastatic disease in breast cancer patients after neoadjuvant treatment in the trials GeparQuinto and GeparSixto (n = 3160) where patients received targeted treatment in addition to taxane and anthracycline-based chemotherapy. Results After a median follow-up of 61 months, 108 (3%) of a total of 3160 patients developed CNS metastases as the first site of recurrence and 411 (13%) patients had metastatic disease outside the CNS. Thirty-six patients (1%) developed both CNS metastases and other distant metastases as the first site of metastatic disease. Regarding subtypes of the primary tumor, 1% of luminal A-like (11/954), 2% of luminal B-like (7/381), 4% of HER2-positive (34/809), and 6% of triple-negative patients (56/1008) developed CNS metastases as the first site of metastatic disease. In multivariate analysis, risk factors for the development of CNS metastases were larger tumor size (cT3–4; HR 1.63, 95% CI 1.08–2.46, p = 0.021), node-positive disease (HR 2.57, 95% CI 1.64–4.04, p < 0.001), no pCR after neoadjuvant chemotherapy (HR 2.29, 95% CI 1.32–3.97, p = 0.003), and HER2-positive (HR 3.80, 95% CI 1.89–7.64, p < 0.001) or triple-negative subtype (HR 6.38, 95% CI 3.28–12.44, p < 0.001). Conclusions Especially patients with HER2-positive and triple-negative tumors are at risk of developing CNS metastases despite effective systemic treatment. A better understanding of the underlying mechanisms is required in order to develop potential preventive strategies.
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Affiliation(s)
- Elena Laakmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Mahdi Rezai
- European Breast Center Duesseldorf, Luise-Rainer-Str. 6-10, 40235, Duesseldorf, Germany
| | - Christian Schem
- Department of Gynecology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105, Kiel, Germany.,Breastcancer Center Hamburg, Moorkamp 2-6, 20357, Hamburg, Germany
| | - Christine Solbach
- Department of Gynecology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Hans Tesch
- Center for Hematology und Oncology Bethanien Frankfurt, Im Prüfling 17-19, 60389, Frankfurt/Main, Germany
| | - Peter Klare
- Medical Center, Lichtenberg, Möllendorffstraße 52, 10367, Berlin, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Christoph Salat
- Medical Center for Hematology and Oncology, Winthirstr. 7, 80639, Munich, Germany
| | - Dirk-Michael Zahm
- Department of Gynecology, SRH Wald-Klinikum Gera gGmbH, Strasse des Friedens 122, 07548, Gera, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Cancer, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Jens Huober
- Department of Gynecology, University of Ulm, Prittwitzstrasse 43, 89075, Ulm, Germany
| | - Claus Hanusch
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - Christian Jackisch
- Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - Mattea Reinisch
- Breast Unit, Kliniken Essen-Mitte Evang. Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany
| | - Michael Untch
- Department of Gynecology, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Gunter von Minckwitz
- German Breast Group GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
| | - Valentina Nekljudova
- German Breast Group GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Sibylle Loibl
- German Breast Group GmbH, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany
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24
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Hennigs A, Riedel F, Feißt M, Köpke M, Rezai M, Nitz U, Moderow M, Golatta M, Sohn C, Heil J. Evolution of the Use of Completion Axillary Lymph Node Dissection in Patients with T1/2N0M0 Breast Cancer and Tumour-Involved Sentinel Lymph Nodes Undergoing Mastectomy: A Cohort Study. Ann Surg Oncol 2019; 26:2435-2443. [PMID: 31049766 DOI: 10.1245/s10434-019-07388-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND In breast cancer, completion axillary lymph node dissection (cALND) was previously recommended for patients with at least one tumour-affected sentinel lymph node (SLN). Several prospective trials predominantly in patients undergoing breast-conserving surgery showed no benefit and increased arm morbidity with this procedure. We report the influence of these trials on clinical practice of patients undergoing mastectomy. METHODS We analysed prospectively collected data from patients with primary invasive breast cancer treated at German breast cancer units between January 2008 and December 2015. Time trends of cALND rates were analysed in patients undergoing mastectomy for T1/2N0M0 breast cancer with one or two tumour-involved SLNs. Multivariable logistic regression was used to determine factors influencing the decision not to perform cALND. RESULTS Among the entire study cohort of 166,074 patients treated at 179 breast cancer units, 4093 patients (2%) had T1/2N0M0 breast cancer with one or two tumour-involved SLNs and underwent mastectomy. cALND rates decreased from 89.9% in 2010 to 55.5% in 2015 (p < 0.001). Rates decreased from 82% to 8% in patients with micrometastatic SLN disease and from 93% to 63% in those with macrometastasis (p < 0.001). In multivariable analysis, factors associated with omission of cALND were treatment at a general, nonacademic hospital, pT1 status, older age, higher number of removed SLNs, fewer tumour-affected SLNs, and SLN micrometastasis (all p < 0.001). CONCLUSIONS Despite limited evidence from prospective trials relating to the omission of cALND specifically in patients undergoing mastectomy, our nationwide data show that use of cALND decreased in these patients in routine clinical practice.
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Affiliation(s)
- André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Melitta Köpke
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Mahdi Rezai
- European Breast Center, Luisen Hospital, Düsseldorf, Germany
| | - Ulrike Nitz
- Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda, Mönchengladbach, Germany
| | | | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
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25
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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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26
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Janning M, Müller V, Vettorazzi E, Cubas-Cordova M, Gensch V, Ben-Batalla I, Zu Eulenburg C, Schem C, Fasching PA, Schnappauf B, Karn T, Fehm T, Just M, Kühn T, Holms F, Overkamp F, Krabisch P, Rack B, Denkert C, Untch M, Tesch H, Rezai M, Kittel K, Pantel K, Bokemeyer C, Loibl S, von Minckwitz G, Loges S. Evaluation of soluble carbonic anhydrase IX as predictive marker for efficacy of bevacizumab: A biomarker analysis from the geparquinto phase III neoadjuvant breast cancer trial. Int J Cancer 2019; 145:857-868. [PMID: 30694523 DOI: 10.1002/ijc.32163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/19/2018] [Revised: 11/14/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022]
Abstract
We analyzed the predictive potential of pretreatment soluble carbonic anhydrase IX levels (sCAIX) for the efficacy of bevacizumab in the phase III neoadjuvant GeparQuinto trial. sCAIX was determined by enzyme-linked immunosorbent assay (ELISA). Correlations between sCAIX and pathological complete response (pCR), disease-free and overall survival (DFS, OS) were assessed with logistic and Cox proportional hazard regression models using bootstrapping for robust estimates and internal validation. 1,160 HER2-negative patient sera were analyzed, of whom 577 received bevacizumab. Patients with low pretreatment sCAIX had decreased pCR rates (12.1 vs. 20.1%, p = 0.012) and poorer DFS (adjusted 5-year DFS 71.4 vs. 80.5 months, p = 0.010) compared to patients with high sCAIX when treated with neoadjuvant chemotherapy (NCT). For patients with low sCAIX, pCR rates significantly improved upon addition of bevacizumab to NCT (12.1 vs. 20.4%; p = 0.017), which was not the case in patients with high sCAIX (20.1% for NCT vs. 17.0% for NCT-B, p = 0.913). When analyzing DFS we found that bevacizumab improved 5-year DFS for patients with low sCAIX numerically but not significantly (71.4 vs. 78.5 months; log rank 0.234). In contrast, addition of bevacizumab worsened 5-year DFS for patients with high sCAIX (81 vs. 73.6 months, log-rank 0.025). By assessing sCAIX levels we identified a patient cohort in breast cancer that is potentially undertreated with NCT alone. Bevacizumab improved pCR rates in this group, suggesting sCAIX is a predictive biomarker for bevacizumab with regards to treatment response. Our data also show that bevacizumab is not beneficial in patients with high sCAIX.
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Affiliation(s)
- Melanie Janning
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Clinic and Policlinic for Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miguel Cubas-Cordova
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria Gensch
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Ben-Batalla
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Zu Eulenburg
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Schem
- Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Benjamin Schnappauf
- Department of Obstetrics and Gynecology, School of Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Thomas Karn
- Department of Obstetrics and Gynecology, School of Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Düsseldorf, Germany
| | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Frank Holms
- Department of Gynecology and Obstetrics, St. Barbara Kliniken Heessen, Hamm, Germany
| | | | - Petra Krabisch
- Department of Gynecology and Obstetrics, Klinikum Chemnitz, Germany
| | - Brigitte Rack
- Department of Obstetrics and Gynecology, Campus Innenstadt, University Hospital Munich, Germany
| | - Carsten Denkert
- Department of Pathology, Charité Berlin Campus Mitte and German Cancer Consortium (DKTK), Berlin, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Hans Tesch
- Centre for Hematology and Oncology, Frankfurt, Germany
| | - Mahdi Rezai
- Centre for Breast Cancer, Luisenkrankenhaus Düsseldorf, Germany
| | | | - Klaus Pantel
- Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Sonja Loges
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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27
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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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Mosaddegh R, Ashayeri N, Rezai M, Masoumi G, Vaziri S, Mohammadi F, Givzadeh H, Noohi N. Are serial hematocrit measurements sensitive enough to predict intra-abdominal injuries in blunt abdominal trama? Open Access Emerg Med 2019; 11:9-13. [PMID: 30662287 PMCID: PMC6327898 DOI: 10.2147/oaem.s180398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Routine serial hematocrit measurements are a component of the trauma evaluation for patients without serious injury identified on initial evaluation. We sought to determine whether serial hematocrit testing was useful in predicting the probable injuries in blunt abdominal trauma. Materials and method We performed a prospective study of trauma patients admitted in our observation unit over a 12-month period. Patients routinely underwent serial hematocrit testing in 6-hour intervals (two hematocrit levels). We compared trauma patients with a hematocrit drop of 5 and 10 points or more to those without a significant hematocrit drop. Results Five hundred forty-two isolated blunt abdominal trauma patients were admitted to observation unit, and 468 patients (86.35%) had serial hematocrit during their 6-hour stay. Of these patients, 36.11% had a hematocrit drop of 5 or more and 12.61% a drop of 10 or more. Of patients with the hematocrit drop >10, 50.8% have had diagnostic manifestations of intra-abdominal injury in both ultrasonographic and computed tomography scanning (P<0.001). There was no significant correlation between hematocrit drop >5 and positive imaging. Conclusion Although serial hematocrit testing may be useful in specific situations, routine use of serial hematocrit testing in trauma patients at a level I trauma center’s observation unit did not significantly aid in the prediction of occult injuries.
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Affiliation(s)
- Reza Mosaddegh
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran,
| | - Neda Ashayeri
- Department of Pediatric Hematology and Oncology, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran,
| | - Gholamreza Masoumi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Vaziri
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran,
| | - Fatemeh Mohammadi
- Research and Development Center of Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Givzadeh
- Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Nasrin Noohi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran,
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Hexam R, Rezai M, Delbari D, Keshmiri YS, Aghdam H, Zohri D. Comparison of intramuscular injection of ketorolac and conventional treatment in the field of cost-effectiveness, length of stay and pain relief in patients admitted to the emergency department with renal colic. Bali Med J 2018. [DOI: 10.15562/bmj.v8i1.1260] [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: 11/05/2022] Open
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Hennigs A, Köpke M, Feißt M, Riedel F, Rezai M, Nitz U, Moderow M, Golatta M, Sohn C, Schneeweiss A, Heil J. Which patients with sentinel node-positive breast cancer after breast conservation still receive completion axillary lymph node dissection in routine clinical practice? Breast Cancer Res Treat 2018; 173:429-438. [DOI: 10.1007/s10549-018-5009-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
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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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34
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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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Mofidi M, Rouhi R, Mahshidfar B, Abbasi S, Hafezimoghadam P, Rezai M, Farsi D. Propofol-Ketamine vs. Propofol-Fentanyl Combinations in Patients Undergoing Closed Reduction: A Randomized, Double-blind, Clinical Trial. Adv J Emerg Med 2018; 2:e44. [PMID: 31172107 PMCID: PMC6548145 DOI: 10.22114/ajem.v0i0.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Painful surgical procedures require adequate sedation and analgesia. A vast array of medications can be used for Procedural Sedation and Analgesia (PSA) in Emergency Departments (EDs). OBJECTIVE The present study was conducted to compare Propofol-Ketamine (PK) and Propofol-Fentanyl (PF) compounds in patients undergoing closed reduction in EDs. METHODS This randomized, double-blind, clinical trial was conducted on 110 consecutive patients who required sedation for closed reduction. The patients were randomly divided into two groups of equal sizes. The PK group received an intravenous bolus of 1 mg/kg of propofol plus 0.5 mg/kg of ketamine, and the PF group received an intravenous bolus of 1 mg/kg of propofol plus 1 µg/kg of fentanyl. The analgesic effect and success rate were the primary outcomes under study. RESULTS The PK group achieved more effective analgesia at the end of the experiment. The success rate was almost the same in both groups Shivering (p=0.005) and a drop in oxygen saturation to below 92% (p=0.048) were two side effects that were more prevalent in the FK group. The mean recovery time was significantly shorter in the PK group (p<0.001). The patients in the PK group were more satisfied. CONCLUSION In comparison with the PF compound, the use of KP leads to better pain relief and greater patient satisfaction and shorter sedation time in PSA.
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Affiliation(s)
| | | | | | | | | | | | - Davood Farsi
- />Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
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Fasching PA, Loibl S, Hu C, Hart SN, Shimelis H, Moore R, Schem C, Tesch H, Untch M, Hilfrich J, Rezai M, Gerber B, Costa SD, Blohmer JU, Fehm T, Huober J, Liedtke C, Weinshilboum RM, Wang L, Ingle JN, Müller V, Nekljudova V, Weber KE, Rack B, Rübner M, von Minckwitz G, Couch FJ. BRCA1/2 Mutations and Bevacizumab in the Neoadjuvant Treatment of Breast Cancer: Response and Prognosis Results in Patients With Triple-Negative Breast Cancer From the GeparQuinto Study. J Clin Oncol 2018; 36:2281-2287. [PMID: 29791287 DOI: 10.1200/jco.2017.77.2285] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose BRCA1/2 mutations are frequent in patients with triple-negative breast cancer (TNBC). These patients are often treated with primary systemic chemotherapy. The aim of this study was to analyze the effects of BRCA1/2 mutations on pathologic complete response (pCR) and disease-free survival (DFS) in a cohort of patients with TNBC treated with anthracycline and taxane-containing chemotherapy, with or without bevacizumab. Patients and Methods Germline DNA was sequenced to identify mutations in BRCA1 and BRCA2 in 493 patients with TNBC from the GeparQuinto study. The pCR rates were compared in patients with and without mutation, as well as in patients treated with and without bevacizumab. In addition, the influence of BRCA1/2 mutation status and pCR status on DFS was evaluated relative to treatment. Results BRCA1/2 mutations were detected in 18.3% of patients with TNBC. Overall, patients with mutations had a pCR rate of 50%, compared with 31.5% in patients without a mutation (odds ratio [OR], 2.17; 95% CI, 1.37 to 3.46; P = .001). The pCR rate among patients treated with bevacizumab was 61.5% for BRCA1/2 mutation carriers and 35.6% for those without mutations (OR, 2.90; 95% CI, 1.43 to 5.89; P = .004). pCR was a strong predictor of DFS for patients without BRCA1/2 mutations (hazard ratio, 0.18; 95% CI, 0.11 to 0.31) but not for patients with BRCA1/2 mutations (hazard ratio, 0.74; 95% CI, 0.32 to 1.69). Conclusion The addition of bevacizumab may increase the pCR after standard neoadjuvant chemotherapy for patients with TNBC with BRCA1/2 mutations. In patients treated with anthracycline and taxane-based chemotherapy (with or without bevacizumab), pCR was a weaker predictor of DFS for BRCA1/2 mutation carriers than for patients without mutations.
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Affiliation(s)
- Peter A Fasching
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Sibylle Loibl
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Chunling Hu
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Steven N Hart
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Hermela Shimelis
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Raymond Moore
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Christian Schem
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Hans Tesch
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Michael Untch
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Jörn Hilfrich
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Mahdi Rezai
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Bernd Gerber
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Serban Dan Costa
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Jens-Uwe Blohmer
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Tanja Fehm
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Jens Huober
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Cornelia Liedtke
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Richard M Weinshilboum
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Liewei Wang
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - James N Ingle
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Volkmar Müller
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Valentina Nekljudova
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Karsten E Weber
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Brigitte Rack
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Matthias Rübner
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Gunter von Minckwitz
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Fergus J Couch
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
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Loibl S, Untch M, Burchardi N, Huober JB, Blohmer JU, Grischke EM, Furlanetto J, Tesch H, Hanusch C, Rezai M, Jackisch C, Schmitt WD, Von Minckwitz G, Thomalla J, Kummel S, Rautenberg B, Fasching PA, Rhiem K, Denkert C, Schneeweiss A. Randomized phase II neoadjuvant study (GeparNuevo) to investigate the addition of durvalumab to a taxane-anthracycline containing chemotherapy in triple negative breast cancer (TNBC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.104] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Jens Bodo Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | - Hans Tesch
- Hämatologisch-Onkologische Gemeinschaftspraxis, Frankfurt, Germany
| | | | - Mahdi Rezai
- Breast Center Duesseldorf, Louisen Hospital, Düsseldorf, Germany
| | | | - Wolfgang D Schmitt
- Institut für Pathologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jörg Thomalla
- Praxisklinik fuer Haematologie und Onkologie, Koblenz, Germany
| | | | | | | | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
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Untch M, von Minckwitz G, Gerber B, Schem C, Rezai M, Fasching PA, Tesch H, Eggemann H, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, Loibl S. Survival Analysis After Neoadjuvant Chemotherapy With Trastuzumab or Lapatinib in Patients With Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer in the GeparQuinto (G5) Study (GBG 44). J Clin Oncol 2018. [DOI: 10.1200/jco.2017.75.9175] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose The GeparQuinto phase III trial demonstrated a lower pathologic complete response (pCR; pT0 ypN0) rate when lapatinib was added to standard anthracycline–taxane chemotherapy compared with trastuzumab in patients with human epidermal growth factor receptor 2 (HER2) –positive breast cancer. Here, we report the long-term outcomes. Methods Patients with HER2-positive tumors (n = 615) received neoadjuvant treatment with epirubicin (E) plus cyclophosphamide (C), followed by docetaxel (T) in combination with either lapatinib (L) or trastuzumab (H; ECH-TH arm: n = 307; ECL-TL arm: n = 308). All patients received adjuvant trastuzumab for a total of 12 months and 18 months in the ECH-TH and ECL-TL arms, respectively. Median follow-up was 55 months. Results Three-year disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) were not significantly different between the two treatment arms. Long-term outcomes correlated with pCR (DFS: hazard ratio [HR], 0.63; P = .042; DDFS: HR, 0.55; P = .021; and OS: HR, 0.31; P = .004). A benefit only for OS was observed in patients who were treated with trastuzumab and achieved pCR versus no pCR (HR, 0.15; P = .010), whereas no difference was found in patients with pCR versus without pCR in the lapatinib arm. DFS and DDFS remained unchanged in both treatment arms according to hormone receptor status, whereas OS was significantly better in hormone receptor–positive patients who were treated with neoadjuvant lapatinib (HR, 0.32; P = .019), followed by adjuvant trastuzumab. No difference was observed in hormone receptor–negative patients; however, the small number of events limits this interpretation. Within the hormone receptor–negative cohort, pCR was significantly associated with DFS, DDFS, and OS ( P = .002, .005, and .002, respectively). Conclusion pCR correlated with long-term outcome. In patients with hormone receptor–positive tumors, prolonged anti-HER2 treatment—neoadjuvant lapatinib for 6 months, followed by adjuvant trastuzumab for 12 months—significantly improved survival compared with anti-HER2 treatment with trastuzumab alone.
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Affiliation(s)
- Michael Untch
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Gunter von Minckwitz
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Bernd Gerber
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Christian Schem
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Mahdi Rezai
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Peter A. Fasching
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Hans Tesch
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Holm Eggemann
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Claus Hanusch
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Jens Huober
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Christine Solbach
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Christian Jackisch
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Georg Kunz
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Jens-Uwe Blohmer
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Maik Hauschild
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Tanja Fehm
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Valentina Nekljudova
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
| | - Sibylle Loibl
- Michael Untch, Helios-Klinikum, Berlin-Buch; Jens-Uwe Blohmer, St Gertrauden Krankenhaus, Berlin; Gunter von Minckwitz, Valentina Nekljudova, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Christian Schem, Mammazentrum am Krankenhaus Jerusalem, Hamburg; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Universitäts-Frauenklinik, Düsseldorf; Peter A. Fasching, Universitätsklinikum Erlangen, Erlangen; Hans Tesch, Hämatologisch-Onkologische
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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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Pfitzner BM, Lederer B, Lindner J, Solbach C, Engels K, Rezai M, Dohnal K, Tesch H, Hansmann ML, Salat C, Beer M, Schneeweiss A, Sinn P, Bankfalvi A, Darb-Esfahani S, von Minckwitz G, Sinn BV, Kronenwett R, Weber K, Denkert C, Loibl S. Clinical relevance and concordance of HER2 status in local and central testing-an analysis of 1581 HER2-positive breast carcinomas over 12 years. Mod Pathol 2018; 31:607-615. [PMID: 29271415 DOI: 10.1038/modpathol.2017.171] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/11/2017] [Accepted: 10/14/2017] [Indexed: 01/07/2023]
Abstract
Human epidermal growth factor receptor 2 (HER2) is a central predictive biomarker in breast cancer. Inaccurate HER2 results in different laboratories could be as high as 20%. However, this statement is based on data generated more than 13 years ago and may not reflect the standards of modern diagnostic pathology. We compared central and local HER2 testing in a total of 1581 HER2-positive tumors from five clinical trials. We evaluated the clinical relevance for pathological complete response (pCR) and disease-free survival in a subgroup of 677 tumors, which received an anti-HER2 therapy. Over the period of 12 years, the discordance rate for HER2 decreased from 52.4 (GeparTrio) to 8.4% (GeparSepto). Discordance rates were significantly higher in hormone receptor (HR)-positive tumors (26.6%), compared to HR-negative tumors (16.3%, P<0.0001), which could be explained by a different distribution of HER2 mRNA levels in HR-positive and HR-negative tumors. pCR rates were significantly lower in discordant tumors (13.7%) compared to concordant tumors (32.2%, GeparQuattro and GeparQuinto, P<0.001). In survival analysis, tumors with discordant HER2 testing had a reduced overall survival (OS) in the HR-negative group (P=0.019) and a trend for improved OS in the HR-positive group (P=0.125). The performance of local HER2 testing was considerably improved over time and has reached a 92% concordance, which shows that quality initiatives in diagnostic pathology are working. Tumors with discordant HER2 testing had a reduced therapy response and different survival rates.
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Affiliation(s)
- Berit M Pfitzner
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Judith Lindner
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Knut Engels
- Center of Pathology, Cytology and Molecular Pathology Neuss, Neuss, Germany
| | - Mahdi Rezai
- European Breast Center, Luisen Hospital, Düsseldorf, Germany
| | - Karel Dohnal
- Center of Pathology and Cytology Düsseldorf, Düsseldorf, Germany
| | - Hans Tesch
- Oncology Bethanien, Frankfurt/Main, Germany
| | - Martin L Hansmann
- Institute of Pathology, University Hospital Frankfurt, Frankfurt/ Main, Germany
| | | | | | - Andreas Schneeweiss
- Division Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Sinn
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Agnes Bankfalvi
- Institute of Pathology Essen, University Hospital Essen, Essen, Germany
| | - Silvia Darb-Esfahani
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Institute of Pathology Spandau, Berlin, Germany
| | - Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, Germany.,University Women's Hospital Frankfurt, Frankfurt/ Main, Germany
| | - Bruno V Sinn
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Carsten Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany.,Gynecological Hospital Sana Klinikum Offenbach, Offenbach, Germany
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Schochter F, Rack B, Tzschaschel M, Polasik A, Andergassen U, Trapp E, Alunni-Fabbroni M, Schneeweiss A, Müller V, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Soeling U, Fehm T, Mahner S, Schindlbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W, Friedl TW. Endocrine Treatment with 2 Years of Tamoxifen versus 2 Years of Exemestane in Postmenopausal Patients with High-Risk Early Breast Cancer and Persisting Circulating Tumor Cells - First Results of the SUCCESS C Endocrine Treatment Sub-Study. Oncol Res Treat 2018; 41:93-98. [DOI: 10.1159/000485566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/22/2017] [Indexed: 11/19/2022]
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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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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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Rezai M, Mahshidfar B, Motaghed F, Nateghi M, Farsi D, Abbasi S, Mofìdi M, Hafezimoghadam P. Evaluation of changes in the types of drugs administered by various treatment services in Emergency Department. J Acute Dis 2018. [DOI: 10.4103/2221-6189.241018] [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: 11/04/2022] Open
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48
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Abbasi S, Shaker H, Zareiee F, Farsi D, Hafezimoghadam P, Rezai M, Mahshidfar B, Mofidi M. Screening performance of Ultrasonographic B-lines in Detection of Lung Contusion following Blunt Trauma; a Diagnostic Accuracy Study. Emerg (Tehran) 2018; 6:e55. [PMID: 30584571 PMCID: PMC6289153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Chest ultrasonography is routinely used in evaluation of chest trauma for diagnosis of pulmonary injury. This study aimed to evaluate the accuracy of B-Lines for diagnosing lung contusion in patients with blunt trauma of the chest. METHODS Trauma patients who met the inclusion criteria were enrolled in the study and underwent ultrasonography by trained emergency medicine residents. Ultrasound results were recorded in terms of number of B-lines and the existence of peripheral parenchymal lesion (PPL). After ultrasound, the patient underwent chest x-ray and chest CT scan (as reference test) and screening performance of B-lines and PPL were evaluated. RESULTS 147 patients underwent chest ultrasound. The mean age of the patients was 40.74 ± 18.6 (78.9% male). B-lines˃3 had 94.0% (95% CI: 83.45-98.75) sensitivity and 57.7% (95% CI: 47.3-67.7) specificity, B-lines˃6 had 90.0% (95% CI: 78.2-96.7) sensitivity and 93.81% (95% CI: 87.0-97.7) specificity, and PPL had 34.0% (95% CI: 21.2-48.8) sensitivity and 100% (95% CI: 96.3-100.0) specificity. Composite findings of B-lines˃6 + PPL had 92.0% (95% CI: 80.8-97. 8) sensitivity and 93.8% (95% CI: 87.0-97.7) specificity in the diagnosis of lung contusion. CONCLUSION PPL and B-Lines˃6 had the highest accuracy in detecting lung contusion. B-Line˃6 had high sensitivity and specificity and was easy to perform; thus, it seems that B-Line˃6 could be considered as an alternative screening tool in detection of lung contusion.
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Affiliation(s)
- Saeed Abbasi
- Emergency medicine management research center, Iran University of Medical Sciences, Rasoul Akram Hospital, Tehran, Iran
| | - Hossein Shaker
- Emergency medicine management research center, Iran University of Medical Sciences, Rasoul Akram Hospital, Tehran, Iran
| | - Fariba Zareiee
- Emergency medicine management research center, Iran University of Medical Sciences, Rasoul Akram Hospital, Tehran, Iran
| | - Davood Farsi
- Emergency medicine management research center, Iran University of Medical Sciences, Rasoul Akram Hospital, Tehran, Iran
| | - Peyman Hafezimoghadam
- Emergency medicine management research center, Iran University of Medical Sciences, Rasoul Akram Hospital, Tehran, Iran
| | - Mahdi Rezai
- Emergency medicine management research center, Iran University of Medical Sciences, Rasoul Akram Hospital, Tehran, Iran
| | - Babak Mahshidfar
- Emergency medicine management research center, Iran University of Medical Sciences, Rasoul Akram Hospital, Tehran, Iran
| | - Mani Mofidi
- Emergency medicine management research center, Iran University of Medical Sciences, Rasoul Akram Hospital, Tehran, Iran ,Corresponding author: Mani Mofidi; Emergency medicine management research center, Rasoul Akram Hospital, Tehran, Iran.
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Mahshidfar B, Mofidi M, Fattahi M, Farsi D, Hafezi Moghadam P, Abbasi S, Rezai M. Acute Pain Management in Emergency Department, Low Dose Ketamine Versus Morphine, A Randomized Clinical Trial. Anesth Pain Med 2017; 7:e60561. [PMID: 29696126 PMCID: PMC5903386 DOI: 10.5812/aapm.60561] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 10/16/2017] [Accepted: 11/29/2017] [Indexed: 11/21/2022] Open
Abstract
Background Ketamine, as an opium alternative, has been proposed for pain relief in the emergency department (ED). Objectives This study was carried out to compare low dose ketamine (LDK) with morphine for pain relief in trauma patients. Methods In this randomized double-blinded clinical trial, 300 trauma patients from the ED of 2 teaching hospitals in Tehran, Iran were enrolled and randomly divided into 2 equal groups. The 1st group received 0.2 mg/kg of ketamine while the 2nd group received 0.1 mg/kg of intravenous morphine. The pain intensity and complications were measured and compared every 15 minutes to 1 hour. Results Fifteen minutes after drug injection in both groups, a significant reduction was found in average pain intensity compared to the initial pain (P = 0.01). At 15 minutes, no significant difference was found in both groups in regards to average pain intensity (P = 0.23). The average pain intensity at 30, 45, and 60 minutes in the group receiving morphine was lower than the ketamine group (P = 0.01, P < 0.001, P < 0.001 respectively). Two complications (drop in O2 saturation below 90% and flushing) were significantly greater in the morphine group. Conclusions The results of this study suggest that LDK, at a dose of 0.2 mg/kg, in the earlier minutes leads to significant reduction of pain when compared to that of intravenous morphine. It also created fewer complications than morphine.
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Affiliation(s)
- Babak Mahshidfar
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
- Corresponding author: Babak Mahshidfar, Assistant Professor of Emergency Medicine, Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran. Tel: +98-9122508170, E-mail:
| | - Mani Mofidi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Maryam Fattahi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Davood Farsi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Peyman Hafezi Moghadam
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Saeed Abbasi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
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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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