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Wolff J, Seidel S, Wuelfing P, Lux MP, zu Eulenburg C, Smollich M, Baumann F, Seitz S, Kuemmel S, Thill M, Tio J, Braun M, Hollaender H, Seitz A, Horn F, Harbeck N, Wuerstlein R. App-based support for breast cancer patients to reduce psychological distress during therapy and survivorship - a multicentric randomized controlled trial. Front Oncol 2024; 14:1354377. [PMID: 38699636 PMCID: PMC11064693 DOI: 10.3389/fonc.2024.1354377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction The negative impact of unmanaged psychological distress on quality of life and outcome in breast cancer survivors has been demonstrated. Fortunately, studies indicate that distress can effectively be addressed and even prevented using evidence-based interventions. In Germany prescription-based mobile health apps, known as DiGAs (digital health applications), that are fully reimbursed by health insurances, were introduced in 2020. In this study, the effectiveness of an approved breast cancer DiGA was investigated: The personalized coaching app PINK! Coach supports and accompanies breast cancer patients during therapy and follow-up. Methods PINK! Coach was specifically designed for breast cancer (BC) patients from the day of diagnosis to the time of Follow-up (aftercare). The app offers individualized, evidence-based therapy and side-effect management, mindfulness-based stress reduction, nutritional and psychological education, physical activity tracking, and motivational exercises to implement lifestyle changes sustainably in daily routine. A prospective, intraindividual RCT (DRKS00028699) was performed with n = 434 patients recruited in 7 German breast cancer centers from September 2022 until January 2023. Patients with BC were included independent of their stage of diseases, type of therapy and molecular characteristics of the tumor. Patients were randomized into one of two groups: The intervention group got access to PINK! over 12 weeks; the control group served as a waiting-list comparison to "standard of care." The primary endpoint was psychological distress objectified by means of Patient Health Questionnaire-9 (PHQ-9). Subgroups were defined to investigate the app's effect on several patient groups such as MBC vs. EBC patients, patients on therapy vs. in aftercare, patients who received a chemotherapy vs. patients who did not. Results Efficacy analysis of the primary endpoint revealed a significant reduction in psychological distress (least squares estimate -1.62, 95% confidence interval [1.03; 2.21]; p<0.001) among intervention group patients from baseline to T3 vs, control group. Subgroup analysis also suggested improvements across all clinical situations. Conclusion Patients with breast cancer suffer from psychological problems including anxiety and depression during and after therapy. Personalized, supportive care with the app PINK! Coach turned out as a promising opportunity to significantly improve psychological distress in a convenient, accessible, and low-threshold manner for breast cancer patients independent of their stage of disease (EBC/MBC), therapy phase (aftercare or therapy) or therapy itself (chemotherapy/other therapy options). The app is routinely available in Germany as a DiGA. Clinical Trial Registration: DRKS Trial Registry (DRKS00028699).
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Affiliation(s)
- Josefine Wolff
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Ludwig-Maximilian University Munich (LMU) University Hospital, Munich, Germany
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Svenja Seidel
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Pia Wuelfing
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Michael Patrick Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise and St. Josefs-Krankenhaus, St. Vincenz Klinik GmbH, Paderborn, Germany
| | - Christine zu Eulenburg
- Department for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Smollich
- Institute of Nutritional Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Freerk Baumann
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | | | - Marc Thill
- Markus Hospital, Breast Center, Frankfurt, Germany
| | - Joke Tio
- Department of Gynecology and Obstetrics, University Hospital of Münster, Münster, Germany
| | - Michael Braun
- Department of Gynecology, Breast Center, Red Cross Hospital, Munich, Germany
| | - Hannah Hollaender
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Ludwig-Maximilian University Munich (LMU) University Hospital, Munich, Germany
| | - Angenla Seitz
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Felicitas Horn
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Ludwig-Maximilian University Munich (LMU) University Hospital, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Ludwig-Maximilian University Munich (LMU) University Hospital, Munich, Germany
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Lux MP, Minartz C, Müller-Huesmann H, Sandor MF, Radeck-Knorre S, Neubauer AS. Budget Impact of the Oncotype DX Breast Recurrence Score ® Test in Patients with Early Primary Hormone-Receptor-Positive, HER2-Negative, Node-Positive Breast Cancer in Germany. Breast Care (Basel) 2024; 19:27-33. [PMID: 38384494 PMCID: PMC10878704 DOI: 10.1159/000534096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/11/2023] [Indexed: 02/23/2024] Open
Abstract
Background Gene expression tests can inform decisions on whether to recommend or omit chemotherapy for patients with early HR+, HER2- breast cancer. The benefit of these tests is well established and fully reimbursed by sickness funds for lymph node-negative (pN0) patients in Germany. A budget impact model was built to evaluate the effect of using the Oncotype DX Breast Recurrence Score® test also for node-positive (pN1: 1-3 positive lymph nodes) patients. Methods The prospective randomized clinical trial, RxPONDER, defined conditions (Recurrence Score result 0-25 for postmenopausal patients with 1-3 positive lymph nodes) under which omitting chemotherapy does not significantly impact invasive disease-free survival with results currently reported for 5-year follow-up. The present budget impact model calculates average total cost per node-positive patient versus no testing from a sickness funds perspective, taking into account not only the budgetary impact of avoiding chemotherapy and associated side effects, but also the costs of treating those patients who develop distant metastasis. The stability of the results was investigated by probabilistic multivariate sensitivity analysis. Results After deducting testing cost, applying the Oncotype DX Breast Recurrence Score test yielded an average savings per node-positive patient of EUR 4,272. Without the test costs, the greatest savings resulted from reductions in direct treatment costs and costs arising from the treatment of chemotherapy-related side effects, which together averaged EUR 6,677. The targeted use of chemotherapy after testing also resulted in slightly lower costs for treatment of distant metastasis, if it did occur. The multivariate sensitivity analysis also almost exclusively resulted in cost savings. Conclusion Analogous to the pN0 situation, this budget impact model demonstrates that the Oncotype DX Breast Recurrence Score test can also reduce healthcare costs in Germany in treatment of node-positive (pN1: 1-3 positive lymph nodes) patients by minimizing both unnecessary chemotherapy and undertreatment. Additional benefits to patients would include reduced morbidity and improved quality of life for those patients who can safely avoid chemotherapy or undertreatment.
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Affiliation(s)
- Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Frauenklinik St. Louise, Paderborn, Frauenklinik St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Kliniken, Paderborn, Germany
| | - Christof Minartz
- Institute for Health- and Pharmacoeconomics (IfGPh), Munich, Germany
| | - Harald Müller-Huesmann
- Kooperatives Brustzentrum Paderborn, Klinik für Hämatologie und Onkologie, Brüderkrankenhaus St. Josef, MVZ im MediCo, Paderborn, Germany
| | - Marianar Felicia Sandor
- Kooperatives Brustzentrum Paderborn, Frauenklinik St. Louise, Paderborn, Frauenklinik St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Kliniken, Paderborn, Germany
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Park-Simon TW, Müller V, Jackisch C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Ditsch N, Fallenberg EM, Fasching PA, Fehm T, Friedrich M, Gerber B, Gluz O, Harbeck N, Hartkopf AD, Heil J, Huober J, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Wuerstlein R, Janni W, Thill M. Arbeitsgemeinschaft Gynäkologische Onkologie Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2023. Breast Care (Basel) 2023; 18:289-305. [PMID: 37900552 PMCID: PMC10601667 DOI: 10.1159/000531578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 10/31/2023] Open
Abstract
Background Each year the interdisciplinary Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), German Gynecological Oncology Group Breast Committee on Diagnosis and Treatment of Breast Cancer provides updated state-of-the-art recommendations for early and metastatic breast cancer. Summary The updated evidence-based treatment recommendation for early and metastatic breast cancer has been released in March 2023. Key Messages This paper concisely captures the updated recommendations for early breast cancer chapter by chapter.
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Affiliation(s)
- Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie und Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Klinik für Gynäkologie und Geburtshilfe, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Eva Maria Fallenberg
- Institut für diagnostische und Interventionelle Radiologie, Klinikum der Technischen Universität München, Rechts der Isar, Munich, Germany
| | - Peter A. Fasching
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld GmbH, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Andreas D. Hartkopf
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Joerg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth und Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Cornelia Kolberg-Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Phaon GmbH, Wiesbaden, Germany
| | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz (Buckow) & Immanuel Klinik Rüdersdorf/Medizinische Hochschule Brandenburg Theodor Fontane (Rüdersdorf), Rüdersdorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Centrum für Integrierte Onkologie (CIO), Universitätsklinikum Köln, Cologne, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Zurich, University of Zurich, Zurich, Switzerland
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Rachel Wuerstlein
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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Thill M, Kolberg-Liedtke C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Ditsch N, Fallenberg EM, Fasching PA, Fehm T, Friedrich M, Gerber B, Gluz O, Harbeck N, Hartkopf AD, Heil J, Huober J, Jackisch C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Müller V, Würstlein R, Janni W, Park-Simon TW. AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2023. Breast Care (Basel) 2023; 18:306-315. [PMID: 37900553 PMCID: PMC10601669 DOI: 10.1159/000531579] [Citation(s) in RCA: 2] [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: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 10/31/2023] Open
Abstract
The Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO) presents the 2023 update of the evidence-based recommendations for the diagnosis and treatment of patients with locally advanced and metastatic breast cancer (mBC).
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Affiliation(s)
- Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | | | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Eva Maria Fallenberg
- Institut für Klinische Radiologie, Klinikum der Universität München Campus Großhadern, Munich, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang, Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Andreas D. Hartkopf
- Department für Frauengesundheit, Forschungsinstitut für Frauengesundheit, Universitätsfrauenklinik, Tübingen, Germany
| | - Jörg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Fachklinik für Onkologische Rehabilitation, Immanuel Hospital Märkische Schweiz, Buckow & Immanuel Hospital Rüdersdorf/Medical University of Brandenburg Theodor Fontane, Rüdersdorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik für Gynäkologie, Universitäts Spital, Zürich, Switzerland
| | - Achim Wöckel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Rachel Würstlein
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Wolfgang Janni
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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Krawczyk N, Ruckhäberle E, Lux MP, Fehm T, Greiling M, Osygus M. Is the (Neo)adjuvant Therapy of Patients with Primary HER2-positive Breast Cancer Cost-Covering?: Process Cost Analysis of Neoadjuvant and Post-Neoadjuvant Systemic Therapy of Patients with Primary HER2-positive Breast Cancer. Geburtshilfe Frauenheilkd 2023; 83:321-332. [PMID: 36908284 PMCID: PMC9998176 DOI: 10.1055/a-1921-9336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/08/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction HER2 positivity is one of the most important predictive factors in the treatment of breast cancer patients. Thanks to new targeted anti-HER2 drugs, the prognosis for HER2-positive breast cancer patients has been significantly improved, and the treatment can now be designed according to the risk situation and the response to treatment. At the same time, these innovative targeted anti-HER2 drugs are associated with high costs and require long and involved patient care. Materials and Methods In this paper, we compare the treatment costs of three post-neoadjuvant treatment regimens (trastuzumab vs. trastuzumab/pertuzumab vs. T-DM1) in early stage HER2-positive breast cancer from the perspective of the oncological outpatient clinic of a certified breast center at a university hospital, and evaluate the cost coverage. Results The highest costs in systemic therapy were the material costs. These were the highest for dual blockade with trastuzumab/pertuzumab, followed by T-DM1 and trastuzumab monotherapy. According to our study, all three of these post-neoadjuvant therapy variants achieve a positive contribution margin. While all three models have similar contribution margins, the treatment pathway with T-DM1 is associated with a 30% lower contribution margin. Conclusions Although these model calculations are associated with limitations in view of the introduction of biosimilar antibodies, it can be shown that modern therapeutic approaches do not always have to be associated with lower profits.
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Affiliation(s)
- Natalia Krawczyk
- Klinik für Frauenheilkunde und Geburtshilfe der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Eugen Ruckhäberle
- Klinik für Frauenheilkunde und Geburtshilfe der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Frauen- und Kinderklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Paderborn, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Michael Greiling
- Institut für Workflow-Management im Gesundheitswesen (IWiG), c/o Europäische Fachhochschule - University of Applied Sciences - Hochschule für Gesundheit, Soziales und Pädagogik, Rheine, Germany
| | - Michael Osygus
- Institut für Workflow-Management im Gesundheitswesen (IWiG), c/o Europäische Fachhochschule - University of Applied Sciences - Hochschule für Gesundheit, Soziales und Pädagogik, Rheine, Germany
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Banys-Paluchowski M, Kühn T, Masannat Y, Rubio I, de Boniface J, Ditsch N, Karadeniz Cakmak G, Karakatsanis A, Dave R, Hahn M, Potter S, Kothari A, Gentilini OD, Gulluoglu BM, Lux MP, Smidt M, Weber WP, Aktas Sezen B, Krawczyk N, Hartmann S, Di Micco R, Nietz S, Malherbe F, Cabioglu N, Canturk NZ, Gasparri ML, Murawa D, Harvey J. Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411). Cancers (Basel) 2023; 15:cancers15041173. [PMID: 36831516 PMCID: PMC9954476 DOI: 10.3390/cancers15041173] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Surgical excision of a non-palpable breast lesion requires a localization step. Among available techniques, wire-guided localization (WGL) is most commonly used. Other techniques (radioactive, magnetic, radar or radiofrequency-based, and intraoperative ultrasound) have been developed in the last two decades with the aim of improving outcomes and logistics. METHODS We performed a systematic review on localization techniques for non-palpable breast cancer. RESULTS For most techniques, oncological outcomes such as lesion identification and clear margin rate seem either comparable with or better than for WGL, but evidence is limited to small cohort studies for some of the devices. Intraoperative ultrasound is associated with significantly higher negative margin rates in meta-analyses of randomized clinical trials (RCTs). Radioactive techniques were studied in several RCTs and are non-inferior to WGL. Smaller studies show higher patient preference towards wire-free localization, but little is known about surgeons' and radiologists' attitudes towards these techniques. CONCLUSIONS Large studies with an additional focus on patient, surgeon, and radiologist preference are necessary. This review aims to present the rationale for the MELODY (NCT05559411) study and to enable standardization of outcome measures for future studies.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
- Correspondence:
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Die Filderklinik, 70794 Filderstadt, Germany
| | - Yazan Masannat
- Aberdeen Breast Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Isabel Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, 28027 Madrid, Spain
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Surgery, Capio St. Göran’s Hospital, 11219 Stockholm, Sweden
| | - Nina Ditsch
- Breast Cancer Center, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Güldeniz Karadeniz Cakmak
- Breast and Endocrine Unit, General Surgery Department, Zonguldak BEUN The School of Medicine, Kozlu/Zonguldak 67600, Turkey
| | - Andreas Karakatsanis
- Department for Surgical Sciences, Faculty of Pharmacy and Medicine, Uppsala University, 75236 Uppsala, Sweden
- Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, 75236 Uppsala, Sweden
| | - Rajiv Dave
- Nightingale & Genesis Breast Cancer Prevention Centre, Manchester University NHS Foundation Trust, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Markus Hahn
- Department for Women’s Health, University of Tübingen, 72076 Tübingen, Germany
| | - Shelley Potter
- Bristol Medical School (THS), Bristol Population Health Science Institute, Bristol BS8 1QU, UK
| | - Ashutosh Kothari
- Guy’s & St Thomas NHS Foundation Trust, Kings College, London SE1 9RT, UK
| | - Oreste Davide Gentilini
- Department of Breast Surgery, San Raffaele University and Research Hospital, 20132 Milan, Italy
| | - Bahadir M. Gulluoglu
- Department of Surgery, Breast Surgery Unit, Marmara University School of Medicine and SENATURK Turkish Academy of Senology, Istanbul 34854, Turkey
| | - Michael Patrick Lux
- Department of Gynecology and Obstetrics, St. Louise Frauen-und Kinderklinik, 33098 Paderborn, Germany
| | - Marjolein Smidt
- Department of Surgical Oncology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Walter Paul Weber
- Division of Breast Surgery, Department of Surgery, Basel University Hospital, 4031 Basel, Switzerland
| | - Bilge Aktas Sezen
- European Breast Cancer Research Association of Surgical Trialists (EUBREAST), 73730 Esslingen, Germany
| | - Natalia Krawczyk
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Steffi Hartmann
- Department of Gynecology and Obstetrics, University Hospital Rostock, 18059 Rostock, Germany
| | - Rosa Di Micco
- Department of Breast Surgery, San Raffaele University and Research Hospital, 20132 Milan, Italy
| | - Sarah Nietz
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Francois Malherbe
- Breast and Endocrine Surgery Unit, Groote Schuur Hospital, University of Cape Town, Cape Town 7935, South Africa
| | - Neslihan Cabioglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul 34093, Turkey
| | - Nuh Zafer Canturk
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli 41001, Turkey
| | - Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, 6900 Lugano, Switzerland
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale, Via Pietro Capelli 1, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Via Giuseppe Buffi 13, 6900 Lugano, Switzerland
| | - Dawid Murawa
- General Surgery and Surgical Oncology Department, Collegium Medicum, University in Zielona Gora, 65-417 Zielona Góra, Poland
| | - James Harvey
- Nightingale & Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester M13 9PL, UK
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Mahtani R, Niyazov A, Arondekar B, Lewis K, Rider A, Massey L, Lux MP. Real-world patient-reported outcomes and physician satisfaction with poly (ADP-ribose) polymerase inhibitors versus chemotherapy in patients with germline BRCA1/2-mutated human epidermal growth factor receptor 2-negative advanced breast cancer from the United States, Europe, and Israel. BMC Cancer 2022; 22:1343. [PMID: 36550413 PMCID: PMC9773591 DOI: 10.1186/s12885-022-10325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In clinical trials, poly (ADP-ribose) polymerase inhibitors (PARPi) versus chemotherapy resulted in significantly improved progression-free survival, manageable adverse event profiles, and favorable patient-reported outcomes (PROs) in patients with human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) and germline BRCA1/2 mutations (gBRCA1/2mut). The objective of this study was to evaluate PROs and physician satisfaction with treatment in patients with gBRCA1/2mut HER2- ABC receiving PARPi or physician's choice of chemotherapy in a multi-country, real-world setting. METHODS This retrospective analysis used data from the Adelphi Real World ABC Disease Specific Programmes in the United States, European Union, and Israel. PROs were assessed at a single timepoint using the EuroQol 5-Dimensions 5-Level (EQ-5D-5L) scale, Cancer Therapy Satisfaction Questionnaire (CTSQ), and European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 (EORTC QLQ-C30) and the breast cancer-specific module (QLQ-BR23). Baseline PROs were not assessed. Physician satisfaction with treatment scores was dichotomized to a 0/1 variable (0 = very dissatisfied/dissatisfied/moderately satisfied; 1 = satisfied/very satisfied). Scores were compared using inverse-probability-weighted regression adjustment, controlling for multiple confounding factors. RESULTS The study included 96 patients (PARPi, n = 38; platinum/non-platinum-based chemotherapy, n = 58). Patients receiving PARPi versus chemotherapy reported significantly better scores on the EQ-5D-5L Health Utility Index. On the EORTC QLQ-C30 functional scales, patients receiving PARPi reported significantly better scores (mean ± SE) for physical functioning (80.0 ± 2.4 vs 71.9 ± 3.4; p < 0.05) and social functioning (82.0 ± 6.2 vs 63.6 ± 3.7; p < 0.05) and, on the symptom scales, reported significantly better scores for constipation (1.9 ± 1.8 vs 18.7 ± 3.2; p < 0.001), breast symptoms (0.4 ± 3.9 vs 13.3 ± 2.6; p < 0.01), arm symptoms (2.6 ± 1.3 vs 11.4 ± 2.4; p = 0.001), and systemic therapy side effects (13.5 ± 1.8 vs 29.4 ± 2.3; p < 0.001). In contrast, patients receiving chemotherapy scored significantly better on the nausea/vomiting scale (18.3 ± 2.8 vs 34.5 ± 5.1; p < 0.01). Patients receiving PARPi reported numerically better satisfaction scores on the CTSQ scales. Physicians were more likely to be satisfied/very satisfied with PARPi versus chemotherapy (95.4% ± 7.3% vs 40.8% ± 6.2%; p < 0.001). CONCLUSIONS The PRO findings in this real-world population of patients with gBRCA1/2mut HER2- ABC complement those from the pivotal clinical trials, providing further support for treatment with PARPi in these patients.
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Affiliation(s)
- Reshma Mahtani
- grid.418212.c0000 0004 0465 0852Miami Cancer Institute, 1228 S Pine Island Road, Plantation, Miami, FL 33324 USA
| | - Alexander Niyazov
- grid.410513.20000 0000 8800 7493Pfizer Inc, 235 42nd St, New York, NY 10017 USA
| | - Bhakti Arondekar
- grid.410513.20000 0000 8800 7493Pfizer Inc, 500 Arcola Road, Collegeville, PA 19426 USA
| | - Katie Lewis
- Adelphi Real World, Adelphi Mill, Cheshire, Bollington, SK10 5JB UK
| | - Alex Rider
- Adelphi Real World, Adelphi Mill, Cheshire, Bollington, SK10 5JB UK
| | - Lucy Massey
- Adelphi Real World, Adelphi Mill, Cheshire, Bollington, SK10 5JB UK
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, Salzkotten Husener Straße 81, 33098 Paderborn, Germany
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Messinger D, Bleß HH, Haidinger R, Schumacher-Wulf E, Lux MP. Use of prognostic gene expression profiling tests in primary breast cancer treatment: a German real-world patient survey. Future Oncol 2022; 18:4371-4383. [PMID: 36656171 DOI: 10.2217/fon-2022-0354] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aims: In primary breast cancer, gene expression profiling tests can support adjuvant chemotherapy treatment decisions. Real-world test use in Germany was investigated in an online survey of female breast cancer patients (n = 475). Materials & methods: Relationships between three groups were examined for clinical and statistical relevance: no test indication (n = 353), test indication and tested (n = 65), and test indication but not tested (n = 57). Results: A total of 47% of participants with a test indication were not tested. Test rates increased by 23% from 2012-2018 (49%) to 2019-2021 (60%). A total of 65% of patients without testing received chemotherapy, whereas only 38% of tested patients received chemotherapy. Conclusion: The use of gene expression profiling tests correlates with a real-world chemotherapy reduction. Gene expression profiling testing may improve patient confidence in the decision for or against chemotherapy.
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Affiliation(s)
| | | | | | | | - Michael Patrick Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauen- und Kinderklinik St. Louise, Paderborn, 33098, Germany
- Klinik für Gynäkologie und Geburtshilfe, St. Josefs-Krankenhaus, Salzkotten, 33154, Germany
- Klinik für Gynäkologie und Geburtshilfe, St. Vincenz Krankenhaus GmbH, Paderborn, 33098, Germany
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Lux MP, Runkel ED, Glastetter E, Vannier C, Buncke J, Frank M, Bartsch R, Thill M, Wöckel A. PERFORM: a non-interventional study assessing the patients' treatment starting with 1L palbociclib in HR+/HER2- ABC. Future Oncol 2022; 18:3971-3982. [PMID: 36427183 DOI: 10.2217/fon-2022-0552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The prospective, non-interventional PERFORM study describes and analyzes the effectiveness of palbociclib in combination with endocrine therapy (aromatase inhibitor or fulvestrant) as first-line treatment for patients with locally advanced or metastatic HR+/HER2- breast cancer in the real-world setting in Germany and Austria. PERFORM will reflect current patient characteristics and routine treatment patterns including treatment sequences and time to subsequent (chemo)therapy. Besides, second-line treatment effectiveness and patient-relevant end points such as longitudinal patient-reported outcome measurements beyond disease progression will be analyzed. Accounting for the heterogenous real-world patient population, data on clinicopathologic subgroups underrepresented in clinical trials such as elderly or male will be analyzed. Taken together, PERFORM will close knowledge gaps from clinical trials in real world.
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Affiliation(s)
- Michael Patrick Lux
- Department for Gynecology & Obstetrics, Frauen- und Kinderklinik St Louise, Husener Str. 81, Paderborn, 33098, Germany
| | | | | | | | - Johanna Buncke
- Pfizer Deutschland GmbH, Linkstr. 10, Berlin, 10785, Germany
| | - Melanie Frank
- iOMEDICO, Ellen-Gottlieb-Str. 19, Freiburg, 79106, Germany
| | - Rupert Bartsch
- Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Marc Thill
- Department of Gynecology & Gynecological Oncology, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, Frankfurt am Main, 60431, Germany
| | - Achim Wöckel
- University Hospital Würzburg, Josef-Schneider-Str. 4, Würzburg, 97080, Germany
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Mahtani R, Niyazov A, Arondekar B, Lewis K, Rider A, Massey L, Lux MP. Real-world study of patients with germline BRCA1/2-mutated human epidermal growth factor receptor 2‒Negative advanced breast cancer: Patient demographics, treatment patterns, adverse events, and physician-reported satisfaction in the United States, Europe, and Israel. Breast 2022; 66:236-244. [PMID: 36368161 PMCID: PMC9650077 DOI: 10.1016/j.breast.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Current guidelines for the treatment of human epidermal growth factor receptor 2‒negative (HER2-) advanced breast cancer (ABC) are informed by tumor characteristics and include platinum- and non-platinum-based chemotherapy, chemotherapy plus immunotherapy, endocrine monotherapy, or endocrine therapy plus a targeted therapy. In addition, poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPi) have recently demonstrated improved clinical and patient-reported outcomes and manageable toxicity profiles compared with chemotherapy in patients with germline breast cancer susceptibility gene 1 or 2 (gBRCA1/2)‒mutated HER2- ABC in clinical trials and are now approved to treat this patient population. This study provides complementary real-world data regarding treatment patterns, adverse events, and physician-reported treatment satisfaction in this population. METHODS This retrospective analysis using the Adelphi Real World ABC Disease Specific Programme in the United States, European Union, and Israel included patients aged ≥18 years receiving therapy for stage IIIb or IV gBRCA1/2-mutated HER2- ABC. Oncologists completed a patient record form detailing patient demographics, clinical assessments, and treatment history and a survey regarding their use of and satisfaction with treatments. RESULTS Among the 543 patients, mean age was 55 years, 25% were premenopausal, 70% had hormone receptor‒positive (HR+) ABC, and 30% had triple-negative breast cancer (TNBC). PARPi were used in 5%, 11%, and 12% of first-line, second-line, and third-line therapies, respectively, for patients with HR+ ABC; for TNBC, percentages were 18%, 44%, and 36%. Across treatment lines, neutropenia, anemia, and nausea occurred in 16%, 24%, and 32% of patients receiving PARPi, respectively; 22%, 38%, and 33% of patients receiving platinum chemotherapy; and 20%, 20%, and 33% of patients receiving non-platinum-based chemotherapy. Physician satisfaction was highest with PARPi and with chemotherapy plus immunotherapy. CONCLUSIONS Findings in this real-world population complement clinical trial observations and provide further support for treatment of patients with PARPi in gBRCA1/2-mutated HER2- ABC.
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Affiliation(s)
- Reshma Mahtani
- Miami Cancer Institute, 1228 S Pine Island Road, Plantation, FL, 33324, USA,Corresponding author.
| | | | | | - Katie Lewis
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK
| | - Alex Rider
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK
| | - Lucy Massey
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Frauenklinik St. Louise, Paderborn, Frauenklinik St. Josefs, Salzkotten Husener Straße 81, 33098, Paderborn, Germany
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Lux MP, Lewis K, Rider A, Niyazov A. Treatment Patterns, Safety, and Patient Reported Outcomes among Adult Women with Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer with or without, or with Unknown, BRCA1/2 Mutation(s): Results of a Real-World Study from the United States, United Kingdom, and four EU Countries. Breast Care (Basel) 2022; 17:460-469. [PMID: 36684399 PMCID: PMC9851071 DOI: 10.1159/000523970] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/05/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction This real-world study assessed the breast cancer susceptibility gene 1 or 2 mutation (BRCA1/2mut) status on treatment patterns, safety, and patient-reported outcomes (PROs) in women with human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) in the USA, the UK, and EU4 countries. Methods Oncologists abstracted data from medical charts of adult women who presented with HER2- ABC from February to May 2015 and from March to July 2017. Data were collected using a physician-reported form and a patient-reported form, which included questions on breast cancer history/treatment and questions from PRO instruments (EuroQol 5-Dimensions 3-Levels [EQ-5D-3L], Brief Pain Inventory [BPI], European Organisation for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire Core 30 and its breast cancer module). Results In total, 742 oncologists provided data for 6,161 patients; 27.5% were tested for BRCA1/2mut. Out of the total patient population, 3.8% had BRCA1/2mut, 16.6% BRCA1/2 wild-type (BRCA1/2wt), and 79.5% were BRCA1/2 unknown (BRCA1/2unk). Hormone receptor-positive (HR+)/HER2- ABC was more frequent within the BRCA1/2wt versus BRCA1/2mut group and triple-negative breast cancer (TNBC) within the BRCA1/2mut versus BRCA1/2wt group. More patients with HR+/HER2- ABC with BRCA1/2mut received chemotherapy (with or without targeted or endocrine therapy) versus BRCA1/2wt (66.0% vs. 50.4%; p < 0.01); more patients had ≥1 AE (58.0% vs. 39.1%; p < 0.001). Among patients with BRCA1/2mut versus BRCA1/2wt, a significantly higher proportion had some problems or worse pain discomfort (p = 0.021) and anxiety/depression (p = 0.007) as measured by the EQ-5D-3L; role functioning (p < 0.01) and dyspnea (p < 0.05) measured by EORTC were worse with BRCA1/2mut. Pain scores by BPI were similar between groups. Conclusions In patients with HER2- ABC in the real-world setting, more patients with BRCA1/2mut had TNBC; received chemotherapy; had >1 AE; and experienced increased discomfort, anxiety, and dyspnea and diminished role functioning versus patients with BRCA1/2wt.
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Affiliation(s)
- Michael Patrick Lux
- aKooperatives Brustzentrum Paderborn, Paderborn, Germany,bDepartment of Gynecology and Obstetrics, Frauenklinik St. Louise, Paderborn, Germany,cFrauenklinik St. Josefs-Krankenhaus, Salzkotten, Germany,*Michael Patrick Lux,
| | - Katie Lewis
- dAdelphi Real World, Oncology Franchise, Cheshire, UK
| | - Alex Rider
- dAdelphi Real World, Oncology Franchise, Cheshire, UK
| | - Alexander Niyazov
- eDepartment of Patient and Health Impact, Pfizer Inc, New York, New York, USA
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Banys-Paluchowski M, Thill M, Kühn T, Ditsch N, Heil J, Wöckel A, Fallenberg E, Friedrich M, Kümmel S, Müller V, Janni W, Albert US, Bauerfeind I, Blohmer JU, Budach W, Dall P, Fasching P, Fehm T, Gluz O, Harbeck N, Huober J, Jackisch C, Kolberg-Liedtke C, Kreipe HH, Krug D, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Gerber B. AGO Recommendations for the Surgical Therapy of Breast Cancer: Update 2022. Geburtshilfe Frauenheilkd 2022; 82:1031-1043. [PMID: 36186147 PMCID: PMC9525149 DOI: 10.1055/a-1904-6231] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
The recommendations of the AGO Breast Committee on the surgical therapy of breast cancer were last updated in March 2022 (www.ago-online.de). Since surgical therapy is one of several partial steps in the treatment of breast cancer, extensive diagnostic and oncological expertise of a breast surgeon and good interdisciplinary cooperation with diagnostic radiologists is of great importance. The most important changes concern localization techniques, resection margins, axillary management in the neoadjuvant setting and the evaluation of the meshes in reconstructive surgery. Based on meta-analyses of randomized studies, the level of recommendation of an intraoperative breast ultrasound for the localization of non-palpable lesions was elevated to "++". Thus, the technique is considered to be equivalent to wire localization, provided that it is a lesion which can be well represented by sonography, the surgeon has extensive experience in breast ultrasound and has access to a suitable ultrasound device during the operation. In invasive breast cancer, the aim is to reach negative resection margins ("no tumor on ink"), regardless of whether an extensive intraductal component is present or not. Oncoplastic operations can also replace a mastectomy in selected cases due to the large number of existing techniques, and are equivalent to segmental resection in terms of oncological safety at comparable rates of complications. Sentinel node excision is recommended for patients with cN0 status receiving neoadjuvant chemotherapy after completion of chemotherapy. Minimally invasive biopsy is recommended for initially suspect lymph nodes. After neoadjuvant chemotherapy, patients with initially 1 - 3 suspicious lymph nodes and a good response (ycN0) can receive the targeted axillary dissection and the axillary dissection as equivalent options.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany,Correspondence/Korrespondenzadresse Priv.-Doz. Dr. med. Maggie Banys-Paluchowski Klinik für Frauenheilkunde und GeburtshilfeUniversitätsklinikum
Schleswig-Holstein Campus LübeckRatzeburger Allee 16023538
LübeckGermany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Jörg Heil
- Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Eva Fallenberg
- Institut für Radiologie, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Peter Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Schweiz
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sibylle Loibl
- German Breast Group c/o GBG Forschungs GmbH, Neu-Isenburg, Neu-Isenburg, Germany,Zentrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Goethe Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Diana Lüftner
- Medical University of Brandenburg Theodor-Fontane & Immanuel Hospital Märkische Schweiz, Buckow, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus
GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Ulrike Nitz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Tjoung Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - H. Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
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13
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Ditsch N, Wöcke A, Untch M, Jackisch C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm TN, Friedrich M, Gerber B, Gluz O, Harbeck N, Heil J, Huober J, Kreipe HH, Krug D, Kühn T, Kümmel S, Kolberg-Liedtke C, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Witzel I, Müller V, Janni W, Thill M. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2022. Breast Care (Basel) 2022; 17:403-420. [PMID: 36156915 PMCID: PMC9453658 DOI: 10.1159/000524879] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 04/30/2022] [Accepted: 04/30/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The AGO (Arbeitsgemeinschaft Gynäkologische Onkologie, German Gynecological Oncology Group) Task Force on Diagnosis and Treatment of Breast Cancer as an interdisciplinary team consists of specialists from gynecological oncology, pathology, diagnostic radiology, medical oncology, and radiation oncology with a special focus on breast cancer. Methods The updated evidence-based treatment recommendation 2022 for early breast cancer (EBC) and metastatic breast cancer of the AGO Task Force has been released. Results and Conclusion This paper captures the update of EBC.
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Affiliation(s)
- Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Achim Wöcke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Klinik für Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Klinik für Gynäkologie und Geburtshilfe, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva Maria Fallenberg
- Institut für Klinische Radiologie, Klinikum der Technischen Universität München, Rechts der Isar, Munich, Germany
| | - Peter A. Fasching
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja N. Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jörg Heil
- Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Cornelia Kolberg-Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Phaon GmbH, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charite, Berlin, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Ulrike Nitz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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Teixeira BC, Rider A, Holbrook T, Piercy J, Lux MP. Overall cancer survival inequalities in the state of São Paulo: A comparison between public and private systems. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6525] [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: 11/20/2022] Open
Abstract
6525 Background: Brazilian cancer patients under the public healthcare system receive diagnoses and treatment at a later disease stage on average than private patients, likely due to the public system having less access than the private system to treatment and diagnostic technologies. The impact of the different healthcare systems on survival is unknown. We aimed to evaluate the difference in overall survival (OS) in cancer patients under public vs. private healthcare systems in São Paulo, Brazil. Methods: Data were drawn from the hospital-based cancer registry of the Fundação Oncocentro de São Paulo capturing clinical and demographic data including clinical setting (private/public), date of diagnosis, and disease stage. All patients had complete medical records and malignant, well classified tumors. Analyses used Cox proportional hazards regressions. For multivariate (MTV) and propensity score matched (PSM) analyses; tumor topology and morphology, patient demographics and diagnostic care setting were used as covariates. Analyses were performed for overall cancers and for 20 separate tumor types as recommended by the National Institute of Cancer. Results: Data from 189,850 patients were analyzed. For all cancers, the hazard ratio (HR) for OS for public vs. private healthcare was 2.30 (CI 95% 2.20 - 2.39) in univariate (UNV), 1.59 (CI 95% 1.52 - 1.66) in MTV and 1.69 (CI 95% 1.61 - 1.77) in PSM, indicating that patients under the public system were between 2.30 and 1.69 times less likely to survive their cancer (Table 1). The cancer type with the biggest HR using PSM was multiple myeloma (HR 2.37 CI95% 1.82 - 3.08). Conclusions: Our results show Brazilian cancer patients under the public healthcare system were in some cases more than twice as likely to die from cancer than private patients. Despite possible differences between these populations in lifestyle and other potential influencing factors, our results most likely reflect differences between the two systems in access to treatment and diagnostic technologies. Our findings highlight the inequality of care in public vs. private healthcare in Brazil. Focus should be on closing the gap between the two systems in cancer diagnosis and treatment.[Table: see text]
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Affiliation(s)
| | - Alex Rider
- Adelphi Real World, Bollington, United Kingdom
| | | | | | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, Paderborn, Germany
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15
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Lux MP, Minartz C, Müller-Huesmann H, Sandor MF, Herrmann KH, Radeck-Knorre S, Neubauer AS. Budget impact of the Oncotype DX® test compared to other gene expression tests in patients with early breast cancer in Germany. Cancer Treat Res Commun 2022; 31:100519. [PMID: 35093682 DOI: 10.1016/j.ctarc.2022.100519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Gene expression tests can inform decisions on whether to recommend chemotherapy for patients with HR+, HER2- early breast cancer. The goal of this analysis was to compare treatment costs by an expanded budget impact model of reimbursed gene expression tests in Germany. METHODS A cost comparison was constructed as an expanded budget impact model to calculate average total costs per patient covered by public health insurance. Based on the strong clinical evidence from the prospective randomized controlled trial TAILORx including more than 10,000 patients with HR+ and node negative breast cancer, the assumption was made that the Oncotype DX® test accurately predicts chemotherapy benefit and clinical outcomes. For the further reimbursed tests (EndoPredict®, MammaPrint®, Prosigna®), results from comparative studies - aligned with prognosis studies - as analyzed in IQWiG Rapid Report D19-01 were applied. RESULTS The use of the Oncotype DX test led to estimated average savings per patient of 2,500 € vs. EndoPredict, 1,936 € vs. MammaPrint, and 649 € vs. Prosigna. Savings were achieved by reduction of unnecessary chemotherapy use, a consequence of false-positive test results (EndoPredict 73%, MammaPrint 42%, Prosigna 20%). False-negative test results (EndoPredict 5%, MammaPrint 22%, Prosigna 49%) reduced necessary chemotherapies, which initially results in cost savings, but may lead to increased long-term costs associated with management of progressive disease. CONCLUSION The results from this model suggest that the use of the Oncotype DX test reduces the cost of health care in Germany making it the most cost effective test compared to the further tests.
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Affiliation(s)
- M P Lux
- Kooperatives Brustzentrum Paderborn, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, Paderborn, Germany
| | - C Minartz
- Institute for Health- and Pharmacoeconomics (IfGPh), Munich, Germany
| | - H Müller-Huesmann
- Kooperatives Brustzentrum Paderborn, Klinik für Hämatologie und Onkologie, Brüderkrankenhaus St. Josef, MVZ im MediCo, Paderborn, Germany
| | - M F Sandor
- Kooperatives Brustzentrum Paderborn, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, Paderborn, Germany
| | | | - S Radeck-Knorre
- Institute for Health- and Pharmacoeconomics (IfGPh), Munich, Germany
| | - A S Neubauer
- Institute for Health- and Pharmacoeconomics (IfGPh), Munich, Germany.
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16
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Lux MP, Ciani O, Dunlop WCN, Ferris A, Friedlander M. The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This? Cancer Manag Res 2021; 13:8457-8471. [PMID: 34795526 PMCID: PMC8592394 DOI: 10.2147/cmar.s328058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/06/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Mature overall survival (OS) data are often unavailable at the time of regulatory and reimbursement decisions for a new cancer treatment. For patients with early-stage cancers treated with potentially curative treatments, demonstrating an OS benefit may take years and may be confounded by subsequent lines of therapy or crossover to the investigational treatment. For patients with advanced-stage cancers, mature OS data may be available but difficult to interpret for similar reasons. There are strong opinions about approval and reimbursement in the absence of mature OS data, with concerns over delay in patient access set against concerns about uncertainty in long-term benefit. This position paper reflects our individual views as patient advocate, clinician or health economist on one aspect of this debate. We look at payer decisions in the absence of mature OS data, considering when and how non-OS trial outcomes could inform decision-making and how uncertainty can be addressed beyond the trial, supporting these views with evidence from the literature. We consider when it is reasonable for payers to expect or not expect mature OS data at the initial reimbursement decision (based on criteria such as cancer stage and treatment efficacy) acknowledging that there are settings in which mature OS data are expected. We propose flexible strategies for generating and appraising patient-relevant evidence, including context-relevant endpoints and quality of life measures, when survival rates are good and mature OS data are not expected. We note that fair reimbursement is important; this means valuing patient benefit as shown through prespecified endpoints and reappraising if there is ongoing uncertainty or failure to show a sustained benefit. We suggest that reimbursement systems continue to evolve to align with scientific advances, because innovation is only meaningful if readily accessible to patients. The proposed strategies have the potential to promote thorough assessment of potential benefit to patients and lead to timely access to effective medicines.
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Affiliation(s)
- Michael Patrick Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise Paderborn, St. Josefs-Krankenhaus Salzkotten, Frauen- und Kinderklinik St. Louise Paderborn, Paderborn, Germany
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management, SDA Bocconi, Milan, Italy
| | | | | | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales and Department of Medical Oncology, The Prince of Wales Hospital, Sydney, NSW, Australia
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17
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Friedrich M, Kühn T, Janni W, Müller V, Banys-Paluchowski M, Kolberg-Liedtke C, Jackisch C, Krug D, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm T, Gerber B, Gluz O, Hanf V, Harbeck N, Heil J, Huober J, Kreipe HH, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Thill M, Ditsch N. Correction: AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update. Geburtshilfe Frauenheilkd 2021; 81:e31. [PMID: 34720743 PMCID: PMC8548988 DOI: 10.1055/a-1674-1114] [Citation(s) in RCA: 1] [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: 10/31/2022] Open
Abstract
[This corrects the article DOI: 10.1055/a-1499-8431.].
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Affiliation(s)
- Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Wolfgang Janni
- Frauenklinik, Klinikum der Universität Ulm, Ulm, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Frauenheilkunde und Geburtshilfe, UK-SH, Lübeck, Germany.,Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | | | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | - David Krug
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Campus Kiel, Kiel, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva M Fallenberg
- Klinikum der Universität München, Campus Großhadern, Institut für Klinische Radiologie, München, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Oleg Gluz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Volker Hanf
- Frauenklinik, Nathanstift Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jörg Heil
- Universitäts-Klinikum Heidelberg, Brustzentrum, Heidelberg, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik, St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | | | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Nina Ditsch
- Frauenklinik, Universitätsklinikum Augsburg, Augsburg, Germany
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18
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Friedrich M, Kühn T, Janni W, Müller V, Banys-Pachulowski M, Kolberg-Liedtke C, Jackisch C, Krug D, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm T, Gerber B, Gluz O, Hanf V, Harbeck N, Heil J, Huober J, Kreipe HH, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Thill M, Ditsch N. AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update. Geburtshilfe Frauenheilkd 2021; 81:1112-1120. [PMID: 34629490 PMCID: PMC8494519 DOI: 10.1055/a-1499-8431] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022] Open
Abstract
For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives
during surgical staging of the axilla in pN+
CNB
stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy.
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Affiliation(s)
- Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Wolfgang Janni
- Frauenklinik, Klinikum der Universität Ulm, Ulm, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maggie Banys-Pachulowski
- Klinik für Frauenheilkunde und Geburtshilfe, UK-SH, Lübeck, Germany.,Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | | | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | - David Krug
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Campus Kiel, Kiel, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva M Fallenberg
- Klinikum der Universität München, Campus Großhadern, Institut für Klinische Radiologie, München, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Oleg Gluz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Volker Hanf
- Frauenklinik, Nathanstift Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jörg Heil
- Universitäts-Klinikum Heidelberg, Brustzentrum, Heidelberg, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik, St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik am Klinikum Südstadt, Klinikum Südstadt Rostock, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | | | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Nina Ditsch
- Frauenklinik, Universitätsklinikum Augsburg, Augsburg, Germany
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Lux MP, Niyazov A, Lewis K, Pike J, Rider A, Arondekar B, Mahtani R. Abstract PS10-47: Physician and patient satisfaction with poly(ADP-ribose) polymerase inhibitors (PARPi) versus chemotherapy in adult patients with germline BRCA1/2 mutated (gBRCA1/2mut) HER2- advanced breast cancer (ABC): Results from a multi-country real-world (RW) study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps10-47] [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: Within the past 3 years, PARPi have demonstrated improved progression-free survival and favorable PROs compared with chemotherapy in randomized clinical trials in patients with gBRCA1/2mut HER2- ABC. These agents are now available in multiple countries for the treatment of gBRCA1/2mut HER2- locally advanced and/or metastatic breast cancer. Limited information is available on physician/patient satisfaction with PARPi from the RW. We assessed RW physician/patient treatment satisfaction among adult patients with gBRCA1/2mut HER2- ABC in Germany, France, Italy, Spain (EU4), US, and Israel.
Methods: Oncologist were recruited to abstract data from medical records (2019/2020) for patients with gBRCA1/2mut HER2- ABC. Physicians were asked to rank (1=very dissatisfied to 5=very satisfied) their satisfaction with their patient’s current ABC treatment. The scores were dichotomized to a 0/1 variable (0=very dissatisfied/ dissatisfied/moderately satisfied; 1=satisfied/very satisfied). A subset of patients completed the Cancer Treatment Satisfaction Questionnaire, a validated instrument that was used to measure patient’s satisfaction with their current therapy. The physician and patient sample were matched. Physician/patient satisfaction scores were compared between chemotherapy and PARPi monotherapy utilizing inverse probability weighted regression adjustment controlling for age at therapy initiation, Charlson Comorbidity Index at time of data collection, baseline symptoms, hormone receptor (HR) status, ECOG score at therapy initiation, stage of therapy initiation (locally advanced breast cancer or metastatic breast cancer) and number of lines of ABC treatment.
Results: Overall 96 adult female patients participated; mean age was 51 years. Tumor characteristics were: 34.4% HR+/HER2-, 65.6% triple negative breast cancer. Chemotherapy (n=58) was received among 60.4% of pts [n=29 (50.0%) platinum based, n=29 (50.0%) non-platinum based], and PARPi monotherapy (n=38) was received among 39.6% of pts. Physicians were significantly more likely to be satisfied or very satisfied with PARPi in comparison with chemotherapy (95.4% vs. 40.8%, p<0.001). Mean patient satisfactions scores were numerically higher with PARPi vs. chemotherapy: expectation of therapy 81.3 vs. 72.0 (p=0.13), feelings about side effects 55.7 vs. 51.4 (p=0.30), satisfaction with therapy 74.0 vs. 68.5 (p=0.13).
Conclusions: PARPi have demonstrated superior efficacy and favorable PROs vs. chemotherapy in randomized controlled trials. In this RW study, physicians reported significantly higher satisfaction with PARPi vs. chemotherapy; patients reported numerically higher satisfaction scores with PARPi vs. chemotherapy across all domains. These findings further support the value of PARPi in patients with gBRCA1/2mut HER2- ABC. Additional studies to validate these findings are planned.
Funding: Pfizer
Citation Format: Michael Patrick Lux, Alexander Niyazov, Katie Lewis, James Pike, Alex Rider, Bhakti Arondekar, Reshma Mahtani. Physician and patient satisfaction with poly(ADP-ribose) polymerase inhibitors (PARPi) versus chemotherapy in adult patients with germline BRCA1/2 mutated (gBRCA1/2mut) HER2- advanced breast cancer (ABC): Results from a multi-country real-world (RW) study [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 PS10-47.
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Affiliation(s)
- Michael Patrick Lux
- 1Kooperatives Brustzentrum Paderborn, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, Paderborn, Germany
| | | | - Katie Lewis
- 3Adelphi Real World, Bollington, United Kingdom
| | - James Pike
- 3Adelphi Real World, Bollington, United Kingdom
| | - Alex Rider
- 3Adelphi Real World, Bollington, United Kingdom
| | | | - Reshma Mahtani
- 5Sylvester Cancer Center, University of Miami, Deerfield Beach, FL
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20
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Mahtani R, Niyazov A, Lewis K, Pike J, Rider A, Arondekar B, Lux MP. Abstract PS10-32: Patient reported outcomes (PROs) with poly(ADP-ribose) polymerase inhibitors (PARPi) versus chemotherapy (CTX) in patients (pts) with germline BRCA1/2 mutated ( gBRCA1/2mut) HER2- advanced breast cancer (ABC): Results from a multi-country real-world (RW) study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps10-32] [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: In ABC, where treatment is palliative, an important goal is the maintenance or improvement of quality of life (QoL). In the past 3 years, PARPi have demonstrated improved progression-free survival and favorable PROs compared with CTX in randomized clinical trials (RCTs) in pts with ABC and a gBRCA1/2mut. These agents are now available in multiple countries for the treatment of gBRCA1/2mut HER2- locally advanced and/or metastatic breast cancer. Limited information is available on the PRO benefit of these agents in the RW setting. We assessed RW cancer-related and breast-cancer specific PROs among adult pts with gBRCA1/2mut HER2- ABC in Germany, France, Italy, Spain (EU4), US, and Israel.
Methods: Oncologists were recruited to abstract data from medical records (2019/2020) for pts with gBRCA1/2mut HER2- ABC. A subset of pts completed the European Organisation for Research and Treatment of Cancer Quality of Life Core 30 (EORTC QLQ-C30) and the breast cancer module QLQ-BR23. PROs were compared between CTX and PARPi monotherapy utilizing inverse probability weighted regression adjustment (IPWRA) controlling for age at therapy initiation, Charlson Comorbidity Index at time of data collection, baseline symptoms, hormone receptor (HR) status, ECOG score at therapy initiation, stage of therapy initiation (locally advanced breast cancer or metastatic breast cancer) and number of lines of ABC treatment.
Results: Overall 96 female pts participated; mean age was 51 years. Tumor characteristics were: 34.4% HR+/HER2-, 65.6% triple negative breast cancer. CTX (n=58) was received among 60.4% of pts [n=29 (50.0%) platinum based, n=29 (50.0%) non-platinum based], and PARPi monotherapy (n=38) was received among 39.6% of pts. Compared to pts receiving CTX, pts receiving PARPi reported significantly better scores in physical and social functioning (Table 1). Pts receiving PARPi reported significantly better symptoms scores vs. CTX in constipation, breast symptoms, arm symptoms and systemic therapy side effects (Table 1). Pts receiving PARPi reported significantly worse scores vs. CTX in nausea/vomiting (Table 1). Global health status (GHS)/QoL scores were numerically better among pts receiving PARPi vs. CTX (Table 1).
Conclusions: PARPi have demonstrated superior efficacy and favorable PROs vs. CTX in RCTs in pts with gBRCA1/2mut HER2- ABC. In this RW study, the PRO benefits reported with PARPi were consistent with what has been observed in RCTs, further supporting the value of PARPi. Additional studies to validate these findings are planned.
Funding: Pfizer
EORTC QLQ-BR23 categories sexual enjoyment and upset by hair loss were excluded from the analysis due to low sample size
Table 1. IPWRA Analysis for the EORTC QLQ-C30 and QLQ BR-23a scoresCTX (n=58)PARPi Monotherapy (n=38)P valueEORTC QLQ-C30 GHS/QoL and functional scalesGHS/QoL56.5665.240.10Physical71.9079.980.045Role64.5568.060.55Emotional61.2464.580.61Cognitive78.2078.840.89Social63.5781.950.01EORTC QLQ-BR23 Functional scalesSexual12.3717.230.31Future perspective46.6844.530.81Body Image53.2265.360.13EORTC QLQ-C30 Symptoms scalesFatigue40.6739.620.87Nausea/vomiting18.2834.510.005Pain34.2638.880.42Dyspnea22.1523.290.82Insomnia30.7832.400.82Appetite loss24.8531.990.29Constipation18.751.85<.001Diarrhea16.2614.570.81Financial difficulties16.2616.830.92EORTC QLQ-BR23 Symptoms ScalesBreast symptoms13.280.350.008Arm symptoms11.392.600.001Systemic therapy side effects29.3913.48<.001
Citation Format: Reshma Mahtani, Alexander Niyazov, Katie Lewis, James Pike, Alex Rider, Bhakti Arondekar, Michael Patrick Lux. Patient reported outcomes (PROs) with poly(ADP-ribose) polymerase inhibitors (PARPi) versus chemotherapy (CTX) in patients (pts) with germline BRCA1/2 mutated (gBRCA1/2mut) HER2- advanced breast cancer (ABC): Results from a multi-country real-world (RW) study [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 PS10-32.
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Affiliation(s)
- Reshma Mahtani
- 1Sylvester Cancer Center, University of Miami, Deerfield Beach, FL
| | | | - Katie Lewis
- 3Adelphi Real World, Bollington, United Kingdom
| | - James Pike
- 3Adelphi Real World, Bollington, United Kingdom
| | - Alex Rider
- 3Adelphi Real World, Bollington, United Kingdom
| | | | - Michael Patrick Lux
- 5Kooperatives Brustzentrum Paderborn, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, Paderborn, Germany
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21
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Gaß P, Häberle L, Hein A, Jud SM, Lux MP, Hack CC, Emons J, Heindl F, Nabieva N, Loehberg CR, Schulz-Wendtland R, Hartmann A, Beckmann MW, Fasching PA, Wunderle M. Einfluss der Familienanamnese eines Mamma- oder Ovarialkarzinoms auf die pathologische Komplettremission und die Prognose bei Patientinnen mit einem Mammakarzinom nach neoadjuvanter Chemotherapie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717891] [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)
- P Gaß
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - L Häberle
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - A Hein
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - SM Jud
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - MP Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauen- und Kinderklinik St. Louise
- St. Josefs-Krankenhaus
| | - CC Hack
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - J Emons
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - F Heindl
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - N Nabieva
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - CR Loehberg
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - R Schulz-Wendtland
- Institut für Diagnostische Radiologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen-Nürnberg
| | - A Hartmann
- Institut für Pathologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen-Nürnberg
| | - MW Beckmann
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - PA Fasching
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
| | - M Wunderle
- Universitätsklinik Erlangen-Nürnberg, Frauenklinik
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22
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Huebner H, Kurbacher C, Kuesters G, Hartkopf AD, Lux MP, Huober J, Volz B, Taran FA, Overkamp F, Tesch H, Häberle L, Lüftner D, Wallwiener M, Müller V, Beckmann MW, Belleville E, Untsch M, Janni W, Fehm TN, Kohlberg HC, Wallwiener D, Brucker SY, Schneeweiss A, Ettl J, Ruebner M, PA F. Nutzung eines molekularen Registers (PRAEGNANT) zur Patienten-Selektion und Biomarker-Analyse für die SHERBOC Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718207] [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)
- H Huebner
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | | | | | | | - MP Lux
- Klinik für Gynäkologie und Geburtshilfe Frauenklinik St. Louise
- St. Josefs-Krankenhaus
| | - J Huober
- Frauenklinik, Universitätsklinikum Ulm
| | - B Volz
- Hochschule für angewandte Wissenschaften Ansbach, Fakultät Wirtschaft
| | - FA Taran
- Frauenklinik, Universitätsklinikum Tübingen
| | | | | | - L Häberle
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | - D Lüftner
- Charite Berlin, Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie (CVK)
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Zentrum für gynäkologische Krebserkrankungen
| | - V Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf
| | - MW Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
| | | | - M Untsch
- Geburtshilfe und Gynäkologie, HELIOS Klinikum Berlin-Buch
| | - W Janni
- Frauenklinik, Universitätsklinikum Ulm
| | - TN Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf
| | | | | | - SY Brucker
- Frauenklinik, Universitätsklinikum Tübingen
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg
| | - J Ettl
- Frauenklinik, Klinikum rechts der Isar, Technische Universität München
| | - M Ruebner
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg (CCC ER-EMN), Friedrich Alexander Universität Erlangen-Nürnberg
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23
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Abstract
AIM The introduction of new and innovative treatment options for cancer patients is accompanied by a tremendous increase in healthcare costs. Consequently, new financing approaches are strongly needed to reduce the burden on the healthcare system. The introduction of biosimilars - biological drugs containing the active substance of an already approved reference biological drug - can potentially relieve the burden on healthcare systems. Calculating the costs for three frequently used biosimilars, we simulated the health-economic impact of biosimilars in the real world for the German healthcare system. METHODS Based on available health-economic analyses, the actual prescription and cost containment potential of biosimilars compared to the originator were calculated exemplarily for the cost-intensive therapies trastuzumab in breast cancer, rituximab in follicular lymphoma and G-CSF in supportive care. Incidence calculations were based e.g. on data from the Robert-Koch-Institution, Munich Cancer Registry, and quality indicators of certified centres. Cost calculation was based on Lauer-Taxe® (official reference for pharmaceutical price information). RESULTS The application of biosimilars would generate potential annual savings for the chosen examples of up to 4.9 Mio EUR for rituximab in follicular lymphoma, 40.5 Mio EUR for filgrastim, 56.4 Mio EUR for pegfilgrastim, and between 95.9 and 120.5 Mio EUR for trastuzumab. CONCLUSIONS The consequent use of biosimilars allows a considerable reduction of overall treatment costs, especially for cost-intensive long-term maintenance treatments and therapies with high incidences. If the option of biosimilar usage is fully exploited, enormous resources could be released within the healthcare system in order to offset financing new innovative therapies.
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Affiliation(s)
- Kai Hübel
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Dept. I of Internal Medicine, Kerpener Str. 62, 50937, Köln, Germany.
| | - Florian Kron
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Dept. I of Internal Medicine, Kerpener Str. 62, 50937, Köln, Germany; FOM University of Applied Sciences, Herkulesstraße 32; 45127, Essen, Germany.
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, Frauenklinik St. Josefs, Salzkotten, Frauen- und Kinderklinik St. Louise, Husener Str. 81, 33098, Paderborn, Germany.
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24
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Dippmann AK, Damrau C, Hengelbrock J, Albert US, Lebeau A, Lux MP, Veit C. [Are men and women with breast cancer treated equally in Germany?]. Z Evid Fortbild Qual Gesundhwes 2020; 155:1-10. [PMID: 32861615 DOI: 10.1016/j.zefq.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Within the statutory health insurance system of the Federal Republic of Germany, a system of quality assurance has been implemented and operationalised through the measurement of quality indicators. For breast surgery, these quality indicators are mainly based on recommendations of the German clinical guideline for screening, diagnosis, therapy and follow-up of breast cancer. The 2018 update of this guideline includes a new chapter on breast cancer in men. The aim of this analysis is to examine whether male and female patients with breast cancer are treated equally where appropriate and recommended by the clinical guideline, as measured by the quality indicators. METHOD Data of ten quality assurance indicators were analysed, for each indicator separately, stratified by sex and pooled over a 5-year period to gain statistical power. This dataset constitutes the largest data pool of men with surgical interventions for breast neoplasm in Germany. Indicator results were then compared between male and female cases. Additional subgroup analyses were carried out for two quality indicators with substantial outcome difference between male and female cases in order to detect possible differences in the treatment of breast cancer between different medical departments. RESULTS The database of the ten quality assurance indicators comprised 551,221 patients (546,324 females and 4,897 males) between 2014 and 2018. Pooled data of nine quality indicators (QIs) showed statistically significant outcome differences between male and female cases. In spite of pooling, the male sample size of four QIs was too small to allow for statistically reliable comparisons between male and female patients. Outcome differences in the remaining five QIs may, on the one hand, be explained by anatomical differences and different extent of the surgery, and on the other hand they confirm international data for lower HER2-positivity rates in male breast cancer patients. However, two process indicators, aiming at pretherapeutic biopsy and sentinel lymph node biopsy in invasive breast cancer recommended by the clinical guideline, show substantial differences of more than 6 percentage points between the sexes: although recommended by the clinical guideline, both procedures are carried out less often in male cases. Further analysis regarding the medical departments that recorded the treatment revealed that risk for non-adherence to guideline recommendation was high if treatment took place in non-gynaecological departments. Compared to gynaecological departments, procedures such as pretherapeutic biopsy and sentinel lymph node biopsy were carried out less frequently if cases were documented to be handled by surgery or plastic surgery departments. DISCUSSION AND CONCLUSION Analysis of breast surgery quality indicators reveals a lower level of adherence to guideline recommendations for men with breast cancer compared to women in some aspects of the guideline, as measured by statutory quality indicators in breast surgery. Male breast cancer might be a rare disease, but nevertheless, awareness-rising is needed in diagnostics, treatment and interdisciplinarity in order to avoid inequality between the sexes.
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Affiliation(s)
- Anja Katharina Dippmann
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland.
| | - Claudia Damrau
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland
| | - Johannes Hengelbrock
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland
| | - Ute-Susann Albert
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf und Gemeinschaftspraxis für Pathologie, Lübeck, Deutschland
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Kinder- und Frauenklinik St. Louise, St. Vincenz-Krankenhaus Paderborn, Paderborn, Deutschland
| | - Christof Veit
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland
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Wunderle M, Häberle L, Hein A, Jud SM, Lux MP, Hack CC, Emons J, Heindl F, Nabieva N, Löhberg CR, Schulz-Wendtland R, Hartmann A, Beckmann MW, Fasching PA, Gaß P. Einfluss der Familienanamnese eines Mamma- oder Ovarialkarzinoms auf die pathologische Komplettremission und die Prognose bei Patientinnen mit einem Mammakarzinom nach neoadjuvanter Chemotherapie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713985] [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)
- M Wunderle
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - L Häberle
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
- Biostatische Einheit, Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - A Hein
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - S M Jud
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - M P Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauen- und Kinderklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten
| | - C C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - J Emons
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - F Heindl
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - N Nabieva
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - C R Löhberg
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - R Schulz-Wendtland
- Institut für Diagnostische Radiologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - A Hartmann
- Institut für Pathologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - P A Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
| | - P Gaß
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen
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Hack CC, Häberle L, Brucker SY, Janni W, Volz B, Loehberg CR, Hartkopf AD, Walter CB, Baake G, Fridman A, Malter W, Wuerstlein R, Harbeck N, Hoffmann O, Kuemmel S, Martin B, Thomssen C, Graf H, Wolf C, Lux MP, Bayer CM, Rauh C, Almstedt K, Gass P, Heindl F, Brodkorb T, Willer L, Lindner C, Kolberg HC, Krabisch P, Weigel M, Steinfeld-Birg D, Kohls A, Brucker C, Schulz V, Fischer G, Pelzer V, Rack B, Beckmann MW, Fehm T, Rody A, Maass N, Hein A, Fasching PA, Nabieva N. Complementary and alternative medicine and musculoskeletal pain in the first year of adjuvant aromatase inhibitor treatment in early breast cancer patients. Breast 2020; 50:11-18. [PMID: 31958661 PMCID: PMC7377331 DOI: 10.1016/j.breast.2019.12.017] [Citation(s) in RCA: 3] [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: 07/14/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/25/2022] Open
Abstract
Background Patients with breast cancer (BC) show strong interest in complementary and alternative medicine (CAM), particularly for adverse effects of adjuvant endocrine treatment — e.g., with letrozole. Letrozole often induces myalgia/limb pain and arthralgia, with potential noncompliance and treatment termination. This analysis investigated whether CAM before aromatase inhibitor (AI) therapy is associated with pain development and the intensity of AI-induced musculoskeletal syndrome (AIMSS) during the first year of treatment. Patients and methods The multicenter phase IV PreFace study evaluated letrozole therapy in postmenopausal, hormone receptor–positive patients with early BC. Patients were asked about CAM use before, 6 months after, and 12 months after treatment started. They recorded pain every month for 1 year in a diary including questions about pain and numeric pain rating scales. Data were analyzed for patients who provided pain information for all time points. Results Of 1396 patients included, 901 (64.5%) had used CAM before AI treatment. Throughout the observation period, patients with CAM before AI treatment had higher pain values, for both myalgia/limb pain and arthralgia, than non-users. Pain increased significantly in both groups over time, with the largest increase during the first 6 months. No significant difference of pain increase was noted regarding CAM use. Conclusions CAM use does not prevent or improve the development of AIMSS. Pain intensity was generally greater in the CAM group. Therefore, because of the risk of non-compliance and treatment discontinuation due to the development of higher pain levels, special attention must be paid to patient education and aftercare in these patients. Pain levels of myalgia/limb pain and arthralgia increase under letrozole intake. Within one year pain levels increase in both, CAM users as well as non-CAM users. In CAM users pain levels were higher at all time points than in non-CAM users. The greatest increase of pain levels was noted in the first six treatment months. CAM does not prevent or improve the development of myalgia/limb pain and arthralgia.
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Affiliation(s)
- C C Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - L Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - B Volz
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C R Loehberg
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; St. Theresien Hospital, Nuremberg, Germany
| | - A D Hartkopf
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - C-B Walter
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | - A Fridman
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - W Malter
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany
| | - R Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - O Hoffmann
- Department of Gynecology, Essen University Hospital, Essen, Germany
| | - S Kuemmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - B Martin
- Tuttlingen Clinic, Tuttlingen, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - H Graf
- Helios Clinics Meiningen, Meiningen, Germany
| | - C Wolf
- Ulm Medical Center, Ulm, Germany
| | - M P Lux
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - K Almstedt
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Department of Gynecology, Mainz University Hospital, Mainz, Germany
| | - P Gass
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - F Heindl
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Brodkorb
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - L Willer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Lindner
- Agaplesion Diakonie Clinic Hamburg, Hamburg, Germany
| | - H-C Kolberg
- Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
| | - P Krabisch
- Department of Gynecology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - M Weigel
- Department of Gynecology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - D Steinfeld-Birg
- Gynecologic Onocologic Practice Steinfeld-Birg, Augsburg, Germany
| | - A Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - C Brucker
- Department of Gynecology and Obstetrics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - V Schulz
- Gynecologic Practice Abts+partner, Kiel, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - V Pelzer
- Department of Gynecology, GFO Clinics Bonn, Bonn, Germany
| | - B Rack
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - M W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, University of Tübingen, Tübingen, Germany; Department of Gynecology, Heinrich Heine University of Dusseldorf, Dusseldorf, Germany
| | - A Rody
- Department of Gynecology, Campus Lübeck, Schleswig-Holstein University Hospital, Schleswig-Holstein, Germany
| | - N Maass
- Department of Gynecology, Campus Kiel, Schleswig-Holstein University Hospital, Schleswig-Holstein, Germany
| | - A Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - P A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - N Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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Erber R, Hartmann A, Beckmann MW, Mackensen A, Kremer A, Reimann H, Hübner H, Hein A, Lux MP, Jud S, Häberle L, Gaß P, Volz B, Schulz-Wendtland R, Rübner M, Fasching PA. [TILGen study-immunological targets in patients with breast cancer : Influence of tumor-infiltrating lymphocytes]. Pathologe 2019; 39:236-240. [PMID: 30406831 DOI: 10.1007/s00292-018-0526-7] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The interaction of our immune system with breast cancer (BC) cells prompted the investigation of tumor-infiltrating lymphocytes (TILs) and targeted, tumor antigen-specific immunotherapy. OBJECTIVES Correlation between TILs and pathological complete response (pCR) after neoadjuvant systemic therapy (NACT). Tumor-specific antigens (TSAs) in HER2+ and triple negative BC and establishment of TSA-specific therapies within the interdisciplinary TILGen study. METHODS Illustration of the TILGen study design. Assessment of TILs and correlation with pCR within this BC study. RESULTS pCR was achieved in 38.4% (56/146) and associated with estrogen receptor/progesterone receptor negative (ER-/PR-) and HER2+ tumors. Lymphocytic predominant BC (LPBC) was found in 16.4% (24/146), particularly in ER-/PR- (ER-: 27.3% vs. ER+: 9.9%, PR-: 22.3% vs. PR+: 8.2%), large, and poorly differentiated BC. TILs were significantly correlated with pCR in multivariate analysis. In LPBC, pCR was achieved in 66.7%, whereas it was 32.8% in non-LPBC. CONCLUSIONS First results confirm the influence of the human immune system on the response to NACT in HER2+ and triple negative BC. TSA-specific immunotherapy might improve the outcome in BC patients but there is an urgent need for comprehensive studies to further investigate this issue.
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Affiliation(s)
- R Erber
- Pathologisches Institut, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 8-10, 91054, Erlangen, Deutschland.
| | - A Hartmann
- Pathologisches Institut, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 8-10, 91054, Erlangen, Deutschland
| | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - A Mackensen
- Medizinische Klinik 5, Hämatologie und Internistische Onkologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - A Kremer
- Medizinische Klinik 5, Hämatologie und Internistische Onkologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - H Reimann
- Medizinische Klinik 5, Hämatologie und Internistische Onkologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - H Hübner
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - A Hein
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - M P Lux
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - S Jud
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - L Häberle
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - P Gaß
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - B Volz
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - R Schulz-Wendtland
- Radiologisches Institut/Gynäkologische Radiologie, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - M Rübner
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - P A Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
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Ditsch N, Untch M, Thill M, Müller V, Janni W, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Diel I, Fasching PA, Fehm T, Friedrich M, Gerber B, Hanf V, Harbeck N, Huober J, Jackisch C, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Müller-Schimpfle M, Mundhenke C, Nitz U, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Wenz F, Witzel I, Wöckel A. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2019. Breast Care (Basel) 2019; 14:224-245. [PMID: 31558897 PMCID: PMC6751475 DOI: 10.1159/000501000] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/16/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nina Ditsch
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kassel, Kassel, Germany
| | | | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Ingo Diel
- Praxisklinik am Rosengarten, Mannheim, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Klinik für Gynäkologie und Geburtshilfe, St. Vinzenz-Krankenhaus GmbH Paderborn, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Markus Müller-Schimpfle
- Klinik für Radiologie, Neuroradiologie und Nuklearmedizin, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Senologie, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Gynäkologische Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | | | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
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Thill M, Jackisch C, Janni W, Müller V, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Diel I, Fasching PA, Fehm T, Friedrich M, Gerber B, Hanf V, Harbeck N, Huober J, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Müller-Schimpfle M, Mundhenke C, Nitz U, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Wenz F, Witzel I, Wöckel A, Ditsch N. AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2019. Breast Care (Basel) 2019; 14:247-255. [PMID: 31558898 DOI: 10.1159/000500999] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/16/2019] [Indexed: 12/13/2022] Open
Abstract
Every year the Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO), a group of gynecological oncologists specialized in breast cancer and interdisciplinary members specialized in pathology, radiologic diagnostics, medical oncology, and radiation oncology, prepares and updates evidence-based recommendations for the diagnosis and treatment of patients with early and metastatic breast cancer. Every update is performed according to a documented rule-fixed algorithm, by thoroughly reviewing and scoring the recent publications for their scientific validity and clinical relevance. This current publication presents the 2019 update on the recommendations for metastatic breast cancer.
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Affiliation(s)
- Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kassel, Kassel, Germany
| | | | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Ingo Diel
- Praxisklinik am Rosengarten, Mannheim, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Klinik für Gynäkologie und Geburtshilfe, St. Vinzenz-Krankenhaus GmbH Paderborn, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt/Main, Germany
| | - Markus Müller-Schimpfle
- Klinik für Radiologie, Neuroradiologie und Nuklearmedizin, Klinikum Frankfurt Höchst GmbH, Frankfurt/Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Senologie, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Gynäkologische Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt/Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | | | - Frederik Wenz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Nina Ditsch
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
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Lux MP, Böhme S, Hücherig S, Jeratsch U, Kürschner N, Lüftner D. Surrogate threshold effect based on a meta-analysis for the predictive value of progression-free survival for overall survival in hormone receptor-positive, HER2-negative metastatic breast cancer. Breast Cancer Res Treat 2019; 176:495-506. [PMID: 31065873 PMCID: PMC6586722 DOI: 10.1007/s10549-019-05262-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/26/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Clinical trials investigating therapies for metastatic breast cancer (mBC) generally use progression-free survival (PFS) as primary endpoint, which is not accepted as patient-relevant outcome within the German benefit assessment. Hence a validation of PFS as surrogate endpoint for overall survival (OS) is needed, e.g., in the indication of HR+, HER2-negative mBC. METHODS A systematic search was conducted. RCT were included if at least one study arm investigated fulvestrant, letrozole, tamoxifen, exemestane, or anastrozole. Additionally, hazard ratios reported for OS/PFS including confidence interval or standard error were mandatory. Pearson correlation coefficient was calculated to estimate the relation of surrogate endpoint PFS and patient-relevant outcome OS as well as the surrogate threshold effect (STE) which is used to determine thresholds for the estimate of the surrogate endpoint. RESULTS 16 studies with 5324 patients in total were included in the analyses. The correlation between hazard ratios of PFS and OS was statistically significant (r = 0.72, 95% CI 0.35-0.90) representing a positive linear relationship. STE analysis was applied. The meta-regression model revealed a STE for HRPFS of 0.60 and sensitivity analyses underlined robustness of the results. CONCLUSIONS Based on the derived STE, it is possible to draw conclusions on a significant effect in OS for a hypothetical trial demonstrating an upper confidence limit of HRPFS < 0.60 in PFS. However, only final OS results are able to confirm if a clinical relevant difference in survival time can be achieved.
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Affiliation(s)
- Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Paderborn, Germany. .,Frauenklinik St. Louise, Paderborn, Germany. .,St. Josefs-Krankenhaus, Salzkotten, Germany. .,Frauen- und Kinderklinik St. Louise, Husener Str. 81, 33098, Paderborn, Germany.
| | - Sarah Böhme
- Pfizer Deutschland GmbH, Linkstraße 10, 10785, Berlin, Germany
| | - Stephanie Hücherig
- AMS Advanced Medical Services GmbH, Rosa-Bavarese-Str. 5, 80639, Munich, Germany
| | - Ulli Jeratsch
- AMS Advanced Medical Services GmbH, Rosa-Bavarese-Str. 5, 80639, Munich, Germany
| | | | - Diana Lüftner
- Klinik für Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
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31
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Müller V, Huober J, Volz B, Overkamp F, Kolberg HC, Hadji P, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lüftner DI, Wallwiener M, Taran FA, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt A, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Fehm TN, Brucker SY, Wallwiener D, Schneeweiss A, Fasching PA, Tesch H. Abstract OT1-11-02: PRAEGNANT - Real world evidence, translational research, big and smart data: A prospective academic translational research network for the optimization of the oncological health care quality in the adjuvant and advanced/ metastatic setting (NCT02338167). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-11-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
During the last decades the treatment of advanced breast cancer (ABC) patients has improved due to a variety of new treatment strategies. Nevertheless, many ABC patients are faced with limited prognosis, and their treatment remains a challenge. New targeted therapies complement the well-established treatment options for ABC (CDK4/6 inhibition, anti-endocrine, chemotherapy, antibody based and bone related therapies), leading to improved treatment regimens tailored to the needs of special patient sub-populations.
SPECIFIC AIMS/TRIAL DESIGN
The PRAEGNANT network study is conducted as an academic, prospective registry and diagnostic translational study, accompanied by biomaterial collection. The pilot phase in more than 60 centers aims at including 3500 ABC patients. The primary objective is to discover biomarkers, which predict progression free survival (PFS). Secondary objectives include overall survival (OS), breast cancer specific survival, objective response rate, patient reported outcomes (PRO), description of therapies used in the metastatic setting, therapy adherence, health economics for patients with ABC, incidence of (serious) adverse events and big data/ machine learning algorithms. The exploratory objectives comprise correlations of gene alterations and their influence on OS, PFS, side effects and PRO. Exploratory biomarkers are assessed at baseline and at every change of therapy. These biomarkers include gene expression profiling of the primary tumor and corresponding metastasis, somatic mutations (measured in the tumor and in circulating tumor DNA), germline genetic variations, epigenetic changes and miRNA variations. Furthermore, plasma and serum markers are assessed. If actionable molecular alterations are detected patients are informed and recruited into suitable studies if available.
ELIGIBILITY CRITERIA:
Any adult patient (>18 years) with the diagnosis of ABC and who is willing and able to sign the informed consent can be enrolled.
STATISTICAL METHODS/TARGET ACCRUAL:
The PRAEGNANT study as a prospective real world registry and diagnostic translational study aims to identify biomarkers in ABC patients, which may predict PFS. Target accrual for the pilot phase is 3500 patients. Each patient will be documented for up to 36 months with an estimated median PFS for all patients of 11 months across all treatment lines.
Citation Format: Müller V, Huober J, Volz B, Overkamp F, Kolberg H-C, Hadji P, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lüftner DI, Wallwiener M, Taran F-A, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt A, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Fehm TN, Brucker SY, Wallwiener D, Schneeweiss A, Fasching PA, Tesch H. PRAEGNANT - Real world evidence, translational research, big and smart data: A prospective academic translational research network for the optimization of the oncological health care quality in the adjuvant and advanced/ metastatic setting (NCT02338167) [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 OT1-11-02.
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Affiliation(s)
- V Müller
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Huober
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - B Volz
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - F Overkamp
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - H-C Kolberg
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - P Hadji
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - L Haeberle
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Ettl
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - AD Hartkopf
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - MP Lux
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - DI Lüftner
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - F-A Taran
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - MW Beckmann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - E Belleville
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - P Wimberger
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Hielscher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Geberth
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Lermann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - A Abenhardt
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Kurbacher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - R Wuerstlein
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Thomssen
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Untch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - W Janni
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - TN Fehm
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - SY Brucker
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - D Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - A Schneeweiss
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - PA Fasching
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - H Tesch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
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Lux MP, Hartkopf AD, Huober J, Volz B, Taran FA, Overkamp F, Hadji P, Tesch H, Haeberle L, Ettl J, Lueftner DI, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Fasching PA, Janni W, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A, Kolberg HC. Abstract P6-17-37: Therapy landscape of patients with metastatic, HER2 positive breast cancer - Data from the real world breast cancer registry PRAEGNANT (NCT02338167). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-37] [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
Purpose:
This analysis describes comprehensive real-world data concerning the use of anti-HER2 therapies in HER2 positive metastatic breast cancer (MBC). Specifically, it describes the therapy patterns of treatments with trastuzumab (TZM), pertuzumab+trastuzumab (PTZ/TZM), lapatinib (LAP) and trastuzumab emtansine (T-DM1).
Methods:
The PRAEGNANT study is a real-time, real-world registry for patients with MBC. Patients can be registered for PRAEGNANT at any time during the course of their metastatic disease and are followed up until death. All therapy lines are documented. This analysis presents the utilization of anti-HER2 therapies as well as therapy sequences.
Results:
Of 1936 patients within PRAEGNANT at the time of database closure 451 were HER2 positive (23.3%). Within the analysis set (417 patients after an unilateral breast cancer diagnosis), of which 53% were included in PRAEGNANT in the 1stline setting, 241 were treated with TZM (58%), 237 with PTZ (57%), 85 with LAP (20%) and 125 with T-DM1 (30%) during the course of their therapies. The sequence PTZ/TZMàT-DM1 was given to 51 patients (12%). Worse ECOG, negative hormone receptor status, and visceral or brain metastases were associated with a more frequent use of this therapy sequence. Most patients received T-DM1 after a therapy with pertuzumab.
Conclusions:
Both novel therapies (PTZ/TZM and T-DM1) are utilized in a high proportion of HER2 positive breast cancer patients. As most patients receive T-DM1 after pertuzumab real world data might help to understand whether this sequence has similar efficacy like in the approval study.
Citation Format: Lux MP, Hartkopf AD, Huober J, Volz B, Taran F-A, Overkamp F, Hadji P, Tesch H, Haeberle L, Ettl J, Lueftner DI, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Fasching PA, Janni W, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A, Kolberg H-C. Therapy landscape of patients with metastatic, HER2 positive breast cancer - Data from the real world breast cancer registry PRAEGNANT (NCT02338167) [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 P6-17-37.
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Affiliation(s)
- MP Lux
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - AD Hartkopf
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Huober
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - B Volz
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - F-A Taran
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - F Overkamp
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - P Hadji
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - H Tesch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - L Haeberle
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Ettl
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - DI Lueftner
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - V Müller
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - MW Beckmann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - E Belleville
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - P Wimberger
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Hielscher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Geberth
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - J Lermann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - W Abenhardt
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Kurbacher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - R Wuerstlein
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - C Thomssen
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - M Untch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - PA Fasching
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - W Janni
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - TN Fehm
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - D Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - SY Brucker
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - A Schneeweiss
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
| | - H-C Kolberg
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Erlangen University Hospital Comprehensive Cancer Center Erlangen-EMN Friedrich-Alexander University, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Kli
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Schneeweiss A, Lux MP, Hartkopf AD, Volz B, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Lüftner DI, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Overkamp F, Huober J, Taran FA, Janni W, Wallwiener D, Brucker SY, Fasching PA, Fehm TN. Abstract P6-17-22: Progression free survival (PFS) and overall survival (OS) of patients treated with trastuzumab emtansine (T-DM1) after previous treatment with pertuzumab in patients with advanced breast cancer (NCT02338167). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-22] [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
Studies leading to the approval of trastuzumab emtansine (T-DM1) have been conducted without pertuzumab as previous therapy. Therefore data about patient characteristics and the efficacy of T-DM1 after a treatment with pertuzumab is scarce. Aim of this study was to analyze a real world patient cohort of advanced breast cancer (aBC) patients, who were treated with T-DM1 after a treatment containing pertuzumab in the metastatic setting with regard to patient characteristics and progression free survival (PFS).
Methods
The PRAEGNANT metastatic breast cancer registry (NCT02338167) is a prospective registry for metastatic breast cancer patients with focus on molecular biomarkers. Patients of all therapy lines with any kind of treatment are eligible for this registry. Collected data comprises all relevant patient and tumor characteristics, therapies, adverse events, quality of life, patient reported outcomes, response and survival (PFS/OS). Here we report on the patient characteristics and PFS data for HER2 positive patients treated with T-DM1 after a treatment with pertuzumab. Patients had to be included before or at the beginning of the T-DM1 therapy.
Results
A total of 58 patients could be identified, who were suitable for the analysis. Of those 34 were treated in the second line, 14 in the third line and 10 in the fourth line or higher. Most of the pertuzumab therapies before T-DM1 were conducted in first line (n=46; 79.3%). Median PFS for all patients was 4.8 months (95% CI: 3.0-7.8 months). Median PFS for patients treated in the 3rdline and 4thline or higher was 4.2 months(95%CI: 2.3 - NA) and 4.0 months (95%CI: 1.8-N.A.), respectively. In patients treated 2ndline with T-DM1 PFS was 7.7 months (95%CI: 2.8 – 12.2).
Conclusion
T-DM1 is effective as 2ndand further line therapy following pretreatment with pertuzumab. Overall PFS was about 5 months with 7.7 months as 2nd-line therapy. The PFS in higher therapy lines might be shorter. As the sample size of this real world cohort was rather low and analyses have to be considered exploratory, this data need to be confirmed in studies with a larger sample size.
Citation Format: Schneeweiss A, Lux MP, Hartkopf AD, Volz B, Kolberg H-C, Hadji P, Tesch H, Haeberle L, Ettl J, Lüftner DI, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Lermann J, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Overkamp F, Huober J, Taran F-A, Janni W, Wallwiener D, Brucker SY, Fasching PA, Fehm TN. Progression free survival (PFS) and overall survival (OS) of patients treated with trastuzumab emtansine (T-DM1) after previous treatment with pertuzumab in patients with advanced breast cancer (NCT02338167) [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 P6-17-22.
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Affiliation(s)
- A Schneeweiss
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - MP Lux
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - AD Hartkopf
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - B Volz
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - H-C Kolberg
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - P Hadji
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - H Tesch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - L Haeberle
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - J Ettl
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - DI Lüftner
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - M Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - V Müller
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - MW Beckmann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - E Belleville
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - P Wimberger
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - C Hielscher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - M Geberth
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - J Lermann
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - W Abenhardt
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - C Kurbacher
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - R Wuerstlein
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - C Thomssen
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - M Untch
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - F Overkamp
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - J Huober
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - F-A Taran
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - W Janni
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - D Wallwiener
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - SY Brucker
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - PA Fasching
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
| | - TN Fehm
- Hamburg-Eppendorf University Medical Center, Hamburg, Germany; Ulm University Hospital, Ulm, Germany; Ulm University Hospital, Erlangen-Nuremberg, Germany; OncoConsult Hamburg GmbH, Hamburg, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; University Hospital Erlangen, Erlangen-Nuremberg, Germany; Klinikum rechts der Isar Technical University of Munich, Munich, Germany; University of Tuebingen, Tuebingen, Germany; Charité University Hospital Berlin Campus Benjamin Franklin Department of Hematology Oncology and Tumour Immunology, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; ClinSol GmbH & Co KG, Wuerzburg, Germany; Carl Gustav Carus University, TU Dresden, Dresden, Germany and National Center for Tumor Diseases and TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Manneim, Germany; Klinikum Bayreut, Bayreuth, Germany; MVZ Onkologie Onkologie im Elisenhof, Munich
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Reimann H, Nguyen A, Hübner H, Erber R, Bausenwein J, Van der Meijden ED, Lux MP, Jud S, Griffioen M, Rauh C, Sanborn JZ, Benz SC, Rabizadeh S, Beckmann MW, Mackensen A, Rübner M, Fasching PA, Kremer AN. Abstract P2-09-04: Identification of a neoantigen targeted by tumor-infiltrating lymphocytes in a patient with Her2+ breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-09-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent studies have demonstrated that the number of tumor infiltrating lymphocytes (TILs) positively correlates with outcome and response to chemotherapy in patients with HER2+ and Triple-Negative Breast Cancer (TNBC). Furthermore, first studies of immune-checkpoint inhibitors showed promising results in those patients. However, the targets of those TILs remain unknown. Neoantigens, which arise in the process of tumorigenesis, appear as potential targets. They can elicit high avidity, tumor-specific T-cell responses. Thus, it is the aim of our study to ascertainif these TILs are directed against tumor-specific mutations.
Methods: TILs from breast cancer biopsies taken at the time point of diagnosis were expanded by unspecific stimulation. Additionally, we used the Gentle Macs Dissociator in combination with flow cytometry to investigate the number of TILs in the tumor tissue. Furthermore, we performed whole-genome sequencing of tumor tissue and as reference autologous blood cells to determine tumor-specific mutations. Mutations leading to a non-synonymous amino acid change were analyzed for RNA expression of the encoding gene as well as to determine potential neoantigens. Neoantigens were evaluated for their potential binding to the patient's specific HLA molecules. Peptides for potential neoantigens were synthesized, loaded onto autologous antigen presenting cells (APCs) and cocultured with TILs. All IFNγ producing T-cells were clonally expanded and retested for peptide specificity to identify neoantigen specific T-cell clones.
Results: Our flow cytometric analysis of the tumor biopsy for more than 300 patients showed higher frequencies of TILs in TNBC as compared to other types of breast cancer or patients without malignancy. Screening for neoantigen specific T-cells in one patient led to identification of three peptide-specific CD4+ T-cell clones isolated from HER2+ breast cancer tissue taken at the time point of diagnosis. All T-cell clones specifically recognized the same tumor-specific mutation and not the wildtype counterpart. Furthermore, we demonstrated that these T-cell clones also recognized the endogenously expressed mutated antigen. This verified the ability of processing and presentation of the respective protein. Interestingly, we could also isolate a T-cell clone recognizing the same neoantigen in the resected tumor tissue after neoadjuvant therapy. Based on CDR3 sequencing we could prove that the four T-cell clones represented individual clones. This confirms the polyclonal nature of the immune response. Moreover, we showed that the same neoepitope was presented in two different HLA restriction molecules of the patient with three of the clones recognizing it in HLA-DPB1*0401 and one in HLA-DPB1*0201. These results further underline the immunogenicity of this neoantigen.
Conclusion: In conclusion, our data demonstrate tumor-specificity of TILs in a patient with HER2+ breast cancer. Furthermore, we show the feasibility to identify individual cancer specific T-cell targets in breast cancer patients. These results may contribute to the development of targeted patient-specific immunotherapies in the future.
Citation Format: Reimann H, Nguyen A, Hübner H, Erber R, Bausenwein J, Van der Meijden ED, Lux MP, Jud S, Griffioen M, Rauh C, Sanborn JZ, Benz SC, Rabizadeh S, Beckmann MW, Mackensen A, Rübner M, Fasching PA, Kremer AN. Identification of a neoantigen targeted by tumor-infiltrating lymphocytes in a patient with Her2+ breast cancer [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 P2-09-04.
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Affiliation(s)
- H Reimann
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - A Nguyen
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - H Hübner
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - R Erber
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - J Bausenwein
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - ED Van der Meijden
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - MP Lux
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - S Jud
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - M Griffioen
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - C Rauh
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - JZ Sanborn
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - SC Benz
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - S Rabizadeh
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - MW Beckmann
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - A Mackensen
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - M Rübner
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - PA Fasching
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
| | - AN Kremer
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Santa Cruz, CA; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; NantOmics, LLC, Culver City, CA; Leiden University Medical Center, Leiden, The Netherlands
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Sommer M, Kirchner M, Gulden C, Egloffstein S, Lux MP, Beckmann MW, Mackensen A, Prokosch HU. Design and Implementation of a Single Source Multipurpose Hospital-Wide Clinical Trial Registry. Stud Health Technol Inform 2019; 258:164-168. [PMID: 30942738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
IT-supported patient recruitment, serious adverse event reporting as well as making information about clinical trials accessible to the public on websites, are still major challenges in clinical trials. Too often the distribution of information about trials being performed within a hospital across numerous institutions and IT systems is a barrier to provide efficient IT support for such scenarios. Thus, the essential prerequisite to mastering those challenges is to achieve one single point of truth with adequate, complete, accurate and up-to-date information about all clinical trials running at a hospital. We describe the design and implementation of such a single source clinical trial registry serving multiple purposes at a university hospital.
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Affiliation(s)
- Marcus Sommer
- Center for Medical Information and Communication Technology, Erlangen University Hospital, Erlangen, Germany
| | - Melanie Kirchner
- Center for Medical Information and Communication Technology, Erlangen University Hospital, Erlangen, Germany
| | - Christian Gulden
- Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sainab Egloffstein
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Erlangen, Germany
| | - Michael Patrick Lux
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Erlangen, Germany
| | | | - Andreas Mackensen
- Department of Internal Medicine 5, Hematology and Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Center for Medical Information and Communication Technology, Erlangen University Hospital, Erlangen, Germany
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Huebner H, Erber R, Hein A, Lux MP, Jud S, Kremer AN, Kranich H, Mackensen A, Häberle L, Hack C, Rauh C, Wunderle M, Gaß P, Rabizadeh S, Brandl AL, Langemann H, Volz B, Nabieva N, Schulz-Wendtland R, Dudziak D, Beckmann MW, Hartmann A, Fasching PA, Rübner M. TILGen: A Program to Investigate Immune Targets in Breast Cancer Patients – First Results on the Influence of Tumor-Infiltrating Lymphocytes. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1675457] [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: 10/27/2022] Open
Affiliation(s)
- H Huebner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - R Erber
- Institute of Pathology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - MP Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - S Jud
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - AN Kremer
- Department of Internal Medicine 5, Haematology and Oncology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Kranich
- Department of Internal Medicine 5, Haematology and Oncology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Mackensen
- Department of Internal Medicine 5, Haematology and Oncology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - L Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - C Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - C Rauh
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - M Wunderle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - P Gaß
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | | | - AL Brandl
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - H Langemann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - B Volz
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - N Nabieva
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - R Schulz-Wendtland
- Institute of Diagnostic Radiology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - D Dudziak
- Department of Dermatology, Laboratory of Dendritic Cell Biology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - MW Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - PA Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - M Rübner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
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Gaß P, Emons J, Bani MR, Wunderle M, Sell C, Preuss C, Rauh C, Schrauder MG, Jud SM, Hack CC, Adler W, Schulz-Wendtland R, Beckmann MW, Fasching PA, Lux MP. The diagnostic accuracy of breast medical tactile examiners (MTE) – A first prospective monocentric study. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671219] [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)
- P Gaß
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - J Emons
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - MR Bani
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - M Wunderle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Sell
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Preuss
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Rauh
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - MG Schrauder
- Department of Gynecology and Obstetrics, Aschaffenburg, Deutschland
| | - SM Jud
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - CC Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - W Adler
- Institute of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Deutschland
| | - R Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Erlangen, Deutschland
| | - MW Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - PA Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
| | - MP Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Deutschland
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Brendle-Behnisch AM, Arkudas A, Bani MR, Jud SM, Schrauder MG, Rauh C, Hack CC, Horch RE, Beckmann MW, Lux MP. Langfristige Kosteneffektivität der Mammareduktionsplastik bei Patientinnen mit Makromastie aus Sicht der Kostenträger und der Gesellschaft. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671209] [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)
- AM Brendle-Behnisch
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - A Arkudas
- Plastisch- und Handchirurgische Klinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - MR Bani
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - SM Jud
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - MG Schrauder
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - C Rauh
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - CC Hack
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - RE Horch
- Plastisch- und Handchirurgische Klinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - MW Beckmann
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
| | - MP Lux
- Frauenklinik des Universitätsklinikums Erlangen, Brustzentrum, Erlangen, Deutschland
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Häberle L, Erber R, Gaß P, Hein A, Jud SM, Lux MP, Langemann H, Rauh C, Hack CC, Schulz-Wendtland R, Hartmann A, Beckmann MW, Fasching PA. Prädiktionsmodelle zur Vorhersage von pathologischer Komplettremission bei Brustkrebspatientinnen nach neoadjuvanter Chemotherapie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671025] [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)
- L Häberle
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - R Erber
- Universitätsklinikum Erlangen, Pathologisches Institut, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - P Gaß
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A Hein
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - SM Jud
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - MP Lux
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - H Langemann
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Rauh
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - CC Hack
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - R Schulz-Wendtland
- Universitätsklinikum Erlangen, Radiologisches Institut, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A Hartmann
- Universitätsklinikum Erlangen, Pathologisches Institut, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - MW Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - PA Fasching
- Universitätsklinikum Erlangen, Frauenklinik, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
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Huebner H, Erber R, Würfel F, Hein A, Lux MP, Jud S, Kremer A, Kranich H, Mackensen A, Häberle L, Hack CC, Rauh C, Wunderle M, Gaß P, Rabizadeh S, Brandl AL, Langemann H, Volz B, Nabieva N, Schulz-Wendtland R, Dudziak D, Beckmann MW, Hartmann A, Fasching PA, Rübner M. TILGen: Eine Studie zur Untersuchung immunonkologischer Marker für die Behandlung des Mammakarzinoms – Erste Ergebnisse zum Einfluss Tumor-infiltrierender Lymphozyten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671057] [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)
- H Huebner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - R Erber
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - F Würfel
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Hein
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - MP Lux
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - S Jud
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Kremer
- Medizinische Klinik 5, Hämatologie und Onkologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - H Kranich
- Medizinische Klinik 5, Hämatologie und Onkologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Mackensen
- Medizinische Klinik 5, Hämatologie und Onkologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - L Häberle
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - CC Hack
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - C Rauh
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - M Wunderle
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - P Gaß
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - S Rabizadeh
- NantOmics, LLC, Santa Cruz, Vereinigte Staaten von Amerika
| | - AL Brandl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - H Langemann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - B Volz
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - N Nabieva
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - R Schulz-Wendtland
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - D Dudziak
- Dermatologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - MW Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Hartmann
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - PA Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - M Rübner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
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Schulz-Wendtland R, Preuß CI, Fasching PA, Loehberg CR, Jud SM, Lux MP, Beckmann MW, Uder M, Müller-Schimpfle M. Galaktografie mit Tomosythese (Galaktomosynthese) – Renaissance einer Methode? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671514] [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)
- R Schulz-Wendtland
- Universitätsklinikum Erlangen, Radiologisches Institut/Gynäkologische Radiologie, Erlangen, Deutschland
| | - CI Preuß
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - PA Fasching
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - CR Loehberg
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - SM Jud
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - MP Lux
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - MW Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - M Uder
- Universitätsklinikum Erlangen, Radiologisches Institut, Erlangen, Deutschland
| | - M Müller-Schimpfle
- Klinikum Frankfurt Hoechst, Klinik für Radiologie, Frankfurt am Main, Deutschland
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Huober J, Fasching PA, Taran FA, Volz B, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lueftner D, Wallwiener M, Mueller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Wallwiener D, Brucker SY, Schneeweiss A, Fehm TN. Abstract P3-11-07: Factors associated with first line chemotherapy use in patients with hormone receptor positive, HER2 negative metastatic breast cancer – data from the PRAEGNANT breast cancer registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-11-07] [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
For breast cancer patients with metastases which are not life threatening national and international guidelines recommend the exhaustion of all antihormonal therapeutic options before recommending chemotherapy. In Germany up to now only everolimus was an additional option to overcome endocrine resistance. CDK4/6 inhibitors recently became available in Germany (Nov 2011). Aim of this analysis was the identification of predictors for a decision against an antihormonal treatment.
Methods
The PRAEGNANT metastatic breast cancer registry (NCT02338167) is a prospective registry for metastatic breast cancer patients. Besides biomarker research the description of real-world treatment data was one of the main study aims. This analysis was restricted to first line metastatic patients who were hormone receptor (HR) positive and HER2 negative. First, predictors were identified with a multiple logistic regression model. Then patients, who received chemo or not ,were compared with regard to overall survival using Cox regression analysis with the predictors for chemotherapy from above and additionally chemo status (yes/no)
Results
A total of 389 HR-positive and HER2-negative patients with detailed treatment information were included during the 1st line therapy into PRAEGNANT. Of those 173 (44.5%) received a chemotherapy, 190 an antihormone therapy (AHT) (48.8%), and 26 (6.7%) everolimus+AHT. In the multiple logistic regression model, older patients, lower graded tumors, bone only disease and previous adjuvant chemotherapy were associated with a lower rate of first line chemotherapies. BMI and number of concomitant diseases had no influence on the choice of first line metastatic therapy. In patients with visceral metastases 58.1% were treated with a 1st line chemo, while in patients with brain metastases or bone only metastases these numbers were 55.6% and 26.9%. Grading had an influence with patients having a G1, G2 and G3 tumor receiving 1st line chemo in 28.0%, 38.4% and 63.2% of the cases respectively. Patients who received chemo seemed to have a worse overall survival than patients who did not receive chemo (adjusted HR 1.58; 95% CI, 0.89 to 2.18). However, this result was not signifcant (p = 0.12). Overall survival was primarily influenced by ECOG and location of metastasis
Conclusion
The usage of chemotherapy can be predicted with age, metastasis pattern, grading and previous use of chemotherapy. However, we could not show that patients benefited from chemotherapy. On contrary, there was a tendency that patients treated with chemotherapy had poorer overall survival. Further studies with larger sample sizes are needed to confirm this claim.
Citation Format: Huober J, Fasching PA, Taran F-A, Volz B, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lueftner D, Wallwiener M, Mueller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Wallwiener D, Brucker SY, Schneeweiss A, Fehm TN. Factors associated with first line chemotherapy use in patients with hormone receptor positive, HER2 negative metastatic breast cancer – data from the PRAEGNANT breast cancer registry [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 P3-11-07.
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Affiliation(s)
- J Huober
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - PA Fasching
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - F-A Taran
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - B Volz
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - F Overkamp
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - HC Kolberg
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - P Hadji
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - H Tesch
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - L Haeberle
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - J Ettl
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - AD Hartkopf
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - MP Lux
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - D Lueftner
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - M Wallwiener
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - V Mueller
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - MW Beckmann
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - E Belleville
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - P Wimberger
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - C Hielscher
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - M Geberth
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - N Fersis
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - W Abenhardt
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - C Kurbacher
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - R Wuerstlein
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - C Thomssen
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - M Untch
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - W Janni
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - D Wallwiener
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - SY Brucker
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - A Schneeweiss
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - TN Fehm
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
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Szeto C, Benz S, Nguyen A, Rübner M, Wallwiener D, Tesch H, Hadji P, Fehm TN, Janni W, Overkamp F, Lueftner D, Lux MP, Wallwiener M, Beckmann MW, Huebner H, Ettl J, Hartkopf AD, Mueller V, Taran FA, Belleville E, Schneeweiss A, Soon-Shiong P, Rabizadeh S, Fasching PA. Abstract P1-07-20: Developing prognostic indicators of poor outcomes in PRAEGNANT metastatic breast cancer cohort. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Despite novel, targeted therapies, metastatic breast cancer patients have an extremely unfavourable prognosis. Prognostic and predictive factors for patients with advanced breast cancer are not well understood. Molecular assessment of the patient and the tumor in the metastatic situation is not routinely performed despite advances in molecular precision medicine indicating great benefit to this patient group. Here we present early findings from the first 142 patients of a prospective molecular breast cancer registry with completed transcriptomic profiling.
Methods: The PRAEGNANT study proctocol (NCT02338767) is a molecular registry designed to provide an infrastructure for the real-time comprehensive analysis of tumor and patient molecular characteristics under study conditions. Formalin fixed paraffin embedded tumors have been used from this registry to identify molecular, transcriptomic predictors for overall survival (OS).
Known clinical correlates for OS (e.g. hormone-receptor status, age at diagnosis, and BMI) were analyzed by Cox proportional hazard ratios, and compared to transcriptomic markers of outcomes. Transcriptomes for all patient tumors were sequenced on the Illumina sequencing platform, and analyzed by RSEM to estimate transcripts per million (TPM) values for each gene isoform. Log-TPM values were used in established (PAM50) and novel (hierarchical clustering) expression-based subtyping of tumor samples. Expression-based subtypes were demonstrated to be strong prognostic indicators by Cox analysis. A Lasso regression machine learning algorithm was used to develop an expression-based predictive model of OS.
Results: Hormone receptor positivity (HR=0.7, p<0.006) and TNBC status (HR=1.4, p<0.01) were significantly associated with outcomes. PAM50 subtypes were also strong indicators of outcomes (e.g. Basal disease compared to Luminal-A subtype has HR=1.4, p<0.017). A novel expression-based high-risk cluster in this cohort was more indicative of poor prognosis than clinical variates or Basal-type, with a HR=2.7 (p<0.009) when compared to Luminal-A subtype. An expression-based survival prediction model achieved a concordance-index of 0.65 in an unseen validation cohort. Patients predicted as having the shortest survival times were in the high-risk cluster.
Conclusions: Here we demonstrate using molecular profiling to develop prognostic signatures that out-perform standard clinical correlates of poor outcomes, even in a small subset of the total cohort. As the PRAEGNANT cohort expands these prognostic tools will continue to improve and supplement physician knowledge to improve patient outcomes.
Citation Format: Szeto C, Benz S, Nguyen A, Rübner M, Wallwiener D, Tesch H, Hadji P, Fehm TN, Janni W, Overkamp F, Lueftner D, Lux MP, Wallwiener M, Beckmann MW, Huebner H, Ettl J, Hartkopf AD, Mueller V, Taran FA, Belleville E, Schneeweiss A, Soon-Shiong P, Rabizadeh S, Fasching PA. Developing prognostic indicators of poor outcomes in PRAEGNANT metastatic breast cancer cohort [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 P1-07-20.
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Affiliation(s)
- C Szeto
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - S Benz
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - A Nguyen
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - M Rübner
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - D Wallwiener
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - H Tesch
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - P Hadji
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - TN Fehm
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - W Janni
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - F Overkamp
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - D Lueftner
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - MP Lux
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - M Wallwiener
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - MW Beckmann
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - H Huebner
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - J Ettl
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - AD Hartkopf
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - V Mueller
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - FA Taran
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - E Belleville
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - A Schneeweiss
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - P Soon-Shiong
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - S Rabizadeh
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
| | - PA Fasching
- NantOmics, LLC, Santa Cruz, CA; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen-Nuremberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Northwest Hospital, Frankfurt, Germany; University Hospital Duesseldorf, Düsseldorf, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; NantWorks, LLC, Culver City, CA
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Taran FA, Fasching PA, Volz B, Huober J, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Lux MP, Hartkopf AD, Lueftner D, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A. Abstract P5-21-09: Overall survival of metastatic breast cancer patients – data from the PRAEGNANT breast cancer registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-21-09] [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 Cancer registries can help to understand how patient groups are treated outside clinical trials and what outcome is to expected for specific patient groups and therapy lines, which are not included into clinical trials. Here we present overall survival data according to therapy lines, patient and tumor characteristics.
Methods
The PRAEGNANT metastatic breast cancer registry (NCT02338167) is a prospective registry for breast cancer patients with focus on molecular biomarkers. Patients of all therapy lines with any kind of treatment are eligible for this registry. Collected data comprises therapies, adverse events, quality of life and other patient reported outcomes. Here we report on the comparison of overall survival data for different patient groups. For that analysis was restricted to patients included in the first therapy line for subgroup comparisons. Only for the analysis of the effect of therapy line on overall survival the complete dataset was used.
Results
A total of 1854 patients took part in this analysis. Of those 1016 were included first line, and 340, 213 and 285 patients 2nd line, 3rd lin4 and 4th line or higher respectively. A total of 339 deaths were observed. Two year survival rates (2Y-OS) for these groups were 75%, 65%, 57% and 36% (p(log-rank)<0.001). All further analyses were done only for the subset of first line treated patients with a total of 127 events. HER2 positive patients had the highest 2Y-OS rate of 84% and TNBC had the worst with 60% (see figure 1). Absolute numbers of deaths for TNBC, luminal A like, luminal B like and HER2 posives were 21, 48, 25, and 21. According to metastastic pattern the following survival rates were seen: brain (48%), other locations (69%), visceral (78%) and bone only (81%). ECOG was another factor that had a large influence on OS with ECOG 0: 83%, ECOG 1: 67% and EGOG 2+: 63% 2Y-OS. Age, BMI, number of concomitant diseases, and primary metastatic status did not have an influence on 2Y-OS.
Conclusion
This breast registry included patients over all therapy lines however mainly during the 1st line of therapy. Simple patient and tumor characteristics can classify patients into patients with differently favourable prognosis. Patients with HER2 positive disease had the best overall survival, while TNBC and luminal B like patients had the worst prognosis. As most of the patients were luminal A like 43% of all deaths occured within the group of luminal A like patients, which will need further focus for therapy development in the future.
Citation Format: Taran F-A, Fasching PA, Volz B, Huober J, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Lux MP, Hartkopf AD, Lueftner D, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A. Overall survival of metastatic breast cancer patients – data from the PRAEGNANT breast cancer registry [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 P5-21-09.
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Affiliation(s)
- F-A Taran
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - PA Fasching
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - B Volz
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - J Huober
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - F Overkamp
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - HC Kolberg
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - P Hadji
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - H Tesch
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - L Haeberle
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - J Ettl
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - MP Lux
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - AD Hartkopf
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - D Lueftner
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - M Wallwiener
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - V Müller
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - MW Beckmann
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - E Belleville
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - P Wimberger
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - C Hielscher
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - M Geberth
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - N Fersis
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - W Abenhardt
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - C Kurbacher
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - R Wuerstlein
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - C Thomssen
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - M Untch
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - W Janni
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - TN Fehm
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - D Wallwiener
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - SY Brucker
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
| | - A Schneeweiss
- University of Tuebingen, Tuebingen, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Ulm University Hospital, Ulm, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany; MVZ Onk
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Wallwiener M, Nabieva N, Haeberle L, Taran FA, Hartkopf AD, Volz B, Overkamp F, Brandl AL, Kolberg HC, Hadji P, Tesch H, Ettl J, Lux MP, Lueftner D, Belleville E, Fasching PA, Janni W, Beckmann MW, Wimberger P, Hielscher C, Fehm T, Brucker SY, Wallwiener D, Schneeweiss A, Mueller V. Abstract P6-11-10: Impact of disease progression on health-related quality of life in patients with metastatic breast cancer in the PRAEGNANT breast cancer registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-11-10] [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: Improved progression-free survival is considered as treatment goal for patients with metastatic breast cancer (MBC) since it is assumed to delay or prevent deterioration of quality of life.Aim of our analysis was to examine the influence of disease progression on health-related quality of life (HRQoL).
Methods: The PRAEGNANT study comprises a real-life registry for patients with MBC. HRQoL was assessed with the EORTC-QLQ-C30 Version 3.0 questionnaire at study entry and every 3 months thereafter. The primary endpoint was minimally important deterioration (MID) in global HRQoL score by ≥ five points between baseline and any follow-up assessment. A logistic regression model was built with MID (yes/no) at a follow-up timepoint as outcome variable and several covariates as predictors.
Results: In total, 329 patients were included in this analysis, with disease progression in 63 patients. Concerning the primary study aim, progression status predicted MID of global HRQoL status in addition to the other covariates. The adjusted odds ratio for the effect of progression status on MID was 2.22 (95% CI: 1.04 – 4.73). Comparisons of mean differences of QoL domains/scales yielded no differences.
Conclusions: We provide evidence that disease progression in patients with metastatic breast cancer in a real-world registry has a significant negative impact on HRQoL as measured by MID of HRQoL. This study emphasizes the relevance of avoiding progression and prolonging PFS to maintain QoL.
Citation Format: Wallwiener M, Nabieva N, Haeberle L, Taran FA, Hartkopf AD, Volz B, Overkamp F, Brandl AL, Kolberg H-C, Hadji P, Tesch H, Ettl J, Lux MP, Lueftner D, Belleville E, Fasching PA, Janni W, Beckmann MW, Wimberger P, Hielscher C, Fehm T, Brucker SY, Wallwiener D, Schneeweiss A, Mueller V. Impact of disease progression on health-related quality of life in patients with metastatic breast cancer in the PRAEGNANT breast cancer registry [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 P6-11-10.
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Affiliation(s)
- M Wallwiener
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - N Nabieva
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - L Haeberle
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - FA Taran
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - AD Hartkopf
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - B Volz
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - F Overkamp
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - AL Brandl
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - H-C Kolberg
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - P Hadji
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - H Tesch
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - J Ettl
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - MP Lux
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - D Lueftner
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - E Belleville
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - PA Fasching
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - W Janni
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - MW Beckmann
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - P Wimberger
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - C Hielscher
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - T Fehm
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - SY Brucker
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - D Wallwiener
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - A Schneeweiss
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
| | - V Mueller
- University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Heidelberg, Baden-Wuerttemberg, Germany; University Hospital Erlangen, Erlangen, Germany; University of Heidelberg, Heidelberg, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Nordwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany; Clin-Sol GmbH Wuerzburg, Wuerzburg, Germany; University Hospital Ulm, Ulm, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Heinrich Heine University of Dusseldorf, Dusseldorf, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamb
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Lux MP, Nabieva N, Hildebrandt T, Rebscher H, Kümmel S, Blohmer JU, Schrauder MG. Budget impact analysis of gene expression tests to aid therapy decisions for breast cancer patients in Germany. Breast 2017; 37:89-98. [PMID: 29128582 DOI: 10.1016/j.breast.2017.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Many women with early-stage, hormone receptor-positive breast cancer may not benefit from adjuvant chemotherapy. Gene expression tests can reduce chemotherapy over- and undertreatment by providing prognostic information on the likelihood of recurrence and, with Oncotype DX, predictive information on chemotherapy benefit. These tests are currently not reimbursed by German healthcare payers. An analysis was conducted to evaluate the budget impact of gene expression tests in Germany. MATERIALS AND METHODS Costs of gene expression tests and medical and non-medical costs associated with treatment were assessed from healthcare payer and societal perspectives. Costs were estimated from data collected at a university hospital and were combined with decision impact data for Oncotype DX, MammaPrint, Prosigna and EndoPredict (EPclin). Changes in chemotherapy use and budget impact were evaluated over 1 year for 20,000 women. RESULTS Chemotherapy was associated with substantial annual costs of EUR 19,003 and EUR 84,412 per therapy from the healthcare payer and societal perspective, respectively. Compared with standard care, only Oncotype DX was associated with cost savings to healthcare payers and society (EUR 5.9 million and EUR 253 million, respectively). Scenario analysis showed that both women at high clinical but low genomic risk and low clinical but high genomic risk were important contributors to costs. CONCLUSIONS Oncotype DX was the only gene expression test that was estimated to reduce costs versus standard care in Germany. The reimbursement of Oncotype DX testing in standard clinical practice in Germany should be considered.
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Affiliation(s)
- M P Lux
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | - N Nabieva
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - T Hildebrandt
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - H Rebscher
- Institut für Gesundheitsökonomie und Versorgungsforschung, Gyhum-Hesedorf, Germany
| | - S Kümmel
- Interdisziplinäres Brust-/Krebszentrum, Kliniken Essen-Mitte, Essen, Germany
| | - J-U Blohmer
- Klinik für Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M G Schrauder
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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Hein A, Rack B, Li L, Ekici AB, Reis A, Lux MP, Cunningham JM, Rübner M, Fridley BL, Schneeweiss A, Tesch H, Lichtenegger W, Fehm T, Heinrich G, Rezai M, Beckmann MW, Janni W, Weinshilboum RM, Wang L, Fasching PA, Häberle L. Genetic Breast Cancer Susceptibility Variants and Prognosis in the Prospectively Randomized SUCCESS A Study. Geburtshilfe Frauenheilkd 2017; 77:651-659. [PMID: 28757652 DOI: 10.1055/s-0042-113189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/13/2022] Open
Abstract
Large-scale genotyping studies have identified over 70 single nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk. However, knowledge regarding genetic risk factors associated with the prognosis is limited. The aim of this study was therefore to investigate the prognostic effect of nine known breast cancer risk SNPs. BC patients (n = 1687) randomly sampled in an adjuvant, randomized phase III trial (SUCCESS A study) were genotyped for nine BC risk SNPs: rs17468277 (CASP8) , rs2981582 (FGFR2) , rs13281615(8q24), rs3817198 (LSP1) , rs889312 (MAP3K1) , rs3803662 (TOX3) , rs13387042(2q35), rs4973768 (SLC4A7) , rs6504950 (COX11) . Cox proportional hazards models were used to test the SNPs' association with overall survival (OS) and progression-free survival (PFS). Additional analyses were carried out for molecular subgroups. rs3817198 in LSP1 (lymphocyte-specific protein 1) was the only SNP that significantly influenced OS (p = 0.01) and PFS (p < 0.01) in the likelihood ratio test comparing the genetic survival model with the clinical survival model. In the molecular subgroups, triple-negative patients with two minor alleles in rs3817198 had a much better prognosis relative to OS (adjusted HR 0.03; 95% CI 0.002 - 0.279) and PFS (HR 0.09; 95% CI 0.02 - 0.36) than patients with the common alleles. The same effect on PFS was shown for patients with luminal A tumors (HR 0.19; 95% CI 0.05 - 0.84), whereas patients with luminal B tumors had a poorer PFS with two minor alleles (HR 2.13; 95% CI 1.02 - 4.40). The variant in rs3817198 has a prognostic effect particularly in the subgroup of patients with triple-negative BC, suggesting a possible link with immunomodulation and BC.
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Affiliation(s)
- A Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - B Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - L Li
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Mayo Medical School-Mayo Foundation, Rochester, MN, USA.,Department of Oncology; Institute of Medicinal Biotechnology; Chinese Academy of Medical Sciences & Peking Union Medical College; Tiantan Xili, Beijing, 100050, China
| | - A B Ekici
- Institute of Human Genetics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - A Reis
- Institute of Human Genetics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - J M Cunningham
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | - M Rübner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - B L Fridley
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.,Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - A Schneeweiss
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, National Center for Tumor Diseases, Heidelberg, Germany
| | - H Tesch
- Department of Oncology, Onkologie Bethanien, Frankfurt am Main, Germany
| | - W Lichtenegger
- Department of Gynecology and Obstetrics, Charité University Hospital Campus Virchow, Berlin, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Duesseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - G Heinrich
- Department of Gynecologic Oncology, Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany
| | - M Rezai
- Department of Breast Diseases, Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - W Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - R M Weinshilboum
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Mayo Medical School-Mayo Foundation, Rochester, MN, USA
| | - L Wang
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Mayo Medical School-Mayo Foundation, Rochester, MN, USA
| | - P A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Department of Medicine, Division of Hematology/Oncology, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - L Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Sehouli J, Tomè O, Dimitrova D, Camara O, Runnebaum IB, Tessen HW, Rautenberg B, Chekerov R, Muallem MZ, Lux MP, Trarbach T, Gitsch G. A phase III, open label, randomized multicenter controlled trial of oral versus intravenous treosulfan in heavily pretreated recurrent ovarian cancer: a study of the North-Eastern German Society of Gynecological Oncology (NOGGO). J Cancer Res Clin Oncol 2016; 143:541-550. [PMID: 27896440 PMCID: PMC5306340 DOI: 10.1007/s00432-016-2307-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 06/27/2016] [Accepted: 11/14/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In recurrent ovarian cancer (ROC), there is a high demand on effective therapies with a mild toxicity profile. Treosulfan is an alkylating agent approved as oral (p.o.) and intravenous (i.v.) formulation for the treatment of recurrent ovarian cancer. Data on safety and efficacy for either formulation are rare. For the first time we conducted a randomized phase III study comparing both formulations in women with ROC. METHODS Patients having received at least two previous lines of chemotherapy were randomly assigned to one of two treatment arms: treosulfan i.v. 7000 mg/m2 d1 q4w or treosulfan p.o. 600 mg/m2 d1-28 q8w. Primary endpoint was safety regarding hematological and gastrointestinal toxicity grade III/IV, secondary endpoints were other toxicities, clinical benefit rate (CBR), time to progression (TTP), overall survival (OS) and quality of life. RESULTS 250 patients were treated with treosulfan i.v. (128) or treosulfan p.o. (122). In general treosulfan therapy was well tolerated in both treatment arms. Leukopenia grade III/IV occurred significantly more frequently in the p.o. arm (3.9% i.v. arm, 14.8% p.o. arm, p = 0.002). Other toxicities were similar in both arms. CBR was comparable between arms (41.4% i.v. arm, 36.9% p.o. arm). No difference in TTP (3.7 months i.v. arm, 3.5 months p.o. arm) or OS (13.6 months i.v. arm, 10.4 months p.o. arm, p = 0.087) occurred. CONCLUSIONS Given the safety and efficacy results treosulfan is an acceptable option for heavily pretreated OC patients. Regarding the toxicity profile the i.v. application was better tolerated with less grade III and IV toxicities.
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Affiliation(s)
- Jalid Sehouli
- Gynecology and Gynecologic Oncology, Charité University Medicine Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Oliver Tomè
- Gynecologic Cancer Centre Karlsruhe, St. Vincentius Clinics, Karlsruhe, Germany
| | - Desislava Dimitrova
- Gynecology and Gynecologic Oncology, Charité University Medicine Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Oumar Camara
- Centre for Gynecology, Hufeland Clinic, Bad Langensalza, Germany
| | | | | | - Beate Rautenberg
- Gynecology and Gynecologic Oncology, University Clinic, Freiburg, Germany
| | - Radoslav Chekerov
- Gynecology and Gynecologic Oncology, Charité University Medicine Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Mustafa Zelal Muallem
- Gynecology and Gynecologic Oncology, Charité University Medicine Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Michael Patrick Lux
- Department of OOGYN, Gyncecological University Cancer Center of Franconia, University Hospital Erlangen, CCC Erlangen-EMN, Erlangen, Germany
| | | | - Gerald Gitsch
- Gynecology and Gynecologic Oncology, University Clinic, Freiburg, Germany
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Fasching PA, Lux MP, Häberle L, Wallwiener M, Schneeweiss A, Tesch H, Belleville E, Spall T, Müller V, Brucker S, Lück HJ. SERAPHINA – Safety, Efficacy and patient Reported outcomes of Advanced breast cancer Patients: tHerapy management wIth NAb-paclitaxel in daily routine (a non-interventional study). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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50
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Gaß P, Bani M, Bayer CM, Beckmann MW, Erber R, Hartmann A, Häberle L, Hein A, Heusinger K, Lux MP, Rauh C, Schulz-Wendtland R, Schrauder MG, Wachter DL, Fasching PA. Prädiktion der kompletten pathologischen Remission nach neoadjuvanter Chemotherapie durch Ki-67, den Östrogen- und Progesteronrezeptor. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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