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Burghaus S, Drazic P, Wölfler M, Mechsner S, Zeppernick M, Meinhold-Heerlein I, Mueller MD, Rothmund R, Vigano P, Becker CM, Zondervan KT, Beckmann MW, Fasching PA, Berner-Gatz S, Grünewald FS, Hund M, Kastner P, Klammer M, Laubender RP, Wegmeyer H, Wienhues-Thelen UH, Renner SP. Multicenter evaluation of blood-based biomarkers for the detection of endometriosis and adenomyosis: A prospective non-interventional study. Int J Gynaecol Obstet 2024; 164:305-314. [PMID: 37635683 DOI: 10.1002/ijgo.15062] [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] [Received: 05/16/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To evaluate blood-based biomarkers to detect endometriosis and/or adenomyosis across nine European centers (June 2014-April 2018). METHODS This prospective, non-interventional study assessed the diagnostic accuracy of 54 blood-based biomarker immunoassays in samples from 919 women (aged 18-45 years) with suspicion of endometriosis and/or adenomyosis versus symptomatic controls. Endometriosis was stratified by revised American Society for Reproductive Medicine stage. Symptomatic controls were "pathologic symptomatic controls" or "pathology-free symptomatic controls". The main outcome measure was receiver operating characteristic-area under the curve (ROC-AUC) and Wilcoxon P values corrected for multiple testing (q values). RESULTS CA-125 performed best in "all endometriosis cases" versus "all symptomatic controls" (AUC 0.645, 95% confidence interval [CI] 0.600-0.690, q < 0.001) and increased (P < 0.001) with disease stage. In "all endometriosis cases" versus "pathology-free symptomatic controls", S100-A12 performed best (AUC 0.692, 95% CI 0.614-0.769, q = 0.001) followed by CA-125 (AUC 0.649, 95% CI 0.569-0.729, q = 0.021). In "adenomyosis only cases" versus "symptomatic controls" or "pathology-free symptomatic controls", respectively, the top-performing biomarkers were sFRP-4 (AUC 0.615, 95% CI 0.551-0.678, q = 0.045) and S100-A12 (AUC 0.701, 95% CI 0.611-0.792, q = 0.004). CONCLUSION This study concluded that no biomarkers tested could diagnose or rule out endometriosis/adenomyosis with high certainty.
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Affiliation(s)
- Stefanie Burghaus
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Endometriosis Center for Franconia, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Predrag Drazic
- Endometriosis Center, Ammerland Clinic GmbH, Westerstede, Germany
| | - Monika Wölfler
- Department of Gynecology and Obstetrics and Gynecology, Medical University, Graz, Austria
| | - Sylvia Mechsner
- Department of Gynecology, Endometriosis Research Center Charité, Charité University Hospital, Campus Virchow Klinikum, Berlin, Germany
| | - Magdalena Zeppernick
- Department of Gynecology and Obstetrics, RWTH Aachen University Hospital, Aachen, Germany
- Department of Gynecology and Obstetrics, Justus Liebig University, Giessen, Germany
| | - Ivo Meinhold-Heerlein
- Department of Gynecology and Obstetrics, RWTH Aachen University Hospital, Aachen, Germany
- Department of Gynecology and Obstetrics, Justus Liebig University, Giessen, Germany
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - Ralf Rothmund
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Paola Vigano
- Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Christian M Becker
- Oxford Endometriosis Care and Research (CaRe) Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Krina T Zondervan
- Oxford Endometriosis Care and Research (CaRe) Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Endometriosis Center for Franconia, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Endometriosis Center for Franconia, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Martin Hund
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | | | | | | | | | | | - Stefan P Renner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Endometriosis Center for Franconia, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Gynecology and Obstetrics, Hospital Böblingen, Klinikverbund-Suedwest, Klinikum Sindelfingen-Böblingen, Böblingen, Germany
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Laubender RP, Mansmann U, Lauseker M. Estimating the distribution of heterogeneous treatment effects from treatment responses and from a predictive biomarker in a parallel‐group RCT: A structural model approach. Biom J 2020; 62:697-711. [DOI: 10.1002/bimj.201800370] [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] [Received: 11/30/2018] [Revised: 12/10/2019] [Accepted: 01/12/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Ruediger P. Laubender
- Faculty of Medicine Institute for Medical Information Processing, Biometry, and Epidemiology LMU Munich Munich Germany
| | - Ulrich Mansmann
- Faculty of Medicine Institute for Medical Information Processing, Biometry, and Epidemiology LMU Munich Munich Germany
| | - Michael Lauseker
- Faculty of Medicine Institute for Medical Information Processing, Biometry, and Epidemiology LMU Munich Munich Germany
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Haas M, Ormanns S, Baechmann S, Remold A, Kruger S, Westphalen CB, Siveke JT, Wenzel P, Schlitter AM, Esposito I, Quietzsch D, Clemens MR, Kettner E, Laubender RP, Jung A, Kirchner T, Boeck S, Heinemann V. Extended RAS analysis and correlation with overall survival in advanced pancreatic cancer. Br J Cancer 2017; 116:1462-1469. [PMID: 28449008 PMCID: PMC5520094 DOI: 10.1038/bjc.2017.115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/21/2017] [Accepted: 04/03/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Mutations in the KRAS gene can be detected in about 70-90% of pancreatic cancer (PC) cases. Whether these mutations have a prognostic or predictive value remains elusive. Furthermore, the clinical relevance of the extended RAS (KRAS+NRAS) mutational status is unclear in PC. METHODS We prospectively defined a PC patient population who received erlotinib-free chemotherapy regimens. A statistically significant difference between KRAS wild-type and KRAS mutated tumours in at least 160 patients in this population would support the assumption of a rather prognostic role of KRAS. RESULTS One hundred and seventy-eight tumour samples were collected from prospective clinical studies and successfully analysed for the extended RAS status: 37 tumours were KRAS wild-type (21%), whereas 141 (79%) carried a KRAS mutation; 132 of these mutations were found in KRAS exon 2 (74%), whereas only 9 mutations (5%) were detected in KRAS exon 3. Within KRAS exon 4 and NRAS exons 2-4, no mutations were apparent. There was no significant difference in overall survival for KRAS wild-type vs mutant patients (9.9 vs 8.3 months, P=0.70). CONCLUSIONS Together with the results of the AIO-PK-0104-trial, the present analysis supports the notion that KRAS mutation status is rather predictive than prognostic in advanced PC.
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Affiliation(s)
- Michael Haas
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, Munich 81377, Germany
| | - Steffen Ormanns
- Institute of Pathology, Ludwig-Maximilians-University of Munich, Germany and German Cancer Consortium (DKTK), Partner Site Munich, Thalkirchner Str. 36, Munich 80377, Germany
| | - Sibylle Baechmann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, Munich 81377, Germany.,Institute of Pathology, Ludwig-Maximilians-University of Munich, Germany and German Cancer Consortium (DKTK), Partner Site Munich, Thalkirchner Str. 36, Munich 80377, Germany
| | - Anna Remold
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, Munich 81377, Germany.,Institute of Pathology, Ludwig-Maximilians-University of Munich, Germany and German Cancer Consortium (DKTK), Partner Site Munich, Thalkirchner Str. 36, Munich 80377, Germany
| | - Stephan Kruger
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, Munich 81377, Germany
| | - Christoph B Westphalen
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, Munich 81377, Germany
| | - Jens T Siveke
- 2nd Medical Department, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, Munich 81675, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany.,Division of Solid Tumour Translational Oncology, German Cancer Consortium (DKTK), Partner Site Essen, University Hospital Essen, Hufelandstr. 55, Essen 45147, Germany
| | - Patrick Wenzel
- 2nd Medical Department, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, Munich 81675, Germany
| | - Anna Melissa Schlitter
- Institute of Pathology, Technical University of Munich, Trogerstr. 18, Munich 81675, Germany
| | - Irene Esposito
- Institute of Pathology, Heinrich Heine University of Duesseldorf, Moorenstr. 5, Duesseldorf 40225, Germany
| | - Detlef Quietzsch
- Department of Internal Medicine II, Klinikum Chemnitz gGmbH, Flemmingstr. 2, Chemnitz 09116, Germany
| | - Michael R Clemens
- Department of Hematology and Oncology, Mutterhaus der Boromaeerinnen, Feldstr. 16, Trier 54290, Germany
| | - Erika Kettner
- Department of Hematology and Oncology, Klinikum Magdeburg, Birkenallee 34, Magdeburg 39130, Germany
| | - Ruediger P Laubender
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, Munich 81377, Germany
| | - Andreas Jung
- Institute of Pathology, Ludwig-Maximilians-University of Munich, Germany and German Cancer Consortium (DKTK), Partner Site Munich, Thalkirchner Str. 36, Munich 80377, Germany
| | - Thomas Kirchner
- Institute of Pathology, Ludwig-Maximilians-University of Munich, Germany and German Cancer Consortium (DKTK), Partner Site Munich, Thalkirchner Str. 36, Munich 80377, Germany
| | - Stefan Boeck
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, Munich 81377, Germany
| | - Volker Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, Munich 81377, Germany
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Palme S, Christenson RH, Jortani SA, Ostlund RE, Kolm R, Kopal G, Laubender RP. Multicenter evaluation of analytical characteristics of the Elecsys ® Periostin immunoassay. Clin Biochem 2016; 50:139-144. [PMID: 27725167 DOI: 10.1016/j.clinbiochem.2016.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The multifunctional cytokine IL-13 is thought to play a central role in Type 2 inflammation in asthma. Serum periostin has been explored as a candidate biomarker for evaluating IL-13 activity in the airway. We describe the technical performance characteristics of a novel, fully automated immunoassay for the determination of periostin in serum. DESIGN AND METHODS Limit of blank [LoB], limit of detection [LoD] and limit of quantitation [LoQ], linearity, precision and reproducibility across sites and lots were evaluated according to Clinical and Laboratory Standards Institute guidelines. Interferences and sample stability were also investigated. RESULTS The pre-specified values for LoB (2ng/mL), LoD (4ng/mL) and LoQ (10ng/mL) were met. The assay was linear throughout the measuring range (10-160ng/mL) with recoveries within ±10% of target at concentrations >30ng/mL and within ±3ng/mL at concentrations ≤30ng/mL. Recovered periostin concentrations were also within ±10% of target in presence of 43 potentially interfering substances and drugs. Samples were stable across various storage conditions and durations (24h at room temperature, 7days at 4°C, 12weeks at -20°C, and 3 freeze/thaw cycles). Repeatability experiments resulted in CVs across samples and controls ranging from 0.9-1.5%. Intermediate precision was 1.2-1.7% and reproducibility including 3 testing sites and 3 reagent lots was 1.7-3.1%. The final assay correlates to the assay version used in previous clinical trials (Pearson's r=0.998, bias at 50ng/mL=1.2%). CONCLUSION The performance evaluation of the Elecsys® Periostin immunoassay including a multicenter precision analysis demonstrated that the assay is suitable for measuring serum periostin at clinically important concentrations around 50ng/mL.
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Affiliation(s)
- Stefan Palme
- Roche Professional Diagnostics, Penzberg, Germany.
| | | | - Saeed A Jortani
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY, USA.
| | - Richard E Ostlund
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Guido Kopal
- Roche Professional Diagnostics, Penzberg, Germany.
| | - Ruediger P Laubender
- Roche Professional Diagnostics, Penzberg, Germany; Institute of Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University of Munich, Munich, Germany.
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Kruger S, Boeck S, Heinemann V, Laubender RP, Vehling-Kaiser U, Waldschmidt D, Kettner E, Märten A, Winkelmann C, Klein S, Kojouharoff G, Gauler TC, Fischer von Weikersthal L, Clemens MR, Geissler M, Greten TF, Hegewisch-Becker S, Modest DP, Stintzing S, Haas M. Impact of hand-foot skin reaction on treatment outcome in patients receiving capecitabine plus erlotinib for advanced pancreatic cancer: a subgroup analysis from AIO-PK0104. Acta Oncol 2015; 54:993-1000. [PMID: 25924969 DOI: 10.3109/0284186x.2015.1034877] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Drug-induced skin toxicity may correlate with treatment efficacy in cancer patients receiving chemotherapy or biological agents. The correlation of the capecitabine-associated hand-foot skin reaction (HFS) on outcome parameters in pancreatic cancer (PC) has not yet been investigated. METHODS Within the multicentre phase III AIO-PK0104 trial, patients with confirmed advanced PC were randomly assigned to first-line treatment with either capecitabine plus erlotinib (150 mg/day, arm A) or gemcitabine plus erlotinib (150 mg/day, arm B). A cross-over to either gemcitabine (arm A) or capecitabine (arm B) was performed after failure of the first-line regimen. Data on skin toxicity were correlated with efficacy study endpoints using uni- and multivariate analyses. To control for guarantee-time bias (GTB), we focused on subgroup analyses of patients who had completed two and three or more treatment cycles. RESULTS Of 281 randomised patients, skin toxicity data were available for 255 patients. Median time to capecitabine-attributed HFS was two cycles, 36 of 47 (77%) HFS events had been observed by the end of treatment cycle three. Considering HFS during first-line treatment in 101 patients treated with capecitabine for at least two cycles within the capecitabine plus erlotinib arm, time to treatment failure after first- and second-line therapy (TTF2) and overall survival (OS) both were significantly prolonged for the 44 patients (44%) with HFS compared to 57 patients without HFS (56%) (TTF2: 7.8 vs. 3.8 months, HR 0.50, p = 0.001; OS: 10.4 vs. 5.9 months, HR 0.55, p = 0.005). A subgroup analysis of 70 patients on treatment with capecitabine for at least three cycles showed similar results (TTF2: 8.3 vs. 4.4 months, HR 0.53, p = 0.010; OS: 10.4 vs. 6.7 months, HR 0.62, p = 0.056). CONCLUSION The present subgroup analysis from AIO-PK0104 suggests that HFS may serve as an independent clinical predictor for treatment outcome in capecitabine-treated patients with advanced PC.
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Affiliation(s)
- Stephan Kruger
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Stefan Boeck
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Volker Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Ruediger P. Laubender
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | - Dirk Waldschmidt
- Department of Gastroenterology and Hepatology at Abdominal Center, University of Cologne, Cologne, Germany
| | - Erika Kettner
- Department of Haematology and Oncology, Klinikum Magdeburg, Magdeburg, Germany
| | - Angela Märten
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Cornelia Winkelmann
- Department of Internal Medicine, Krankenhaus Lutherstadt-Wittenberg, Lutherstadt-Wittenberg, Germany
| | - Stefan Klein
- Department of Internal Medicine IV, Klinikum Bayreuth, Bayreuth, Germany
| | | | - Thomas C. Gauler
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen of University Duisburg-Essen, Essen, Germany
| | | | - Michael R. Clemens
- Department of Haematology and Oncology, Mutterhaus der Boromaeerinnen, Trier, Germany
| | - Michael Geissler
- Department of Gastroenterology and Oncology, Klinikum Esslingen, Esslingen, Germany
| | - Tim F. Greten
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany
| | | | - Dominik P. Modest
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sebastian Stintzing
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Michael Haas
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
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Kisser U, Ertl-Wagner B, Hempel JM, Müller J, D'Anastasi M, Schrötzlmair F, Adderson-Kisser C, Laubender RP, Stelter K, Braun C, Pomschar A. High-resolution computed tomography-based length assessments of the cochlea--an accuracy evaluation. Acta Otolaryngol 2014; 134:1011-5. [PMID: 25220722 DOI: 10.3109/00016489.2014.913313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONCLUSION The length of the cochlea can be determined with good precision using a 3D-curved multiplanar reconstruction analysis technique and linear reconstruction of the cochlea. The method is not time-consuming and can be applied during clinical routine. OBJECTIVE A preoperative prediction of the best cochlear implant electrode length can help reduce the risk of intraoperative cochlear trauma in patients who need to retain residual acoustic hearing for electric-acoustic stimulation or in patients with anatomical anomalies or malformations. The goal of this study was to evaluate the accuracy and reliability of length measurement of the cochlea after linear reconstruction using 3D-curved multiplanar reconstrucion analysis of high resolution computed tomography (CT) scans. METHODS Human cadaveric temporal bone specimens underwent cochlear implantation using custom-made electrodes with two radiopaque markers of a defined length before CTscans were made. Length measurement was performed by four readers and the results were compared to the true value. Inter-reader reliability was calculated. The time needed for analysis was recorded. RESULTS The mean time needed for analysis of one specimen's radiologic data was 6.1 (± 3.4) min. The mean deviation of the length measurement from the true value was 0.8 (± 0.7) mm. Inter-reader reliability was excellent (0.76, p = 0.006).
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Affiliation(s)
- Ulrich Kisser
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich
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7
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Proft F, Steinbach S, Dechant C, Witt M, Reindl C, Schulz S, Vielhauer V, Hilge R, Laubender RP, Manger K, Nüsslein H, Wendler J, Schuch F, Schulze-Koops H, Grunke M. Gustatory and olfactory function in patients with granulomatosis with polyangiitis (Wegener's). Scand J Rheumatol 2014; 43:512-8. [PMID: 25204208 DOI: 10.3109/03009742.2014.915056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Recent findings suggest that autoimmune disorders predispose to a diminished capacity to taste and smell. This has been shown for patients with systemic lupus erythematosus as well as for patients with rheumatoid arthritis (RA). Granulomatosis with polyangiitis (GPA), with its particular manifestations in the upper respiratory tract, may therefore have an even higher impact on these senses. The aims of this study were to evaluate the gustatory and olfactory function in patients with GPA, to compare them to sex- and age-matched healthy controls, and to correlate these findings with their GPA disease severity. METHOD Patients with established GPA were analysed by standardized assessments for gustatory and olfactory functions and examined for disease activity, stage of disease, and treatment. RESULTS Forty-four GPA patients were tested for their chemosensory functions. Compared to age- and sex-matched healthy controls, GPA patients showed significantly decreased olfactory scores along with diminished scores for their gustatory functions. The diminished sense of smell in GPA patients correlated significantly with elevated C-reactive protein (CRP) values whereas the gustatory impairment correlated with the duration and extent of the disease. CONCLUSIONS Our results indicate that olfactory and gustatory functions are significantly decreased in GPA. As the olfactory function of these patients was comparable to patients with RA, chemosensory impairment may not simply be a consequence of the involvement of the upper respiratory tract, but rather a common complication of systemic autoimmune diseases.
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Affiliation(s)
- F Proft
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Polyclinic IV, Ludwig-Maximilians-University Munich , Germany
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Michl M, Koch J, Laubender RP, Modest DP, Giessen C, Schulz C, Heinemann V. Tumor markers CEA and CA 19-9 correlate with radiological imaging in metastatic colorectal cancer patients receiving first-line chemotherapy. Tumour Biol 2014; 35:10121-7. [PMID: 25023402 DOI: 10.1007/s13277-014-2280-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/24/2014] [Indexed: 12/16/2022] Open
Abstract
In patients with metastatic colorectal cancer (mCRC), radiological imaging represents the current standard to evaluate the efficacy of chemotherapy. However, with growing knowledge about tumor biology, other diagnostic tools become of interest which can supplement radiology. The aim of the present study was to examine the correlation of tumor and serum markers with radiological imaging in patients with mCRC receiving first-line therapy. Patients were included if tumor (carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9)) and serum marker (lactatdehydrogenase (LDH), γ-glutamyltransferase (γGT), alkaline phosphatase (AP), C-reactive protein (CRP), leucocyte count (WBC), hemoglobin (Hb)) levels were available at baseline and at least two times during treatment. The decline and increase of tumor and serum markers over time were approximated for each patient by estimating slopes depending on the radiological assessment. A linear mixed effects multiple regression model for each subject was used to evaluate the intra-class correlation of these slopes modeling tumor and serum marker changes with radiological imaging. Data of 124 patients (41 female, 83 male; median age 62.9 years, range 27-85) who received first-line chemotherapy for mCRC from 11/2007 to 04/2010 were analyzed retrospectively. CEA level slopes (n = 49; slopes = 102) differed between radiologically determined progressive disease (PD) and partial response (PR) (p = 0.005) and between PD and stable disease (SD) (p = 0.042). CA 19-9 level slopes (n = 57; slopes = 127) also showed a significant difference between PD and PR (p = 0.002) and PD and SD (p = 0.058). Furthermore, CRP slopes (n = 62; slopes = 134) differed significantly between PD and PR (p = 0.009). For LDH, ALP, γGT, Hb, and WBC, no correlations were observed. The results indicate the correlation of the tumor markers CEA, CA 19-9, and the serum marker CRP with radiological imaging in patients with mCRC receiving first-line chemotherapy. Further data analyses would be helpful to develop a predictive model for tumor response based on an early tumor marker increase or decrease.
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Affiliation(s)
- M Michl
- Department of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Marchioninistr 15, D-81377, Munich, Germany,
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Lange P, Greif M, Vogel A, Thaumann A, Helbig S, Schwarz F, Schmitz C, Becker C, D’Anastasi M, Boekstegers P, Pohl T, Laubender RP, Steinbeck G, Kupatt C. Reduction of pacemaker implantation rates after CoreValve® implantation by moderate predilatation. EUROINTERVENTION 2014; 9:1151-7. [DOI: 10.4244/eijv9i10a195] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Michl M, Haug AR, Jakobs TF, Paprottka P, Hoffmann RT, Bartenstein P, Boeck S, Haas M, Laubender RP, Heinemann V. Radioembolization with Yttrium-90 microspheres (SIRT) in pancreatic cancer patients with liver metastases: efficacy, safety and prognostic factors. Oncology 2013; 86:24-32. [PMID: 24401529 DOI: 10.1159/000355821] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 09/13/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the clinical efficacy of (90)Y radioembolization in liver metastases from pancreatic cancer, to describe treatment toxicities and to identify biomarkers as predictors of outcome. METHODS Data from 19 pancreatic cancer patients (9 females/10 males) who had received (90)Y radioembolization for metastatic liver disease between 06/2004 and 01/2011 were analyzed retrospectively. RESULTS The median age at (90)Y radioembolization was 63 years (range 43-77). In 16 patients, previous palliative gemcitabine-based chemotherapy was given for metastatic disease. Objective response in the liver after (90)Y radioembolization was 47%. Median local progression-free survival in the liver was 3.4 months (range 0.9-45.0). Median overall survival (OS) was 9.0 months (range 0.9-53.0) and 1-year survival was 24%. Cox regression models for baseline biomarkers at (90)Y radioembolization revealed correlations of increased carbohydrate antigen 19-9 (p = 0.02) and C-reactive protein (p = 0.03) with shorter OS. Short-term adverse events (nausea, vomiting, fatigue, fever and abdominal pain) did not exceed grade 3. As long-term adverse events, liver abscesses, gastroduodenal ulceration, cholestasis and cholangitis, ascites and spleen infarction were observed. CONCLUSION (90)Y radioembolization is able to induce an encouraging local response rate of liver metastases of pancreatic cancer patients. Most short-term toxicities are manageable; however, patients should be followed up carefully for severe long-term toxicities.
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Affiliation(s)
- M Michl
- Department of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, Munich, Germany
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11
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Affiliation(s)
- Ruediger P. Laubender
- Institute of Medical Informatics, Biometry, and Epidemiology; Marchioninistrasse 15 81377 Munich Germany
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12
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Giessen C, Fischer von Weikersthal L, Laubender RP, Stintzing S, Modest DP, Schalhorn A, Schulz C, Heinemann V. Evaluation of prognostic factors in liver-limited metastatic colorectal cancer: a preplanned analysis of the FIRE-1 trial. Br J Cancer 2013; 109:1428-36. [PMID: 23963138 PMCID: PMC3776986 DOI: 10.1038/bjc.2013.475] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/24/2013] [Accepted: 07/23/2013] [Indexed: 02/07/2023] Open
Abstract
Background: Liver-limited disease (LLD) denotes a specific subgroup of metastatic colorectal cancer (mCRC) patients. Patients and Methods: A total of 479 patients with unresectable mCRC from an irinotecan-based randomised phase III trial were evaluated. Patients with LLD and non-LLD and hepatic resection were differentiated. Based on baseline patient characteristic, prognostic factors for hepatic resection were evaluated. Furthermore, prognostic factors for median overall survival (OS) were estimated via Cox regression in LLD patients. Results: Secondary liver resection was performed in 38 out of 479 patients (resection rate: 7.9%). Prognostic factors for hepatic resection were LLD, lactate dehydrogenase (LDH), node-negative primary, alkaline phosphatase (AP) and Karnofsky performance status (PS). Median OS was significantly increased after hepatic resection (48 months), whereas OS in LLD (17 months) and non-LLD (19 months) was comparable in non-resected patients. With the inapplicability of Koehne's risk classification in LLD patients, a new score based on only the independent prognostic factors LDH and white blood cell (WBC) provided markedly improved information on the outcome. Conclusion: Patients undergoing hepatic resection showed favourable long-term survival, whereas non-resected LLD patients and non-LLD patients did not differ with regard to progression-free survival and OS. The LDH levels and WBC count were confirmed as prognostic factors and provide a useful and simple score for OS-related risk stratification also in LLD.
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Affiliation(s)
- C Giessen
- Department of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
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13
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Laubender RP, Bender R. A note on calculating asymptotic confidence intervals for the adjusted risk difference and number needed to treat in the Cox regression model. Stat Med 2013; 33:798-810. [DOI: 10.1002/sim.5913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/23/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Ruediger P. Laubender
- German Cancer Consortium (DKTK); Heidelberg Germany
- Institute of Medical Informatics, Biometry, and Epidemiology (IBE), Faculty of Medicine; Ludwig-Maximilians-University Munich; Munich Germany
- German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Ralf Bender
- Department of Medical Biometry; Institute for Quality and Efficiency in Health Care (IQWiG); Cologne Germany
- Faculty of Medicine; University of Cologne; Cologne Germany
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14
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Modest DP, Laubender RP, Stintzing S, Giessen C, Schulz C, Haas M, Mansmann U, Heinemann V. Early tumor shrinkage in patients with metastatic colorectal cancer receiving first-line treatment with cetuximab combined with either CAPIRI or CAPOX: an analysis of the German AIO KRK 0104 trial. Acta Oncol 2013; 52:956-62. [PMID: 23244709 DOI: 10.3109/0284186x.2012.752580] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study investigated the impact of early tumor shrinkage (ETS) on progression-free- (PFS) and overall survival (OS) in patients with metastatic colorectal cancer (mCRC) treated within the AIO KRK 0104 trial as first-line therapy. Moreover, correlations of ETS with clinical characteristics and prognostic markers were evaluated. PATIENTS AND METHODS In total, 121 patients were included into this analysis. Patients were treated with cetuximab combined with either CAPIRI or CAPOX. ETS at six weeks was defined as a relative change of ≥ 20% in the sum of the longest diameters of target lesions compared to baseline. Survival times were compared between patients with ETS ≥ 20% versus no-ETS. RESULTS ETS ≥ 20% was observed in 59% of all patients with KRAS wild-type tumors. In these patients ETS ≥ 20% was associated with higher overall response rate (82% vs. 19%, p < 0.001). Also, PFS (8.9 vs. 4.7 months, p < 0.001) and OS (31.6 vs. 15.8 months, p = 0.005) were significantly superior in ETS ≥ 20% of patients compared to no-ETS. In patients with KRAS mutant mCRC ETS ≥ 20% neither had an effect on PFS nor OS. Cetuximab-induced skin toxicity correlated with the occurrence of ETS ≥ 20% (p = 0.002). CONCLUSION In patients with KRAS wild-type tumors treated with cetuximab plus capecitabine-based chemotherapy ETS ≥ 20% is an important predictor of favorable outcome.
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Affiliation(s)
- Dominik P Modest
- Department of Medicine III and Comprehensive Cancer Center, University of Munich, Munich, Germany
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15
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Giessen C, Laubender RP, Fischer von Weikersthal L, Schalhorn A, Modest DP, Stintzing S, Haas M, Mansmann UR, Heinemann V. Early tumor shrinkage in metastatic colorectal cancer: retrospective analysis from an irinotecan-based randomized first-line trial. Cancer Sci 2013; 104:718-24. [PMID: 23480146 DOI: 10.1111/cas.12148] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 12/14/2022] Open
Abstract
Early tumor shrinkage (ETS) has been highlighted as a favorable prognostic factor related to progression-free survival (PFS) and overall survival (OS) in cytotoxic treatment of metastatic colorectal cancer. Data from a randomized phase III study comparing infusional 5-fluorouracil plus irinotecan (FUFIRI) versus irinotecan plus oxaliplatin (mIROX) were evaluated. Patient groups were analyzed according to the relative change in maximum tumor diameter between baseline and after 7 weeks of treatment. The ETS cohort was defined as a decrease of ≥20%. Additionally, the non-ETS cohort was subdivided into "minor shrinkage" (0-19%), "tumor progression" (any increase) and development of "new metastatic lesions". Progression-free survival and OS were estimated in all patient subgroups. Assessment of ETS was possible in 201 patients. Early tumor shrinkage was observed in 47% (94/201) and non-ETS in 53% (107/201) of patients. Patients with ETS had a more favorable outcome with regard to PFS (9.9 months vs 6.1 months, P = 0.029) and OS (27.5 months vs 17.8 months, P = 0.002). In the non-ETS subgroups, patients with "minor shrinkage" (PFS 8.4 months, OS 21.6 months) showed a markedly better outcome than patients with "early tumor progression" (PFS 4.0 months, OS 15.3 months) or with "new metastatic lesions (PFS 2.2 months, OS 7.6 months). In conclusion, ETS assessment offers accelerated response evaluation when compared to RECIST. In patients treated with chemotherapy alone, ETS ≥20% is associated with excellent outcome. Non-ETS is a heterogeneous subgroup where patients with minor shrinkage clearly benefit from treatment, and patients with early progression or development of new lesions have an unfavorable prognosis.
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Affiliation(s)
- Clemens Giessen
- Department of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Greif M, von Ziegler F, Wakili R, Tittus J, Becker C, Helbig S, Laubender RP, Schwarz W, D'Anastasi M, Schenzle J, Leber AW, Becker A. Increased pericardial adipose tissue is correlated with atrial fibrillation and left atrial dilatation. Clin Res Cardiol 2013; 102:555-62. [PMID: 23584714 DOI: 10.1007/s00392-013-0566-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/03/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pericardial adipose tissue (PAT), a visceral fat depot surrounding the heart, serves as an endocrine active organ and is associated with inflammation. There is growing evidence that atrial fibrillation (AF) is linked with inflammation, which in turn can be a promoter of left atrial remodeling. The aim of this study was to evaluate a potential correlation of PAT to AF and left atrial structural remodeling represented by LA size. METHODS PAT was measured in 1,288 patients who underwent coronary artery calcium-scanning for coronary risk stratification. LA size was determined by two independent readers. Patients were subdivided into patients without AF, patients with paroxysmal and persistent AF. RESULTS PAT was independently correlated with AF, persistent AF, and LA size (all p values <0.001). No association could be observed between paroxysmal AF and PAT. These associations persisted after multivariate adjustment for AF risk factors such as age, hypertension, valvular disease, heart failure, and body mass index (AF: OR 1.52, 95 % CI 1.15-2.00, p = 0.003; persistent AF: OR 2.58, 95 % CI 1.69-3.99, p = 0.001; LA size: regression coefficient 0.15 with 95 % CI 0.10-0.20, p < 0.001). CONCLUSION PAT is associated with AF, in particular with persistent AF and LA size. These findings suggest that PAT could be an independent risk factor for the development of AF and for LA remodeling.
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Affiliation(s)
- Martin Greif
- Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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Heinemann V, Ebert MP, Laubender RP, Bevan P, Mala C, Boeck S. Phase II randomised proof-of-concept study of the urokinase inhibitor upamostat (WX-671) in combination with gemcitabine compared with gemcitabine alone in patients with non-resectable, locally advanced pancreatic cancer. Br J Cancer 2013; 108:766-70. [PMID: 23412098 PMCID: PMC3590684 DOI: 10.1038/bjc.2013.62] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: To evaluate the efficacy and tolerability of the urokinase plasminogen activator (uPA) inhibitor upamostat in combination with gemcitabine in locally advanced pancreatic adenocarcinoma (LAPC). Methods: Within a prospective multicenter study, LAPC patients were randomly assigned to receive 1000 mg m−2 of gemcitabine IV weekly either alone (arm A) or in combination with 200 mg (arm B) or 400 mg (arm C) oral upamostat daily. Efficacy endpoints of this proof-of-concept study included response rate, time to first metastasis, progression-free and overall survival (OS). Results: Of the 95 enroled patients, 85 were evaluable for response and 93 for safety. Median OS was 12.5 months (95% CI 8.2–18.2) in arm C, 9.7 months (95% CI 8.4–17.1) in arm B and 9.9 months (95% CI 7.4–12.1) in arm A; corresponding 1-year survival rates were 50.6%, 40.7% and 33.9%, respectively. More patients achieved a partial remission (confirmed responses by RECIST) with upamostat combination therapy (arm C: 12.9% arm B: 7.1% arm A: 3.8%). Overall, only 12 patients progressed by developing detectable distant metastasis (arm A: 4, arm B: 6, arm C: 2). The most common adverse events considered to be related to upamostat were asthenia, fever and nausea. Conclusion: In this proof-of-concept study targeting the uPA system in LAPC, the addition of upamostat to gemcitabine was tolerated well; similar survival results were observed for the three treatment arms.
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Affiliation(s)
- V Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, D-81377 Munich, Germany.
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Rochat MK, Laubender RP, Kuster D, Braendli O, Moeller A, Mansmann U, von Mutius E, Wildhaber J. Spirometry reference equations for central European populations from school age to old age. PLoS One 2013; 8:e52619. [PMID: 23320075 PMCID: PMC3540072 DOI: 10.1371/journal.pone.0052619] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022] Open
Abstract
Background Spirometry reference values are important for the interpretation of spirometry results. Reference values should be updated regularly, derived from a population as similar to the population for which they are to be used and span across all ages. Such spirometry reference equations are currently lacking for central European populations. Objective To develop spirometry reference equations for central European populations between 8 and 90 years of age. Materials We used data collected between January 1993 and December 2010 from a central European population. The data was modelled using “Generalized Additive Models for Location, Scale and Shape” (GAMLSS). Results The spirometry reference equations were derived from 118'891 individuals consisting of 60'624 (51%) females and 58'267 (49%) males. Altogether, there were 18'211 (15.3%) children under the age of 18 years. Conclusion We developed spirometry reference equations for a central European population between 8 and 90 years of age that can be implemented in a wide range of clinical settings.
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Boeck S, Jung A, Laubender RP, Neumann J, Egg R, Goritschan C, Vehling-Kaiser U, Winkelmann C, Fischer von Weikersthal L, Clemens MR, Gauler TC, Märten A, Klein S, Kojouharoff G, Barner M, Geissler M, Greten TF, Mansmann U, Kirchner T, Heinemann V. EGFR pathway biomarkers in erlotinib-treated patients with advanced pancreatic cancer: translational results from the randomised, crossover phase 3 trial AIO-PK0104. Br J Cancer 2012; 108:469-76. [PMID: 23169292 PMCID: PMC3566829 DOI: 10.1038/bjc.2012.495] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: We aimed to identify molecular epidermal growth factor receptor (EGFR) tissue biomarkers in pancreatic cancer (PC) patients treated with the anti-EGFR agent erlotinib within the phase 3 randomised AIO-PK0104 study. Methods: AIO-PK0104 was a multicenter trial comparing gemcitabine/erlotinib followed by capecitabine with capecitabine/erlotinib followed by gemcitabine in advanced PC; primary study end point was the time-to-treatment failure after first- and second-line therapy (TTF2). Translational analyses were performed for KRAS exon 2 mutations, EGFR expression, PTEN expression, the EGFR intron 1 and exon 13 R497K polymorphism (PM). Biomarker data were correlated with TTF, overall survival (OS) and skin rash. Results: Archival tumour tissue was available from 208 (74%) of the randomised patients. The KRAS mutations were found in 70% (121 out of 173) of patients and exclusively occurred in codon 12. The EGFR overexpression was detected in 89 out of 181 patients (49%) by immunohistochemistry (IHC), and 77 out of 166 patients (46%) had an EGFR gene amplification by fluorescence in-situ hybridisation (FISH); 30 out of 171 patients (18%) had a loss of PTEN expression, which was associated with an inferior TTF1 (first-line therapy; HR 0.61, P=0.02) and TTF2 (HR 0.66, P=0.04). The KRAS wild-type status was associated with improved OS (HR 1.68, P=0.005); no significant OS correlation was found for EGFR–IHC (HR 0.96), EGFR–FISH (HR 1.22), PTEN–IHC (HR 0.77), intron 1 (HR 0.91) or exon 13 R497K PM (HR 0.83). None of the six biomarkers correlated with the occurrence of skin rash. Conclusion: The KRAS wild-type was associated with an improved OS in erlotinib-treated PC patients in this phase 3 study; it remains to be defined whether this association is prognostic or predictive.
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Affiliation(s)
- S Boeck
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr 15, Munich D-81377, Germany.
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20
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Hofheinz RD, Heinemann V, von Weikersthal LF, Laubender RP, Gencer D, Burkholder I, Hochhaus A, Stintzing S. Capecitabine-associated hand-foot-skin reaction is an independent clinical predictor of improved survival in patients with colorectal cancer. Br J Cancer 2012; 107:1678-83. [PMID: 23033005 PMCID: PMC3493864 DOI: 10.1038/bjc.2012.434] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Hand–foot–skin reaction (HFSR) is an adverse event frequently observed during treatment with capecitabine (cape). In the present analysis, we sought to evaluate the potential association of HFSR and survival in German patients with metastatic colorectal cancer and locally advanced rectal cancer treated with cape in clinical trials. Methods: Patients of the Arbeitsgemeinschaft für Internistische Onkologie (AIO) KRK-0104 and the Mannheim rectal cancer trial were evaluated. HFSR was graded according to NCI-CTC criteria in both trials. Time to first occurrence of HFSR was described per cycle and HFSR developing during cycles 1 and 2 was defined as ‘early HFSR’. Baseline characteristics between the patient groups with or without HFSR were compared using Mann–Whitney-U, Fisher’s exact or χ2-test, as appropriate. Haematological and non-haematological toxicities observed in both groups were compared using Fisher’s exact test. Progression-free (PFS) or disease-free (DFS) as well as overall survival (OS) data from both trials were pooled and the HFSR group was compared with the non-HFSR using Kaplan–Meier analysis. Results: A total of 374 patients were included, of whom 29.3% developed any HFSR. Of these, 51% had early HFSR. Baseline characteristics were comparable between both HFSR groups concerning age, gender, ECOG performance status and UICC stage. On multivariate analysis none of these factors had influence on the occurrence of HFSR. The percentage of all-grade (and grade 3–4) haematological toxicities did not differ between both the groups. By contrast, patients exhibiting HFSR had a significantly higher rate of all-grade (but not grade 3–4) diarrhoea, stomatitis/mucositis and fatigue (P<0.01, respectively). Patients with HFSR had improved PFS/DFS (29.0 vs 11.4 months; P=0.015, HR 0.69) and OS (75.8 vs 41.0 months; P=0.001, HR=0.56). Within the HFSR group, PFS/DFS and OS were comparable between patients with early vs late HFSR. Interpretation: The present analysis provides evidence for the association of HFSR and survival in patients with colorectal cancer. Baseline characteristics, with the exception of UICC stage, older age and ECOG performance status, and the time of occurrence of HFSR had no impact on survival. Patients with HFSR had a higher probability of developing any-grade gastrointestinal toxicity and fatigue while no correlation with haematological toxicity was found.
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Affiliation(s)
- R-D Hofheinz
- TagesTherapieZentrum (TTZ), Interdisciplinary Tumour Centre, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Haus 9, Mannheim 68167, Germany.
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Modest DP, Brodowicz T, Stintzing S, Jung A, Neumann J, Laubender RP, Ocvirk J, Kurteva G, Papai Z, Knittelfelder R, Kirchner T, Heinemann V, Zielinski CC. Impact of the specific mutation in KRAS codon 12 mutated tumors on treatment efficacy in patients with metastatic colorectal cancer receiving cetuximab-based first-line therapy: a pooled analysis of three trials. Oncology 2012; 83:241-7. [PMID: 22948721 DOI: 10.1159/000339534] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/02/2012] [Indexed: 12/30/2022]
Abstract
PURPOSE This study investigated the impact of specific mutations in codon 12 of the Kirsten-ras (KRAS) gene on treatment efficacy in patients with metastatic colorectal cancer (mCRC). PATIENTS Overall, 119 patients bearing a KRAS mutation in codon 12 were evaluated. All patients received cetuximab-based first-line chemotherapy within the Central European Cooperative Oncology Group (CECOG), AIO KRK-0104 or AIO KRK-0306 trials. RESULTS Patients with KRAS codon 12 mutant mCRC showed a broad range of outcome when treated with cetuximab-based first-line regimens. Patients with tumors bearing a KRAS p.G12D mutation showed a strong trend to a more favorable outcome compared to other mutations (overall survival 23.3 vs. 14-18 months; hazard ratio 0.66, range 0.43-1.03). An interaction model illustrated that KRAS p.G12C was associated with unfavorable outcome when treated with oxaliplatin plus cetuximab. CONCLUSION The present analysis suggests that KRAS codon 12 mutation may not represent a homogeneous entity in mCRC when treated with cetuximab-based first-line therapy.
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Affiliation(s)
- Dominik P Modest
- Department of Medicine III, University Hospital Grosshadern, University of Munich, Munich, Germany.
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Grunke M, Witt MN, Ronneberger M, Schnez A, Laubender RP, Engelbrecht M, Kavanaugh A, Schulze-Koops H. Use of the 28-joint count yields significantly higher concordance between different examiners than the 66/68-joint count. J Rheumatol 2012; 39:1334-40. [PMID: 22660799 DOI: 10.3899/jrheum.110677] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Joint counts are the key outcome measure in rheumatoid arthritis (RA). There is a great variability between different assessors of the same patient; this variability can be reduced by standardized training. The training effect is far less pronounced for the 66/68-joint count compared to the 28-joint count. We evaluated the reason for the higher interrater disagreement in the 66/68 compared to the 28-joint count. METHODS Participants in joint examination seminars evaluated a patient with RA before and after training in the European League Against Rheumatism technique. Joints were rated positive or negative for tenderness and swelling. The number of positive joints and the variability between examiners before and after the training were compared. Concordance was calculated for every single joint using the Fleiss-Kappa test. RESULTS In total, 256 health professionals were instructed in the 66/68-joint count and 84 in the 28-joint count. The disagreement between examiners was higher for swelling than for tenderness. After the training, there was a significant reduction of interrater variability, which was more pronounced in the 28 than in the 66/68-joint count. Comparisons between joint counts revealed that the joints of the feet were more likely to be rated negative, yet interrater disagreement was still high. CONCLUSION Standardization of joint examination significantly reduces variability between assessors. The better performance of the 28-joint count is due to the lower number of joints examined, especially the foot joints, which remain difficult to assess reliably even after training.
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Affiliation(s)
- Mathias Grunke
- Division of Rheumatology, Medizinische Klinik and Poliklinik IV, University of Munich, Munich, Germany.
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Mansmann UR, Laubender RP, Giessen CA, Sartorius U, Heinemann V. Validating the prognostic relevance of initial change in tumor size using a series of therapeutic regimens for patients with metastatic colorectal cancer (mCRC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
580 Background: Piessevaux et al. (ESMO 2010, Abstr. #596P) proposed a decrease in tumor size of 20% at week 8 following 1st-line therapy for mCRC as a predictor of clinical outcome (PFS and OS). Based on the results of a single study Suzuki et al. (Ann. Oncol. 2011) also claimed that change in tumor size at the first follow-up CT scan was strongly prognostic for PFS and OS in mCRC. It is of interest to validate these findings in different treatment regimens. Methods: Based on data from 4 randomized trials (FIRE-1, n = 479; CIOX, n = 185; OPUS, n = 337; CRYSTAL, n = 1198) a total of 6 treatment regimens were studied (mIROX/FUFIRI, CAPIRI/CAPOX + cetuximab, FOLFOX4 + cetuximab, FOLFOX4, FOLFIRI + cetuximab, FOLFIRI). A joint model was used to quantify the non-linear, J-shaped individual relationships between time and largest diameter (LD) and incorporate them into the formal risk calculation for PFS and OS. The first radiological tumor assessment was performed weeks 7-9 after the start of treatment and relative tumor shrinkage compared to baseline evaluated. Results: All 6 groups showed a consistent pattern for PFS and OS. Distinctive shrinkage week 8 (weeks 7-9) was associated with an improved individual prognosis (p<0.0001 in each group). This was even more pronounced for larger sized tumors (LD >100 mm) at baseline (p<0.01 in each group). Distinctive individual shrinkage for a corresponding treatment was defined as shrinkage exceeding the 8 week shrinkage of its mean tumor kinetics. Distinctive shrinkage for the 3 combination chemotherapy regimens was observed with individual shrinkage above 16%, 23%, or 26%. For the 3 combination chemotherapy regimens + cetuximab distinctive shrinkage was reached if individual shrinkage was greater than 21%, 24%, and 29% respectively, independent of KRAS status. Predictivity has not yet been examined. Conclusions: Our results validate the prognostic relevance of the 20% cut-off for shrinkage at week 8. Early tumor shrinkage is a promising surrogate for PFS and OS using a variety of therapeutic regimens for mCRC. These data may serve as a basis for modifying the widely adopted RECIST criteria in favor of modified response evaluation criteria.
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Affiliation(s)
- Ulrich Robert Mansmann
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany
| | - Ruediger P. Laubender
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany
| | - Clemens Albrecht Giessen
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany
| | - Ute Sartorius
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany
| | - Volker Heinemann
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany
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Stintzing S, Kapaun C, Laubender RP, Jung A, Neumann J, Modest DP, Giessen CA, Moosmann N, Wollenberg A, Kirchner T, Heinemann V. Cetuximab-related skin toxicity in metastatic colorectal cancer (mCRC) patients and its correlation with molecular markers: Results from the German AIO CRC 0104 trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
491 Background: Skin toxicity is a frequent adverse event of EGFR targeting agents. The role of cetuximab induced skin toxicity (Cet-ST), for the most acneiform skin rash, as a prognostic or a predictive factor of treatment efficacy is currently under discussion. Methods: The prognostic and predictive value of Cet-ST in relation to treatment response and survival of patients of a randomized trial investigating CAPIRI plus cetuximab versus CAPOX plus cetuximab as first-line treatment of mCRC was analyzed. Cet-ST was grouped into clinically relevant (grade 2-3) and non relevant (grade 0-1) toxicity (NCI-CTCAE 3.0). KRAS mutations in codons 12 and 13, EGFR-FISH, EGFR-IHC and EGFR intron-1 polymorphism were evaluated in tumor specimens. Results: A total of 149 patients got cetuximab until the first tumor assessment (6 weeks) and were used for this analysis. Overall response rate was higher in patients with grade 2-3 Cet-ST when compared to grade 0-1 (62.1% vs. 41.3%). Patients without Cet-ST (grade 0) had a short PFS (1.9 months) and OS (11.0 months). PFS (7.8 months vs. 5.2 months) and OS (30.3 months vs. 18.0 months) were longer in patients with Cet-ST grade 2-3 than in patients with grade 0-1 Cet-ST. Almost 90% of Cet-ST occurred during the first two cycles of treatment. When only KRAS codon-12 mutated tumors which are thought not to be sensitive to cetuximab were investigated, Kaplan-Meier differences in PFS and OS times between patients with grade 0-1 Cet-ST and grade 2-3 Cet-ST became statistically significant. In a multivariate analysis, male gender, age and EGFR intron-1 polymorphism were significantly correlated with Cet-ST. Conclusions: Cetuximab related skin toxicity is a strong predictor of outcome. It is proposed that Cet-ST is rather a prognostic than a predictive factor since this effect is most evident in patients with KRAS codon-12 mutated tumors. EGFR intron-1 polymorphism appears to be a predictor of Cet-ST.
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Affiliation(s)
- Sebastian Stintzing
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Christine Kapaun
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Ruediger P. Laubender
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Andreas Jung
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Jens Neumann
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Dominik Paul Modest
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Clemens Albrecht Giessen
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Nicolas Moosmann
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Andreas Wollenberg
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Thomas Kirchner
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
| | - Volker Heinemann
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Department of Pathology, University of Munich, Munich, Germany; Department of Dermatology and Allergology, University of Munich, Munich, Germany
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Heinemann V, Reinacher-Schick A, Stintzing S, Giessen CA, Tannapfel A, Laubender RP, Brodowicz T, Knittelfelder R, Vrbanec D, Schmiegel W, Modest DP, Zielinski C. Cetuximab-based or bevacizumab-based first-line treatment in patients with KRAS p.G13D mutated metastatic colorectal cancer (mCRC)? A meta-analysis of 54 cases. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
511 Background: KRAS p.G13D mutant metastatic colorectal cancer (mCRC) has been identified to represent a cetuximab-sensitive subtype of KRAS mutant mCRC. This analysis aims to answer the question whether first-line treatment of p.G13D mCRCs should contain cetuximab or bevacizumab. Methods: Fifty-four patients with p.G13D mutant mCRC were pooled in this analysis. All patients underwent systemic 1st-line treatment with a fluoropyrimidine and oxaliplatin/irinotecan that was combined with either cetuximab or bevacizumab. Results: Overall response rate was comparable between cetuximab- and bevacizumab-based regimens (58% vs 57%). Progression-free survival was comparable (8.0 months-cetuximab-group vs 8.7 months bevacizumab-group). Overall survival (OS) was longer in patients treated with cetuximab as first-line therapy (20.1 months vs 14.9 months). Logistic regressions modelling OS revealed oxaliplatin-based first-line treatment to correlate significantly with poor outcome (p=0.03). Moreover, a strong trend in favour of capecitabine compared to infusional 5-FU (p=0.06) was seen.. Responders among our cohort showed a benefit concerning PFS and OS undergoing cetuximab- but not bevacizumab-based regimen. Conclusions: This retrospective pooled analysis suggests that cetuximab-based first-line therapy in p.G13D mutant mCRC shows similar activity compared to bevacizumab-containing regimen. Infusional 5-FU and oxaliplatin may represent inferior options compared to capecitabine and irinotecan in p.G13D mutant mCRC 1st-line treatment.
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Affiliation(s)
- Volker Heinemann
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Anke Reinacher-Schick
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Sebastian Stintzing
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Clemens Albrecht Giessen
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Andrea Tannapfel
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Ruediger P. Laubender
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Thomas Brodowicz
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Regina Knittelfelder
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Damir Vrbanec
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Wolff Schmiegel
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Dominik Paul Modest
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
| | - Christoph Zielinski
- Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Knappschaftskrankenhaus, Ruhr Universität Bochum, Bochum, Germany; Institut für Pathologie der Ruhr-Universität Bochum an der Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil GmbH, Bochum, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Medical University of Vienna, Vienna, Austria; CECOG, Central European Cooperative Oncology Group,
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Laubender RP, Schlichting M, Sartorius U, Modest DP, Mansmann UR, Heinemann V, Graser A. Evaluating the agreement between the empirical volumes of tumor lesions and the estimated volumes of tumor lesions based on the longest diameter. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
635 Background: Tumor lesions are commonly evaluated by RECIST or WHO criteria, which involves reducing the development of a three-dimensional tumor to a two-dimensional process. However, volume measurements might reflect the clinical impact of the disease process more precisely. Therefore, we investigated if the volume of a tumor lesion can be reconstructed from RECIST- or WHO-based measurements. Methods: 20 colorectal cancer patients underwent routine staging MDCT examinations as part of the multicenter phase II CIOX trial comparing cetuximab + XELOX versus cetuximab + XELIRI. Two hepatic target lesions per patient were defined at baseline and measured using 1) semi-automated volumetry (Siemens Syngo Via Oncology, Siemens Healthcare) with manual correction and 2) semi-automated measurement of the longest diameter (LD) according to RECIST 1.1 and the corresponding longest orthogonal diameter (LOD). Patient lesions were followed over time using the same measurement strategies. An algorithm was developed for reconstructing the volume of a lesion based on the LD and the corresponding LOD. Agreement of the volume data generated by both methods was analyzed by a Bland-Altman plot. The limits of agreements were calculated using a variance components model considering repeated tumor assessments based on the log-transformed sum over the volume of a patient’s lesions. Results: 151 lesions from the 20 patients were measured at 73 tumor assessments. Volume was slightly overestimated by the algorithm compared to the volumetric measurements (p = 0.07). The Bland-Altman plot showed good agreement (mean difference −0.05, limits of agreement [−0.40, 0.30]). As expected, three out of the 73 measurements fell outside the limits of agreement. Conclusions: The proposed algorithm for the WHO-based reconstruction of the tumor volume provides a good approximation to the true sum of the volumes of the lesions. In future studies, volumetric tumor information can be included even if not all centers have full volumetric software available. This enables further research on the impact of changes in tumor volume on disease prognosis and/or prediction of treatment efficacy.
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Affiliation(s)
- Ruediger P. Laubender
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Department of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - Michael Schlichting
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Department of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - Ute Sartorius
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Department of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - Dominik Paul Modest
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Department of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - Ulrich Robert Mansmann
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Department of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - Volker Heinemann
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Department of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - Anno Graser
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany; Merck KGaA, Darmstadt, Germany; Department of Internal Medicine III, Klinikum Grosshadern, University of Munich, Munich, Germany; Department of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany
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Ertl-Wagner B, Koerte I, Kümpfel T, Blaschek A, Laubender RP, Schick M, Steffinger D, Kaufmann D, Heinen F, Reiser M, Alperin N, Hohlfeld R. Non-specific alterations of craniocervical venous drainage in multiple sclerosis revealed by cardiac-gated phase-contrast MRI. Mult Scler 2011; 18:1000-7. [PMID: 22194216 DOI: 10.1177/1352458511432742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is an on-going controversy about venous drainage abnormalities in multiple sclerosis (MS). We applied cardiac-gated phase-contrast and venographic magnetic resonance (MR) techniques to compare venous drainage patterns in patients with MS, healthy controls, and subjects with migraine. METHODS A total of 27 patients with MS (21 female, age 12-59 years, mean disease duration 8.4 ± 8.5 years) and 27 age- and gender-matched healthy controls (21 female, age 12-60 years) were investigated with velocity-encoded cine-phase contrast MR sequences and a 2D time-of-flight MR venography of the cervicocranial region on a 3-T MRI. The data were compared with 26 patients with chronic migraine headaches (19 female, age 17-62 years), previously investigated with the same protocol. The degree of primary and secondary venous outflow in relation to the total cerebral blood flow (tCBF) was compared both quantitatively and qualitatively. Statistical analyses were performed using linear regression models. RESULTS Secondary venous outflow was significantly increased in patients with MS compared with healthy controls, both qualitatively (p < 0.001) and quantitatively (p < 0.013). The observed changes were independent of age and disease duration. Very similar alterations of venous drainage were detectable with the same approach in patients with migraine, without significant differences between MS and migraine patients (p = 0.65). CONCLUSION Our MRI-based study suggests that patients with MS have alterations of cerebral venous drainage similar to subjects with chronic migraine. These non-disease-specific changes seem to a secondary phenomenon rather than being of primary pathogenic importance.
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Affiliation(s)
- Birgit Ertl-Wagner
- Institute of Clinical Radiology, University of Munich - Grosshadern Campus, Ludwig-Maximilians-University Munich, Germany.
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Maier T, Laubender RP, Sturm RA, Klingenstein A, Korting HC, Ruzicka T, Berking C. Osteopontin expression in plasma of melanoma patients and in melanocytic tumours. J Eur Acad Dermatol Venereol 2011; 26:1084-91. [PMID: 21838826 DOI: 10.1111/j.1468-3083.2011.04210.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND While the serological tumour marker S100 is well established for the detection of metastatic melanoma, the extracellular matrix protein osteopontin (OPN) seems to be a promising novel marker for invasive melanoma. OBJECTIVES We analysed the potential of OPN as a serological tumour marker for metastatic melanoma and evaluated its combination with S100 and lactate dehydrogenase (LDH) levels to increase the reliability of these biomarkers for the detection of metastatic disease. METHODS We examined OPN in the peripheral blood of 110 melanoma patients using enzyme-linked immunosorbent assay and combined it with S100 and LDH levels. In addition, the protein expression of OPN was analysed in tissue sections of melanocytic nevi and melanomas of different progression stages by immunohistochemistry. RESULTS The independent comparison of S100 and OPN levels in metastatic vs. non-metastatic patients revealed a P-value <0.001 respectively. The predictiveness of OPN, S100 and LDH was 0.85, 0.89 and 0.69 as measured by the area under the receiver operating curve (AUC) respectively, while the combination of the two biomarkers OPN and S100 showed an AUC of 0.97. The optimal cut-off of the combination of OPN and S100 yielded a specificity of 85.9% and a sensitivity of 95.5%. By immunohistochemistry, OPN protein expression was detected in 29% (7/24) of melanocytic nevi, 67% (30/45) of primary melanomas and 39% (7/18) of metastatic melanomas. CONCLUSIONS Together, OPN seems to be a promising novel biomarker for the detection of metastatic disease in melanoma patients, showing elevated plasma levels in metastatic disease and increased protein expression in melanocytic lesions. The combination of OPN with the well-established tumour marker S100 might increase the prediction of metastases.
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Affiliation(s)
- T Maier
- Department of Dermatology and Allergology, Ludwig-Maximilian University of Munich, Munich, Germany.
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Laubender RP, Bender R. Estimating adjusted risk difference (RD) and number needed to treat (NNT) measures in the Cox regression model. Stat Med 2010; 29:851-9. [PMID: 20213710 DOI: 10.1002/sim.3793] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In medical research, risk difference (RD) and number needed to treat (NNT) measures for survival times have been mainly proposed without consideration of covariates. In this paper, we develop adjusted RD and NNT measures for use in observational studies with survival time outcomes within the framework of the Cox proportional hazards regression model taking the distribution of confounders into account. We consider the typical situation of a cohort study in which the effect of an exposure on a survival time outcome is investigated and important covariates have to be taken into account. The exposure effect described by means of the RD and NNT measures in dependence on whether the effect of allocating an exposure to unexposed persons (number needed to be exposed) or that of removing an exposure from exposed persons (exposure impact number) is considered. Estimation of these adjusted RD and NNT measures is performed by using the average RD approach recently developed for logistic regression. To determine standard errors and confidence intervals for these estimators we use two approaches, the delta method with respect to the regression coefficients of the Cox model and bootstrapping and compare each other. The performance of these estimators is assessed by performing Monte Carlo simulations demonstrating clear advantages of the bootstrap method. The proposed method for point and interval estimation of adjusted RD and NNT measures in the Cox model is illustrated by means of data of the Düsseldorf Obesity Mortality Study (DOMS).
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Affiliation(s)
- R P Laubender
- Institute of Medical Informatics, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University Munich, Germany.
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