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Jakob DA, Müller M, Jud S, Albrecht R, Hautz W, Pietsch U. The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2023; 31:37. [PMID: 37550763 PMCID: PMC10405424 DOI: 10.1186/s13049-023-01107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Trauma related deaths remain a relevant public health problem, in particular in the younger male population. A significant number of these deaths occur prehospitally without transfer to a hospital. These patients, sometimes termed "the forgotten cohort", are usually not included in clinical registries, resulting in a lack of information about prehospitally trauma deaths. The aim of the present study was to compare patients who died prehospital with those who sustained life-threatening injuries in order to analyze and potentially improve prehospital strategies. METHODS This cohort study included all primary operations carried out by Switzerland's largest helicopter emergency medical service (HEMS) between January 1, 2011, and December 31, 2021. We included all adult trauma patients with life-threatening or fatal conditions. The outcome of this study is the vital status of the patient at the end of mission, i.e. fatal or life-threatening. Injury, rescue characteristics, and interventions of the forgotten trauma cohort, defined as patients with a fatal injury (NACA score of VII), were compared with life-threatening injuries (NACA score V and VI). RESULTS Of 110,331 HEMS missions, 5534 primary operations were finally analyzed, including 5191 (93.8%) life-threatening and 343 (6.2%) fatal injuries. More than two-thirds of patients (n = 3772, 68.2%) had a traumatic brain injury without a significant difference between the two groups (p > 0.05). Thoracic trauma (44.6% vs. 28.7%, p < 0.001) and abdominal trauma (22.2% vs. 16.1%, p = 0.004) were more frequent in fatal missions whereas pelvic trauma was similar between the two groups (13.4% vs. 12.9%, p = 0.788). Pneumothorax decompression rate (17.2% vs. 3.7%, p < 0.001) was higher in the forgotten cohort group and measures for bleeding control (15.2% vs. 42.7%, p < 0.001) and pelvic belt application (2.9% vs. 13.1% p < 0.001) were more common in the life-threating injury group. CONCLUSION Chest decompression rates and measures for early hemorrhage control are areas for potential improvement in prehospital care.
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Affiliation(s)
- Dominik A Jakob
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Sebastian Jud
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Roland Albrecht
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Wolf Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Urs Pietsch
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
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Emons G, Steiner E, Vordermark D, Uleer C, Paradies K, Tempfer C, Aretz S, Cremer W, Hanf V, Mallmann P, Ortmann O, Römer T, Schmutzler RK, Horn LC, Kommoss S, Lax S, Schmoeckel E, Mokry T, Grab D, Reinhardt M, Steinke-Lange V, Brucker SY, Kiesel L, Witteler R, Fleisch MC, Friedrich M, Höcht S, Lichtenegger W, Mueller M, Runnebaum I, Feyer P, Hagen V, Juhasz-Böss I, Letsch A, Niehoff P, Zeimet AG, Battista MJ, Petru E, Widhalm S, van Oorschot B, Panke JE, Weis J, Dauelsberg T, Haase H, Beckmann MW, Jud S, Wight E, Prott FJ, Micke O, Bader W, Reents N, Henscher U, Schallenberg M, Rahner N, Mayr D, Kreißl M, Lindel K, Mustea A, Strnad V, Goerling U, Bauerschmitz GJ, Langrehr J, Neulen J, Ulrich UA, Nothacker MJ, Blödt S, Follmann M, Langer T, Wenzel G, Weber S, Erdogan S. Endometrial Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry Number 032/034-OL, September 2022). Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer, Geriatric Assessment and Supply Structures. Geburtshilfe Frauenheilkd 2023; 83:919-962. [PMID: 37588260 PMCID: PMC10427205 DOI: 10.1055/a-2066-2051] [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: 03/17/2023] [Accepted: 06/22/2023] [Indexed: 08/18/2023] Open
Abstract
Summary The S3-guideline on endometrial cancer, first published in April 2018, was reviewed in its entirety between April 2020 and January 2022 and updated. The review was carried out at the request of German Cancer Aid as part of the Oncology Guidelines Program and the lead coordinators were the German Society for Gynecology and Obstetrics (DGGG), the Gynecology Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Cancer Aid (DKH). The guideline update was based on a systematic search and assessment of the literature published between 2016 and 2020. All statements, recommendations and background texts were reviewed and either confirmed or amended. New statements and recommendations were included where necessary. Aim The use of evidence-based risk-adapted therapies to treat women with endometrial cancer of low risk prevents unnecessarily radical surgery and avoids non-beneficial adjuvant radiation therapy and/or chemotherapy. For women with endometrial cancer and a high risk of recurrence, the guideline defines the optimum level of radical surgery and indicates whether chemotherapy and/or adjuvant radiation therapy is necessary. This should improve the survival rates and quality of life of these patients. The S3-guideline on endometrial cancer and the quality indicators based on the guideline aim to provide the basis for the work of certified gynecological cancer centers. Methods The guideline was first compiled in 2018 in accordance with the requirements for S3-level guidelines and was updated in 2022. The update included an adaptation of the source guidelines identified using the German Instrument for Methodological Guideline Appraisal (DELBI). The update also used evidence reviews which were created based on selected literature obtained from systematic searches in selected literature databases using the PICO process. The Clinical Guidelines Service Group was tasked with carrying out a systematic search and assessment of the literature. Their results were used by interdisciplinary working groups as a basis for developing suggestions for recommendations and statements which were then modified during structured online consensus conferences and/or additionally amended online using the DELPHI process to achieve a consensus. Recommendations Part 1 of this short version of the guideline provides recommendations on epidemiology, screening, diagnosis, and hereditary factors. The epidemiology of endometrial cancer and the risk factors for developing endometrial cancer are presented. The options for screening and the methods used to diagnose endometrial cancer are outlined. Recommendations are given for the prevention, diagnosis, and therapy of hereditary forms of endometrial cancer. The use of geriatric assessment is considered and existing structures of care are presented.
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Affiliation(s)
- Günter Emons
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Eric Steiner
- Frauenklinik GPR Klinikum Rüsselsheim am Main, Rüsselsheim, Germany
| | - Dirk Vordermark
- Universität Halle (Saale), Radiotherapie, Halle (Saale), Germany
| | - Christoph Uleer
- Facharzt für Frauenheilkunde und Geburtshilfe, Hildesheim, Germany
| | - Kerstin Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpfleger (KOK), Hamburg, Germany
| | - Clemens Tempfer
- Frauenklinik der Ruhr-Universität Bochum, Bochum/Herne, Germany
| | - Stefan Aretz
- Institut für Humangenetik, Universität Bonn, Zentrum für erbliche Tumorerkrankungen, Bonn, Germany
| | | | - Volker Hanf
- Frauenklinik Nathanstift – Klinikum Fürth, Fürth, Germany
| | | | - Olaf Ortmann
- Universität Regensburg, Fakultät für Medizin, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Germany
| | - Thomas Römer
- Evangelisches Klinikum Köln Weyertal, Gynäkologie Köln, Köln, Germany
| | - Rita K. Schmutzler
- Universitätsklinikum Köln, Zentrum Familiärer Brust- und Eierstockkrebs, Köln, Germany
| | | | - Stefan Kommoss
- Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Sigurd Lax
- Institut für Pathologie, LKH Graz Süd-West, Graz, Austria
| | | | - Theresa Mokry
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg, Germany
| | - Dieter Grab
- Universitätsklinikum Ulm, Frauenheilkunde und Geburtshilfe, Ulm, Germany
| | - Michael Reinhardt
- Klinik für Nuklearmedizin, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Verena Steinke-Lange
- MGZ – Medizinisch Genetisches Zentrum München, München, Germany
- Medizinische Klinik und Poliklinik IV, LMU München, München, Germany
| | - Sara Y. Brucker
- Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Ludwig Kiesel
- Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
| | - Ralf Witteler
- Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
| | - Markus C. Fleisch
- Helios, Universitätsklinikum Wuppertal, Landesfrauenklinik, Wuppertal, Germany
| | | | - Michael Friedrich
- Helios Klinikum Krefeld, Klinik für Frauenheilkunde und Geburtshilfe, Krefeld, Germany
| | - Stefan Höcht
- XCare, Praxis für Strahlentherapie Saarlouis, Saarlouis, Germany
| | - Werner Lichtenegger
- Universitätsmedizin Berlin, Frauenklinik Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Michael Mueller
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Petra Feyer
- Vivantes Klinikum Neukölln, Klinik für Strahlentherapie und Radioonkologie, Berlin, Germany
| | - Volker Hagen
- Klinik für Innere Medizin II, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | | | - Anne Letsch
- Universitätsklinikum Schleswig Holstein, Campus Kiel, Innere Medizin, Kiel, Germany
| | - Peter Niehoff
- Strahlenklinik, Sana Klinikum Offenbach, Offenbach, Germany
| | - Alain Gustave Zeimet
- Medizinische Universität Innsbruck, Universitätsklinik für Gynäkologie und Geburtshilfe, Innsbruck, Austria
| | | | - Edgar Petru
- Med. Univ. Graz, Frauenheilkunde, Graz, Austria
| | | | - Birgitt van Oorschot
- Universitätsklinikum Würzburg, Interdisziplinäres Zentrum Palliativmedizin, Würzburg, Germany
| | - Joan Elisabeth Panke
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V. Essen, Essen, Germany
| | - Joachim Weis
- Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Tumorzentrum Freiburg – CCCF, Freiburg, Germany
| | - Timm Dauelsberg
- Universitätsklinikum Freiburg, Klinik für Onkologische Rehabilitation, Freiburg, Germany
| | | | | | | | - Edward Wight
- Frauenklinik des Universitätsspitals Basel, Basel, Switzerland
| | - Franz-Josef Prott
- Facharzt für Radiologie und Strahlentherapie, Wiesbaden, Wiesbaden, Germany
| | - Oliver Micke
- Franziskus Hospital Bielefeld, Klinik für Strahlentherapie und Radioonkologie, Bielefeld, Germany
| | - Werner Bader
- Klinikum Bielefeld Mitte, Zentrum für Frauenheilkunde, Bielefeld, Germany
| | | | | | | | | | | | - Doris Mayr
- LMU München, Pathologisches Institut, München, Germany
| | - Michael Kreißl
- Universität Magdeburg, Medizinische Fakultät, Universitätsklinik für Radiologie und Nuklearmedizin, Germany
| | - Katja Lindel
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Alexander Mustea
- Universitätsklinikum Bonn, Zentrum Gynäkologie und gynäkologische Onkologie, Bonn, Germany
| | - Vratislav Strnad
- Universitätsklinikum Erlangen, Brustzentrum Franken, Erlangen, Germany
| | - Ute Goerling
- Universitätsmedizin Berlin, Campus Charité Mitte, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Gerd J. Bauerschmitz
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Jan Langrehr
- Martin-Luther-Krankenhaus, Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Berlin, Germany
| | - Joseph Neulen
- Uniklinik RWTH Aachen, Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Aachen, Germany
| | - Uwe Andreas Ulrich
- Martin-Luther-Krankenhaus, Johannesstift Diakonie, Gynäkologie, Berlin, Germany
| | | | | | - Markus Follmann
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Thomas Langer
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Gregor Wenzel
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Sylvia Weber
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Saskia Erdogan
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
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Preuss C, Wunderle M, Hack CC, Beckmann MW, Wenkel E, Jud S, Heindl F. [Correction: Breast cancer in men]. Dtsch Med Wochenschr 2023; 148:e67. [PMID: 37156531 DOI: 10.1055/a-2082-3140] [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: 05/10/2023]
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Preuss C, Wunderle M, Hack CC, Beckmann MW, Wenkel E, Jud S, Heindl F. [Breast cancer in men]. Dtsch Med Wochenschr 2023; 148:301-306. [PMID: 36878228 DOI: 10.1055/a-1924-3194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Male breast cancer is an unknown field for many practitioners. Patients often see different doctors before the correct diagnosis is made - often too late. This article is intended to point out risk factors, initiation of diagnostics and therapy. In the dawning age of molecular medicine, we will also take a look at genetics.
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Lux MP, Wasner S, Meyer J, Häberle L, Hack CC, Jud S, Hein A, Wunderle M, Emons J, Gass P, Fasching PA, Egloffstein S, Krebs J, Erim Y, Beckmann MW, Loehberg CR. Analysis of Oncological Second Opinions in a Certified University Breast and Gynecological Cancer Center Regarding Consensus between the First and Second Opinion and Conformity with the Guidelines. Breast Care (Basel) 2020; 16:291-298. [PMID: 34248471 DOI: 10.1159/000509127] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Oncological second opinions are becoming increasingly important in the era of complex treatments and established certified cancer centers. Oncological guidelines with the highest levels of evidence are available, but these can only be effective to the extent that they are implemented. Therefore, we analyzed the effects of second opinions with regard to their agreement with first opinions and conformity with guidelines. Methods In 164 patients with a diagnosis of breast cancer or gynecological malignancy who requested a second opinion, the first and second opinions, established at the interdisciplinary tumor conference, and conformity with the guidelines were evaluated. Results The first opinion was not in agreement with the guidelines in 34.8% (15.2% diagnosis, 12.8% surgical therapy, 13.4% systemic therapy, and 5.5% radiotherapy), and the recommendations were optimized in the second opinion in 56.7% (28.7% diagnosis, 15.9% surgical therapy, 30.5% systemic therapy, and 8.5% radiotherapy). Conclusions Oncological second opinions showed significant effects and one-third of first opinions were not in conformity with the guidelines. In a significant proportion of cases, the existing treatment plan was changed or supplemented to allow modern and individualized treatment approaches.
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Affiliation(s)
- Michael P Lux
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Breast and Gynecological Cancer Center, Women's Hospital St. Louise, and St. Josefs-Krankenhaus Salzkotten, St. Vincenz Hospital GmbH Paderborn, Paderborn, Germany
| | - Sonja Wasner
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Meyer
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sainab Egloffstein
- Comprehensive Cancer Center Erlangen - European Metropolitan Region Nürnberg (CCC Erlangen-EMN), Erlangen, Germany
| | - Jessica Krebs
- Department of Psychosomatic and Psychotherapeutic, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic and Psychotherapeutic, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen - European Metropolitan Region Nürnberg (CCC Erlangen-EMN), Erlangen, Germany
| | - Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Hack CC, Wasner S, Meyer J, Häberle L, Jud S, Hein A, Wunderle M, Emons J, Gass P, Fasching PA, Egloffstein S, Beckmann MW, Lux MP, Loehberg CR. Analysis of Oncological Second Opinions in a Certified University Breast and Gynecological Cancer Center in Relation to Complementary and Alternative Medicine. Complement Med Res 2020; 27:431-439. [PMID: 32544918 DOI: 10.1159/000508235] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Oncological second opinions are becoming increasingly important given more complex treatment strategies, simultaneously more patients use complementary and alternative medicine (CAM), and many comprehensive cancer centers initiate integrative medicine programs. The present study focuses on analyzing the effects of a second opinion in relation to attitudes toward CAM. METHODS In this prospective study patients (n = 97) with a diagnosis of breast cancer or gynecological malignancies who had requested a second opinion received a questionnaire before and after the second opinion concerning their attitudes toward CAM. RESULTS The majority of patients had breast cancer (72.2%, n = 70). Only 6.2% (n = 6) stated that they had been informed about CAM by the doctors who treated them first, 21.6% (n = 21) had received information about it when seeking the second opinion. After the first opinion, 42.3% (n = 41) wanted to try CAM, the same proportion trusted orthodox medicine alone. After the second opinion, 24 patients (24.7%) wanted to try CAM, while 38.1% (n = 37) relied exclusively on orthodox medicine. There was a significant correlation between an increased patients' need for information and interest in CAM (p = 0.02). CONCLUSIONS Today, aspects of CAM still are very often no part of oncological first and second opinions. This might hence lead to discouraging patients to try out CAM and therefore integrative medicine programs in comprehensive cancer centers might be problem-solving.
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Affiliation(s)
- Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Sonja Wasner
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Julia Meyer
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Sainab Egloffstein
- Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany.,Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany.,Breast and Gynecological Cancer Center, Women's Hospital St. Louise, Paderborn, Women's Hospital St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, St. Vincenz Hospital, Paderborn, Germany
| | - Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany,
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Loehberg CR, Meyer J, Häberle L, Hack CC, Jud S, Hein A, Wunderle M, Emons J, Gass P, Fasching PA, Egloffstein S, Krebs J, Erim Y, Beckmann MW, Lux MP, Wasner S. Analysis of motives and patient satisfaction in oncological second opinions provided by a certified university breast and gynecological cancer center. Arch Gynecol Obstet 2020; 301:1299-1306. [PMID: 32274639 PMCID: PMC7181428 DOI: 10.1007/s00404-020-05525-2] [Citation(s) in RCA: 4] [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: 12/02/2019] [Accepted: 03/28/2020] [Indexed: 01/08/2023]
Abstract
Purpose Second opinions in oncology are becoming increasingly important in an era of more complex treatments and a growing demand for information by patients. Therefore, we analyzed their effects and influencing factors like patients’ motives, subjective extent of information and satisfaction with communications. Methods This prospective study evaluated second opinions for patients with breast cancer or gynecological malignancy. The patients received a questionnaire before and two months after, which inquired expectations, reasons, and satisfaction with the second opinion and the attending physicians. Results A total of 164 patients were included and the majority had breast cancer (75.0%). Receiving the second opinion made 89.7% feel better informed, their need for information decreased (from 75.3% to 39.2%, P < 0.0001), and satisfaction with doctor–patient communications increased (from 61.9 to 91.8%, P = 0.0002). There were various reasons for requesting a second opinion, e.g., the extremely stressful situation of a cancer diagnosis, hope for change in the treatment recommendation or dissatisfaction with the initial physicians. Conclusions Second opinions can lead to significantly greater patient satisfaction, meeting the need for information and leading to better management of patients in the extremely stressful situation of a cancer diagnosis. Doctor–patient communications play a key role. Electronic supplementary material The online version of this article (10.1007/s00404-020-05525-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany.
| | - Julia Meyer
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Sainab Egloffstein
- Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Jessica Krebs
- Psychosomatic and Psychotherapeutic Department, Erlangen University Hospital, Erlangen, Germany
| | - Yesim Erim
- Psychosomatic and Psychotherapeutic Department, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany.,Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany.,Breast and Gynecological Cancer Center, Women´s Hospital St. Louise, Paderborn, Women´s Hospital St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, St. Vincenz Hospital, Paderborn, Germany
| | - Sonja Wasner
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, 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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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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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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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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Würfel F, Erber R, Huebner H, 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: A Program to Investigate Immune Targets in Breast Cancer Patients - First Results on the Influence of Tumor-Infiltrating Lymphocytes. Breast Care (Basel) 2018; 13:8-14. [PMID: 29950961 PMCID: PMC6016056 DOI: 10.1159/000486949] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite advancements in the treatment of primary and metastatic breast cancer, many patients lack a durable response to these treatments. Patients with triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2(HER2)-positive breast cancer who do not have a pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) have a very poor prognosis. Tumor-infiltrating lymphocytes (TILs) have been identified as a predictive marker for pCR after NACT in TNBC and HER2-positive breast cancer. These patient populations could also be suitable for novel treatment strategies including neoepitope-based therapies. This work analyses the effect of TILs on the pCR in neoadjuvantly treated patients in the TILGen study and presents the procedures aimed at establishing neoepitope-based therapies in this study. METHODS Neoadjuvantly treated HER2-positive and TNBC patients were eligible for the presented analysis concerning the association between TILs and pCR. A total of 146 patients could be identified within the TILGen study. TILs were evaluated as percentage of stromal tumor tissue in core biopsies at primary diagnosis. The phenotype 'lymphocyte-predominant breast cancer' (LPBC) was associated with pCR by logistic regression adjusted for estrogen receptor status, progesterone receptor status, HER2 status, age at diagnosis, and grading. RESULTS LPBC was seen in 24 (16.4%) patients. In this patient group, 66.7% achieved a pCR, while the pCR rate was 32.8% in patients with a low TIL count. The adjusted odds ratio was 6.60 (95% confidence interval 2.02-21.56; p < 0.01). CONCLUSION TILs are a strong predictor of pCR in TNBC and HER2-positive breast cancer patients. Implications for the use of this information including the effect on prognosis might help to identify patients most likely to benefit from a neoepitope-based therapy approach.
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Affiliation(s)
- Franziska Würfel
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Hanna Huebner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Michael P. Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Anita 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
| | - Hannah 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
| | - Andreas 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
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
- Department of Gynecology and Obstetrics, Biostatistics Unit, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Carolin C. Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Paul Gaß
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | | | - Anna-Lisa Brandl
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Hanna Langemann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Bernhard Volz
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Diana Dudziak
- Department of Dermatology, Laboratory of Dendritic Cell Biology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias 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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13
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Huebner H, Fasching PA, Gumbrecht W, Jud S, Rauh C, Matzas M, Paulicka P, Friedrich K, Lux MP, Volz B, Gass P, Häberle L, Meier-Stiegen F, Hartkopf A, Neubauer H, Almstedt K, Beckmann MW, Fehm TN, Ruebner M. Filtration based assessment of CTCs and CellSearch® based assessment are both powerful predictors of prognosis for metastatic breast cancer patients. BMC Cancer 2018; 18:204. [PMID: 29463222 PMCID: PMC5819661 DOI: 10.1186/s12885-018-4115-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 08/23/2017] [Accepted: 02/09/2018] [Indexed: 12/17/2022] Open
Abstract
Background The assessment of circulating tumor cells (CTCs) has been shown to enable monitoring of treatment response and early detection of metastatic breast cancer (MBC) recurrence. The aim of this study was to compare a well-established CTC detection method based on immunomagnetic isolation with a new, filtration-based platform. Methods In this prospective study, two 7.5 ml blood draws were obtained from 60 MBC patients and CTC enumeration was assessed using both the CellSearch® and the newly developed filtration-based platform. We analyzed the correlation of CTC-positivity between both methods and their ability to predict prognosis. Overall survival (OS) was calculated and Kaplan-Meier curves were estimated with thresholds of ≥1 and ≥5 detected CTCs. Results The CTC positivity rate of the CellSearch® system was 56.7% and of the filtration-based platform 66.7%. There was a high correlation of CTC enumeration obtained with both methods. The OS for patients without detected CTCs, regardless of the method used, was significantly higher compared to patients with one or more CTCs (p < 0.001). The median OS of patients with no CTCs vs. ≥ 1 CTC assessed by CellSearch® was 1.83 years (95% CI: 1.63–2.02) vs. 0.74 years (95% CI: 0.51–1.52). If CTCs were detected by the filtration-based method the median OS times were 1.88 years (95% CI: 1.74–2.03) vs. 0.59 years (95% CI: 0.38–0.80). Conclusions The newly established EpCAM independently filtration-based system is a suitable method to determine CTC counts for MBC patients. Our study confirms CTCs as being strong predictors of prognosis in our population of MBC patients.
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Affiliation(s)
- Hanna Huebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Walter Gumbrecht
- Siemens Healthcare GmbH, Günther-Scharowsky-Str.1, 91058, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Mark Matzas
- Siemens Healthcare GmbH, Günther-Scharowsky-Str.1, 91058, Erlangen, Germany
| | - Peter Paulicka
- Siemens Healthcare GmbH, Günther-Scharowsky-Str.1, 91058, Erlangen, Germany
| | - Katja Friedrich
- Siemens Healthcare GmbH, Günther-Scharowsky-Str.1, 91058, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Bernhard Volz
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany.,Biostatistics Unit. Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Franziska Meier-Stiegen
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Andreas Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Hans Neubauer
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Katrin Almstedt
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany.
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14
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Kalder M, Müller T, Fischer D, Müller A, Bader W, Beckmann MW, Brucker C, Hack CC, Hanf V, Hasenburg A, Hein A, Jud S, Kiechle M, Klein E, Paepke D, Rotmann A, Schütz F, Dobos G, Voiß P, Kümmel S. A Review of Integrative Medicine in Gynaecological Oncology. Geburtshilfe Frauenheilkd 2016; 76:150-155. [PMID: 26941447 DOI: 10.1055/s-0042-100208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In recent years complementary and alternative medicine (CAM) has increasingly been the focus of international research. Numerous subsidised trials (7903) and systematic reviews (651) have been published, and the evidence is starting to be integrated into treatment guidelines. However, due to insufficient evidence and/or insufficient good quality evidence, this has mostly not translated to practice recommendations in reviews by the Cochrane collaboration gynaecology group. There is nevertheless a not insignificant number of CAM providers and users. The percentage of oncology patients who use CAM varies between 5 and 90 %. Doctors have been identified as the main providers of CAM. Half of gynaecologists offer CAM because of personal conviction or on suggestion from colleagues. This must be viewed in a critical light, since CAM is mostly practiced without appropriate training, often without sufficient evidence for a given method - and where evidence exists, practice guidelines are lacking - and lack of safety or efficacy testing. The combination of patient demand and lucrativeness for doctors/alternative medicine practitioners, both based on supposed effectiveness CAM, often leads to its indiscriminate use with uncertain outcomes and significant cost for patients. On the other hand there is published, positive level I evidence for a number of CAM treatment forms. The aim of this article is therefore to review the available evidence for CAM in gynaecological oncology practice. The continued need for research is highlighted, as is the need to integrate practices supported by good evidence into conventional gynaecological oncology.
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Affiliation(s)
- M Kalder
- Klinik für Frauenheilkunde und Geburtshilfe, Philipps-Universität Marburg, Marburg
| | - T Müller
- AGAPLESION Markus Krankenhaus, Abteilung für Gynäkologie und Geburtshilfe, Frankfurt am Main
| | - D Fischer
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Ernst von Bergmann, Potsdam
| | - A Müller
- Frauenklinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe
| | - W Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld
| | - M W Beckmann
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - C Brucker
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - C C Hack
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - V Hanf
- Frauenklinik und Brustzentrum Nathanstift, Klinikum Fürth, Fürth
| | - A Hasenburg
- Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Universitätsmedizin Mainz, Mainz
| | - A Hein
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - S Jud
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - M Kiechle
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - E Klein
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - D Paepke
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - A Rotmann
- Praxis für Frauenheilkunde, Geburtshilfe und Naturheilkunde, Rodgau
| | - F Schütz
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg, Heidelberg
| | - G Dobos
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
| | - P Voiß
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
| | - S Kümmel
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
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15
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Schulz-Wendtland R, Fasching PA, Bani MR, Lux MP, Jud S, Rauh C, Bayer C, Wachter DL, Hartmann A, Beckmann MW, Uder M, Loehberg CR. Touch Imprint Cytology and Stereotactically-Guided Core Needle Biopsy of Suspicious Breast Lesions: 15-Year Follow-up. Geburtshilfe Frauenheilkd 2016; 76:59-64. [PMID: 26855442 DOI: 10.1055/s-0041-110395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introduction: Stereotactically-guided core needle biopsies (CNB) of breast tumours allow histological examination of the tumour without surgery. Touch imprint cytology (TIC) of CNB promises to be useful in providing same-day diagnosis for counselling purposes and for planning future surgery. Having addressed the issue of accuracy of immediate microscopic evaluation of TIC, we wanted to re-examine the usefulness of this procedure in light of the present health care climate of cost containment by incorporating the surgical 15-year follow-up data and outcome. Patients and Methods: From January until December 1996 we performed TIC in core needle biopsies of 173 breast tumours in 169 patients, consisting of 122 malignant and 51 benign tumours. Histology of core needle biopsies was proven by surgical histology in all malignant and in 5 benign tumours. Surgical breast biopsy was not performed in 46 patients with 46 benign lesions, as the histological result from the core needle biopsy and the result of the TIC were in agreement with the suspected diagnosis from the complementary breast diagnostics. A 15-year follow-up of these patients followed in 2013 and follow-up data was collected from 40 women. Results: In the 15-year follow-up of the 40 benign lesions primarily confirmed using CNB and TIC, a diagnostic sensitivity, specificity, positive and negative predictive value and accuracy of 100 % was found. Conclusion: TIC and stereotactically guided CNB showed excellent long-term follow-up in patients with benign breast lesions. The use of TIC to complement CNB can therefore provide immediate cytological diagnosis of breast lesions.
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Affiliation(s)
- R Schulz-Wendtland
- Department of Gyn. Radiology, Institute of Diagnostic Radiology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M R Bani
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M P Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - S Jud
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C Rauh
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C Bayer
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - D L Wachter
- Institute of Pathology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M Uder
- Institute of Diagnostic Radiology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C R Loehberg
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Kalder M, Müller T, Fischer D, Müller A, Bader W, Beckmann M, Brucker C, Hack C, Hanf V, Hasenburg A, Hein A, Jud S, Kiechle M, Klein E, Paepke D, Rotmann A, Schütz F, Dobos G, Voiß P, Kümmel S. Arbeitsgruppe Integrative Medizin (AG IMed) der AGO e.V.. Begriffsdefinition, Gründung, Ziele und Perspektiven der AG Integrative Medizin. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1546226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lux M, Hildebrandt T, Beyer-Finkler E, Bani M, Loehberg C, Jud S, Rauh C, Schrauder M, Fasching P, Beckmann M. Relevance of health economics in breast cancer treatment - the view of certified breast centres and their patients. ACTA ACUST UNITED AC 2014; 8:15-21. [PMID: 24715838 DOI: 10.1159/000347098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Breast cancer centres - certified in accordance with the criteria of the German Cancer Association and the German Mastology Association - are established throughout Germany. Although the setting up of centres and the subsequent need for certification are associated with a marked increase in costs, initial data show positive effects on quality. Certified centres are cost-effective from the point of view of health economics - they lead to improved quality in processes and results without creating any increase in costs for the funding bodies. However, the organization of the necessary structures, with interdisciplinary treatment, documentation and quality-assurance measures, requires considerable resources. Increasing consolidation of inpatient services is also involved, while shortening of the patients' hospitalization periods is leading to reduced remuneration from the funding bodies. The current cost deficits, which have resulted from the increased resources required, need to be recouped through additional charges. It will only be possible to maintain the high quality achieved if additional charges become available to cover the centres' added costs. Good data are increasingly becoming available as a basis for negotiations on charges - e.g., with regard to the quality of results and the National Cancer Plan - as well as clear support from patients.
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Affiliation(s)
- Michael Lux
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Thomas Hildebrandt
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | | | - Mayada Bani
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Christian Loehberg
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Sebastian Jud
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Claudia Rauh
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Michael Schrauder
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Peter Fasching
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias Beckmann
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
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Adamietz BR, Fasching PA, Jud S, Schulz-Wendtland R, Anders K, Uder M, Wüst W, Rauh C, Meier-Meitinger M. Ultrasound elastography of pulmonary lesions - a feasibility study. Ultraschall Med 2014; 35:33-37. [PMID: 24327473 DOI: 10.1055/s-0033-1355893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The potential of sonography in the examination of lung tissue is extremely limited by the air-filled alveoles of the lung. Only in special circumstances like pleural adhesion lesions, atelectasis or pneumonia can lung tissue be visualized by B-mode sonography. Real-time elastography was primarily applied to detect and visualize pulmonary lesions. METHODS AND PATIENTS 8 patients with a total of 18 histologically proven metastases of the lung were included. All pulmonary lesions were detected by computed tomography. Sonographic examination was performed with a 7.5 MHz linear transducer (Acuson Antares premium edition, Siemens, Erlangen, Germany), including B-mode and real-time elastography (RTE). The mean distance between pleura and the lesions ranged from 0 to 2.5 cm. Two lesions were located in the upper right lobe, eleven lesions in the lower right and five in the lower left lobe. RESULTS RTE was able to detect and visualize all 18 pulmonary lesions in contrast to B-mode. The size and distance of the lesions from the pleura correlated with the CT findings. CONCLUSION In contrast to B-mode sonography, RTE is able to detect and visualize peripheral, non-pleural adherent pulmonary lesions.
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Affiliation(s)
| | - P A Fasching
- Department of Gynaecology and Obstetrics, University of Erlangen
| | - S Jud
- Department of Gynaecology and Obstetrics, University of Erlangen
| | | | - K Anders
- Institute of Radiology, University of Erlangen
| | - M Uder
- Institute of Radiology, University of Erlangen
| | - W Wüst
- Institute of Radiology, University of Erlangen
| | - C Rauh
- Department of Gynaecology and Obstetrics, University of Erlangen
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Grischke EM, Wallwiener D, Souchon R, Fehm T, Loehberg C, Jud S, Lux M, Beckmann M, Renner S. Isolated Loco-Regional Recurrence of Breast Cancer - Established and Innovative Therapy Concepts. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0032-1328660] [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: 10/26/2022] Open
Affiliation(s)
- E.-M. Grischke
- Dept. of OB/Gyn, University Hospital of Tübingen, Tübingen
| | - D. Wallwiener
- Dept. of OB/Gyn, University Hospital of Tübingen, Tübingen
| | - R. Souchon
- Dept. of Radiotherapy, University Hospital of Tübingen, Tübingen
| | - T. Fehm
- Dept. of OB/Gyn, University Hospital of Düsseldorf, Düsseldorf
| | - C. Loehberg
- Dept. of OB/Gyn, University Hospital of Erlangen, Erlangen
| | - S. Jud
- Dept. of OB/Gyn, University Hospital of Erlangen, Erlangen
| | - M. Lux
- Dept. of OB/Gyn, University Hospital of Erlangen, Erlangen
| | - M. Beckmann
- Dept. of OB/Gyn, University Hospital of Erlangen, Erlangen
| | - S. Renner
- Dept. of OB/Gyn, University Hospital of Erlangen, Erlangen
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Lux M, Hildebrandt T, Bani M, Loehberg C, Schrauder M, Rauh C, Jud S, Fasching P, Hartmann A, Beckmann M. Health Economic Evaluation of Different Decision Aids for the Individualised Treatment of Patients with Breast Cancer. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0032-1328627] [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: 10/26/2022] Open
Affiliation(s)
- M. Lux
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
| | - T. Hildebrandt
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
| | - M. Bani
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
| | - C. Loehberg
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
| | - M. Schrauder
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
| | - C. Rauh
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
| | - S. Jud
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
| | - P. Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
| | - A. Hartmann
- Institute of Pathology, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
| | - M. Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Brustzentrum CCC ER-EMN, Erlangen
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Von Minckwitz G, Schneeweiss A, Salat C, Rezai M, Zahm DM, Klare P, Blohmer JU, Tesch H, Khandan F, Jud S, Jackisch C, Mehta K, Loibl S, Untch M. A randomized phase II trial investigating the addition of carboplatin to neoadjuvant therapy for triple-negative and HER2-positive early breast cancer (GeparSixto). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1004 Background: Use of carboplatin in neoadjuvant chemotherapy (NACT) has never been prospectively examined in breast cancer. Cohort studies suggest a high sensitivity to DNA-damaging agents (e.g., carboplatin in triple negative breast cancer [TNBC]), which have a high prevalence of BRCA mutations. Two trials examining carboplatin in HER2+ metastatic disease have shown conflicting results, but one was biased by different dosage of docetaxel in treatment arms. GeparSixto investigates the impact of carboplatin in addition to an identical, optimized cytotoxic-targeted regimen on pathological complete response (pCR) in these two breast cancer subtypes. Methods: In GeparSixto trial (NCT01426880) patients were treated for 18 weeks with paclitaxel 80mg/m² q1w and non-pegylated-liposomal doxorubicin (NPLD) 20mg/m² q1w. HER2+ patients received concurrently trastuzumab 6(8) mg/kg q3w and lapatinib 750mg daily. TNBC patients received concurrently Bevacizumab 15mg/kg i.v. q2w. All patients were randomized 1:1 to receive concurrently carboplatin AUC 1.5-2 q1w vs not, stratified by subtype. Primary objective is pCR rates (ypT0 ypN0), secondary objectives are pCR rate in predefined subgroups or by other definitions, clinical response rate, compliance and tolerability of carboplatin. Carboplatin dose was reduced from AUC 2.0 to 1.5 by an amendment after 330 patients due to carboplatin-related toxicity at pre-planned safety analyses. Results: 595 patients were recruited (8/2011 - 12/2012) in 51 German centers, 299 did not receive carboplatin. Median age was 47/48 years (no carb/carb), 36.8/36.5% were postmenopausal; 14.0/13.3% had T3, 5.0/3.7% T4, 41.8/37.6% N+, 93.0/92.9% ductal invasive, 64.5/65.3% G3 tumors; 46.2/46.3% had HER2+, 53.8/53.7% TNBC. 225 patients had a SAE (149 no carb/177 carb) and 3 died (postoperative pneumonia; reduced general condition; acute myocardial infarct), all in no carb arms. Final analysis on primary endpoint will be presented. Conclusions: This is first study, evaluating efficacy and safety of the addition of carboplatin to anthracycline-taxane containing NACT in patients with primary HER2+ and TNBC. Clinical trial information: NCT 01426880.
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Affiliation(s)
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | | | - Mahdi Rezai
- Breast Center Duesseldorf, Louis Hospital, Düsseldorf, Germany
| | | | - Peter Klare
- Praxisklinik Krebsheilkunde, Berlin, Germany
| | | | - Hans Tesch
- Onkologische Gemeinschaftspraxis am Bethanien-Krankenhaus, Frankfurt/Main, Germany
| | - Fariba Khandan
- Frauenklinik, St. Markus Krankenhaus, Frankfurt, Germany
| | - Sebastian Jud
- Frauenklinik, Universitätsklinikum, Erlangen, Germany
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Broeks A, Schmidt MK, Sherman ME, Couch FJ, Hopper JL, Dite GS, Apicella C, Smith LD, Hammet F, Southey MC, Van 't Veer LJ, de Groot R, Smit VTHBM, Fasching PA, Beckmann MW, Jud S, Ekici AB, Hartmann A, Hein A, Schulz-Wendtland R, Burwinkel B, Marme F, Schneeweiss A, Sinn HP, Sohn C, Tchatchou S, Bojesen SE, Nordestgaard BG, Flyger H, Ørsted DD, Kaur-Knudsen D, Milne RL, Pérez JIA, Zamora P, Rodríguez PM, Benítez J, Brauch H, Justenhoven C, Ko YD, Hamann U, Fischer HP, Brüning T, Pesch B, Chang-Claude J, Wang-Gohrke S, Bremer M, Karstens JH, Hillemanns P, Dörk T, Nevanlinna HA, Heikkinen T, Heikkilä P, Blomqvist C, Aittomäki K, Aaltonen K, Lindblom A, Margolin S, Mannermaa A, Kosma VM, Kauppinen JM, Kataja V, Auvinen P, Eskelinen M, Soini Y, Chenevix-Trench G, Spurdle AB, Beesley J, Chen X, Holland H, Lambrechts D, Claes B, Vandorpe T, Neven P, Wildiers H, Flesch-Janys D, Hein R, Löning T, Kosel M, Fredericksen ZS, Wang X, Giles GG, Baglietto L, Severi G, McLean C, Haiman CA, Henderson BE, Le Marchand L, Kolonel LN, Alnæs GG, Kristensen V, Børresen-Dale AL, Hunter DJ, Hankinson SE, Andrulis IL, Mulligan AM, O'Malley FP, Devilee P, Huijts PEA, Tollenaar RAEM, Van Asperen CJ, Seynaeve CS, Chanock SJ, Lissowska J, Brinton L, Peplonska B, Figueroa J, Yang XR, Hooning MJ, Hollestelle A, Oldenburg RA, Jager A, Kriege M, Ozturk B, van Leenders GJLH, Hall P, Czene K, Humphreys K, Liu J, Cox A, Connley D, Cramp HE, Cross SS, Balasubramanian SP, Reed MWR, Dunning AM, Easton DF, Humphreys MK, Caldas C, Blows F, Driver K, Provenzano E, Lubinski J, Jakubowska A, Huzarski T, Byrski T, Cybulski C, Gorski B, Gronwald J, Brennan P, Sangrajrang S, Gaborieau V, Shen CY, Hsiung CN, Yu JC, Chen ST, Hsu GC, Hou MF, Huang CS, Anton-Culver H, Ziogas A, Pharoah PDP, Garcia-Closas M. Low penetrance breast cancer susceptibility loci are associated with specific breast tumor subtypes: findings from the Breast Cancer Association Consortium. Hum Mol Genet 2011; 20:3289-303. [PMID: 21596841 PMCID: PMC3140824 DOI: 10.1093/hmg/ddr228] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 05/10/2011] [Accepted: 05/16/2011] [Indexed: 01/23/2023] Open
Abstract
Breast cancers demonstrate substantial biological, clinical and etiological heterogeneity. We investigated breast cancer risk associations of eight susceptibility loci identified in GWAS and two putative susceptibility loci in candidate genes in relation to specific breast tumor subtypes. Subtypes were defined by five markers (ER, PR, HER2, CK5/6, EGFR) and other pathological and clinical features. Analyses included up to 30 040 invasive breast cancer cases and 53 692 controls from 31 studies within the Breast Cancer Association Consortium. We confirmed previous reports of stronger associations with ER+ than ER- tumors for six of the eight loci identified in GWAS: rs2981582 (10q26) (P-heterogeneity = 6.1 × 10(-18)), rs3803662 (16q12) (P = 3.7 × 10(-5)), rs13281615 (8q24) (P = 0.002), rs13387042 (2q35) (P = 0.006), rs4973768 (3p24) (P = 0.003) and rs6504950 (17q23) (P = 0.002). The two candidate loci, CASP8 (rs1045485, rs17468277) and TGFB1 (rs1982073), were most strongly related with the risk of PR negative tumors (P = 5.1 × 10(-6) and P = 4.1 × 10(-4), respectively), as previously suggested. Four of the eight loci identified in GWAS were associated with triple negative tumors (P ≤ 0.016): rs3803662 (16q12), rs889312 (5q11), rs3817198 (11p15) and rs13387042 (2q35); however, only two of them (16q12 and 2q35) were associated with tumors with the core basal phenotype (P ≤ 0.002). These analyses are consistent with different biological origins of breast cancers, and indicate that tumor stratification might help in the identification and characterization of novel risk factors for breast cancer subtypes. This may eventually result in further improvements in prevention, early detection and treatment.
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Affiliation(s)
- Annegien Broeks
- Department of Experimental Therapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Beckmann K, Jud S, Hein A, Heusinger K, Bayer C, Schwenk M, Häberle L, Beckmann M. Dokumentation in der gynäkologischen Onkologie. Gynäkologe 2010. [DOI: 10.1007/s00129-009-2503-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Heusinger K, Fasching PA, Jud S, Schulz-Wendtland R, Beckmann MW, Löhberg CR. Zentrale versus dezentrale Bestimmung der mammografischen Dichte bei Brustkrebspatientinnen. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1225207] [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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Wiesner FG, Magener A, Fasching PA, Wesse J, Bani MR, Rauh C, Jud S, Schrauder M, Loehberg CR, Beckmann MW, Hartmann A, Lux MP. Ki-67 as a prognostic molecular marker in routine clinical use in breast cancer patients. Breast 2009; 18:135-41. [PMID: 19342238 DOI: 10.1016/j.breast.2009.02.009] [Citation(s) in RCA: 63] [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: 07/10/2008] [Revised: 01/20/2009] [Accepted: 02/17/2009] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The proliferation biomarker Ki-67 is a prognostic factor for breast cancer that has been investigated in several retrospective studies and a few prospective ones. The aims of the present study were to examine interactions between Ki-67 and other biomarkers in breast cancer patients and to assess the relationship of Ki-67 to histological grading. PATIENTS AND METHODS Patients with uniform immunohistochemical staining of Ki-67 by MIB-1 were identified from the database of the University Breast Center for Franconia. Data were available for 1232 of 2523 patients with invasive breast cancer who had been treated between 1998 and 2005. Ki-67 index was determined during routine work-up of the breast cancers by several surgical pathologists according to a standardized procedure. The Ki-67 proliferation index was correlated with hormone receptor status, HER2/neu status, age, tumor staging, and prognosis. In routine clinical practice, the grading was assessed according to Elston and Ellis, along with all other parameters. RESULTS Ki-67 proliferation index>or=20% was found to be associated with all of the prognostic factors that were tested. However, it also maintained statistical significance relative to poor overall survival in a multivariate Cox proportional hazards model (hazards ratio 1.81; 95% CI, 1.17-2.78). The hazards ratio for disease-free survival did not reach statistical significance (HR 1.41; 95% CI, 0.95-2.09; P=0.086). However, in both models the grade was not an independent prognostic factor. CONCLUSIONS For routine clinical purposes, grading appears to add only limited information about the prognosis in comparison with Ki-67 expression. Further investigation of quality assurance for grading and of Ki-67 as a prognostic and predictive factor is warranted.
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Affiliation(s)
- Folkward G Wiesner
- University Breast Center for Franconia, Erlangen University Hospital, Erlangen, Germany
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Müller A, Thiel F, Jud S, Lermann J, Hildebrandt T, Winkler M, Beckmann M, Renner S. Hysterektomie - was ist zeitgemäß? Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-989348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Jud S, Schrauder M, Lux M, Fasching P, Beckmann M, Löhberg C. Signalhemmer in der gynäkologischen Onkologie. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965764] [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: 10/22/2022] Open
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Fasching PA, Lux MP, Rauh C, Jud S, Beckmann MW. Clinical and Preclinical Experience with Gefitinib and Sunitinib. Breast Care (Basel) 2007. [DOI: 10.1159/000101381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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