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Fehm T, Mueller V, Banys-Paluchowski M, Fasching PA, Friedl TWP, Hartkopf A, Huober J, Loehberg C, Rack B, Riethdorf S, Schneeweiss A, Wallwiener D, Meier-Stiegen F, Krawczyk N, Jaeger B, Reinhardt F, Hoffmann O, Mueller L, Wimberger P, Ruckhaeberle E, Blohmer JU, Cieslik JP, Franken A, Niederacher D, Neubauer H, Pantel K, Janni W. Efficacy of Lapatinib in Patients with HER2-Negative Metastatic Breast Cancer and HER2-Positive Circulating Tumor Cells-The DETECT III Clinical Trial. Clin Chem 2024; 70:307-318. [PMID: 38175595 DOI: 10.1093/clinchem/hvad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The phenotypes of tumor cells change during disease progression, but invasive rebiopsies of metastatic lesions are not always feasible. Here we aimed to determine whether initially HER2-negative metastatic breast cancer (MBC) patients with HER2-positive circulating tumor cells (CTCs) benefit from a HER2-targeted therapy. METHODS The open-label, interventional randomized phase III clinical trial (EudraCT Number 2010-024238-46, CliniclTrials.gov Identifier: NCT01619111) recruited from March 2012 until September 2019 with a follow-up duration of 19.5 months. It was a multicenter clinical trial with 94 participating German study centers. A total of 2137 patients with HER2-negative MBC were screened for HER2-positive CTCs with a final modified intention-to-treat population of 101 patients. Eligible patients were randomized to standard therapy with or without lapatinib. Primary study endpoints included CTC clearance (no CTCs at the end of treatment) and secondary endpoints were progression-free survival, overall survival (OS), and safety. RESULTS In both treatment arms CTC clearance at first follow-up visit-although not being significantly different for both arms at any time point-was significantly associated with improved OS (42.4 vs 14.1 months; P = 0.002). Patients treated additionally with lapatinib had a significantly improved OS over patients receiving standard treatment (20.5 vs 9.1 months, P = 0.009). CONCLUSIONS DETECT III is the first clinical study indicating that phenotyping of CTCs might have clinical utility for stratification of MBC cancer patients to HER2-targeting therapies. The OS benefit could be related to lapatinib, but further studies are required to prove this clinical observation. ClinicalTrials.gov Registration Number: NCT01619111.
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Affiliation(s)
- Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - Volkmar Mueller
- Department of Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Andreas Hartkopf
- Department of Women's Health, University of Tuebingen, Tuebingen, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
- Kantonsspital St. Gallen, Brustzentrum, St. Gallen, Switzerland
| | - Christian Loehberg
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Sabine Riethdorf
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | | | - Franziska Meier-Stiegen
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - Natalia Krawczyk
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - Bernadette Jaeger
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - Florian Reinhardt
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - Oliver Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen-Duisburg, Essen, Germany
| | | | - Pauline Wimberger
- National Center for Tumor Diseases Dresden and Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Eugen Ruckhaeberle
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan-Philipp Cieslik
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - André Franken
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - Dieter Niederacher
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - Hans Neubauer
- Department of Gynecology and Obstetrics, University Hospital and Medical Faculty of Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Germany, Germany
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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Schrage T, Görlach M, Betz CS, Bokemeyer C, Kröger N, Mueller V, Krüll A, Schulz H, Bleich C. Evaluation of a short instrument for measuring health-related quality of life in oncological patients in routine care (HELP-6): an observational study. Front Psychol 2023; 14:1158449. [PMID: 37260965 PMCID: PMC10228503 DOI: 10.3389/fpsyg.2023.1158449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/14/2023] [Indexed: 06/02/2023] Open
Abstract
Purpose Patient-reported outcomes have not been sufficiently implemented into the routine care of cancer patients because the existing instruments are often too long and complex or not cancer-specific. The aim of this study is the determination of psychometric properties and item reduction of a newly developed health-related quality of life (HrQoL) questionnaire for use in oncological clinical routines. Methods This observational study with a repeated measurements design included oncological inpatients and outpatients. A total of 630 patients participated at the first point of measurement and 404 at the second point of measurement. To evaluate the instrument, we conducted hierarchical confirmative factor analyses and for further validation correlated the resulting factors with standardized and validated HrQoL measurements. Test-retest reliability and responsiveness to change were tested. Results The developed questionnaire "HELP-6" ("Hamburg Inventory for Measuring Quality of Life in Oncological Patients") has a six-factor structure and has moderate-to-good convergent validity (r= -0.25 --0.68). Test-retest reliability was moderate-to-good (r =0.56-0.81, p < 0.001). Indications for responsiveness to change were found for three dimensions. The final version of the questionnaire HELP-6 has six dimensions with one item each. Conclusion With the HELP-6 instrument for measuring HrQoL in cancer patients, we provide a short and practical patient-reported outcome instrument. Though responsiveness to change could not be confirmed for all dimensions in this study, the HELP-6 includes time-efficient completion and evaluation and is informative in relevant HrQoL dimensions of cancer patients. Therefore, the HELP-6 poses an important addition to inpatient and outpatient routine cancer care. Trial registration This study was registered at Open Science Framework (https://osf.io/y7xce/), on 9 June 2018.
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Affiliation(s)
- Theresa Schrage
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Mirja Görlach
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christian Stephan Betz
- Department of Otolaryngology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Medical Clinic and Polyclinic, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Andreas Krüll
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christiane Bleich
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Fasching PA, Szeto C, Denkert C, Benz S, Weber K, Spilman P, Budczies J, Schneeweiss A, Stickeler E, Schmatloch S, Jackisch C, Karn T, Sinn HP, Warm M, van Mackelenbergh M, Rabizadeh S, Schem C, Heinmoeller E, Mueller V, Marme F, Soon-Shiong P, Nekljudova V, Untch M, Loibl S. Inferred immune-cell activity is an independent predictor of HER2 negative breast cancer prognosis and response to paclitaxel-based therapy in the GeparSepto trial. Clin Cancer Res 2023:725123. [PMID: 37014668 DOI: 10.1158/1078-0432.ccr-22-2213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/13/2022] [Accepted: 03/31/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Tumor microenvironment (TME) immune markers have been correlated with both response to neoadjuvant therapy and prognosis in breast cancer (BC) patients. Here, immune-cell activity of BC tumors was inferred by expression-based analysis to determine if it is prognostic and/or predictive of response to neoadjuvant paclitaxel-based therapy in the GeparSepto (G7) trial (NCT01583426). EXPERIMENTAL DESIGN Pre-study biopsies from 279 HER2 negative BC patients in the G7 trial underwent RNAseq-based profiling of 104 immune-cell specfic genes to assess inferred Immune Cell Activity (iICA) of 23 immune-cell types. Hierarchical clustering was used to classify tumors as iICA 'hot', 'warm' or 'cold' by comparison of iICA in the G7 cohort relative to that of 1467 samples from a tumor database established by Nantomics LLC. Correlations between iICA cluster, pathology-assessed TILs, and hormone receptor (HR) status for pathologic complete response (pCR), disease-free survival (DFS) and overall survival (OS), were determined. RESULTS iICA cluster correlated with TIL levels. The highest pCR rates were observed in hot cluster tumors, and those with relatively higher TILs. Greater inferred activity of several T-cell types was significantly associated with pCR and survival. DFS and OS were prolonged in patients with hot or warm cluster tumors, the latter particularly for HR negative tumors, even if TILs were relatively low. CONCLUSIONS Overall, TIL level better predicted pCR, but iICA cluster better predicted survival. Differences in associations between TILs, cluster, pCR and survival were observed for HR positive versus negative tumors, suggesting expanded study of the implication of these findings is warranted.
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Affiliation(s)
- Peter A Fasching
- Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Carsten Denkert
- Philipps-University Marburg and University Hospital Marburg, Marburg, Germany
| | - Stephen Benz
- ImmunityBio, Inc., Santa Cruz, CA, United States
| | - Karsten Weber
- German Breast Group, Neu Isenburg. Germany, Neu-Isenburg, Germany
| | | | - Jan Budczies
- Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Sabine Schmatloch
- Brustzentrum Kassel, Elisabeth Krankenhaus, Kassel, Germany, Germany
| | | | - Thomas Karn
- Goethe University Hospital Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | | | | | - Frederik Marme
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | | | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Hessen, Germany
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Lin NU, Murthy RK, Abramson V, Anders C, Bachelot T, Bedard PL, Borges V, Cameron D, Carey LA, Chien AJ, Curigliano G, DiGiovanna MP, Gelmon K, Hortobagyi G, Hurvitz SA, Krop I, Loi S, Loibl S, Mueller V, Oliveira M, Paplomata E, Pegram M, Slamon D, Zelnak A, Ramos J, Feng W, Winer E. Tucatinib vs Placebo, Both in Combination With Trastuzumab and Capecitabine, for Previously Treated ERBB2 (HER2)-Positive Metastatic Breast Cancer in Patients With Brain Metastases: Updated Exploratory Analysis of the HER2CLIMB Randomized Clinical Trial. JAMA Oncol 2023; 9:197-205. [PMID: 36454580 PMCID: PMC9716438 DOI: 10.1001/jamaoncol.2022.5610] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Importance It is estimated that up to 50% of patients with ERBB2 (HER2)-positive metastatic breast cancer (MBC) will develop brain metastases (BMs), which is associated with poor prognosis. Previous reports of the HER2CLIMB trial have demonstrated that tucatinib in combination with trastuzumab and capecitabine provides survival and intracranial benefits for patients with ERBB2-positive MBC and BMs. Objective To describe overall survival (OS) and intracranial outcomes from tucatinib in combination with trastuzumab and capecitabine in patients with ERBB2-positive MBC and BMs with an additional 15.6 months of follow-up. Design, Setting, and Participants HER2CLIMB is an international, multicenter, randomized, double-blind, placebo-controlled clinical trial evaluating tucatinib in combination with trastuzumab and capecitabine. The 612 patients, including those with active or stable BMs, had ERBB2-positive MBC previously treated with trastuzumab, pertuzumab, and trastuzumab emtansine. The study was conducted from February 23, 2016, to May 3, 2019. Data from February 23, 2016, to February 8, 2021, were analyzed. Interventions Patients were randomized 2:1 to receive tucatinib (300 mg orally twice daily) or placebo (orally twice daily), both in combination with trastuzumab (6 mg/kg intravenously or subcutaneously every 3 weeks with an initial loading dose of 8 mg/kg) and capecitabine (1000 mg/m2 orally twice daily on days 1-14 of each 3-week cycle). Main Outcomes and Measures Evaluations in this exploratory subgroup analysis included OS and intracranial progression-free survival (CNS-PFS) in patients with BMs, confirmed intracranial objective response rate (ORR-IC) and duration of intracranial response (DOR-IC) in patients with measurable intracranial disease at baseline, and new brain lesion-free survival in all patients. Only OS was prespecified before the primary database lock. Results At baseline, 291 of 612 patients (47.5%) had BMs. Median age was 52 years (range, 22-75 years), and 289 (99.3%) were women. At median follow-up of 29.6 months (range, 0.1-52.9 months), median OS was 9.1 months longer in the tucatinib-combination group (21.6 months; 95% CI, 18.1-28.5) vs the placebo-combination group (12.5 months; 95% CI, 11.2-16.9). The tucatinib-combination group showed greater clinical benefit in CNS-PFS and ORR-IC compared with the placebo-combination group. The DOR-IC was 8.6 months (95% CI, 5.5-10.3 months) in the tucatinib-combination group and 3.0 months (95% CI, 3.0-10.3 months) in the placebo-combination group. Risk of developing new brain lesions as the site of first progression or death was reduced by 45.1% in the tucatinib-combination group vs the placebo-combination group (hazard ratio, 0.55 [95% CI, 0.36-0.85]). Conclusions and Relevance This subgroup analysis found that tucatinib in combination with trastuzumab and capecitabine improved OS while reducing the risk of developing new brain lesions, further supporting the importance of this treatment option for patients with ERBB2-positive MBC, including those with BMs. Trial Registration ClinicalTrials.gov Identifier: NCT02614794.
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Affiliation(s)
- Nancy U. Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | - Philippe L. Bedard
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - David Cameron
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Lisa A. Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - A. Jo Chien
- University of California at San Francisco, San Francisco
| | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milano, Italy
- University of Milano, Milano, Italy
| | | | - Karen Gelmon
- British Columbia Cancer–Vancouver Centre, Vancouver, British Columbia, Canada
| | | | - Sara A. Hurvitz
- David Geffen School of Medicine at UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Ian Krop
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Yale Cancer Center, New Haven, Connecticut
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | - Elisavet Paplomata
- Carbone Cancer Center, University of Wisconsin, Madison
- ICON Plc, Blue Bell, Pennsylvania
| | - Mark Pegram
- Stanford Cancer Institute, Palo Alto, California
| | - Dennis Slamon
- David Geffen School of Medicine at UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, California
| | | | | | | | - Eric Winer
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Yale Cancer Center, New Haven, Connecticut
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Laakmann E, Riecke K, Neunhöffer T, Park-Simon TW, Weide R, Polasik A, Schmidt M, Puppe J, Fasching P, Hesse T, Decker T, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Mueller V, Witzel I. 269P Long-term survival of HER2-positive breast cancer patients with brain metastases: Subanalysis of the BMBC registry. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hägele M, Müller KR, Denkert C, Schneeweiss A, Sinn B, Untch M, Van Mackelenbergh M, Jackisch C, Nekljudova V, Karn T, Alber M, Marmé F, Schem C, Stickeler E, Fasching P, Mueller V, Weber K, Lederer B, Loibl S, Klauschen F. 68MO Generalization of a deep learning model for HER2 status predictions on H&E-stained whole slide images derived from 3 neoadjuvant clinical studies. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Trapp EK, Fasching PA, Fehm T, Schneeweiss A, Mueller V, Harbeck N, Lorenz R, Schumacher C, Heinrich G, Schochter F, de Gregorio A, Tzschaschel M, Rack B, Janni W, Friedl TWP. Does the Presence of Circulating Tumor Cells in High-Risk Early Breast Cancer Patients Predict the Site of First Metastasis—Results from the Adjuvant SUCCESS A Trial. Cancers (Basel) 2022; 14:cancers14163949. [PMID: 36010945 PMCID: PMC9406108 DOI: 10.3390/cancers14163949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Due to recent advances in breast cancer detection and treatment strategies, the number of breast cancer survivors has increased over the past decades. However, breast cancer follow-up guidelines have not changed for years. The presence of CTCs detected during follow-up has been shown to indicate poor prognosis in high-risk breast cancer patients. Here, we evaluated if the presence of CTCs also indicates the site of metastatic disease by analyzing CTC status and metastatic location in 206 patients with distant recurrence from the large adjuvant breast cancer trial SUCCESS A. Patients who were CTC-positive both before and after chemotherapy were more likely to show bone-only first distant disease (37.5% vs. 21.0%) and first distant disease at multiple sites (31.3% vs. 12.6%) than patients without CTCs. These data indicate that CTCs might serve as a liquid biopsy surveillance-marker enabling risk-stratification for deciding on further adjuvant add-on-treatment. Abstract The prognostic relevance of circulating tumor cells (CTCs) in breast cancer is well established. However, little is known about the association of CTCs and site of first metastasis. In the SUCCESS A trial, 373 out of 3754 randomized high-risk breast cancer patients developed metastatic disease. CTC status was assessed by the FDA-approved CellSearch®-System (Menarini Silicon Biosystems, Bologna, Italy) in 206 of these patients before chemotherapy and additionally in 159 patients after chemotherapy. CTCs were detected in 70 (34.0%) of 206 patients before (median 2 CTCs, 1–827) and in 44 (27.7%) of 159 patients after chemotherapy (median 1 CTC, 1–124); 16 (10.1%) of 159 patients were CTC-positive at both timepoints. The site of first distant disease was bone-only, visceral-only, and other-site-only in 44 (21.4%), 60 (29.1%), and 74 (35.9%) patients, respectively, while 28 (13.6%) patients had multiple sites of first metastatic disease. Patients with CTCs at both timepoints more often showed bone-only first distant disease (37.5% vs. 21.0%) and first distant disease at multiple sites (31.3% vs. 12.6%) than patients without CTCs before and/or after chemotherapy (p = 0.027). In conclusion, the presence of CTCs before and after chemotherapy is associated with multiple-site or bone-only first-distant disease and may trigger intensified follow-up and perhaps further treatment.
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Affiliation(s)
- Elisabeth K. Trapp
- Department of Gynecology and Obstetrics, Medical University of Graz, 8036 Graz, Austria
- Correspondence:
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, 40225 Düsseldorf, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, 69120 Heidelberg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, 81337 München, Germany
| | - Ralf Lorenz
- Gynecologic Practice Dr. Lorenz, N. Hecker, Dr. Kreiss-Sender, 38100 Braunschweig, Germany
| | - Claudia Schumacher
- Department of Gynecology and Obstetrics, St. Elisabeth’s Hospital, 50935 Cologne, Germany
| | | | - Fabienne Schochter
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Amelie de Gregorio
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Marie Tzschaschel
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Thomas W. P. Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
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Ding Y, Oliveira-Ferrer L, Vettorazzi E, Legler K, Milde-Langosch K, Woelber L, Jaeger A, Prieske K, Mueller V, Schmalfeldt B, Kuerti S. VEGF-C serum level is associated with response to bevacizumab maintenance therapy in primary ovarian cancer patients. PLoS One 2022; 17:e0269680. [PMID: 35687576 PMCID: PMC9187059 DOI: 10.1371/journal.pone.0269680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Objective At present, maintenance therapy with the antiangiogenic agent bevacizumab or with PARP-inhibitors represent two options for BRCA-wildtype ovarian cancer patients, after platinum-based first line chemotherapy. The identification of molecular markers to predict patient response to different maintenance therapies remains a major challenge. In the present study we analyzed the predictive potential of vascular endothelial growth factor C (VEGF-C) to identify ovarian cancer patients that might benefit from an antiangiogenic therapy. Methods 101 patients with primary epithelial ovarian cancer were analyzed for serum levels of VEGF-A,–C and CA-125 by ELISA. Serum levels were compared between patients with low pT-stage (pT1a-pT2c n = 11), healthy individuals (n = 27) and patients with higher pT-stage (> = pT3 n = 90). Adjusted ROC curves and an adjusted logistic regression model were carried out to evaluate the potential impact of VEGF-A and -C, as well as CA-125 serum level concentration on bevacizumab-therapy response, under consideration of covariates such as FIGO, pM, pN and residual tumor after surgery. Results A patient which has in comparison twice the VEGF-C concentration in serum, has a significant increased chance of response to bevacizumab by a factor of 2.79. Further, only VEGF-C serum levels were significantly higher in the group of patients with lower pT-stage compared to healthy individuals, whereas VEGF-A or CA-125 serum levels could not discriminate between healthy individuals and patients with ovarian cancer at low pT-stages. Conclusion VEGF-C serum level might serve as as a biomarker to evaluate treatment response under bevacizumab.
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Affiliation(s)
- Yi Ding
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Leticia Oliveira-Ferrer
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karen Legler
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Milde-Langosch
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Linn Woelber
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Jaeger
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Prieske
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Mueller
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Kuerti
- Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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9
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Greil R, Lin NU, Murthy RK, Abramson V, Anders C, Bachelot T, Bedard PL, Borges V, Cameron D, Carey L, Chien AJ, Curigliano G, DiGiovanna MP, Gelmon K, Hortobagyi G, Hurvitz S, Krop I, Loi S, Loibl S, Mueller V, Oliveira M, Paplomata E, Pegram M, Slamon D, Zelnak A, Ramos J, Feng W, Winer E. Aktualisierte Ergebnisse von Tucatinib versus Placebo in Kombination
mit Trastuzumab und Capecitabin bei Patienten mit vorbehandeltem, metastasierten
HER2-positiven Brustkrebs mit ZNS-Metastasen (HER2CLIMB). Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1746156] [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: 10/18/2022] Open
Affiliation(s)
- R Greil
- Dritte medizinische Abteilung, Paracelsus Medizinische
Universität Salzburg, Salzburger Krebsforschungsinstitut –
Zentrum für Klinische Krebs- und Immunologiestudien und Cancer Cluster
Salzburg, Salzburg. Österreich
| | - N U Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - R K Murthy
- MD Anderson Cancer Center, Houston, Texas, USA
| | - V Abramson
- Vanderbilt University Medical Center, Nashville, Tennessee,
USA
| | - C Anders
- Duke Cancer Institute, Durham, North Carolina, USA
| | | | - P L Bedard
- University Health Network, Princess Margaret Cancer Centre, Toronto,
Ontario, Kanada
| | - V Borges
- University of Colorado Cancer Center, Aurora, Colorado,
USA
| | - D Cameron
- Edinburgh Cancer Research Centre, Edinburgh, Vereinigtes
Königreich
| | - L Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North
Carolina, USA
| | - A J Chien
- University of California at San Francisco, San Francisco, Kalifornien,
USA
| | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS, University of Milano, Mailand,
Italien
| | | | - K Gelmon
- British Columbia Cancer – Vancouver Centre, British Columbia,
Kanada
| | | | - S Hurvitz
- UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los
Angeles, Kalifornien, USA
| | - I Krop
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - S Loi
- Peter MacCallum Cancer Centre, Melbourne, Australien
| | - S Loibl
- Deutsche Brust-Gruppe, Neu-Isenburg. Deutschland
| | - V Mueller
- Universitätsklinikum Hamburg-Eppendorf, Hamburg,
Deutschland
| | - M Oliveira
- Hospital Universitario Vall D‘Hebron, Barcelona,
Spanien
| | - E Paplomata
- Carbone Cancer Center University of Wisconsin, Madison, Wisconsin,
USA
| | - M Pegram
- Stanford Comprehensive Cancer Institute Palo Alto, Kalifornien,
USA
| | - D Slamon
- UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los
Angeles, Kalifornien, USA
| | - A Zelnak
- Northside Hospital, Sandy Springs, Georgia, USA
| | - J Ramos
- Seagen Inc., Bothell, Washington, USA
| | - W Feng
- Seagen Inc., Bothell, Washington, USA
| | - E. Winer
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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10
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Lin NU, Murthy RK, Abramson V, Anders C, Bachelot T, Bedard P, Borges V, Cameron D, Cameron D, Carey L, Chien AJ, Curigliano G, DiGiovanna M, Gelmon K, Hortobagyi G, Hurvitz S, Krop I, Loi S, Loibl S, Mueller V, Oliveira M, Paplomata E, Pegram M, Slamon D, Zelnak A, Ramos J, Feng W, Winer E. Abstract PD4-04: Updated results of tucatinib vs placebo added to trastuzumab and capecitabine for patients with previously treated HER2-positive metastatic breast cancer with brain metastases (HER2CLIMB). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd4-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tucatinib is an oral tyrosine kinase inhibitor highly specific for HER2 that is approved for use in combination with trastuzumab and capecitabine in adults with advanced or metastatic HER2+ breast cancer, including patients with brain metastases, who have received one or more prior anti-HER2-based regimens in the metastatic setting. In the HER2CLIMB trial, the tucatinib regimen significantly prolonged progression-free survival (PFS) and overall survival (OS) in patients with HER2+ metastatic breast cancer (Murthy, NEJM 2020), including in patients with untreated, treated stable, and treated progressing brain metastases (Lin, J Clin Oncol, 2020). With an additional 15.6 months of follow-up, addition of tucatinib continued to show clinically meaningful prolongation of PFS and OS in the total study population (Curigliano, ASCO Meeting, 2021). We report updated results of exploratory efficacy analyses in patients with brain metastases. Methods: All patients in HER2CLIMB had a baseline brain MRI. Patients with brain metastases were eligible and classified as untreated, treated stable, or treated progressing. Patients were randomized 2:1 to receive tucatinib 300 mg twice daily or placebo, in combination with trastuzumab and capecitabine. Following the primary analysis, the protocol was amended to unblind sites to treatment assignment and allowed crossover from the placebo regimen to the tucatinib regimen. Efficacy analyses in patients with brain metastases at baseline were performed at approximately 2 years from the last patient randomized by applying RECIST 1.1 to the brain based on investigator evaluation. OS and CNS-PFS (progression in the brain or death) were evaluated in all patients with brain metastases. Patients without CNS-PFS events were censored at the last brain MRI. Confirmed intracranial (IC) objective response rate (ORR-IC) was evaluated in patients with measurable IC disease. Results: At a median follow-up of 29.6 months, median OS was 21.6 months vs 12.5 months in all patients with brain metastases (HR: 0.60; 95% CI: 0.44, 0.81), 21.4 months vs 11.8 months in patients with untreated/treated progressing brain metastases (HR: 0.52; 95% CI: 0.36, 0.77), and 21.6 months vs 16.4 months in patients with treated stable brain metastases (HR: 0.70; 95% CI: 0.42, 1.16). Median CNS-PFS was 9.9 months vs 4.2 months in all patients with brain metastases (HR: 0.39; 95% CI: 0.27, 0.56), 9.6 months vs 4.0 months in patients with untreated/treated progressing brain metastases (HR: 0.34; 95% CI: 0.22, 0.54), and 13.9 months vs 5.6 months in patients with treated stable brain metastases (HR: 0.41; 95% CI: 0.19, 0.85). ORR-IC was higher in the tucatinib arm (47.3%; 95% CI: 33.7, 61.2) vs the placebo arm (20.0%; 95% CI: 5.7, 43.7) for patients with brain metastases, and median duration of response (DOR) was 8.6 months (95% CI: 5.5, 10.3) vs 3.0 months (95% CI: 3.0, 10.3). Conclusions: With 15.6 months of additional follow-up, the tucatinib-trastuzumab-capecitabine regimen resulted in a robust and durable prolongation of OS for all patients with HER2+ metastatic breast cancer and brain metastases. Additionally, this benefit was maintained in patients with untreated/treated progressing and treated stable brain metastases. Treatment with tucatinib continued to show clinically meaningful benefit in CNS-PFS consistent with the primary analysis.
Citation Format: Nancy U Lin, Rashmi K Murthy, Vandana Abramson, Carey Anders, Thomas Bachelot, Philippe Bedard, Virginia Borges, David Cameron, David Cameron, Lisa Carey, A Jo Chien, Giuseppe Curigliano, Michael DiGiovanna, Karen Gelmon, Gabriel Hortobagyi, Sara Hurvitz, Ian Krop, Sherene Loi, Sibylle Loibl, Volkmar Mueller, Mafalda Oliveira, Elisavet Paplomata, Mark Pegram, Dennis Slamon, Amelia Zelnak, Jorge Ramos, Wentao Feng, Eric Winer. Updated results of tucatinib vs placebo added to trastuzumab and capecitabine for patients with previously treated HER2-positive metastatic breast cancer with brain metastases (HER2CLIMB) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD4-04.
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Affiliation(s)
| | | | | | | | | | - Philippe Bedard
- University Health Network, Princess Margaret Cancer Centre,, Toronto, ON, Canada
| | | | - David Cameron
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - David Cameron
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Lisa Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - A Jo Chien
- University of California at San Francisco, San Francisco, CA
| | | | | | - Karen Gelmon
- British Columbia Cancer - Vancouver Centre, Vancouver, BC, Canada
| | | | - Sara Hurvitz
- UCLA Medical Center/Jonsson Comprehensive Cancer Center,, Los Angeles, CA
| | - Ian Krop
- Dana-Farber Cancer Institute, Boston, MA
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | | | - Mark Pegram
- Stanford Comprehensive Cancer Institute, Palo Alto, CA
| | - Dennis Slamon
- UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | - Eric Winer
- Dana-Farber Cancer Institute, Boston, MA
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11
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Reuter S, Woelber L, Trepte CC, Perez D, Zapf A, Cevirme S, Mueller V, Schmalfeldt B, Jaeger A. The impact of Enhanced Recovery after Surgery (ERAS) pathways with regard to perioperative outcome in patients with ovarian cancer. Arch Gynecol Obstet 2021; 306:199-207. [PMID: 34958401 PMCID: PMC9300507 DOI: 10.1007/s00404-021-06339-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022]
Abstract
Purpose Major surgery for ovarian cancer is associated with significant morbidity. Recently, guidelines for perioperative care in gynecologic oncology with a structured “Enhanced Recovery after Surgery (ERAS)” program were presented. Our aim was to evaluate if implementation of ERAS reduces postoperative complications in patients undergoing extensive cytoreductive surgery for ovarian cancer. Methods 134 patients with ovarian cancer (FIGO I-IV) were included. 47 patients were prospectively studied after implementation of a mandatory ERAS protocol (ERAS group) and compared to 87 patients that were treated before implementation (pre-ERAS group). Primary endpoints of this study were the effects of the ERAS protocol on postoperative complications and length of stay in hospital. Results Preoperative and surgical data were comparable in both groups. Only the POSSUM score was higher in the ERAS group (11.8% vs. 9.3%, p < 0.001), indicating a higher surgical risk in the ERAS group. Total number of postoperative complications (ERAS: 29.8% vs. pre-ERAS: 52.8%, p = 0.011), and length of hospital stay (ERAS: 11 (6–23) vs pre-ERAS: 13 (6–50) days; p < 0.001) differed significantly. A lower fraction of patients of the ERAS group (87.2%) needed postoperative admission to the ICU compared to the pre-ERAS group (97.7%), p = 0.022). Mortality within the ERAS group was 0% vs. 3.4% (p = 0.552) in the pre-ERAS group. Conclusion The implementation of a mandatory ERAS protocol was associated with a lower rate of postoperative complications and a reduced length of stay in hospital. If ERAS has influence on long-term outcome needs to be further evaluated.
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Affiliation(s)
- Susanne Reuter
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Martinistraße 52, 20246, Hamburg, Germany.
| | - Linn Woelber
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Martinistraße 52, 20246, Hamburg, Germany
| | - Constantin C Trepte
- Department of Anaesthesiology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Daniel Perez
- Department of General, Visceral and Thoracic Surgery, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sinan Cevirme
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Mueller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Martinistraße 52, 20246, Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Martinistraße 52, 20246, Hamburg, Germany
| | - Anna Jaeger
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Martinistraße 52, 20246, Hamburg, Germany
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12
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Strati A, Zavridou M, Kallergi G, Politaki E, Kuske A, Gorges TM, Riethdorf S, Joosse SA, Koch C, Bohnen AL, Mueller V, Koutsodontis G, Kontopodis E, Poulakaki N, Psyrri A, Mavroudis D, Georgoulias V, Pantel K, Lianidou ES. A Comprehensive Molecular Analysis of in Vivo Isolated EpCAM-Positive Circulating Tumor Cells in Breast Cancer. Clin Chem 2021; 67:1395-1405. [PMID: 34322698 DOI: 10.1093/clinchem/hvab099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Circulating tumor cell (CTC) analysis is highly promising for liquid biopsy-based molecular diagnostics. We undertook a comprehensive molecular analysis of in vivo isolated CTCs in breast cancer (BrCa). METHODS In vivo isolated CTCs from 42 patients with early and 23 patients with metastatic breast cancer (MBC) were prospectively collected and analyzed for gene expression, DNA mutations, and DNA methylation before and after treatment. 19 healthy donor (HD) samples were analyzed as a control group. In identical blood draws, CTCs were enumerated using CellSearch® and characterized by direct IF staining. RESULTS All 19 HD samples were negative for CK8, CK18, CK19, ERBB2, TWIST1, VEGF, ESR1, PR, and EGFR expression, while CD44, CD24, ALDH1, VIM, and CDH2 expression was normalized to B2M (reference gene). At least one gene was expressed in 23/42 (54.8%) and 8/13 (61.5%) CTCs in early BrCa before and after therapy, and in 20/23 (87.0%) and 5/7 (71.4%) MBC before and after the first cycle of therapy. PIK3CA mutations were detected in 11/42 (26.2%) and 3/13 (23.1%) in vivo isolated CTCs in early BrCa before and after therapy, and in 11/23 (47.8%) and 2/7 (28.6%) MBC, respectively. ESR1 methylation was detected in 5/32 (15.7%) and 1/10 (10.0%) CTCs in early BrCa before and after therapy, and in 3/15(20.0%) MBC before the first line of therapy. The comprehensive molecular analysis of CTC revealed a higher sensitivity in relation to CellSearch or IF staining when based on creatine kinase selection. CONCLUSIONS In vivo-CTC isolation in combination with a comprehensive molecular analysis at the gene expression, DNA mutation, and DNA methylation level comprises a highly powerful approach for molecular diagnostic applications using CTCs.
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Affiliation(s)
- Areti Strati
- Department of Chemistry, Analysis of Circulating Tumor Cells Laboratory, University of Athens, Greece
| | - Martha Zavridou
- Department of Chemistry, Analysis of Circulating Tumor Cells Laboratory, University of Athens, Greece
| | - Galatea Kallergi
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Heraklion, Crete, Greece.,Division of Genetics, Cell, and Developmental Biology, Department of Biology, University of Patras, Patras, Greece
| | - Eleni Politaki
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Andra Kuske
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias M Gorges
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Riethdorf
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon A Joosse
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Koch
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna-Lena Bohnen
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - George Koutsodontis
- Oncology Unit, Second Department of Internal Medicine, Attikon University Hospital, Haidari, Greece
| | - Emmanouil Kontopodis
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | | | - Amanda Psyrri
- Oncology Unit, Second Department of Internal Medicine, Attikon University Hospital, Haidari, Greece
| | - Dimitris Mavroudis
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Heraklion, Crete, Greece.,Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - Vasilis Georgoulias
- Laboratory of Τumor Cell Biology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evi S Lianidou
- Department of Chemistry, Analysis of Circulating Tumor Cells Laboratory, University of Athens, Greece
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13
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Mueller V, Wardley A, Paplomata E, Hamilton E, Zelnak A, Fehrenbacher L, Jakobsen E, Curtit E, Boyle F, Harder Brix E, Brenner A, Crouzet L, Ferrario C, Muñoz-Mateu M, Arkenau HT, Iqbal N, Aithal S, Block M, Cold S, Cancel M, Hahn O, Poosarla T, Stringer-Reasor E, Colleoni M, Cameron D, Curigliano G, Siadak M, DeBusk K, Ramos J, Feng W, Gelmon K. Preservation of quality of life in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer treated with tucatinib or placebo when added to trastuzumab and capecitabine (HER2CLIMB trial). Eur J Cancer 2021; 153:223-233. [PMID: 34214937 DOI: 10.1016/j.ejca.2021.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
AIMS In HER2CLIMB, tucatinib significantly improved progression-free and overall survival in patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer. We evaluated the impact of tucatinib on health-related quality of life (HR-QoL) in HER2CLIMB. METHODS Patients were randomised 2:1 to tucatinib or placebo combined with trastuzumab and capecitabine. Starting with protocol version 7, the EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) questionnaire and EQ visual analogue scale (VAS) were administered at day 1 of cycle 1, every two cycles during cycles 3-9, every three cycles during cycle 12 and thereafter and at each patient's 30-day follow-up visit. RESULTS Among 364 patients eligible for HR-QoL assessment, 331 (91%) completed ≥1 assessment. EQ-VAS scores were similar for both arms at baseline and maintained throughout treatment. EQ-5D-5L scores were similar between the treatment arms, stable throughout therapy and worsened after discontinuing treatment. Risk of meaningful deterioration (≥7 points) on EQ-VAS was reduced 19% in the tucatinib vs. placebo arm (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.55, 1.18); the median (95% CI) time to deterioration was not reached in the tucatinib arm and was 5.8 months (4.3, -) in the placebo arm. Among patients with brain metastases (n = 164), risk of meaningful deterioration on EQ-VAS was reduced 49% in the tucatinib arm (HR: 0.51; 95% CI: 0.28, 0.93); the median (95% CI) time to deterioration was not reached in the tucatinib arm and was 5.5 months (4.2, -) in the placebo arm. CONCLUSIONS HR-QoL was preserved for patients with HER2+ metastatic breast cancer who were treated with tucatinib added to trastuzumab and capecitabine and maintained longer with tucatinib therapy than without it among those with brain metastases. CLINICAL TRIAL REGISTRATION NCT02614794.
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Affiliation(s)
- Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Andrew Wardley
- Manchester Breast Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
| | - Elisavet Paplomata
- Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Erika Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA
| | | | | | | | - Elsa Curtit
- University Hospital of Besançon, Besançon, France
| | | | | | - Andrew Brenner
- Mays Cancer Center at the UT Health San Antonio, San Antonio, TX, USA
| | | | | | - Montserrat Muñoz-Mateu
- Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics, Institut d'Investigacions Biomèdiques Pi i Sunyer-IDIBAPS, Barcelona, Spain
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute UK and Cancer Institute, University College London, London, UK
| | - Nayyer Iqbal
- Saskatoon Cancer Centre, Saskatoon, Saskatchewan, Canada
| | - Sramila Aithal
- Cancer Treatment Centers of America / Eastern Regional Medical Center, Philadelphia, PA, USA
| | | | | | | | - Olwen Hahn
- University of Chicago Medical Center, Chicago, IL, USA
| | - Teja Poosarla
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Erica Stringer-Reasor
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marco Colleoni
- IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - David Cameron
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Edinburgh, Scotland
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, and University of Milano, Milan, Italy
| | | | - Kendra DeBusk
- Health Economics Outcome Research, Seagen Inc., Bothell, WA, USA
| | - Jorge Ramos
- Clinical Development, Seagen Inc., Bothell, WA, USA
| | | | - Karen Gelmon
- British Columbia Cancer Agency - Vancouver Centre, Vancouver, BC, Canada
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14
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Curigliano G, Mueller V, Borges VF, Hamilton EP, Hurvitz SA, Loi S, Murthy RK, Okines AFC, Paplomata E, Cameron DA, Carey LA, Gelmon KA, Hortobagyi GN, Krop IE, Loibl S, Pegram MD, Slamon DJ, Ramos J, Zhang C, Winer EP. Updated results of tucatinib versus placebo added to trastuzumab and capecitabine for patients with pretreated HER2+ metastatic breast cancer with and without brain metastases (HER2CLIMB). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1043] [Citation(s) in RCA: 5] [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
1043 Background: Tucatinib (TUC) is an oral tyrosine kinase inhibitor (TKI) highly specific for HER2. TUC is approved for use in combination with trastuzumab (T) and capecitabine (C) in patients (pts) with and without brain metastases (BM) who have received 1 or more prior anti-HER2–based regimens in the metastatic setting. In the primary analysis from the pivotal HER2CLIMB trial, the addition of TUC to T and C in pts with HER2+ metastatic breast cancer showed a statistically significant and clinically meaningful prolongation of progression-free (PFS) (HR = 0.54 [95% CI: 0.42, 0.71]; P < 0.001) and overall survival (OS) (HR = 0.66 [95% CI: 0.50, 0.88]; P = 0.005) (Murthy, et al. NEJM 2020). TUC in combination with T and C was well tolerated with few discontinuations other than for disease progression. Based on these data, the protocol was amended for unblinding of sites to treatment assignment to allow for crossover from the placebo arm to receive TUC in combination with T and C. Methods: HER2CLIMB (NCT02614794) is a global, randomized, double-blind, placebo-controlled trial in pts with unresectable locally advanced or metastatic HER2+ breast cancer previously treated with T, pertuzumab, and T-emtansine (T-DM1), including pts with untreated, treated stable, or treated and progressing BM. Overall 612 pts were randomized 2:1 to receive TUC 300 mg BID or placebo, each in combination with T and C. Randomization was stratified by BM, ECOG performance status, and geographic region. Protocol prespecified analysis of OS, PFS (by investigator assessment) and safety in the total study population will be performed at approximately 2 years from the last patient randomized. Results: Updated Kaplan-Meier time-to-event analysis of OS and PFS with hazard ratios and 95% confidence intervals for TUC arm vs placebo arm will be presented overall, as well as for OS in the prespecified subgroups reported previously (Murthy, et al. NEJM 2020). Safety and tolerability assessments will include frequency of adverse events by severity, dose modifications and discontinuation of study medications. Conclusions: Conclusions will be presented in the presentation. Clinical trial information: NCT02614794 .
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Affiliation(s)
- Giuseppe Curigliano
- Istituto Europeo di Oncologia, Milan, IRCCS and University of Milano, Milan, Italy
| | | | | | | | - Sara A. Hurvitz
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | - Elisavet Paplomata
- Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, Madison, WI
| | | | - Lisa A. Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Karen A. Gelmon
- British Columbia Cancer - Vancouver Centre, Vancouver, BC, Canada
| | | | | | | | | | - Dennis J. Slamon
- University of California, Los Angeles/Jonsson Comprehensive Cancer Center, Los Angeles, CA
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15
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Turner NC, Jhaveri KL, Bardia A, Niikura N, Dieras V, Barrios CH, Im SA, Mueller V, Bellet M, Chang CW, Ross GA, Patre M, Loi S. persevERA Breast Cancer (BC): Phase III study evaluating the efficacy and safety of giredestrant (GDC-9545) + palbociclib versus letrozole + palbociclib in patients (pts) with estrogen-receptor-positive, HER2-negative locally advanced or metastatic BC (ER+/HER2– LA/mBC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps1103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS1103 Background: Modulating estrogen synthesis and/or ER activity is the mainstay of treatment for pts with ER+ BC. Despite substantial progress, many pts experience relapse during/after adjuvant endocrine therapy. However, even though resistant to aromatase inhibitors (AIs) or tamoxifen, growth and survival of the majority of tumors are thought to remain dependent on ER signaling. Therefore, pts with ER+ BC can still respond to second- or third-line endocrine treatment after progression on prior therapy (Di Leo 2010; Baselga 2012). Therapeutic resistance can arise from mutations in ESR1, which can drive estrogen-independent transcription and proliferation. The highly potent, non-steroidal oral selective ER degrader giredestrant achieves robust ER occupancy and is active regardless of ESR1 mutation status. Phase I data indicate that giredestrant is well tolerated, with encouraging activity as a single agent and in combination with the CDK4/6 inhibitor palbociclib (Lim 2020). Single-agent activity was observed after prior treatment with fulvestrant and/or a CDK4/6 inhibitor (Jhaveri 2019). Methods: persevERA BC (NCT04546009) is a double-blind, placebo-controlled, randomized, multicenter phase III study designed to evaluate the efficacy and safety of first-line giredestrant + palbociclib in pts with ER+/HER2– LA/mBC. Randomization: 1:1 to either giredestrant (30 mg PO) plus letrozole placebo QD or letrozole (2.5 mg PO) plus giredestrant placebo QD on Days 1–28 of each 28-day cycle, with palbociclib (125 mg PO QD) on Days 1–21 of each 28-day cycle. Men and premenopausal women will receive an LHRH agonist. Eligibility: females or males ≥18 years old with measurable disease or evaluable bone disease and no prior treatment for advanced disease. Pts who received prior fulvestrant or who have relapsed within 12 months of completion of (neo)adjuvant therapy with an AI and/or prior therapy with CDK4/6 inhibitor are not eligible; relapse during tamoxifen therapy but > 24 months after the start of tamoxifen therapy is allowed. Stratification: site of disease, disease-free interval since the end of (neo)adjuvant therapy, menopausal status, and geographic region. Primary efficacy endpoint: progression-free survival (determined locally by the investigator per RECIST v1.1). Secondary endpoints include overall survival, objective response rate, duration of response, clinical benefit rate, QoL, and safety. Enrollment is open (first patient in: Oct 9, 2020); target recruitment is 978 pts across all sites in a global enrollment phase. After completion of the global enrollment, additional pts may be enrolled in China. Clinical trial information: NCT04546009 .
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Affiliation(s)
| | | | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | | | - Seock-Ah Im
- Seoul National University College of Medicine, Seoul, South Korea
| | | | - Meritxell Bellet
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | | | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Vladimirova V, Schneeweiss A, Jackisch C, Weber K, Denkert C, Schmatloch S, Karn T, Fasching P, Braun S, Szeto C, Sinn B, van Mackelenbergh M, Schem C, Stickeler E, Soon-Shiong P, Marmé F, Mueller V, Untch M, Nekljudova V, Loibl S. 21P BACH1 and HIF1α predict response to neoadjuvant nab-paclitaxel (nP) treatment in early breast cancer (BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.035] [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: 12/01/2022] Open
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Mueller V, Ruhnke M, Hoffmann O, Grafe A, Tomé O, Fett W, Bruch HR, Sommer AK, Schneeweiss A. 98P Final results from AVANTI, a multicentre German observational study of first-line bevacizumab (BEV) + chemotherapy (CT) in >2000 patients (pts) with advanced breast cancer (aBC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.112] [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: 10/21/2022] Open
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Laakmann E, Witzel I, Neunhöffer T, Park-Simon TW, Weide R, Riecke K, Polasik A, Schmidt M, Puppe J, Mundhenke C, Lübbe K, Hesse T, Thill M, Zahm DM, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Mueller V. 95MO Characteristics of patients with brain metastases from HER2-positive breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Leichsenring J, Vladimirova V, Solbach C, Karn T, Ataseven B, Sinn B, Barinoff J, Mueller V, Blohmer JU, Schem C, Engels K, Marmé F, Fissler-Eckhoff A, Fasching P, Stickeler E, van Mackelenbergh M, Denkert C, Stenzinger A, Loibl S, Gröschel S. 28P EVI1 expression in early-stage breast cancer patients treated with neoadjuvant chemotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Furlanetto J, Denkert C, Untch M, Sinn B, Lederer B, Schneeweiss A, Mueller V, van Mackelenbergh M, Stickeler E, Fasching P, Schem C, Karn T, Marmé F, Nekljudova V, Loibl S. 17P Impact of body mass index (BMI) on prognostic and predictive value of stromal tumour-infiltrating lymphocytes (sTILs) in triple-negative breast cancer (TNBC): A pooled analysis of six neoadjuvant trials. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Wardley A, Mueller V, Paplomata E, Crouzet L, Iqbal N, Aithal S, Block M, Cold S, By MA, Hahn O, Poosarla T, Stringer-Reasor E, Colleoni M, Cameron D, Curigliano G, DeBusk K, Siadak M, Ramos J, An X, Gelmon K. Abstract PD13-04: Impact of tucatinib on health-related quality of life in patients with HER2+ metastatic breast cancer with stable and active brain metastases. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd13-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Patients (pts) with human epidermal growth factor receptor 2 positive (HER2+) metastatic breast cancer (MBC) who have brain metastases (BM) have limited treatment options and lower health-related quality of life (HRQoL) compared with pts without BM (Hurvitz 2019). HER2CLIMB is a randomized trial (2:1) of tucatinib vs. placebo in combination with trastuzumab and capecitabine in pts with HER2+ MBC that included pts with stable and active brain metastases (NCT02614794). In HER2CLIMB, the addition of tucatinib to trastuzumab + capecitabine demonstrated a statistically significant and clinically meaningful improvement in overall survival (OS) in pts with HER2+ MBC and in those with stable and active BM, with importantly, a tolerable and manageable safety profile (Murthy 2020). An evaluation of the impact of tucatinib on HRQoL in pts with stable and active BM is presented here. Methods HRQoL data were available from 330 of 612 pts, including 163 pts with BMs. HRQoL was assessed using the EQ-5D-5L tool which includes a visual analog scale (EQ-VAS) and a descriptive system (EQ-5D) comprising 5 dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. Data were collected at Cycle 1 Day 1, Cycles 3-9 (every 2 cycles; 21-day cycles), Cycle 12 and beyond (every 3 cycles), and at the 30-day follow-up. The EQ-5D-5L scores were summarized by cycle for each treatment arm. Time to deterioration, defined as a >7-point change from baseline on the EQ-VAS, was estimated by the Kaplan-Meier approach. The median time to deterioration (and 95% CIs) were computed for each arm. Results In total, 163 pts with stable and active BM were included in this HRQoL analysis, 107 pts on the tucatinib arm and 56 pts on the placebo arm. Compared to the placebo arm, pts on the tucatinib arm had an approximately 49% reduction in the risk of deterioration (hazard ratio: 0.51; 95% CI: 0.28, 0.93); the median time to deterioration has not been reached in the tucatinib arm with available follow-up and was 5.5 months (95% CI; 4.2, -) in the placebo arm. Decline in all domains of the EQ-5D-5L and the EQ-VAS scores were seen once pts discontinued therapy, particularly on the ‘usual activities’ domain. Additional available QoL data will be presented. Conclusions Pts with MBC and BM treated with tucatinib in combination with trastuzumab + capecitabine demonstrated significantly longer and clinically meaningful time to deterioration of HRQoL. HRQoL was maintained throughout the treatment course, allowing them to receive full benefit of the therapeutic approach and resulting in statistically significant and clinically meaningful improvement in OS. References Hurvitz SA, O’Shaugnessy J, Mason G, et al. Central Nervous System Metastasis in Patients with HER2-Positive Metastatic Breast Cancer: Patient Characteristics, Treatment, and Survival from SystHERs. Clin Cancer Res. 2019;25(8):2433-2441.Murthy RK, Loi S, Okines A, et al. Tucatinib, Trastuzumab, and Capecitabine for HER2-Positive Metastatic Breast Cancer. N Engl J Med. 2020;382(7):597-609.
Citation Format: Andrew Wardley, Volkmar Mueller, Elisavet Paplomata, Laurence Crouzet, Nayyer Iqbal, Sramila Aithal, Margaret Block, Søren Cold, Marie-Agnes By, Olwen Hahn, Teja Poosarla, Erica Stringer-Reasor, Marco Colleoni, David Cameron, Giuseppe Curigliano, Kendra DeBusk, Muriel Siadak, Jorge Ramos, Xuebei An, Karen Gelmon. Impact of tucatinib on health-related quality of life in patients with HER2+ metastatic breast cancer with stable and active brain metastases [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD13-04.
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Affiliation(s)
- Andrew Wardley
- 1The NIHR Manchester Clinical Research Facility at The Christie NHS Foundation & Trust Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Volkmar Mueller
- 2University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elisavet Paplomata
- 3Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, Madison, WI
| | | | | | - Sramila Aithal
- 6Cancer Treatment Centers of America / Eastern Regional Medical Center, Philadelphia, PA
| | | | - Søren Cold
- 8Odense University Hospital, Odense, Denmark
| | | | - Olwen Hahn
- 10University of Chicago Medical Center, Chicago, IL
| | - Teja Poosarla
- 11Mitchell Cancer Institute, University of South Alabama, Mobile, AL
| | - Erica Stringer-Reasor
- 12O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | | | - David Cameron
- 14IGMM, University of Edinburgh, Western General Hospital, Edinburg, United Kingdom
| | - Giuseppe Curigliano
- 15European Institute of Oncology, IRCCS and University of Milano, Milan, Italy
| | | | | | | | - Xuebei An
- 16Seattle Genetics, Inc., Bothell, WA
| | - Karen Gelmon
- 17British Columbia Cancer Agency - Vancouver Centre, Vancouver, BC, Canada
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Fehm T, Mueller V, Banys-Paluchowski M, Fasching PA, Friedl TWP, Hartkopf A, Huober J, Loehberg C, Rack B, Riethdorf S, Schneeweiss A, Wallwiener D, Meier-Stiegen F, Hoffmann O, Müller L, Wimberger P, Ruckhaeberle E, Blohmer J, Janni W. Abstract PD3-12: Efficacy of the tyrosine kinase inhibitor lapatinib in the treatment of patients with HER2-negative metastatic breast cancer and HER2-positive circulating tumor cells - results from the randomized phase III DETECT III trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd3-12] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: It is well-known that tumor biology may change during the course of the disease due to clonal evolution, and such changes might have important implications for response to targeted treatments. Circulating tumor cells (CTCs) could serve as a real-time liquid biopsy to detect changes in tumor biology. It has been demonstrated that patients with HER2-negative metastatic breast cancer (MBC) may have discordant, HER2-positive CTCs in the peripheral blood. However, up to now there is no randomized clinical trial investigating whether treatment decisions based on CTC phenotype provide benefits in terms of improved outcome. The aim of the DETECT III study is to investigate whether patients with initially HER2-negative MBC and HER2-positive CTCs benefit from HER2-targeted therapy with the tyrosine kinase inhibitor lapatinib. In addition, the significance of CTCs as an early predictive marker for response to therapy will be analyzed. Methods: The randomized phase III DETECT III trial (NCT01619111) compares lapatinib in combination with standard therapy versus standard therapy alone in patients with initially HER2-negative MBC and HER2-positive CTCs. Efficacy of lapatinib treatment is evaluated by CTC clearance rate, progression-free survival (PFS) and overall survival (OS). In addition, we investigate the association between CTC results and both PFS and OS to assess the utility of CTCs as an early predictive marker for treatment response. CTC enumeration and phenotyping was performed using the CellSearch® technology (Menarini Silicon Biosystems; Bologna, Italy). Survival data are analyzed using log rank tests, univariable and adjusted multivariable cox regressions. Results: First results on CTC clearance rates, PFS and OS of 105 prospectively randomized patients will be presented. Conclusion: This first randomized clinical trial in breast cancer patients with treatment decisions being based on the phenotype of CTCs will show whether patients with HER2 negative MBC and HER2 positive CTCs benefit from additional HER2-targeted therapy with lapatinib. This finding might be increasingly important as novel HER2-targeted drugs become available.
Citation Format: Tanja Fehm, Volkmar Mueller, Maggie Banys-Paluchowski, Peter A Fasching, Thomas WP Friedl, Andreas Hartkopf, Jens Huober, Christian Loehberg, Brigitte Rack, Sabine Riethdorf, Andreas Schneeweiss, Diethelm Wallwiener, Franziska Meier-Stiegen, Oliver Hoffmann, Lothar Müller, Pauline Wimberger, Eugen Ruckhaeberle, Jens Blohmer, Wolfgang Janni. Efficacy of the tyrosine kinase inhibitor lapatinib in the treatment of patients with HER2-negative metastatic breast cancer and HER2-positive circulating tumor cells - results from the randomized phase III DETECT III trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD3-12.
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Affiliation(s)
- Tanja Fehm
- 1Department of Gynecology and Obstetrics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Volkmar Mueller
- 2Department of Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Peter A Fasching
- 4Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Thomas WP Friedl
- 5Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Andreas Hartkopf
- 6Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Jens Huober
- 5Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Christian Loehberg
- 7Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Brigitte Rack
- 5Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Sabine Riethdorf
- 8Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Schneeweiss
- 9National Center for Tumor Diseases and Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Diethelm Wallwiener
- 6Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Franziska Meier-Stiegen
- 1Department of Gynecology and Obstetrics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Oliver Hoffmann
- 10Department of Gynecology and Obstetrics, University Hospital Essen-Duisburg, Essen, Germany
| | - Lothar Müller
- 11Onkologische Schwerpunktpraxis Leer, Leer, Germany
| | - Pauline Wimberger
- 12Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Eugen Ruckhaeberle
- 1Department of Gynecology and Obstetrics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jens Blohmer
- 13Department of Gynecology and Obstetrics, University Hospital Charite, Berlin, Germany
| | - Wolfgang Janni
- 5Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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Bell AR, Wrathall DJ, Mueller V, Chen J, Oppenheimer M, Hauer M, Adams H, Kulp S, Clark PU, Fussell E, Magliocca N, Xiao T, Gilmore EA, Abel K, Call M, Slangen ABA. Migration towards Bangladesh coastlines projected to increase with sea-level rise through 2100. Environ Res Lett 2021; 16:024045. [PMID: 36034333 PMCID: PMC9415774 DOI: 10.1088/1748-9326/abdc5b] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
To date, projections of human migration induced by sea-level change (SLC) largely suggest large-scale displacement away from vulnerable coastlines. However, results from our model of Bangladesh suggest counterintuitively that people will continue to migrate toward the vulnerable coastline irrespective of the flooding amplified by future SLC under all emissions scenarios until the end of this century. We developed an empirically calibrated agent-based model of household migration decision-making that captures the multi-faceted push, pull and mooring influences on migration at a household scale. We then exposed ~4800 000 simulated migrants to 871 scenarios of projected 21st-century coastal flooding under future emissions pathways. Our model does not predict flooding impacts great enough to drive populations away from coastlines in any of the scenarios. One reason is that while flooding does accelerate a transition from agricultural to non-agricultural income opportunities, livelihood alternatives are most abundant in coastal cities. At the same time, some coastal populations are unable to migrate, as flood losses accumulate and reduce the set of livelihood alternatives (so-called 'trapped' populations). However, even when we increased access to credit, a commonly-proposed policy lever for incentivizing migration in the face of climate risk, we found that the number of immobile agents actually rose. These findings imply that instead of a straightforward relationship between displacement and migration, projections need to consider the multiple constraints on, and preferences for, mobility. Our model demonstrates that decision-makers seeking to affect migration outcomes around SLC would do well to consider individual-level adaptive behaviors and motivations that evolve through time, as well as the potential for unintended behavioral responses.
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Affiliation(s)
- A R Bell
- Department of Earth and Environment, Boston University, Boston, MA 02215, United States of America
- Department of Environmental Studies, New York University, New York, NY 10012, United States of America
| | - D J Wrathall
- College of Earth, Ocean and Atmospheric Sciences, Oregon State University, Corvallis, OR 97331-5503, United States of America
| | - V Mueller
- School of Politics and Global Studies, Arizona State University, Tempe, AZ 85287-3902, United States of America
- International Food Policy Research Institute, Washington, DC 20005, United States of America
| | - J Chen
- Department of Agricultural, Environmental, and Development Economics, The Ohio State University, Columbus, OH 43210, United States of America
| | - M Oppenheimer
- School of Public and International Affairs and Department of Geosciences, Princeton University, Princeton, NJ 08544-1013, United States of America
| | - M Hauer
- Department of Sociology, Florida State University, Tallahassee, FL 32306, United States of America
| | - H Adams
- Department of Geography, King's College London, London WC2R 2LS, United Kingdom
| | - S Kulp
- Climate Central, Princeton, NJ 08542, United States of America
| | - P U Clark
- College of Earth, Ocean and Atmospheric Sciences, Oregon State University, Corvallis, OR 97331-5503, United States of America
- School of Geography and Environmental Sciences, University of Ulster, Coleraine, Northern Ireland BT52 1SA, United Kingdom
| | - E Fussell
- Population Studies and Training Center and the Institute at Brown on Environment and Society, Brown University, Providence, RI 02912, United States of America
| | - N Magliocca
- Department of Geography, University of Alabama, Tuscaloosa, AL 35401, United States of America
| | - T Xiao
- School of Public and International Affairs and Department of Geosciences, Princeton University, Princeton, NJ 08544-1013, United States of America
| | - E A Gilmore
- Department of International Development, Community and Environment, Clark University, Worcester, MA 01610-1477, United States of America
| | - K Abel
- College of Earth, Ocean and Atmospheric Sciences, Oregon State University, Corvallis, OR 97331-5503, United States of America
| | - M Call
- USAID, Washington, DC, United States of America
| | - A B A Slangen
- Department of Estuarine and Delta Systems, NIOZ Royal Netherlands Institute for Sea Research, Yerseke 4401 NT, The Netherlands
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Woelber L, Mathey S, Prieske K, Kuerti S, Hillen C, Burandt E, Coym A, Mueller V, Schmalfeldt B, Jaeger A. Targeted Therapeutic Approaches in Vulvar Squamous Cell Cancer (VSCC): Case Series and Review of the Literature. Oncol Res 2020; 28:645-659. [PMID: 33308371 PMCID: PMC7962928 DOI: 10.3727/096504020x16076861118243] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Therapeutic options in recurrent or metastasized vulvar squamous cell cancer (VSCC) not amenable to radiotherapy or radical surgery are limited. Evidence for the use of targeted therapies is sparse. All patients with VSCC treated at the Gynecological Cancer Center Hamburg-Eppendorf 2013–2019 were retrospectively evaluated for targeted therapeutic approaches. Furthermore, a MEDLINE, EMBASE, Web of Science, Scopus, and OVID database search was performed using the terms: “vulvar cancer” AND “targeted therapy,” “erlotinib,” “EGFR,” “bevacizumab,” “VEGF,” “pembrolizumab,” or “immunotherapy.” Twelve of 291 patients (4.1%) with VSCC received at least one targeted therapy at our institution. Previously, one or more platinum-based chemotherapy was applied to all patients [median 3.5 previous lines (range 2–5)]. In the erlotinib subgroup, two of five patients (40%) achieved stable disease (SD), while two patients (2/5, 40%) experienced partial response (PR). Treatment was given as monotherapy in second/third line for a median of 3.4 months (range 2–6 months). Bevacizumab (n = 9) was given as maintenance therapy after platinum-based first-line chemotherapy (9/9); best response was complete response (CR) (n = 2/9 22.2%). Median duration of treatment was 7 months (range 4–13 months) with two patients still under ongoing treatment. Best response in the pembrolizumab (n = 3) subset was SD (n = 1/3 33%). Treatment was given as monotherapy in second/third line for a median of 3.3 months (range 3–4 months). Nine of 12 patients (75%) experienced treatment-related adverse events (TRAEs), most commonly grade 1/2. Rapidly evolving antibody treatments have proven clinical benefit especially in HPV-driven tumor entities; however, clinical investigations in VSCC are still limited. These reported cases provide evidence for the clinical utility and feasibility while ensuring an acceptable safety profile.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Sabrina Mathey
- Department of Gynecology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Katharina Prieske
- Department of Gynecology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Sascha Kuerti
- Department of Gynecology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Christoph Hillen
- Department of Gynecology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Eike Burandt
- Department of Pathology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Anja Coym
- Center for Oncology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Anna Jaeger
- Department of Gynecology, University Medical Center Hamburg-EppendorfHamburgGermany
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Jaeger A, Woelber L, Prieske K, Trepte C, Nawrath L, Mueller V, Reuter S, Schmalfeldt B. Präliminäre Ergebnisse der Implementierung des “Enhanced Recovery After Surgery” (ERAS) Programms in der gynäkologischen Onkologie am Universitätsklinikum Hamburg - Eppendorf (UKE). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Jaeger
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf
| | - L Woelber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf
| | - K Prieske
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf
| | - C Trepte
- Klinik für Anästhesie, Universitätsklinikum Hamburg - Eppendorf
| | - L Nawrath
- Klinik für Anästhesie, Universitätsklinikum Hamburg - Eppendorf
| | - V Mueller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf
| | - S Reuter
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf
| | - B Schmalfeldt
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf
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Riecke K, Mueller V, Neunhöffer T, Weide R, Schmidt M, Park-Simon TW, Mundhenke C, Polasik A, Hesse T, Lübbe K, Laakmann E, Thill M, Fasching P, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Witzel I. Predicting prognosis of breast cancer patients with brain metastases in the BMBC registry – comparison of three different prognostic scores. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- K Riecke
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - V Mueller
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | | | - R Weide
- Institut für Versorgungsforschung in der Onkologie
| | | | | | | | | | - T Hesse
- Agaplesion Diakonieklinikum Rotenburg
| | - K Lübbe
- Diakovere Henriettenstift, Breast Center
| | - E Laakmann
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - M Thill
- Agaplesion Markus Krankenhaus
| | | | - C Denkert
- Institut für Pathologie UKGM – Universitätsklinikum Marburg
| | - T Fehm
- Universitätsklinikum Düsseldorf
| | | | - J Rey
- German Breast Group, GBG Forschungs GmbH
| | - S Loibl
- German Breast Group, GBG Forschungs GmbH
| | - I Witzel
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
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Mueller V, Paplomata E, Hamilton E, Zelnak A, Fehrenbacher L, Jakobsen E, Curtit E, Boyle F, Brix E, Brenner A, Ferrario C, Munoz-Mateu M, Arkenau T, Gelmon K, Cameron D, Curigliano G, DeBusk K, Ramos J, An X, Wardley A. 275O Impact of tucatinib on health-related quality of life (HRQoL) in patients with HER2+ metastatic breast cancer (MBC) with and without brain metastases (BM). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lin NU, Borges V, Anders C, Murthy RK, Paplomata E, Hamilton E, Hurvitz S, Loi S, Okines A, Abramson V, Bedard PL, Oliveira M, Mueller V, Zelnak A, DiGiovanna MP, Bachelot T, Chien AJ, O’Regan R, Wardley A, Conlin A, Cameron D, Carey L, Curigliano G, Gelmon K, Loibl S, Mayor J, McGoldrick S, An X, Winer EP. Intracranial Efficacy and Survival With Tucatinib Plus Trastuzumab and Capecitabine for Previously Treated HER2-Positive Breast Cancer With Brain Metastases in the HER2CLIMB Trial. J Clin Oncol 2020; 38:2610-2619. [PMID: 32468955 PMCID: PMC7403000 DOI: 10.1200/jco.20.00775] [Citation(s) in RCA: 305] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the HER2CLIMB study, patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer with brain metastases (BMs) showed statistically significant improvement in progression-free survival (PFS) with tucatinib. We describe exploratory analyses of intracranial efficacy and survival in participants with BMs. PATIENTS AND METHODS Patients were randomly assigned 2:1 to tucatinib or placebo, in combination with trastuzumab and capecitabine. All patients underwent baseline brain magnetic resonance imaging; those with BMs were classified as active or stable. Efficacy analyses were performed by applying RECIST 1.1 criteria to CNS target lesions by investigator assessment. CNS-PFS (intracranial progression or death) and overall survival (OS) were evaluated in all patients with BMs. Confirmed intracranial objective response rate (ORR-IC) was evaluated in patients with measurable intracranial disease. RESULTS There were 291 patients with BMs: 198 (48%) in the tucatinib arm and 93 (46%) in the control arm. The risk of intracranial progression or death was reduced by 68% in the tucatinib arm (hazard ratio [HR], 0.32; 95% CI, 0.22 to 0.48; P < .0001). Median CNS-PFS was 9.9 months in the tucatinib arm versus 4.2 months in the control arm. Risk of death was reduced by 42% in the tucatinib arm (OS HR, 0.58; 95% CI, 0.40 to 0.85; P = .005). Median OS was 18.1 versus 12.0 months. ORR-IC was higher in the tucatinib arm (47.3%; 95% CI, 33.7% to 61.2%) versus the control arm (20.0%; 95% CI, 5.7% to 43.7%; P = .03). CONCLUSION In patients with HER2-positive breast cancer with BMs, the addition of tucatinib to trastuzumab and capecitabine doubled ORR-IC, reduced risk of intracranial progression or death by two thirds, and reduced risk of death by nearly half. To our knowledge, this is the first regimen to demonstrate improved antitumor activity against BMs in patients with HER2-positive breast cancer in a randomized, controlled trial.
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Affiliation(s)
| | | | | | | | | | - Erika Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology–Nashville, Nashville, TN
| | - Sara Hurvitz
- University of California Los Angeles Medical Center/Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alicia Okines
- Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Philippe L. Bedard
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | - A. Jo Chien
- University of California at San Francisco, San Francisco, CA
| | - Ruth O’Regan
- Carbone Cancer Center/University of Wisconsin, Madison, WI
| | - Andrew Wardley
- Christie NHS Foundation Trust, Manchester Academic Health Science Centre & Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | | | - David Cameron
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Lisa Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico, University of Milano, Milan, Italy
| | - Karen Gelmon
- British Columbia Cancer–Vancouver Centre, Vancouver, BC, Canada
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Lin N, Murthy R, Anders C, Borges V, Hurvitz S, Loi S, Abramson V, Bedard P, Oliveira M, Zelnack A, DiGiovanna M, Bachelot T, Chien AJ, O’Regan R, Wardley A, Mueller V, Carey L, McGoldrick S, An X, Winer E. 53. TUCATINIB VS PLACEBO ADDED TO TRASTUZUMAB AND CAPECITABINE FOR PATIENTS WITH PREVIOUSLY TREATED HER2+ METASTATIC BREAST CANCER (MBC) WITH BRAIN METASTASES (BM) (HER2CLIMB). Neurooncol Adv 2020. [PMCID: PMC7401403 DOI: 10.1093/noajnl/vdaa073.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
HER2CLIMB (NCT02614794) primary results have been reported previously (Murthy, NEJM 2019). We report results of exploratory efficacy analyses in pts with brain metastases (BM).
METHODS
All HER2+ MBC pts enrolled had a baseline brain MRI. Pts with BM were eligible and randomized 2:1 to receive tucatinib (TUC) or placebo, in combination with trastuzumab and capecitabine. Efficacy analyses were performed by applying RECIST 1.1 to the brain based on investigator evaluation. CNS-PFS and OS were evaluated in BM pts overall. Intracranial (IC) confirmed ORR-IC and DOR-IC were evaluated in BM pts with measurable IC disease. After isolated brain progression, pts could continue study therapy until second progression, and time from randomization to second progression or death was evaluated.
RESULTS
Overall, 291 pts (48%) had BM at baseline: 198 (48%) in the TUC arm and 93 (46%) in the control arm. There was a 68% reduction in risk of CNS-PFS in the TUC arm (HR: 0.32; P<0.0001). Median CNS-PFS was 9.9 mo in the TUC arm vs 4.2 mo in the control arm. Risk of overall death was reduced by 42% in the TUC arm (OS HR: 0.58; P=0.005). Median OS was 18.1 mo vs 12.0 mo. ORR-IC was higher in the TUC arm (47.3%) vs the control arm (20.0%). Median DOR-IC was 6.8 mo vs 3.0 mo. In pts with isolated brain progression who continued study therapy after local treatment (n=30), risk of second progression or death was reduced by 71% (HR: 0.29), and median time from randomization to second progression or death was 15.9 mo vs 9.7 mo, favoring the TUC arm.
CONCLUSIONS
In pts with previously treated HER2+ MBC with BM, TUC in combination with trastuzumab and capecitabine doubled the ORR-IC, reduced risk of IC progression or death by two-thirds and reduced risk of death by nearly half.
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Affiliation(s)
- Nancy Lin
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Sara Hurvitz
- UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Philippe Bedard
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | - A Jo Chien
- University of California at San Francisco, San Francisco, CA, USA
| | - Ruth O’Regan
- Carbone Cancer Center / University of Wisconsin, Madison, WI, USA
| | - Andrew Wardley
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre & Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Lisa Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | - Eric Winer
- Dana-Farber Cancer Institute, Boston, MA, USA
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Schrage T, Görlach M, Betz CS, Bokemeyer C, Kröger N, Mueller V, Petersen C, Krüll A, Schulz H, Bleich C. Development of a Short Instrument for Measuring Health-Related Quality of Life in Oncological Patients for Clinical Use: Protocol for an Observational Study. JMIR Res Protoc 2020; 9:e17854. [PMID: 32726289 PMCID: PMC7424483 DOI: 10.2196/17854] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 01/26/2023] Open
Abstract
Background Cancer patients often suffer from the physical and psychological burden of their disease and its treatment. This is frequently insufficiently identified and addressed in clinical practice. In the context of improving patient-centered care in oncological patients, patient-reported outcomes (PROs) represent an important addition to current routine care. So far, available PRO questionnaires for cancer patients are unsuitable for routine procedures due to their length and complexity. Objective This study aimed to develop and psychometrically test a short questionnaire to measure health-related quality of life (HrQoL) in cancer patients for use in routine care. Methods This observational study consists of two parts: (1) a qualitative study to develop a short questionnaire measuring HrQoL and (2) a quantitative study to psychometrically test this questionnaire in five oncological departments of a comprehensive cancer center. In part 1 of the study, semistructured interviews with 28 cancer patients, as well as five focus groups with 22 clinicians and nurses, were conducted to identify clinically relevant dimensions of HrQoL. The identified dimensions were complemented with related dimensions from empirical studies and reviewed via expert discussion. Based on this, a short instrument was developed. In part 2 of the study, the developed questionnaire was tested in cancer in- and outpatients at five participating oncological clinics using additional standardized questionnaires assessing HrQoL and other important PROs. The questionnaire was presented to more than 770 patients twice during treatment. Results The project started in May 2017 with recruitment for study phase I beginning in December 2017. Recruitment for study phases I and II ended in April 2018 and February 2019, respectively. After study phase II and psychometrical analyses, the newly developed questionnaire measuring the HrQoL of all cancer entities in routine care was finalized. Conclusions With five to six dimensions and one item per dimension, the developed questionnaire is short enough to not disrupt routine procedures during treatment and is profound enough to inform clinicians about the patient’s HrQoL impairments and status. Trial Registration Open Science Framework Registries 10.17605/OSF.IO/Y7XCE; https://osf.io/y7xce/ International Registered Report Identifier (IRRID) RR1-10.2196/17854
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Affiliation(s)
- Theresa Schrage
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirja Görlach
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Stephan Betz
- Department of Otolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Krüll
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Bleich
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Curigliano G, Murthy R, Loi S, Okines A, Paplomata E, Hamilton E, Hurvitz S, Cameron D, Borges V, Bedard P, Oliveira M, Jakobsen E, Bachelot T, Shachar S, Mueller V, Carey L, Loibl S, Feng W, Walker L, Winer E. 137O Tucatinib vs placebo added to trastuzumab and capecitabine in previously treated HER2+ metastatic breast cancer with and without brain metastases (HER2CLIMB). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Murthy R, Loi S, Okines A, Paplomata E, Hamilton E, Hurvitz S, Lin N, Borges V, Abramson VG, Anders C, Bedard PL, Oliveira M, Jakobsen E, Bachelot T, Shachar SS, Mueller V, Braga S, Duhoux FP, Greil R, Cameron D, Carey L, Curigliano G, Gelmon K, Hortobagyi G, Krop I, Loibl S, Pegram M, Slamon D, Palanca-Wessels MC, Walker L, Feng W, Winer E. Abstract GS1-01: Tucatinib vs placebo, both combined with capecitabine and trastuzumab, for patients with pretreated HER2-positive metastatic breast cancer with and without brain metastases (HER2CLIMB). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-gs1-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: The primary analysis from the HER2CLIMB study will describe the efficacy and safety of tucatinib, trastuzumab, and capecitabine, a treatment regimen under investigation for patients (pts) with advanced HER2+ metastatic breast cancer (BC) refractory to standard-of-care regimens.
Rationale: Fifteen to 20% of pts diagnosed with BC annually have overexpression or amplification of the HER2 receptor. While significant advances have been made in the treatment of pts with HER2+ BC, treatment of metastatic disease remains a clinical challenge for which no curative options are available. The management of HER2+ CNS metastases (which occur at any time during the disease course in 30-50% of those with HER2+ metastatic BC) remains an area of unmet clinical need. Tucatinib is an investigational, oral tyrosine kinase inhibitor (TKI) that is highly specific to HER2 with minimal inhibition of the EGFR receptor. In a Phase 1b study, tucatinib plus capecitabine and trastuzumab showed an acceptable toxicity profile and encouraging anti-tumour activity, including in pts with active brain metastases.
Methodology: In this double-blind, international, multicenter study (NCT02614794), 612 pts with locally advanced or metastatic HER2+ BC previously treated with trastuzumab, pertuzumab, and T-DM1 were randomized 2:1 to receive tucatinib (300 mg BID) or placebo, in combination with capecitabine (1000 mg/m2 BID, Days 1–14 of each 21-day cycle) and trastuzumab (6 mg/kg once every 21 days). Pts with newly diagnosed, progressing, or stable brain metastases not requiring immediate local therapy were included. The primary endpoint is PFS per RECIST 1.1 by blinded independent central review for the first 480 pts enrolled. Secondary endpoints, including PFS in pts with brain metastases and OS, will be evaluated in all 612 pts. The primary and key secondary endpoints will be compared between treatment arms using a stratified log rank test; the hazard ratio from Cox regression model will also be reported.
Anticipated Results: Baseline demographics and disease characteristics will be presented by treatment arms. PFS, response rates, and duration of response for pts receiving tucatinib vs placebo will be reported for the first 480 pts. Common AEs and SAEs will be reported for both treatment arms in all treated pts. Secondary objectives, including PFS in pts with brain metastases and OS, may be presented if the data are sufficiently mature.
Citation Format: Rashmi Murthy, Sherene Loi, Alicia Okines, Elisavet Paplomata, Erika Hamilton, Sara Hurvitz, Nancy Lin, Virginia Borges, Vandana Gupta Abramson, Carey Anders, Philippe L Bedard, Mafalda Oliveira, Erik Jakobsen, Thomas Bachelot, Shlomit S Shachar, Volkmar Mueller, Sofia Braga, Francois P Duhoux, Richard Greil, David Cameron, Lisa Carey, Giuseppe Curigliano, Karen Gelmon, Gabriel Hortobagyi, Ian Krop, Sibylle Loibl, Mark Pegram, Dennis Slamon, Maria Corinna Palanca-Wessels, Luke Walker, Wentao Feng, Eric Winer. Tucatinib vs placebo, both combined with capecitabine and trastuzumab, for patients with pretreated HER2-positive metastatic breast cancer with and without brain metastases (HER2CLIMB) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr GS1-01.
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Affiliation(s)
| | - Sherene Loi
- 2Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alicia Okines
- 3The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Sara Hurvitz
- 6UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Nancy Lin
- 7Dana-Farber Cancer Institute, Boston, MA
| | - Virginia Borges
- 8University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, CO
| | | | | | - Philippe L Bedard
- 11University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | | | - Erik Jakobsen
- 13Sygehus Lillebaelt - Vejle Sygehus, Velje, Denmark
| | | | | | | | - Sofia Braga
- 17Hospital Cuf Descobertas R. Mário Botas, Lisbon, Portugal
| | | | - Richard Greil
- 193rd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute-CCCIT; Cancer Cluster Salzburg, Salzburg, Austria
| | - David Cameron
- 20Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Lisa Carey
- 21UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Karen Gelmon
- 23British Columbia Cancer Agency - Vancouver Centre, Vancouver, BC, Canada
| | | | - Ian Krop
- 7Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Dennis Slamon
- 6UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | - Eric Winer
- 7Dana-Farber Cancer Institute, Boston, MA
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Trapp EK, Fasching PA, Fehm T, Schneeweiss A, Mueller V, Harbeck N, Lorenz R, Schumacher C, Heinrich G, deGregorio deGregorio A, Tzschaschel M, Bekes I, Scholz C, Rack B, Janni W, Friedl TWP. Abstract P4-01-01: Presence of circulating tumor cells in high-risk early breast cancer do not predict site of metastatic lesions - Results of the SUCCESS A trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The prognostic relevance of circulating tumor cells (CTCs) during adjuvant breast cancer treatment and follow up has been well established. However, little information is available regarding CTC-detection and its association to site of first metastatic disease. Methods: The adjuvant phase III SUCCESS A trial, an open label, randomized, multicenter study, compared chemotherapy with three cycles of epirubicin, fluorouracil and cyclophosphamide followed by either three cycles of docetaxel or three cycles of docetaxel plus gemcitabine in patients with early high-risk breast cancer. Following chemotherapy, patients were randomized to two or five years of zoledronate treatment. CTC status was assessed before and after chemotherapy using the FDA-approved CellSearch® System (Menarini Silicon Biosystems; Bologna, Italy). The association between the presence of CTCs and the site of first distant disease was assessed using Chi Square tests. Findings: Of 3754 SUCCESS A patients, 373 developed metastatic disease. 206 of these patients participated in the translational research program of the trial so the CTC status at baseline was assessed. These patients were included into the analysis. At least one CTC before chemotherapy was detected in 70 (34.0%) of patients (median 2 CTCs, range 1 - 827 CTCs). For 159 patients, CTC status after chemotherapy could also be evaluated. Disease progression in terms of first distant disease occurred in 44 patients (21.4 %) in the bones, in 60 (29.1 %) in visceral sites (lung, liver), in 23 (11.2 %) in the brain or neural system, and in 51 patients (24.7 %) in other sites. In 28 patients (13.6 %), more than one site of metastatic disease was overt at the time of first distant recurrence. The median time to metastatic disease (measured from date of randomization) was 33.0 months (range 0.7 - 92.4 months). Overall, patients with bone-only first distant disease were numerically most likely to be CTC positive before chemotherapy (40.9 %); however, there was no significant association between site of first metastatic disease (bones, visceral, other) and the presence of CTCs before chemotherapy (p.224). Adding CTC status after chemotherapy did not change the results. However, patients with persistently positive CTCs were significantly more likely to show first distant disease at multiple sites than patients with a negative CTC status before and/or after chemotherapy. Interpretation: Although the presence of CTCs predicts poor prognosis in early breast cancer, no association of positive CTC status before and after chemotherapy with the site of metastatic disease was found. Therefore, a positive CTC status should trigger routine diagnostic intervention depending on clinical evaluation.
Citation Format: Elisabeth Katharina Trapp, Peter A Fasching, Tanja Fehm, Andreas Schneeweiss, Volkmar Mueller, Nadia Harbeck, R. Lorenz, Claudia Schumacher, Georg Heinrich, Amelie deGregorio deGregorio, Marie Tzschaschel, Inga Bekes, Christoph Scholz, Brigitte Rack, Wolfgang Janni, Thomas WP Friedl. Presence of circulating tumor cells in high-risk early breast cancer do not predict site of metastatic lesions - Results of the SUCCESS A trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-01-01.
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Affiliation(s)
| | - Peter A Fasching
- 2Department of Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja Fehm
- 3Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Andreas Schneeweiss
- 4National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Volkmar Mueller
- 5Department of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nadia Harbeck
- 6Department of Gynecology and Obstetrics, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - R. Lorenz
- 7Private Practice for Gynaecology Casparistreet, Braunschweig, Germany
| | - Claudia Schumacher
- 8Department of Obstetrics and Gynecology St. Elisabeth's Hospital of Cologne, Cologne, Germany
| | - Georg Heinrich
- 9Private Practice for Gynaecology, Fürstenwalde, Germany
| | | | - Marie Tzschaschel
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Inga Bekes
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Scholz
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Brigitte Rack
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Thomas WP Friedl
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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Degenhardt T, Fasching P, Luftner D, Mueller V, Thomssen C, Schem C, Witzel I, Decker T, Tesch H, Kuemmel S, Uleer C, Wuerstlein R, Riese C, Schinköthe T, Kates R, Schumacher J, Harbeck N, Schmidt M. Abstract OT3-14-02: Impact of CANKADO-based eHealth-support on quality of life in metastatic breast cancer patients treated with palbociclib and endocrine therapy - Precycle. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-ot3-14-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Efficacy and quality of life (QoL) are key factors when selecting therapies for metastatic breast cancer (MBC) patients. The addition of targeted oral agents such as CDK4/6 inhibitors to endocrine therapy is the new standard for hormone receptor (HR)+ HER2- MBC and substantially prolongs progression-free survival. However more complex oral medication in oncology might require substantial improvement of patient management. Despite several advantages of an oral treatment, patients become increasingly self-responsible and physician/patient contact is reduced. Adherence, maintaining patients’ satisfaction, and early detection and management of side effects become important challenges and new ways of continuous support for oncological patients are needed. An eHealth-based platform could help to support therapy management and physician-patient interaction. Methods: PRECYCLE is a multicenter, randomized, phase IV trial in HR+ HER2- MBC. All patients (n = 960) receive the CDK4/6 inhibitor palbociclib either in first (62.5%) or later line (37.5%) together with endocrine therapy (AI, fulvestrant) according to national guidelines. Primary study aim is the time to deterioration (TTD) of QoL in patients supported by two eHealth systems with substantially different functionality. To date (05/07/2019), 250 patients have been registered in all 72 participating centers and 230 randomized to the different study arms: - CANKADO inform with only a CANKADO-based eHealth service with a personal login, documentation of daily drug intake and passive text information (disease, treatment), but no further functions. vs. - CANKADO active with the fully functional CANKADO-based eHealth treatment support system (+ drug diary, QoL, AEs, automated recommendations, etc.) To evaluate QoL, the FACT-B questionnaire is completed at every visit. Primary objective is to test the hypothesis of superiority for TTD with regards to QoL (FACT-G scale) in patients supported by an eHealth therapy management system (CANKADO active) versus in those merely receiving eHealth-based information (CANKADO inform). As little is known about relationships between behavioral patterns (e.g. adherence), genetic background, and drug efficacy. The trial also includes a large translational program that aims at the discovery and validation of biomarkers concerning efficacy, toxicity, adherence and QoL. Recruitment is ongoing.
Citation Format: Tom Degenhardt, Peter Fasching, Diana Luftner, Volkmar Mueller, Christoph Thomssen, Christian Schem, Isabel Witzel, Thomas Decker, Hans Tesch, Sherko Kuemmel, Christoph Uleer, Rachel Wuerstlein, Christoph Riese, Timo Schinköthe, Ronald Kates, Johannes Schumacher, Nadia Harbeck, Marcus Schmidt. Impact of CANKADO-based eHealth-support on quality of life in metastatic breast cancer patients treated with palbociclib and endocrine therapy - Precycle [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT3-14-02.
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Affiliation(s)
| | | | | | - Volkmar Mueller
- 4Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | | | | | - Isabel Witzel
- 7University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Hans Tesch
- 9Hämatologisch-Onkologische, Frankfurt, Germany
| | | | | | | | | | | | - Ronald Kates
- 14West German Study Group, Moenchengladbach, Germany
| | | | | | - Marcus Schmidt
- 16Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
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Franken A, Honisch E, Reinhardt F, Meier-Stiegen F, Yang L, Jaschinski S, Esposito I, Alberter B, Polzer B, Huebner H, Fasching PA, Pancholi S, Martin LA, Ruckhaeberle E, Schochter F, Tzschaschel M, Hartkopf AD, Mueller V, Niederacher D, Fehm T, Neubauer H. Detection of ESR1 Mutations in Single Circulating Tumor Cells on Estrogen Deprivation Therapy but Not in Primary Tumors from Metastatic Luminal Breast Cancer Patients. J Mol Diagn 2020; 22:111-121. [DOI: 10.1016/j.jmoldx.2019.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 08/12/2019] [Accepted: 09/12/2019] [Indexed: 02/07/2023] Open
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Trapp E, Janni W, Schindlbeck C, Jückstock J, Andergassen U, deGregorio A, Alunni-Fabbroni M, Tzschaschel M, Polasik A, Koch JG, Friedl TWP, Fasching PA, Haeberle L, Fehm T, Schneeweiss A, Beckmann MW, Pantel K, Mueller V, Rack B, Scholz C. Response to Di Cosimo, Torri, and Porcu. J Natl Cancer Inst 2019; 111:1234-1235. [PMID: 31187135 DOI: 10.1093/jnci/djz095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/09/2019] [Indexed: 11/12/2022] Open
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Bidard FC, Michiels S, Riethdorf S, Mueller V, Esserman LJ, Lucci A, Naume B, Horiguchi J, Gisbert-Criado R, Sleijfer S, Toi M, Garcia-Saenz JA, Hartkopf A, Generali D, Rothé F, Smerage J, Muinelo-Romay L, Stebbing J, Viens P, Magbanua MJM, Hall CS, Engebraaten O, Takata D, Vidal-Martínez J, Onstenk W, Fujisawa N, Diaz-Rubio E, Taran FA, Cappelletti MR, Ignatiadis M, Proudhon C, Wolf DM, Bauldry JB, Borgen E, Nagaoka R, Carañana V, Kraan J, Maestro M, Brucker SY, Weber K, Reyal F, Amara D, Karhade MG, Mathiesen RR, Tokiniwa H, Llombart-Cussac A, Meddis A, Blanche P, d'Hollander K, Cottu P, Park JW, Loibl S, Latouche A, Pierga JY, Pantel K. Circulating Tumor Cells in Breast Cancer Patients Treated by Neoadjuvant Chemotherapy: A Meta-analysis. J Natl Cancer Inst 2019; 110:560-567. [PMID: 29659933 DOI: 10.1093/jnci/djy018] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background We conducted a meta-analysis in nonmetastatic breast cancer patients treated by neoadjuvant chemotherapy (NCT) to assess the clinical validity of circulating tumor cell (CTC) detection as a prognostic marker. Methods We collected individual patient data from 21 studies in which CTC detection by CellSearch was performed in early breast cancer patients treated with NCT. The primary end point was overall survival, analyzed according to CTC detection, using Cox regression models stratified by study. Secondary end points included distant disease-free survival, locoregional relapse-free interval, and pathological complete response. All statistical tests were two-sided. Results Data from patients were collected before NCT (n = 1574) and before surgery (n = 1200). CTC detection revealed one or more CTCs in 25.2% of patients before NCT; this was associated with tumor size (P < .001). The number of CTCs detected had a detrimental and decremental impact on overall survival (P < .001), distant disease-free survival (P < .001), and locoregional relapse-free interval (P < .001), but not on pathological complete response. Patients with one, two, three to four, and five or more CTCs before NCT displayed hazard ratios of death of 1.09 (95% confidence interval [CI] = 0.65 to 1.69), 2.63 (95% CI = 1.42 to 4.54), 3.83 (95% CI = 2.08 to 6.66), and 6.25 (95% CI = 4.34 to 9.09), respectively. In 861 patients with full data available, adding CTC detection before NCT increased the prognostic ability of multivariable prognostic models for overall survival (P < .001), distant disease-free survival (P < .001), and locoregional relapse-free interval (P = .008). Conclusions CTC count is an independent and quantitative prognostic factor in early breast cancer patients treated by NCT. It complements current prognostic models based on tumor characteristics and response to therapy.
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Affiliation(s)
| | | | | | | | | | | | - Bjørn Naume
- Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Andreas Hartkopf
- Women's Health Center, University of Tuebingen, Tuebingen, Germany
| | - Daniele Generali
- Women Cancer Centre, University of Trieste, ASST of Cremona, Cremona, Italy
| | - Françoise Rothé
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jeffrey Smerage
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | | | - Patrice Viens
- Institut Paoli Calmettes, Aix Marseille University, CNRS, Inserm, Marseilles, France
| | | | | | - Olav Engebraaten
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Wendy Onstenk
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | | | | | | | | | - Denise M Wolf
- University of California at San Francisco, San Francisco, CA
| | | | | | | | | | - Jaco Kraan
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marisa Maestro
- Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | | | | | - Fabien Reyal
- Institut Curie, PSL Research University, Paris, France
| | - Dominic Amara
- University of California at San Francisco, San Francisco, CA
| | | | | | | | | | | | - Paul Blanche
- LMBA, Université de Bretagne Sud, Vannes, France
| | | | - Paul Cottu
- Institut Curie, PSL Research University, Paris, France
| | - John W Park
- University of California at San Francisco, San Francisco, CA
| | | | | | | | - Klaus Pantel
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Fasching PA, Hu C, Hart S, Hartkopf AD, Taran FA, Janni W, Tesch H, Haeberle L, Ettl J, Overkamp F, Lux MP, Lüftner D, Wallwiener M, Mueller V, Kolberg HC, Fehm TN, Wallwiener D, Brucker S, Schneeweiss A, Couch F. Germline BRCA1and BRCA2 mutations in patients with HER2-negative metastatic breast cancer (mBC) treated with first-line chemotherapy: Data from the German PRAEGNANT registry. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1048 Background: Germline BRCA1/2 ( gBRCA) mutations (mt) are some of the few actionable alterations in mBC patients. The PARP inhibitors olaparib/talazoparib are more effective than chemotherapy (ctx) in patients with a gBRCAmt and HER2 negative(-) mBC. In mBC patients the TNT-study suggested a better progression-free survival (PFS) for g BRCA-mt compared to patients with a gBRCA1/2 wildtype (wt) when treated with platinum and not with a taxane. Otherwise little is known about the prognostic effect of g BRCA1/2mt in mBC patients. Methods: PRAEGNANT (NCT02338167) is a prospective mBC registry with a focus on molecular biomarkers. Patients were eligible for this analysis if their mBC was HER2- and treated with ctx for the first time (referred to as first-line ctx). Hormone receptor (HR) positive patients had to have all hormone therapies exhausted. Mutation frequencies and their association with patient and tumor characteristics were analyzed. Multivariable Cox regression models were built with commonly established prognostic factors and g BRCA mutation status as predictors of PFS and overall survival (OS) from first-line ctx. Results: Out of 2932 PRAEGNANT patients, 576 were HER2- and received first-line ctx. Of those 529 patients with g BRCA genotype results and follow up information could be analyzed. 24 patients (4.5%) had a g BRCAmt (11 BRCA1, 13 BRCA2). Mutation rate in HR positive patients was 3.9% (17/432) and 7.2% (7/97) in HR negative patients. Most patients received ctx either as the first treatment in the metastatic setting or after one line of hormone therapy (n=382; 72.2%). Multivariable Cox regression models showed an adjusted hazard ratio for gBRCAmt vs. gBRCAwt patients of 0.70 (95% CI: 0.43-1.15) for PFS and of 0.41 (95% CI: 0.18-0.93) for OS. Most frequent ctx treatments were taxane (52%) or capecitabine based (21%). Additionally, the prevalence of somatic BRCA1/2 mutations in this population will be presented. Conclusions: In this HER2- mBC population under ctx g BRCA mutation rates were within the expected range of about 5%. Within the analyzed population patients with a g BRCA mutation seemed to have a better OS than patients without a mutation. PFS results pointed in the same direction without statistical significance. However, with only 24 mutations replication of these results in additional cohorts is warranted. Clinical trial information: NCT02338167.
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Affiliation(s)
| | | | | | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
| | - Florin A Taran
- Department of Obstetrics and Gynecology, Tuebingen, Germany
| | | | - Hans Tesch
- Hämatologisch-Onkologische Gemeinschaftspraxis Bethanien, Frankfurt, Germany
| | | | | | | | - Michael P Lux
- Department of Obstetrics and Gynaecology, University Breast Centre for Franconia, Erlangen, Germany
| | - Diana Lüftner
- University Hospital Berlin, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynaecology, University of Heidelberg, Heidelberg, Germany
| | | | | | | | - Diethelm Wallwiener
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Sara Brucker
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
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Seliger B, Karn T, Denkert C, Schneeweiss A, Hanusch C, Blohmer JU, Jackisch C, van Mackelenbergh M, Marme F, Mueller V, Huober JB, Untch M, Loibl S, Mueller A, Biehl K, Weber KE, Massa C. Correlation of the tumor mutational burden with the composition of the immune cell subpopulations in peripheral blood of triple-negative breast cancer patients undergoing neoadjuvant therapy with durvalumab: Results from the prospectively randomized GeparNuevo trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
588 Background: The GeparNuevo trial is a randomized, double-blind, multi-center phase II trial of neoadjuvant therapy in patients with early-stage triple negative breast cancer (TNBC) investigating the role of durvalumab, an anti-PD-L1 antibody, which blocks PD-L1 binding to PD1 and CD80, in addition to standard chemotherapy with nab-Paclitaxel (nab-Pac) followed by Epirubicin plus Cyclophosphamid (EC; Loibl S et al. ASCO 2018). Since the tumor mutational burden (TMB) has been suggested to be associated with a better outcome of patients undergoing immunotherapy and an increased T cell response, we determined whether there exists a link between TMB and immune cell composition, frequency and function in patients of the GeparNuevo trial. Methods: In order to determine possible predictive and / or prognostic biomarkers, tumor biopsies taken at recruitment from 149 patients out of the 174 enrolled patients underwent deep sequencing in order to determine the TMB. In addition, for 120 patients blood samples were taken at recruitment and during different time points of treatment (after durvalumab pre-treatment, after Nab-Pac and at surgery after EC) and evaluated using multicolor flow cytometry by monitoring the absolute cell counts of T cells, B cells and NK cells as well as the frequency, composition and functionality of different immune cell populations. Results: The TMB of the GeparNuevo cohort was in line with published data with a mean of 1.8 mutations/MB (range 0.02 – 7.65), respectively. Preliminary evaluation demonstrated a significant correlation of TMB with blood parameters, in particular with subsets of CD8+ T cells. Interestingly, the data suggest a negative correlation of TMB with the frequency of effector cells while a positive correlation exists with the effector memory cells at recruitment. In depth analyses of a correlation with treatment arm and clinical responses are currently performed. Conclusions: Using this approach we hope to identify biomarkers, which will allow a better selection of TNBC patients undergoing specific immunotherapies. Clinical trial information: NCT02685059.
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Affiliation(s)
| | - Thomas Karn
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | | | - Jens Uwe Blohmer
- Department of Gynecology/Breast Center of the Charité, Berlin, Germany
| | | | | | - Frederik Marme
- University of Heidelberg, National Center for Tumor Disease/Department of Gynecology, Heidelberg, Germany
| | - Volkmar Mueller
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Bodo Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | - Sibylle Loibl
- German Breast Group (GBG) and Centre for Haematology and Oncology Bethanien, Frankfurt, Neu-Isenburg, Germany
| | - Anja Mueller
- Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | | | - Chiara Massa
- Martin Luther University Halle-Wittenberg, Halle, Germany
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Paplomata E, Bachelot T, Mueller V, Murias C, Murthy R, Okines A, Wardley A, Walker L, Antunes De Melo e Oliveira A. A randomized, double-blinded, controlled study of tucatinib (ONT-380) vs placebo in combination with capecitabine (C) and trastuzumab (T) in patients with pretreated HER2+ unresectable locally advanced or metastatic breast carcinoma (mBC) (HER2CLIMB). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz100.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jank P, Loibl S, Fasching P, Karn T, Marmé F, Mueller V, Schem C, Stickeler E, Lederer B, Denkert C. Influence of PIK3CA mutations on breast cancer proliferation, lymphocyte infiltration and clinical outcome: Pooled analysis of 484 patients from three prospective multicentre GBG trials. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Grimm D, Woelber L, Prieske K, Schmalfeldt B, Kürti S, Busch CJ, Teudt I, Brummer O, Mueller V, Meyer T. Comparison of PapilloCheck and Linear Array to Detect and Differentiate Human Papillomaviruses in Cervical and Tonsillar Smears from Females with Cervical Intraepithelial Lesions. Eur J Microbiol Immunol (Bp) 2018; 8:107-111. [PMID: 30719326 PMCID: PMC6348707 DOI: 10.1556/1886.2018.00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/18/2018] [Indexed: 12/14/2022] Open
Abstract
A subgroup of oropharyngeal squamous cell carcinomas (OSCCs) are causally linked to infection with high-risk human papillomaviruses (HR-HPVs). To evaluate the prevalence of simultaneous oral HPV infection in females with cervical high-grade squamous intraepithelial lesions (HSIL), tonsillar- and cervical smears were collected simultaneously from 73 patients and analyzed for HPV using two commercial assays, PapilloCheck (Greiner-Bio-One) and Linear Array (Roche). Only 3/73 (4.1%) tonsillar smears were HPV positive (HPV+), with HPV types 16, 35, and 45, respectively, detected by both assays (100% agreement). Concordant results were also found in 60/66 (91%) evaluable cervical smears. Of specimens, positive by both assays, typing results completely coincide in 71% (all types are identical) and partially coincide in 27% (at least one type is identical). Taken together, results of HPV detection and typing by PapilloCheck and Linear Array are highly congruent and confirm the low prevalence of HR-HPV in tonsillar smears of patients with HSIL of the uterine cervix. Our data indicate low prevalence of oropharyngeal HPV infection in patients with high-grade cervical dysplasia. The low detection rate was confirmed by using two different commercial assays with largely consistent results of HPV detection and typing, but with some variation for particular HPV types. Comparative testing of larger numbers is required to identify the HPV types prone to escape detection with particular assays.
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Affiliation(s)
- Donata Grimm
- Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Linn Woelber
- Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Katharina Prieske
- Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Barbara Schmalfeldt
- Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Sascha Kürti
- Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Chia-Jung Busch
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Ingo Teudt
- Department of Otolaryngology, Head and Neck Surgery, Asklepios Klinik Hamburg Altona, Germany.,HNO-in-Altona, Private Praxis of Otorhinolaryngology, Hamburg, Germany
| | - Oliver Brummer
- TagesklinikAltonaer Strasse, Private Praxis of Gynaecology, Hamburg, Germany
| | - Volkmar Mueller
- Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Thomas Meyer
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany
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Trapp E, Janni W, Schindlbeck C, Jückstock J, Andergassen U, de Gregorio A, Alunni-Fabbroni M, Tzschaschel M, Polasik A, Koch JG, Friedl TWP, Fasching PA, Haeberle L, Fehm T, Schneeweiss A, Beckmann MW, Pantel K, Mueller V, Rack B, Scholz C. Presence of Circulating Tumor Cells in High-Risk Early Breast Cancer During Follow-Up and Prognosis. J Natl Cancer Inst 2018; 111:380-387. [DOI: 10.1093/jnci/djy152] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/23/2018] [Accepted: 08/03/2018] [Indexed: 01/01/2023] Open
Affiliation(s)
- Elisabeth Trapp
- Department of Gynecology and Obstetrics, University Hospital, Ludwig-Maximilians-University, Munich, Germany
- Department of Gynecology, Medical University of Graz, Graz, Austria
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christian Schindlbeck
- Department of Gynecology and Obstetrics, Clinical Center Traunstein, Traunstein, Germany
| | - Julia Jückstock
- Department of Gynecology and Obstetrics, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich Andergassen
- Department of Gynecology and Obstetrics, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Amelie de Gregorio
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Marianna Alunni-Fabbroni
- Department of Gynecology and Obstetrics, University Hospital, Ludwig-Maximilians-University, Munich, Germany
- Ludwig-Maximilians-University of Munich Clinic and Policlinic for Radiology, Munich, Germany
| | - Marie Tzschaschel
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Arkadius Polasik
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Julian G Koch
- Department of Gynecology and Obstetrics, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Peter A Fasching
- Department of Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Haeberle
- Department of Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Ruprecht-Karls-University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Klaus Pantel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Scholz
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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Iacoi A, Brobeil A, Goette M, Enzensberger C, Mueller V, Axt-Fliedner R. Hydrops fetalis And Congenital Pulmonary Capillary Haemangiomatosis in a Premature Infant, A Case Report And Literature Review. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660616] [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)
- A Iacoi
- Division of Prenatal Medicine, Dept. Obstetrics and Gynecology, Justus-Liebig-University Gießen, UKGM, Gießen
| | - A Brobeil
- Division of Pathology, Justus-Liebig-University, UKGM, Gießen
| | - M Goette
- Division of Prenatal Medicine, Dept. Obstetrics and Gynecology, Justus-Liebig-University Gießen, UKGM, Gießen
| | - C Enzensberger
- Division of Prenatal Medicine, Dept. Obstetrics and Gynecology, Justus-Liebig-University Gießen, UKGM, Gießen
| | - V Mueller
- Division of Prenatal Medicine, Dept. Obstetrics and Gynecology, Justus-Liebig-University Gießen, UKGM, Gießen
| | - R Axt-Fliedner
- Division of Prenatal Medicine, Dept. Obstetrics and Gynecology, Justus-Liebig-University Gießen, UKGM, Gießen
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Noske A, Weber K, Moebus V, Schmatloch S, Weichert W, Kohne CH, Solbach C, Ingold Heppner B, Steiger K, Mueller V, Fasching PA, Karn T, van Mackelenbergh M, Marme F, Schmitt WD, Schem C, Stickeler E, Denkert C, Loibl S. Tumor infiltrating lymphocytes to predict DFS from intense dose-dense (idd) EPC regimen: Results from the German Adjuvant Intergroup Node-positive study (GAIN-1). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Aurelia Noske
- Institut für Pathologie, Technische Universität München, München, Germany
| | | | | | | | - Wilko Weichert
- Institut für Pathologie, Technische Universität München, München, Germany
| | - Claus-Henning Kohne
- Universitätsklinik für Innere Medizin – Onkologie und Hämatologie, Oldenburg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | | | - Katja Steiger
- Institut für Pathologie, Technische Universität München, München, Germany
| | | | - Peter A. Fasching
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Thomas Karn
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | | | - Frederik Marme
- National Center for Tumor Diseases (NCT) and Women´s University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang D Schmitt
- Institut für Pathologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Schem
- Mammazentrum Hamburg – Brustklinik am Krankenhaus Jerusalem, Hamburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Carsten Denkert
- Institut für Pathologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim NK, Rugo HS, Twelves C, Diéras V, Mueller V, Hannah A, Tagliaferri MA, Cortés J. ATTAIN: Phase 3 study of etirinotecan pegol (EP) vs. treatment of physician's choice (TPC) in patients (pts) with metastatic breast cancer (MBC) who have stable brain metastases (BM) previously treated with an anthracycline, a taxane, and capecitabine (ATC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Nuhad K. Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hope S. Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Chris Twelves
- University of Leeds and St. James's Institute of Oncology, Leeds, United Kingdom
| | | | - Volkmar Mueller
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Javier Cortés
- Ramon y Cajal University Hospital, Madrid, and Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Woelber L, Breuer J, Meyer T, Vettorazzi E, Prieske K, Bohlmann I, Busch CJ, Teudt I, Brummer O, Mueller V, Schmalfeldt B, Grimm D. Oral Human Papillomavirus in Women With High-Grade Cervical Intraepithelial Neoplasia. J Low Genit Tract Dis 2018; 21:177-183. [PMID: 28481782 DOI: 10.1097/lgt.0000000000000313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was designed to investigate the co-prevalence of cervical and oropharyngeal human papillomavirus (HPV) infection in patients with HPV-related high-grade disease of the uterine cervix (high-grade squamous intraepithelial lesion [HSIL]). MATERIALS AND METHODS In a prospective cohort study, women with abnormal cervical cytology admitted to our colposcopy units received HPV testing of the uterine cervix and the oropharynx via smear. From a subset of patients, oral lavage was collected to compare detection rates of HPV DNA between lavage and swab. Patients with confirmed high-risk HPV (HR-HPV)-positive HSIL of the cervix were further investigated. Sexual behavior and lifestyle factors were documented with a standardized questionnaire. RESULTS Two hundred thirty-five women were included in the study. Of the 235 women, 135 (57.5%) were cervically HR-HPV positive with histologically confirmed high-grade cervical intraepithelial lesion (median [range] age = 30 [21-45] years). Of these, only 6 (4.4%) also had a positive oral specimen. In 3 (50%) of the 6 cases, the same HPV type was detected in oral and cervical samples (HPV 16, 35, and 45). Oral HPV detection was not higher when combining swab and lavage compared with swab alone. A relation between sexual behavior and oral HPV detection could not be demonstrated. CONCLUSIONS Oral HPV prevalence in women with cervical HPV infection and HSIL is low. Simultaneous testing of oropharyngeal and cervical HPV infection does not seem promising as future screening strategy.
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Affiliation(s)
- Linn Woelber
- 1Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Germany; 2Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany; 3Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 4Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Germany; 5Department of Otolaryngology, Head and Neck Surgery, Asklepios Klinik Hamburg Altona, Germany; 6HNO-in-Altona, Private Otorhinolaryngology Praxis, Hamburg, Germany; 7Tagesklinik Altonaer Strasse, Private Gynaecology Praxis, Hamburg, Germany; and 8Department of Gynaecology and Gynaecologic Oncology, Medical Center Asklepios Altona, Hamburg, Germany
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48
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Prguda-Mujic J, Milde-Langosch K, Mueller V, Suljagic M, Coric J, Ler D. The Predictive Significance of Metastasis-Associated in Colon Cancer-1 (MACC1) in Primary Breast Cancer. Ann Clin Lab Sci 2018; 48:191-196. [PMID: 29678846] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Metastasis-Associated in Colon Cancer-1(MACC1) was first identified as a transcriptional activator of the HGF/MET pathway. Deregulation of HGF/MET signaling is reported as a prognostic marker for tumorigenesis, early stage invasion, and metastasis which is associated with poor clinical outcome in breast cancer patients. The aim of the present study was to further investigate the prognostic or predictive value of MACC1 expression in breast cancer. MATERIALS AND METHODS We analyzed the MACC1 expression in 105 primary breast cancer samples by Western-Blot analysis and immunohistochemistry. RESULTS A significant correlation of high MACC1 expression with shorter disease-free survival was found within the group of lymph-node-negative patients. Additionally, an association of high MACC1 expression and shorter disease-free survival was observed within estrogen receptor positive tumors and patients without adjuvant chemotherapy. CONCLUSION Our results support a biologic role and potentially open the perspective for the use of MACC1 as a prognostic marker for treatment decision in breast cancer patients.
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Affiliation(s)
- Jasminka Prguda-Mujic
- Genetics and Bioengineering Department, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Molecular Diagnostics Department, Health Institution and Polyclinic Eurofarm, Sarajevo, Bosnia and Herzegovina
| | - Karin Milde-Langosch
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirza Suljagic
- Genetics and Bioengineering Department, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Jozo Coric
- Department of Clinical Biochemistry, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Daria Ler
- Genetics and Bioengineering Department, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Molecular Diagnostics Department, Health Institution and Polyclinic Eurofarm, Sarajevo, Bosnia and Herzegovina
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49
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Huober J, Fasching PA, Taran FA, Volz B, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lueftner D, Wallwiener M, Mueller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Wallwiener D, Brucker SY, Schneeweiss A, Fehm TN. Abstract P3-11-07: Factors associated with first line chemotherapy use in patients with hormone receptor positive, HER2 negative metastatic breast cancer – data from the PRAEGNANT breast cancer registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-11-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
For breast cancer patients with metastases which are not life threatening national and international guidelines recommend the exhaustion of all antihormonal therapeutic options before recommending chemotherapy. In Germany up to now only everolimus was an additional option to overcome endocrine resistance. CDK4/6 inhibitors recently became available in Germany (Nov 2011). Aim of this analysis was the identification of predictors for a decision against an antihormonal treatment.
Methods
The PRAEGNANT metastatic breast cancer registry (NCT02338167) is a prospective registry for metastatic breast cancer patients. Besides biomarker research the description of real-world treatment data was one of the main study aims. This analysis was restricted to first line metastatic patients who were hormone receptor (HR) positive and HER2 negative. First, predictors were identified with a multiple logistic regression model. Then patients, who received chemo or not ,were compared with regard to overall survival using Cox regression analysis with the predictors for chemotherapy from above and additionally chemo status (yes/no)
Results
A total of 389 HR-positive and HER2-negative patients with detailed treatment information were included during the 1st line therapy into PRAEGNANT. Of those 173 (44.5%) received a chemotherapy, 190 an antihormone therapy (AHT) (48.8%), and 26 (6.7%) everolimus+AHT. In the multiple logistic regression model, older patients, lower graded tumors, bone only disease and previous adjuvant chemotherapy were associated with a lower rate of first line chemotherapies. BMI and number of concomitant diseases had no influence on the choice of first line metastatic therapy. In patients with visceral metastases 58.1% were treated with a 1st line chemo, while in patients with brain metastases or bone only metastases these numbers were 55.6% and 26.9%. Grading had an influence with patients having a G1, G2 and G3 tumor receiving 1st line chemo in 28.0%, 38.4% and 63.2% of the cases respectively. Patients who received chemo seemed to have a worse overall survival than patients who did not receive chemo (adjusted HR 1.58; 95% CI, 0.89 to 2.18). However, this result was not signifcant (p = 0.12). Overall survival was primarily influenced by ECOG and location of metastasis
Conclusion
The usage of chemotherapy can be predicted with age, metastasis pattern, grading and previous use of chemotherapy. However, we could not show that patients benefited from chemotherapy. On contrary, there was a tendency that patients treated with chemotherapy had poorer overall survival. Further studies with larger sample sizes are needed to confirm this claim.
Citation Format: Huober J, Fasching PA, Taran F-A, Volz B, Overkamp F, Kolberg HC, Hadji P, Tesch H, Haeberle L, Ettl J, Hartkopf AD, Lux MP, Lueftner D, Wallwiener M, Mueller V, Beckmann MW, Belleville E, Wimberger P, Hielscher C, Geberth M, Fersis N, Abenhardt W, Kurbacher C, Wuerstlein R, Thomssen C, Untch M, Janni W, Wallwiener D, Brucker SY, Schneeweiss A, Fehm TN. Factors associated with first line chemotherapy use in patients with hormone receptor positive, HER2 negative metastatic breast cancer – data from the PRAEGNANT breast cancer registry [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-11-07.
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Affiliation(s)
- J Huober
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - PA Fasching
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - F-A Taran
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - B Volz
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - F Overkamp
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - HC Kolberg
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - P Hadji
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - H Tesch
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - L Haeberle
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - J Ettl
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - AD Hartkopf
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - MP Lux
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - D Lueftner
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - M Wallwiener
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - V Mueller
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - MW Beckmann
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - E Belleville
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - P Wimberger
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - C Hielscher
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - M Geberth
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - N Fersis
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - W Abenhardt
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - C Kurbacher
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - R Wuerstlein
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - C Thomssen
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - M Untch
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - W Janni
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - D Wallwiener
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - SY Brucker
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - A Schneeweiss
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
| | - TN Fehm
- Ulm University Hospital, Ulm, Germany; Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; University of Tuebingen, Tuebingen, Germany; Oncologianova GmbH, Recklinghausen, Germany; Marienhospital Bottrop, Bottrop, Germany; Northwest Hospital, Frankfurt, Germany; Oncology Practice at Bethanien Hospital, Frankfurt, Germany; Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Biostatistics Unit, University Hospital Erlangen, Erlangen, Germany; Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany; University of Heidelberg, Heidelberg, Germany; Hamburg-Eppendorf University Medical Center, Hamburg, Germany; ClinSol Gmbh & Co KG, Wuerzburg, Bavaria, Germany; University Hospital Dresden, TU Dresden, Dresden, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Gynäkologische Praxisklinik am Rosengarten, Mannheim, Germany; Klinik Hohe Warte, Bayreuth, Germany
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Loibl S, Barinoff J, Seiler S, Decker T, Denkert C, Hardy-Bessard AC, Senkus-Konefka E, Cognetti F, Palmieri C, Gelmon K, Luebbe K, Furlanetto J, Mueller V, Mundhenke C, Schmidt M, von Minckwitz G, Uhlig M, Burchardi N, Thill M. Abstract OT3-05-04: A randomized, open-label, multi-center phase IV study evaluating palbociclib plus endocrine treatment versus a chemotherapy-based treatment strategy in patients with hormone receptor-positive, HER2-negative metastatic breast cancer in a real world setting (PADMA). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-05-04] [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:
Although endocrine therapy (ET) is recommended as first-line therapy for hormone receptor (HR)-positive, HER2-negative metastatic breast cancer (MBC) up to 50% of patients receive chemotherapy in this setting. Meanwhile new targeted treatment options for combination with ET have been developed and endocrine-based therapy with the CDK4/6 inhibitor Palbociclib (P) improves the progression free survival (PFS) of ET alone by about 50%. So far, there is no data comparing chemotherapy with or without maintenance ET and ET in combination with P as first-line therapy. Patients included in clinical trials are often criticized not to mirror the general breast cancer population and every-day clinical practice due to rigid inclusion and exclusion criteria, limited number of treatment options, strict monitoring intervals and study assessments.
Methods:
PADMA trial is a so called low intervention trial with no rigid inclusion and exclusion criteria, and study assessments.Patients with first-line HR+/HER2- MBC who are candidate for mono-chemotherapy will be eligible to receive either P plus ET per label or mono-chemotherapy per investigator´s choice with or without maintenance ET (1:1 randomization). Primary objective is to compare the time-to-treatment failure (TTF) for patients randomized to receive the mono-chemotherapy treatment strategy versus those randomized to receive P and ET. TTF is defined as time from randomization to discontinuation of treatment due to disease progression, treatment toxicity, patient's preference, or death. Main secondary objectives are progression free survival, overall survival at 36 months, amongst other time to event endpoints as well as toxicity and compliance. All patients receive a specific mobile device (PADMA-Phone) and a validated wearable device (ActiWatch) in order to collect data regarding sleep and activity levels, patient well-being and health care utilization (number and duration of phone calls, and patient visits to investigator site) for assessment of daily monitoring treatment impact (DMTI).
Results:
Overall, 360 patients will be accrued to show an improved TTF for P in combination with ET compared to mono-chemotherapy of investigator´s choice with or without maintenance ET. Recruitment will start in QIII/2017 and is planned for approximately 18 months in 100 sites in Germany, Spain, Poland, Italy, France, UK and Canada.
Conclusions:
The aim of PADMA is to demonstrate that an endocrine-based strategy consisting of ET plus P is superior to a chemotherapy-based strategy as first-line therapy in women with HR+/HER2- MBC in a real world setting. Assessment of patient-reported outcome, health care utilization, and sleep and activity levels will deliver important information on the differences between endocrine-based and chemotherapy-based treatment.
Citation Format: Loibl S, Barinoff J, Seiler S, Decker T, Denkert C, Hardy-Bessard A-C, Senkus-Konefka E, Cognetti F, Palmieri C, Gelmon K, Luebbe K, Furlanetto J, Mueller V, Mundhenke C, Schmidt M, von Minckwitz G, Uhlig M, Burchardi N, Thill M. A randomized, open-label, multi-center phase IV study evaluating palbociclib plus endocrine treatment versus a chemotherapy-based treatment strategy in patients with hormone receptor-positive, HER2-negative metastatic breast cancer in a real world setting (PADMA) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-05-04.
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Affiliation(s)
- S Loibl
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - J Barinoff
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - S Seiler
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - T Decker
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - C Denkert
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - A-C Hardy-Bessard
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - E Senkus-Konefka
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - F Cognetti
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - C Palmieri
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - K Gelmon
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - K Luebbe
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - J Furlanetto
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - V Mueller
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - C Mundhenke
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - M Schmidt
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - G von Minckwitz
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - M Uhlig
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - N Burchardi
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
| | - M Thill
- German Breast Group; Charité Universitätsmedizin Berlin; Onkologie Ravensburg; Centre Armoricaine d'Oncologie; Medical University of Gdańsk; Istituto Nazionale Tumori Regina Elena; University of Liverpool; University of British Columbia; Diakovere Henriettenstiftung; University Hospital Eppendorf Frauenklinik; University of Kiel; Johannes Gutenberg Universität; Agaplesion Markus Hospital
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