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Wimmer K, Hlauschek D, Balic M, Pfeiler G, Greil R, Singer CF, Halper S, Steger G, Suppan C, Gampenrieder SP, Helfgott R, Egle D, Filipits M, Jakesz R, Sölkner L, Fesl C, Gnant M, Fitzal F. Is the CTS5 a helpful decision-making tool in the extended adjuvant therapy setting? Breast Cancer Res Treat 2024; 205:227-239. [PMID: 38273214 PMCID: PMC11101536 DOI: 10.1007/s10549-023-07186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
PURPOSE The Clinical Treatment Score post-5 years (CTS5) is an easy-to-use tool estimating the late distant recurrence (LDR) risk in patients with hormone receptor-positive breast cancer after 5 years of endocrine therapy (ET). Apart from evaluating the prognostic value and calibration accuracy of CTS5, the aim of this study is to clarify if this score is able to identify patients at higher risk for LDR who will benefit from extended ET. METHODS Prognostic power, calibration, and predictive value of the CTS5 was tested in patients of the prospective ABCSG-06 and -06a trials (n = 1254 and 860 patients, respectively). Time to LDR was analyzed with Cox regression models. RESULTS Higher rates of LDR in the years five to ten were observed in high- and intermediate-risk patients compared to low-risk patients (HR 4.02, 95%CI 2.26-7.15, p < 0.001 and HR 1.93, 95%CI 1.05-3.56, p = 0.035). An increasing continuous CTS5 was associated with increasing LDR risk (HR 2.23, 95% CI 1.74-2.85, p < 0.001). Miscalibration of CTS5 in high-risk patients could be observed. Although not reaching significance, high-risk patients benefitted the most from prolonged ET with an absolute reduction of the estimated 5-year LDR of - 6.1% (95%CI - 14.4 to 2.3). CONCLUSION The CTS5 is a reliable prognostic tool that is well calibrated in the lower and intermediate risk groups with a substantial difference of expected versus observed LDR rates in high-risk patients. While a numerical trend in favoring prolonged ET for patients with a higher CTS5 was found, a significantly predictive value for the score could not be confirmed. CLINICAL TRIAL REGISTRATION ABCSG-06 trial (NCT00309491), ABCSG-06A7 1033AU/0001 (NCT00300508).
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Affiliation(s)
- Kerstin Wimmer
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria.
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | | | - Marija Balic
- Department of Oncology, Medical University of Graz, Graz, Austria
| | - Georg Pfeiler
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
- Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Christian F Singer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Stefan Halper
- Department of Surgery, Regional Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Günther Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christoph Suppan
- Department of Oncology, Medical University of Graz, Graz, Austria
| | - Simon P Gampenrieder
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
- Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Ruth Helfgott
- Department of Surgery, Ordensklinikum Linz - Sisters of Charity, Linz, Austria
| | - Daniel Egle
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Filipits
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Raimund Jakesz
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Lidija Sölkner
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Christian Fesl
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Michael Gnant
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Wimmer K, Hlauschek D, Balic M, Pfeiler G, Greil R, Singer CF, Halper S, Steger G, Suppan C, Gampenrieder SP, Helfgott R, Egle D, Filipits M, Jakesz R, Sölkner L, Fesl C, Gnant M, Fitzal F. Correction: Is the CTS5 a helpful decision-making tool in the extended adjuvant therapy setting? Breast Cancer Res Treat 2024:10.1007/s10549-024-07351-5. [PMID: 38704775 DOI: 10.1007/s10549-024-07351-5] [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: 05/07/2024]
Affiliation(s)
- Kerstin Wimmer
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria.
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | | | - Marija Balic
- Department of Oncology, Medical University of Graz, Graz, Austria
| | - Georg Pfeiler
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
- Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Christian F Singer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Stefan Halper
- Department of Surgery, Regional Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Günther Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christoph Suppan
- Department of Oncology, Medical University of Graz, Graz, Austria
| | - Simon P Gampenrieder
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
- Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Ruth Helfgott
- Department of Surgery, Ordensklinikum Linz - Sisters of Charity, Linz, Austria
| | - Daniel Egle
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Filipits
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Raimund Jakesz
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Lidija Sölkner
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Christian Fesl
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Michael Gnant
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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3
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Guarneri V, Passos Coelho JL, Duhoux FP, Egle D, García-Sáenz JÁ, Penault-Llorca F, Selander K, Wildiers H, Zaman K, Laeis P, Lucerna M, Pierga JY. Study design for DESTINY-Breast Respond HER2-low Europe: T-DXd in patients with HER2-low advanced breast cancer. Future Oncol 2024. [PMID: 38592002 DOI: 10.2217/fon-2024-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Trastuzumab deruxtecan (T-DXd) is approved for the treatment of human epidermal growth factor receptor 2 (HER2)-low metastatic breast cancer (mBC). Results on T-DXd treatment in HER2-low mBC have so far been limited to clinical trials. DESTINY-Breast Respond HER2-low Europe (NCT05945732) is a multi-center, multi-country, observational, prospective, non-interventional study planning to enroll 1350 patients from 216 sites receiving T-DXd or conventional chemotherapy as their routine clinical care for advanced stage breast cancer in 12 European countries. This non-interventional study will provide real-world insight into T-DXd treatment for HER2-low mBC with data on effectiveness, safety and tolerability, patient-reported outcomes, treatment patterns, geriatric health status and HER2 testing. This will be beneficial for improving guidance to maximize patient treatment benefit.
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Affiliation(s)
- Valentina Guarneri
- Medical Oncology 2, Veneto Institute of Oncology (IOV), IRCCS, Via Gattamelata, 64, 35128 Padova PD, Italy
- Department of Surgery, Oncology & Gastroenterology, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padova PD, Italy
| | | | - Francois P Duhoux
- Department of Medical Oncology, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Av. Hippocrate 10, 1200 Brussels, Belgium
| | - Daniel Egle
- Department of Gynaecology & Obstetrics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52 A, Fritz-Pregl-Straße 3, 6020 Innsbruck, Austria
| | - José Ángel García-Sáenz
- Department of Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Calle del Prof Martin Lagos, s/n, Moncloa - Aravaca, 28040 Madrid, Spain
| | - Frédérique Penault-Llorca
- Centre Jean Perrin, Université Clermont Auvergne, INSERM, U1240 Imagerie Moléculaire Et Stratégies Théranostiques, Rue Montalebert, 63000 Clermont-Ferrand, France
| | - Katri Selander
- Department of Oncology & Radiation Therapy, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- Cancer Research & Translational Medicine Research Unit, University of Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Khalil Zaman
- Department of Oncology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Petra Laeis
- Daiichi Sankyo Europe GmbH, Zielstattstraße 48 81379 Munich, Germany
| | - Markus Lucerna
- Daiichi Sankyo Europe GmbH, Zielstattstraße 48 81379 Munich, Germany
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris Cité, 75005 Paris, France
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4
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Schoberleitner I, Faserl K, Tripp CH, Pechriggl EJ, Sigl S, Brunner A, Zelger B, Hermann-Kleiter N, Baier L, Steinkellner T, Sarg B, Egle D, Brunner C, Wolfram D. Silicone implant surface microtopography modulates inflammation and tissue repair in capsular fibrosis. Front Immunol 2024; 15:1342895. [PMID: 38566997 PMCID: PMC10985323 DOI: 10.3389/fimmu.2024.1342895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Excessive fibrous capsule formation around silicone mammary implants (SMI) involves immune reactions to silicone. Capsular fibrosis, a common SMI complication linked to host responses, worsens with specific implant topographies. Our study with 10 patients investigated intra- and inter-individually, reduced surface roughness effects on disease progression, wound responses, chronic inflammation, and capsular composition. The results illuminate the significant impact of surface roughness on acute inflammatory responses, fibrinogen accumulation, and the subsequent fibrotic cascade. The reduction of surface roughness to an average roughness of 4 μm emerges as a promising approach for mitigating detrimental immune reactions, promoting healthy wound healing, and curbing excessive fibrosis. The identified proteins adhering to rougher surfaces shed light on potential mediators of pro-inflammatory and pro-fibrotic processes, further emphasizing the need for meticulous consideration of surface design. The composition of the implant capsule and the discovery of intracapsular HSP60 expression highlight the intricate web of stress responses and immune activation that can impact long-term tissue outcomes.
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Affiliation(s)
- Ines Schoberleitner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Faserl
- Protein Core Facility, Institute of Medical Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph H. Tripp
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Judith Pechriggl
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Sigl
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Brunner
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
- INNPATH GmbH, Tirol Kliniken, Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Natascha Hermann-Kleiter
- Institute of Cell Genetics, Department for Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Leoni Baier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Theresia Steinkellner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Sarg
- Protein Core Facility, Institute of Medical Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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5
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Weber WP, Heidinger M, Hayoz S, Matrai Z, Tausch C, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Montagna G, Andreozzi M, Goldschmidt M, Schulz A, Mueller A, Ackerknecht M, Tampaki EC, Bjelic-Radisic V, Kurzeder C, Sávolt Á, Smanykó V, Hagen D, Müller DJ, Gnant M, Loibl S, Fitzal F, Markellou P, Bekes I, Egle D, Heil J, Knauer M. ASO Visual Abstract: Impact of Imaging-Guided Localization on Performance of Tailored Axillary Surgery in Patients with Clinically Node-Positive Breast Cancer: Prospective Cohort Study Within TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Ann Surg Oncol 2024; 31:1012-1013. [PMID: 37957506 DOI: 10.1245/s10434-023-14489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Martin Heidinger
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Zoltan Matrai
- Department of Oncoplastic Breast Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Christoph Tausch
- University of Basel, Basel, Switzerland
- Breast Center Zurich, Zurich, Switzerland
| | - Guido Henke
- Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Frank Zimmermann
- University of Basel, Basel, Switzerland
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mariacarla Andreozzi
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maite Goldschmidt
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alexandra Schulz
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Andreas Mueller
- SAKK Competence Center, Bern, Switzerland
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Markus Ackerknecht
- University of Basel, Basel, Switzerland
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Ekaterini Christina Tampaki
- Department of Plastic, Reconstructive Surgery and Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece
| | | | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ákos Sávolt
- National Institute of Oncology, Budapest, Hungary
| | - Viktor Smanykó
- National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Daniela Hagen
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Austrian Breast and Colorectal Cancer Study Group, ABCSG, Vienna, Austria
| | - Sibylle Loibl
- German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - Florian Fitzal
- Austrian Breast and Colorectal Cancer Study Group, ABCSG, Vienna, Austria
- Atomos Klinik Waehring, Vienna, Austria
| | - Pagona Markellou
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Inga Bekes
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel Egle
- Austrian Breast and Colorectal Cancer Study Group, ABCSG, Vienna, Austria
- Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Jörg Heil
- Breast Center Heidelberg, Heidelberg, Germany
| | - Michael Knauer
- Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
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6
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Weber WP, Heidinger M, Hayoz S, Matrai Z, Tausch C, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Montagna G, Andreozzi M, Goldschmidt M, Schulz A, Mueller A, Ackerknecht M, Tampaki EC, Bjelic-Radisic V, Kurzeder C, Sávolt Á, Smanykó V, Hagen D, Müller DJ, Gnant M, Loibl S, Fitzal F, Markellou P, Bekes I, Egle D, Heil J, Knauer M. Impact of Imaging-Guided Localization on Performance of Tailored Axillary Surgery in Patients with Clinically Node-Positive Breast Cancer: Prospective Cohort Study Within TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Ann Surg Oncol 2024; 31:344-355. [PMID: 37903951 PMCID: PMC10695869 DOI: 10.1245/s10434-023-14404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Tailored axillary surgery (TAS) is a novel surgical concept for clinical node-positive breast cancer. It consists of the removal of the sentinel lymph nodes (LNs), as well as palpably suspicious nodes. The TAS technique can be utilized in both the upfront and neoadjuvant chemotherapy (NACT) setting. This study assessed whether/how imaging-guided localization (IGL) influenced TAS. PATIENTS AND METHODS This was a prospective observational cohort study preplanned in the randomized phase-III OPBC-03/TAXIS trial. IGL was performed at the surgeon's discretion for targeted removal of LNs during TAS. Immediate back-up axillary lymph node dissection (ALND) followed TAS according to TAXIS randomization. RESULTS Five-hundred patients were included from 44 breast centers in six countries, 151 (30.2%) of whom underwent NACT. IGL was performed in 84.4% of all patients, with significant variation by country (77.6-100%, p < 0.001). No difference in the median number of removed (5 vs. 4, p = 0.3) and positive (2 vs. 2, p = 0.6) LNs by use of IGL was noted. The number of LNs removed during TAS with IGL remained stable over time (p = 0.8), but decreased significantly without IGL, from six (IQR 4-6) in 2019 to four (IQR 3-4) in 2022 (p = 0.015). An ALND was performed in 249 patients, removing another 12 (IQR 9-17) LNs, in which a median number of 1 (IQR 0-4) was positive. There was no significant difference in residual nodal disease after TAS with or without IGL (68.0% vs. 57.6%, p = 0.2). CONCLUSIONS IGL did not significantly change either the performance of TAS or the volume of residual nodal tumor burden. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03513614.
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Affiliation(s)
- Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Martin Heidinger
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Zoltan Matrai
- Department of Oncoplastic Breast Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Christoph Tausch
- University of Basel, Basel, Switzerland
- Breast Center Zurich, Zurich, Switzerland
| | - Guido Henke
- Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Günther Gruber
- Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Frank Zimmermann
- University of Basel, Basel, Switzerland
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mariacarla Andreozzi
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maite Goldschmidt
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alexandra Schulz
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Andreas Mueller
- SAKK Competence Center, Bern, Switzerland
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Markus Ackerknecht
- University of Basel, Basel, Switzerland
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Ekaterini Christina Tampaki
- Department of Plastic, Reconstructive Surgery and Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Clinic, University Witten/Herdecke, Witten, Germany
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ákos Sávolt
- National Institute of Oncology, Budapest, Hungary
| | - Viktor Smanykó
- National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Daniela Hagen
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Sibylle Loibl
- German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - Florian Fitzal
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Atomos Klinik Waehring, Vienna, Austria
| | - Pagona Markellou
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Inga Bekes
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel Egle
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Jörg Heil
- Breast Center Heidelberg, Heidelberg, Germany
| | - Michael Knauer
- Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
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7
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Wimmer K, Sachet M, Ramos C, Frantal S, Birnleitner H, Brostjan C, Exner R, Filipits M, Bago-Horvath Z, Rudas M, Bartsch R, Gnant M, Singer CF, Balic M, Egle D, Oehler R, Fitzal F. Differential immunomodulatory effects of epirubicin/cyclophosphamide and docetaxel in breast cancer patients. J Exp Clin Cancer Res 2023; 42:300. [PMID: 37957750 PMCID: PMC10644559 DOI: 10.1186/s13046-023-02876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Epirubicin/cyclophosphamide (EC) and docetaxel (D) are commonly used in a sequential regimen in the neoadjuvant treatment of early, high-risk or locally advanced breast cancer (BC). Novel approaches to increase the response rate combine this treatment with immunotherapies such as PD-1 inhibition. However, the expected stimulatory effect on lymphocytes may depend on the chemotherapy backbone. Therefore, we separately compared the immunomodulatory effects of EC and D in the setting of a randomized clinical trial. METHODS Tumor and blood samples of 154 patients from the ABCSG-34 trial were available (76 patients received four cycles of EC followed by four cycles of D; 78 patients get the reverse treatment sequence). Tumor-infiltrating lymphocytes, circulating lymphocytes and 14 soluble immune mediators were determined at baseline and at drug change. Furthermore, six BC cell lines were treated with E, C or D and co-cultured with immune cells. RESULTS Initial treatment with four cycles of EC reduced circulating B and T cells by 94% and 45%, respectively. In contrast, no comparable effects on lymphocytes were observed in patients treated with initial four cycles of D. Most immune mediators decreased under EC whereas D-treatment resulted in elevated levels of CXCL10, urokinase-type plasminogen activator (uPA) and its soluble receptor (suPAR). Accordingly, only the exposure of BC cell lines to D induced similar increases as compared to E. While treatment of BC cells with E was associated with cell shrinkage and apoptosis, D induced cell swelling and accumulation of cells in G2 phase. CONCLUSION The deleterious effect of EC on lymphocytes indicates strong immunosuppressive properties of this combination therapy. D, in contrast, has no effect on lymphocytes, but triggers the secretion of stimulatory proteins in vivo and in vitro, indicating a supportive effect on the immune system. Underlying differences in the induced cell death might be causal. These divergent immunomodulatory effects of epirubicin/cyclophosphamide and docetaxel should be considered when planning future combinations with immunotherapies in breast cancer.
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Affiliation(s)
- Kerstin Wimmer
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Monika Sachet
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Cristiano Ramos
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Sophie Frantal
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Hanna Birnleitner
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Christine Brostjan
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Ruth Exner
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Martin Filipits
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Center for Cancer Research, Medical University of Vienna, 1090, Vienna, Austria
| | - Zsuzsanna Bago-Horvath
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Pathology, Medical University of Vienna, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rupert Bartsch
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, 1090, Vienna, Austria
| | - Michael Gnant
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christian F Singer
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Department of Gynecology, Medical University of Vienna, 1090, Vienna, Austria
| | - Marija Balic
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Oncology, Medical University of Graz, Graz, Austria
| | - Daniel Egle
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Rudolf Oehler
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria.
| | - Florian Fitzal
- Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
- Austrian Breast & Colorectal Cancer Study Group (ABCSG), Vienna, Austria
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8
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Deeg J, Swoboda M, Egle D, Wieser V, Soleiman A, Ladenhauf V, Galijasevic M, Amort B, Haushammer S, Daniaux M, Gruber L. The Tomosynthesis Broken Halo Sign: Diagnostic Utility for the Classification of Newly Diagnosed Breast Tumors. Tomography 2023; 9:1987-1998. [PMID: 37987341 PMCID: PMC10661244 DOI: 10.3390/tomography9060155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Compared to conventional 2D mammography, digital breast tomosynthesis (DBT) offers greater breast lesion detection rates. Ring-like hypodense artifacts surrounding dense lesions are a common byproduct of DBT. This study's purpose was to assess whether minuscule changes spanning this halo-termed the "broken halo sign"-could improve lesion classification. METHODS This retrospective study was approved by the local ethics review board. After screening 288 consecutive patients, DBT studies of 191 female participants referred for routine mammography with a subsequent histologically verified finding of the breast were assessed. Examined variables included patient age, histological diagnosis, architectural distortion, maximum size, maximum halo depth, conspicuous margins, irregular shape and broken halo sign. RESULTS While a higher halo strength was indicative of malignancy in general (p = 0.031), the broken halo sign was strongly associated with malignancy (p < 0.0001, odds ratio (OR) 6.33), alongside architectural distortion (p = 0.012, OR 3.49) and a diffuse margin (p = 0.006, OR 5.49). This was especially true for denser breasts (ACR C/D), where the broken halo sign was the only factor predicting malignancy (p = 0.03, 5.22 OR). CONCLUSION DBT-associated halo artifacts warrant thorough investigation in newly found breast lesions as they are associated with malignant tumors. The "broken halo sign"-the presence of small lines of variable diameter spanning the peritumoral areas of hypodensity-is a strong indicator of malignancy, especially in dense breasts, where architectural distortion may be obfuscated due to the surrounding tissue.
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Affiliation(s)
- Johannes Deeg
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (S.H.); (M.D.); (L.G.)
| | - Michael Swoboda
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (S.H.); (M.D.); (L.G.)
| | - Daniel Egle
- Department of Gynecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (D.E.); (V.W.)
| | - Verena Wieser
- Department of Gynecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (D.E.); (V.W.)
| | - Afschin Soleiman
- Institute for Pathology, INNPath, University Hospital Tirol Kliniken, Anichstraße 35, 6020 Innsbruck, Austria;
| | - Valentin Ladenhauf
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (S.H.); (M.D.); (L.G.)
| | - Malik Galijasevic
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (S.H.); (M.D.); (L.G.)
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (S.H.); (M.D.); (L.G.)
| | - Silke Haushammer
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (S.H.); (M.D.); (L.G.)
| | - Martin Daniaux
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (S.H.); (M.D.); (L.G.)
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (S.H.); (M.D.); (L.G.)
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9
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Weber WP, Matrai Z, Hayoz S, Tausch C, Henke G, Zimmermann F, Montagna G, Fitzal F, Gnant M, Ruhstaller T, Muenst S, Mueller A, Lelièvre L, Heil J, Knauer M, Egle D, Sávolt Á, Heidinger M, Kurzeder C. Association of Axillary Dissection With Systemic Therapy in Patients With Clinically Node-Positive Breast Cancer. JAMA Surg 2023; 158:1013-1021. [PMID: 37466971 PMCID: PMC10357358 DOI: 10.1001/jamasurg.2023.2840] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/08/2023] [Indexed: 07/20/2023]
Abstract
Importance The role of axillary lymph node dissection (ALND) to determine nodal burden to inform systemic therapy recommendations in patients with clinically node (cN)-positive breast cancer (BC) is currently unknown. Objective To address the association of ALND with systemic therapy in cN-positive BC in the upfront surgery setting and after neoadjuvant chemotherapy (NACT). Design, Setting, and Participants This was a prospective, observational, cohort study conducted from August 2018 to June 2022. This was a preplanned study within the phase 3 randomized clinical OPBC-03/TAXIS trial. Included were patients with confirmed cN-positive BC from 44 private, public, and academic breast centers in 6 European countries. After NACT, residual nodal disease was mandatory, and a minimum follow-up of 2 months was required. Exposures All patients underwent tailored axillary surgery (TAS) followed by ALND or axillary radiotherapy (ART) according to TAXIS randomization. TAS removed suspicious palpable and sentinel nodes, whereas imaging-guidance was optional. Systemic therapy recommendations were at the discretion of the local investigators. Results A total of 500 patients (median [IQR] age, 57 [48-69] years; 487 female [97.4%]) were included in the study. In the upfront surgery setting, 296 of 335 patients (88.4%) had hormone receptor (HR)-positive and Erb-B2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)-negative disease: 145 (49.0%) underwent ART, and 151 (51.0%) underwent ALND. The median (IQR) number of removed positive lymph nodes without ALND was 3 (1-4) nodes compared with 4 (2-9) nodes with ALND. There was no association of ALND with the proportion of patients undergoing adjuvant chemotherapy (81 of 145 [55.9%] vs 91 of 151 [60.3%]; adjusted odds ratio [aOR], 0.72; 95% CI, 0.19-2.67) and type of systemic therapy. Of 151 patients with NACT, 74 (51.0%) underwent ART, and 77 (49.0%) underwent ALND. The ratio of removed to positive nodes was a median (IQR) of 4 (3-7) nodes to 2 (1-3) nodes and 15 (12-19) nodes to 2 (1-5) nodes in the ART and ALND groups, respectively. There was no observed association of ALND with the proportion of patients undergoing postneoadjuvant systemic therapy (57 of 74 [77.0%] vs 55 of 77 [71.4%]; aOR, 0.86; 95% CI, 0.43-1.70), type of postneoadjuvant chemotherapy (eg, capecitabine: 10 of 74 [13.5%] vs 10 of 77 [13.0%]; trastuzumab emtansine-DM1: 9 of 74 [12.2%] vs 11 of 77 [14.3%]), or endocrine therapy (eg, aromatase inhibitors: 41 of 74 [55.4%] vs 36 of 77 [46.8%]; tamoxifen: 8 of 74 [10.8%] vs 6 of 77 [7.8%]). Conclusion Results of this cohort study suggest that patients without ALND were significantly understaged. However, ALND did not inform systemic therapy recommendations.
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Affiliation(s)
- Walter P. Weber
- Breast Center, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Zoltan Matrai
- Hamad Medical Corporation, Dept of Oncoplastic Breast Surgery, Doha, Qatar
| | | | | | - Guido Henke
- Department of Radiation Oncology, St Gallen Cantonal Hospital, St Gallen, Switzerland
- Breast Center, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Frank Zimmermann
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Florian Fitzal
- Department of Surgery, Medical University Vienna, Vienna, Austria
- Comprehensive Cancer Center Medical University Vienna, Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center Medical University Vienna, Vienna, Austria
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Thomas Ruhstaller
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Tumor and Breast Center Eastern Switzerland, St Gallen, Switzerland
| | - Simone Muenst
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Andreas Mueller
- Competence Center of SAKK, Bern, Switzerland
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Loïc Lelièvre
- Breast Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jörg Heil
- Breast Center Heidelberg, Heidelberg, Germany
| | - Michael Knauer
- Tumor and Breast Center Eastern Switzerland, St Gallen, Switzerland
| | - Daniel Egle
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Ákos Sávolt
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Martin Heidinger
- Breast Center, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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10
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Bartsch R, Rinnerthaler G, Petru E, Egle D, Gnant M, Balic M, Sliwa T, Singer C. Updated Austrian treatment algorithm for metastatic triple-negative breast cancer. Wien Klin Wochenschr 2023:10.1007/s00508-023-02254-9. [PMID: 37682349 DOI: 10.1007/s00508-023-02254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 09/09/2023]
Abstract
Approximately 15% of newly diagnosed breast cancer patients have neither hormone receptors expression nor HER2 overexpression and/or HER2/neu gene amplification. This subtype of breast cancer is known as Triple Negative Breast Cancer (TNBC), and carries a significantly elevated risk of local and distant recurrence. In comparison with other breast cancer subtypes, there is a higher rate of visceral and brain metastases. The majority of metastases of TNBC are diagnosed within three years after initial breast cancer diagnosis. While there have been major advances in hormone-receptor- positive and in human epidermal growth factor receptor 2 (HER2)-positive disease over the past two decades, only limited improvements in outcomes for patients with triple negative breast cancer (TNBC) have been observed. A group of Austrian breast cancer specialists therefore convened an expert meeting to establish a comprehensive clinical risk-benefit profile of available mTNBC therapies and discuss the role sacituzumab govitecan may play in the treatment algorithm of the triple-negative breast cancer patients.
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Affiliation(s)
- Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gabriel Rinnerthaler
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Division of Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Daniel Egle
- Department of Gynecology, Breast Cancer Center Tirol, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Clinical Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Thamer Sliwa
- 3rd Medical Department, Hematology and Oncology, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
| | - Christian Singer
- Department of Gynecology, Breast Cancer Center Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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11
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Wang XQ, Danenberg E, Huang CS, Egle D, Callari M, Bermejo B, Dugo M, Zamagni C, Thill M, Anton A, Zambelli S, Russo S, Ciruelos EM, Greil R, Győrffy B, Semiglazov V, Colleoni M, Kelly CM, Mariani G, Del Mastro L, Biasi O, Seitz RS, Valagussa P, Viale G, Gianni L, Bianchini G, Ali HR. Spatial predictors of immunotherapy response in triple-negative breast cancer. Nature 2023; 621:868-876. [PMID: 37674077 PMCID: PMC10533410 DOI: 10.1038/s41586-023-06498-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/28/2023] [Indexed: 09/08/2023]
Abstract
Immune checkpoint blockade (ICB) benefits some patients with triple-negative breast cancer, but what distinguishes responders from non-responders is unclear1. Because ICB targets cell-cell interactions2, we investigated the impact of multicellular spatial organization on response, and explored how ICB remodels the tumour microenvironment. We show that cell phenotype, activation state and spatial location are intimately linked, influence ICB effect and differ in sensitive versus resistant tumours early on-treatment. We used imaging mass cytometry3 to profile the in situ expression of 43 proteins in tumours from patients in a randomized trial of neoadjuvant ICB, sampled at three timepoints (baseline, n = 243; early on-treatment, n = 207; post-treatment, n = 210). Multivariate modelling showed that the fractions of proliferating CD8+TCF1+T cells and MHCII+ cancer cells were dominant predictors of response, followed by cancer-immune interactions with B cells and granzyme B+ T cells. On-treatment, responsive tumours contained abundant granzyme B+ T cells, whereas resistant tumours were characterized by CD15+ cancer cells. Response was best predicted by combining tissue features before and on-treatment, pointing to a role for early biopsies in guiding adaptive therapy. Our findings show that multicellular spatial organization is a major determinant of ICB effect and suggest that its systematic enumeration in situ could help realize precision immuno-oncology.
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Affiliation(s)
- Xiao Qian Wang
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Esther Danenberg
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Chiun-Sheng Huang
- National Taiwan University Hospital, College of Medicine, National Taiwan University and Taiwan Breast Cancer Consortium, Taipei, Taiwan
| | - Daniel Egle
- Department of Gynecology, Brust Gesundheit Zentrum Tirol, Medical University Innsbruck, Innsbruck, Austria
| | | | - Begoña Bermejo
- Medical Oncology, Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
- Medicine Department, Universidad de Valencia, Valencia, Spain
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
| | | | - Claudio Zamagni
- IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Anton Anton
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Stefania Russo
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Richard Greil
- 3rd Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria
- Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Balázs Győrffy
- Department of Bioinformatics, Semmelweis University, Budapest, Hungary
- Cancer Biomarker Research Group, Research Centre for Natural Sciences, Institute of Enzymology, Budapest, Hungary
| | | | | | - Catherine M Kelly
- Mater Private Hospital, Dublin and Cancer Trials Ireland Breast Group, Dublin, Ireland
| | | | - Lucia Del Mastro
- IRCCS Ospedale Policlinico San Martino, UO Clinica di Oncologia Medica, Genoa, Italy
- Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Università di Genova, Genoa, Italy
| | - Olivia Biasi
- IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | | | | | - Giuseppe Viale
- IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
- University of Milan, Milan, Italy
| | | | | | - H Raza Ali
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK.
- Department of Histopathology, Addenbrookes Hospital, Cambridge, UK.
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12
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Tausch C, Däster K, Hayoz S, Matrai Z, Fitzal F, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Andreozzi M, Goldschmidt M, Schulz A, Maggi N, Saccilotto R, Heidinger M, Mueller A, Tampaki EC, Bjelic-Radisic V, Sávolt Á, Smanykó V, Hagen D, Müller DJ, Gnant M, Loibl S, Markellou P, Bekes I, Egle D, Ruhstaller T, Muenst S, Kuemmel S, Vrieling C, Satler R, Becciolini C, Bucher S, Kurzeder C, Simonson C, Fehr PM, Gabriel N, Maráz R, Sarlos D, Dedes KJ, Leo C, Berclaz G, Fansa H, Hager C, Reisenberger K, Singer CF, Montagna G, Reitsamer R, Winkler J, Lam GT, Fehr MK, Naydina T, Kohlik M, Clerc K, Ostapenko V, Lelièvre L, Heil J, Knauer M, Weber WP. Trends in use of neoadjuvant systemic therapy in patients with clinically node-positive breast cancer in Europe: prospective TAXIS study (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Breast Cancer Res Treat 2023; 201:215-225. [PMID: 37355526 PMCID: PMC10361860 DOI: 10.1007/s10549-023-06999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of this study was to evaluate clinical practice heterogeneity in use of neoadjuvant systemic therapy (NST) for patients with clinically node-positive breast cancer in Europe. METHODS The study was preplanned in the international multicenter phase-III OPBC-03/TAXIS trial (ClinicalTrials.gov Identifier: NCT03513614) to include the first 500 randomized patients with confirmed nodal disease at the time of surgery. The TAXIS study's pragmatic design allowed both the neoadjuvant and adjuvant setting according to the preferences of the local investigators who were encouraged to register eligible patients consecutively. RESULTS A total of 500 patients were included at 44 breast centers in six European countries from August 2018 to June 2022, 165 (33%) of whom underwent NST. Median age was 57 years (interquartile range [IQR], 48-69). Most patients were postmenopausal (68.4%) with grade 2 and 3 hormonal receptor-positive and human epidermal growth factor receptor 2-negative breast cancer with a median tumor size of 28 mm (IQR 20-40). The use of NST varied significantly across the countries (p < 0.001). Austria (55.2%) and Switzerland (35.8%) had the highest percentage of patients undergoing NST and Hungary (18.2%) the lowest. The administration of NST increased significantly over the years (OR 1.42; p < 0.001) and more than doubled from 20 to 46.7% between 2018 and 2022. CONCLUSION Substantial heterogeneity in the use of NST with HR+/HER2-breast cancer exists in Europe. While stringent guidelines are available for its use in triple-negative and HER2+ breast cancer, there is a need for the development of and adherence to well-defined recommendations for HR+/HER2-breast cancer.
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Affiliation(s)
- Christoph Tausch
- Breast Center Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | | | - Zoltan Matrai
- Hamad Medical Corporation, Department of Oncoplastic Breast Surgery, Doha, Qatar
- International Breast Cancer Study Group - a division of ETOP IBCSG Partners Foundation, Bern, Switzerland
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Guido Henke
- Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
- Department of Radiation Oncology, Kantonsspital Münsterlingen/Spital Thurgau AG, Münsterlingen, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Günther Gruber
- Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Frank Zimmermann
- University of Basel, Basel, Switzerland
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Mariacarla Andreozzi
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Maite Goldschmidt
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Alexandra Schulz
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nadia Maggi
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Ramon Saccilotto
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Martin Heidinger
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Andreas Mueller
- SAKK Competence Center, Bern, Switzerland
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Ekaterini Christina Tampaki
- Department of Plastic, Reconstructive Surgery and Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece
| | | | - Ákos Sávolt
- National Institute of Oncology, Budapest, Hungary
| | | | - Daniela Hagen
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Michael Gnant
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Sibylle Loibl
- German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - Pagona Markellou
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Inga Bekes
- Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel Egle
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Ruhstaller
- University of Basel, Basel, Switzerland
- Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Simone Muenst
- University of Basel, Basel, Switzerland
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Charité, Essen, Germany
- Department of Gynecology with Breast Center, Universitätsmedizin Berlin, Berlin, Germany
| | - Conny Vrieling
- Department of Radiation Oncology, Hirslanden Clinique des Grangettes, Geneva, Switzerland
| | - Rok Satler
- Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Charles Becciolini
- Breast Center, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Susanne Bucher
- Breast Center, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Christian Kurzeder
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Colin Simonson
- Department of Gynecology, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
| | - Peter M Fehr
- Breast Center Graubünden, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - Robert Maráz
- Department of Oncology, Bacs-Kiskun Country Hospital, Kecskemet, Hungary
| | - Dimitri Sarlos
- Breast Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | | | - Cornelia Leo
- Breast Center, Cantonal Hospital Baden, Baden, Switzerland
| | | | - Hisham Fansa
- Breast Center Zürich, Bethanien & Spital Zollikerberg, Zurich, Switzerland
| | - Christopher Hager
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Klaus Reisenberger
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Department of Gynecology and Obstetrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Christian F Singer
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roland Reitsamer
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Breast Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Giang Thanh Lam
- Breast Center, University Hospital of Geneva, Geneva, Switzerland
| | | | | | | | - Karine Clerc
- Brustzentrum Freiburg, Centre du Sein Fribourg, Fribourg, Switzerland
| | | | | | - Jörg Heil
- Breast Center Heidelberg, Heidelberg, Germany
| | - Michael Knauer
- Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Walter Paul Weber
- University of Basel, Basel, Switzerland
- Breast Center, University Hospital Basel, Basel, Switzerland
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13
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Brunner C, Egle D, Ritter M, Kofler R, Giesinger JM, Schneitter L, Sztankay M, Emmelheinz M, Abdel Azim S, Wieser V, Oberguggenberger A. PRO Hair Safe Study: The Patient's Perspective on the Effects of Scalp Cooling on Hair Preservation. Breast Cancer (Dove Med Press) 2023; 15:485-494. [PMID: 37484698 PMCID: PMC10361405 DOI: 10.2147/bctt.s412338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/11/2023] [Indexed: 07/25/2023]
Abstract
Purpose Alopecia has been reported a distressing side-effect of chemotherapy for breast cancer patients (BCP) that is highly relevant for quality of life during treatment. For the prevention of chemotherapy-induced alopecia, scalp cooling (SC) has been reported to be an effective and safe intervention. However, data on the patient's perspective on effectiveness and applicability of SC in a clinical routine setting are scarce. In this comparative study, we aimed at a longitudinal assessment of patient-reported outcome (PRO) data on the effect of SC on alopecia and its effect on symptoms and functional health when applied in clinical routine in BCP receiving taxane or anthracycline-based chemotherapy. Patients and Methods Study participants were allocated either to the intervention group receiving SC or to the control group based on patient preference (non-randomized study). All patients completed PRO-measures on hair preservation (EORTC Item Library items on hair loss), symptom and functional health measures (EORTC QLQ-C30 and -BR23) and the Body Image Scale (BIS). Outcomes were assessed at chemotherapy start (baseline), mid-chemotherapy, last chemotherapy cycle, 3 months follow-up and 6-9 months follow-up. Results Overall, we included 113 patients: 75 patients underwent SC (mean age = 51.3 years, 52.7% premenopausal); 38 patients standard care (mean age = 55.6 years, 39.5% premenopausal). A total of 53 patients (70.7%) discontinued SC, with 39 patients (73.5%) stating alopecia as the primary reason. On average, BCP stayed on treatment with the cooling cap for 40.2% of the duration of their chemotherapy (SD 25.3%). In an intention-to-treat analysis, we found no difference between the SC group and the control group with regard to their patient-reported hair loss (p=0.831) across the observation period, overall QOL (p=0.627), emotional functioning (p=0.737), social functioning (p=0.635) and body image (p=0.463) did not differ between groups. Conclusion We found a high rate of SC-decliners and no beneficial effects of SC for patient-reported hair loss, symptoms and functional health. The efficacy and tolerability of SC applied in a clinical routine setting hence appeared to be limited. The further determination and up-front definition of criteria prognostic for effectiveness of SC may be helpful to identify patient subgroups that may experience a treatment benefit.
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Affiliation(s)
- Christine Brunner
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Egle
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Ritter
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ricarda Kofler
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes M Giesinger
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Lisa Schneitter
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Miriam Emmelheinz
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Samira Abdel Azim
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Wieser
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Oberguggenberger
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
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14
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Gruber L, Deeg J, Egle D, Soleiman A, Ladenhauf V, Luger A, Amort B, Daniaux M. Peritumoural Strain Elastography of Newly Diagnosed Breast Tumours: Does Maximum Peritumoural Halo Depth Correlate with Tumour Differentiation and Grade? Diagnostics (Basel) 2023; 13:2064. [PMID: 37370959 DOI: 10.3390/diagnostics13122064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
To evaluate the diagnostic utility of the maximum ultrasound strain elastography (SE) halo depth in newly diagnosed and histologically confirmed breast lesions, a retrospective study approval was granted by the local Ethical Review Board. Overall, the maximum strain elastography peritumoural halos (SEPHmax)-the maximum distance between the SE stiffening area and the B-mode lesion size-in 428 cases with newly diagnosed breast lesions were retrospectively analysed alongside patient age, affected quadrant, tumour echogenicity, size, acoustic shadowing, and vascularity. Statistical analysis included an ordinary one-way ANOVA to compare the SEPHmax between BI-RADS 2, 3, and 5 groups and between tumour grades 1, 2, and 3. A binary regression analysis was used to determine the correlation between tumour malignancy and the above-mentioned demographic and imaging factors. SEPHmax was significantly higher in BI-RADS 5 tumours (5.5 ± 3.9 mm) compared to BI-RADS 3 (0.9 ± 1.7 mm, p < 0.0001) and 2 (0.6 ± 1.4 mm, p < 0.0001). The receiver operating characteristic area under the curve was 0.933 for the detection of BI-RADS 5 lesions. Furthermore, tumour grades 2 (5.6 ± 3.6 mm, p = 0.001) and 3 (6.8 ± 4.2 mm, p < 0.0001) exhibited significantly higher SEPHmax than grade 1 tumours (4.0 ± 3.9 mm). Similarly, St. Gallen Ki67-stratified low-risk (p = 0.005) and intermediate-risk (p = 0.013) tumours showed smaller SEPHmax than high-risk tumours. Multivariate analysis revealed a significant correlation between malignant differentiation and SEPHmax (standardized regression coefficient 3.17 [95% confidence interval (CI) 2.42-3.92], p < 0.0001), low tumour echogenicity (1.68 [95% CI 0.41-3.00], p = 0.03), and higher patient age (0.89 [95% CI 0.52-1.26], p < 0.0001). High SEPHmax is a strong predictor for tumour malignancy and a higher tumour grade and can be used to improve tumour characterisation before histopathological evaluation. It may also enable radiologists to identify lesions warranting observation rather than immediate biopsy.
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Affiliation(s)
- Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Johannes Deeg
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynaecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Afschin Soleiman
- Institute for Pathology, INNPath, University Hospital Tirol Kliniken, Anichstraße 35, 6020 Innsbruck, Austria
| | - Valentin Ladenhauf
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Anna Luger
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Daniaux
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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15
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Daniaux M, Gruber L, De Zordo T, Geiger-Gritsch S, Amort B, Santner W, Egle D, Baltzer PAT. Preoperative staging by multimodal imaging in newly diagnosed breast cancer: Diagnostic performance of contrast-enhanced spectral mammography compared to conventional mammography, ultrasound, and MRI. Eur J Radiol 2023; 163:110838. [PMID: 37080064 DOI: 10.1016/j.ejrad.2023.110838] [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] [Received: 11/02/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To compare contrast-enhanced spectral mammography (CESM) with mammography (Mx), ultrasound (US), and magnetic resonance imaging (MRI) regarding breast cancer detection rate and preoperative local staging. MATERIAL AND METHODS This prospective observational, single-centre study included 128 female patients (mean age 55.8 ± 11.5 years) with a newly diagnosed malignant breast tumour during routine US and Mx were prospectively enrolled. CESM and MRI examinations were performed within the study. Analysis included interreader agreement, tumour type and grade distribution, detection rates (DR), imaging morphology, contrast-enhancement and was performed by two independent readers blinded to patient history and histopathological diagnosis. Assessment of local disease extent was compared between modalities via Bland-Altman plots. RESULTS One-hundred-and-ten tumours were classified as NST (85.9%), 4 as ILC (3.1%) and 10 as DCIS (7.8%). DR was highest for MRI (128/128, 100.0%), followed by US (124/128, 96.9%) and CESM (123/128, 96.1%) and lowest for conventional Mx (106/128, 82.8%) (p = 0.0002). Higher breast density did not negatively affect DR of US, CESM or MRI. Local tumour extent measurements based on CESM (Bland-Altman bias 6.6, standard deviation 30.2) showed comparable estimation results to MRI, surpassing Mx (23.4/43.7) and US (35.4/40.5). Even though detection of multifocality and multicentricity was highest for CESM and MRI (p < 0.0001), second-look rates, i.e., targeted US examinations after MRI or CESM, were significantly lower for CESM (10.2% of cases) compared to MRI (16.2%) with a significantly higher true positive rate for CESM (72.0%) vs. MRI (42.5%). CONCLUSION CESM is a viable alternative to MRI for lesion detection and local staging in newly diagnosed malignant breast cancer and provides higher specificity in regard to second-look examinations.
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Affiliation(s)
- Martin Daniaux
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria.
| | - Tobias De Zordo
- Department of Radiology, Brixsana Private Clinic, Julius-Durst-Straße 28, Brixen, Italy
| | - Sabine Geiger-Gritsch
- Medizinisches Projektmanagement, Tirol Kliniken GmbH, Anichstraße 35, Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Wolfram Santner
- Department of Radiology, Privatklinik Hirslanden, Rigistrasse 1, Cham, Switzerland
| | - Daniel Egle
- Department of Gynaecology and Obstetrics, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währingergürtel 18-20, Vienna, Austria
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Wimmer K, Hlauschek D, Balic M, Pfeiler G, Strobl-Kacerovsky S, Greil R, Singer C, Halper S, Steger G, Suppan C, Gampenrieder S, Helfgott R, Egle D, Filipits M, Jakesz R, Sölkner L, Fesl C, Gnant M, Fitzal F. P270 Is the CTS5 a helpful decision-making tool in the extended adjuvant therapy setting? Breast 2023. [DOI: 10.1016/s0960-9776(23)00388-0] [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: 03/16/2023] Open
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17
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Rinnerthaler G, Gampenrieder SP, Tinchon C, Petzer A, Balic M, Heibl S, Sandholzer M, Zabernigg AF, Egle D, Hager C, Pichler P, Roitner F, Andel J, Strasser-Weippl K, Knauer M, Hubalek M, Singer CF, Greil R. Abstract P3-05-49: Number of involved organs at baseline is prognostic for overall survival in patients with metastatic breast cancer: Results from the AGMT_MBC-Registry. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-05-49] [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: 03/06/2023]
Abstract
Abstract
Background: Hormone-receptor (HR) status, HER2 Status, de novo metastatic disease, distant recurrence-free interval (DRFI), and visceral disease are known prognostic factors in metastatic breast cancer (MBC). Therefore, in the majority of clinical trials, randomization is stratified for these parameters. Whether the number of involved organs at baseline has an additional prognostic value was examined in this analysis.
Patients and methods: The AGMT-MBC-Registry is a multicenter nationwide ongoing retrospective and prospective registry for MBC patients in Austria. In this analysis, patients with known HR status, HER2 status, and available survival data were included. Multivariable hazard ratios were estimated by COX proportional hazard models. For variable selection a backward stepwise model selection using the Akaike information criterion was performed.
Results: As of 04/05/2022, 2,235 patients have been included in the registry, of which 1,840 patients fulfilled the inclusion criteria. In two different multivariable COX proportional hazard models for overall survival, the number of involved organs was a highly statistically significant independent prognostic factor: (1) a model including the number of involved organs at baseline together with known prognostic factors (see Table 1); (2) a stepwise selection model additionally including menopausal status and involved metastatic organ sites (bone, liver, lung, brain, and lymph nodes) separately. This effect was maintained in sensitivity analysis taking different breast cancer subtypes as well as visceral and non-visceral disease into account.
Conclusion: The number of involved organs at baseline is an independent prognostic factor in MBC and should be considered as a stratification factor in randomized trials.
Table 1. Multivariable Model for overall survival.
Citation Format: Gabriel Rinnerthaler, Simon P. Gampenrieder, Christoph Tinchon, Andreas Petzer, Marija Balic, Sonja Heibl, Margit Sandholzer, August F. Zabernigg, Daniel Egle, Christopher Hager, Petra Pichler, Florian Roitner, Johannes Andel, Kathrin Strasser-Weippl, Michael Knauer, Michael Hubalek, Christian F. Singer, Richard Greil. Number of involved organs at baseline is prognostic for overall survival in patients with metastatic breast cancer: Results from the AGMT_MBC-Registry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-49.
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Affiliation(s)
- Gabriel Rinnerthaler
- 1Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Simon P. Gampenrieder
- 2Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Christoph Tinchon
- 3Internal Medicine - Department for Haemato-Oncology, LKH Hochsteiermark, Leoben, Austria
| | - Andreas Petzer
- 4Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern – Elisabethinen, Linz, Austria
| | - Marija Balic
- 5Division of Oncology, Department for Internal Medicine, Medical University Graz, Graz, Austria
| | - Sonja Heibl
- 6Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Margit Sandholzer
- 7Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - August F. Zabernigg
- 8Department of Internal Medicine, County Hospital Kufstein, Kufstein, Austria
| | - Daniel Egle
- 9Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Christopher Hager
- 10Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Petra Pichler
- 11University Hospital St.Pölten, Department for Internal Medicine 1, St. Pölten, Austria
| | - Florian Roitner
- 12Department of Internal Medicine II, Hospital Braunau, Braunau, Austria
| | - Johannes Andel
- 13Department of Internal Medicine II, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | | | - Michael Knauer
- 15Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Michael Hubalek
- 16Department of Gynecology, Breast Health Center Schwaz, Schwaz, Austria
| | - Christian F. Singer
- 17Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Richard Greil
- 18Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
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18
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Weber WP, Matrai Z, Hayoz S, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Ruhstaller T, Muenst S, Ackerknecht M, Kurzeder C, Küemmel S, Bjelic-Radisic V, Smanykó V, Vrieling C, Satler R, Meyer I, Becciolini C, Bucher S, Simonson C, Fehr PM, Gabriel N, Maráz R, Sarlos D, Dedes KJ, Leo C, Berclaz G, Fansa H, Hager C, Reisenberger K, Sávolt Á, Singer CF, Reitsamer R, Winkler J, Lam GTL, Fehr MK, Naydina T, Kohlik M, Clerc K, Ostapenko V, Fitzal F, Heidinger M, Maggi N, Schulz A, Markellou P, Lelièvre L, Egle D, Heil J, Knauer M, Tausch C. Abstract P2-14-08: Trends in neoadjuvant systemic therapy rates in Europe: Pre-planned substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-14-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Introduction: Even though randomized controlled trials could not show a significant survival benefit for the use of neoadjuvant systemic therapy (NST), it is increasingly recommended for patients with clinically node-positive breast cancer due to its implications on prognosis, locoregional downstaging and response-driven adjuvant systemic therapy. The aim of this study was to assess the need for international standardization of treatment recommendations by evaluating clinical practice heterogeneity in use of NST for patients with clinically node-positive breast cancer in Europe. Methods: The study was preplanned in the international multicenter phase-III OPBC-03/TAXIS trial (ClinicalTrials.gov Identifier: NCT03513614) after randomization of the first 500 patients with clinically node-positive breast cancer who underwent axillary lymph node dissection (ALND) or axillary radiation (ART) without ALND after tailored axillary surgery (TAS) in the context of extended regional nodal irradiation. Clinically node-positive breast cancer was defined by confirmed nodal disease at the time of initial diagnosis; in case of neoadjuvant therapy, residual nodal disease was mandatory. Investigators were encouraged to enroll all eligible patients consecutively. However, TAXIS is unique inasmuch as its pragmatic design allows both the neoadjuvant and adjuvant setting according to the preferences of the treating physicians and institutions and thus provides an excellent opportunity to study patterns and trends in use of NST in patients with clinically positive nodes in Europe. Results: A total of 500 patients with a median age of 57 years (IQR: 48-69 years) were included at 44 breast centers in 6 European countries from August 2018 to June 2022. Subtype was hormone receptor (HR) positive (+) and human epidermal growth factor receptor 2 (HER2) negative (-) in 393 (80.0%), HR+/HER2+ in 52 (10.6%), HR-/HER2+ in 5 (1.0%) and HR-/HER2- in 34 (6.9%) patients. The rate of patients undergoing NST was 31.4% with a significant upward trend over time during the study period (from 20.0% in 2018 to 38.1% in 2022; p=0.044). The use of NST varied significantly by country (p=< 0.001) and by site (p=0.015). For patients with clinical AJCC tumor stage II and III, the rates of patients undergoing NST in Switzerland were 26.5% (18 of 68) and 35.9% (92 of 256), in Germany 22.2% (2 of 9) and 30.4% (7 of 23), in Austria 50% (7 of 14) and 60% (9 of 15) and in Hungary 0% (0 of 15) and 20.7% (18 of 87), respectively (p=0.019 and 0.004). Large differences by country were found for ER+/HER2- breast cancer, ranging from 13.1% (11 of 84) in Hungary to 47.8% (11 of 23) in Austria (p=0.007). Within Switzerland, which was the country with most included patients (328 of 500) and participating sites (n=25), the rate of patients undergoing NST for ER+/HER2- breast cancer varied considerably by site, ranging from 10% (2 of 20) to 50% (11 of 22). Discussion: This study revealed substantial heterogeneity in clinical practice in Europe, indicating the need for development of and adherence to consistent guidelines to standardize the international use of NST.
Citation Format: Walter P. Weber, Zoltan Matrai, Stefanie Hayoz, Guido Henke, Daniel R. Zwahlen, Günther Gruber, Frank Zimmermann, Thomas Ruhstaller, Simone Muenst, Markus Ackerknecht, Christian Kurzeder, Sherko Küemmel, Vesna Bjelic-Radisic, Viktor Smanykó, Conny Vrieling, Rok Satler, Inna Meyer, Charles Becciolini, Susanne Bucher, Colin Simonson, Peter M. Fehr, Natalie Gabriel, Robert Maráz, Dimitri Sarlos, Konstantin J. Dedes, Cornelia Leo, Gilles Berclaz, Hisham Fansa, Christopher Hager, Klaus Reisenberger, Ákos Sávolt, Christian F. Singer, Roland Reitsamer, Jelena Winkler, Giang Thanh Lam Lam, Mathias K. Fehr, Tatiana Naydina, Magdalena Kohlik, Karine Clerc, Valerijus Ostapenko, Florian Fitzal, Martin Heidinger, Nadia Maggi, Alexandra Schulz, Pagona Markellou, Loïc Lelièvre, Daniel Egle, Jörg Heil, Michael Knauer, Christoph Tausch. Trends in neoadjuvant systemic therapy rates in Europe: Pre-planned substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-08.
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Affiliation(s)
- Walter P. Weber
- 1Breast Center, University Hospital of Basel, Basel, Basel-Stadt, Switzerland
| | - Zoltan Matrai
- 2Hamad Medical Corporation, General Surgery, Doha, Qatar
| | | | - Guido Henke
- 4Department of Radiation Oncology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland; Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel R. Zwahlen
- 5Department of Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Günther Gruber
- 6Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Frank Zimmermann
- 7University Hospital of Basel; Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Thomas Ruhstaller
- 8Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Simone Muenst
- 9Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Markus Ackerknecht
- 10Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Christian Kurzeder
- 11Breast Center, University Hospital of Basel, Basel, Basel-Stadt, Switzerland
| | | | | | - Viktor Smanykó
- 14Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Conny Vrieling
- 15Department of Radiation Oncology, Hirslanden Clinique des Grangettes, Geneva, Switzerland
| | - Rok Satler
- 16Breast Center, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Inna Meyer
- 17Lindenhof Hospital, Praxis Frauenzentrum, Bern, Switzerland
| | - Charles Becciolini
- 18Breast Center, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Susanne Bucher
- 19Breast Center, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Colin Simonson
- 20Department of Gynecology, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Switzerland
| | - Peter M. Fehr
- 21Breast Center Graubünden, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - Robert Maráz
- 23Department of Oncology, Bacs-Kiskun Country Hospital, Kecskemet, Hungary
| | - Dimitri Sarlos
- 24Breast Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | | | - Cornelia Leo
- 26Breast Center, Cantonal Hospital Baden, Baden, Switzerland
| | - Gilles Berclaz
- 27Breast Center Bern, Lindenhof Group, Bern, Switzerland
| | - Hisham Fansa
- 28Breast Center Zürich, Bethanien & Spital Zollikerberg, Zurich, Switzerland
| | - Christopher Hager
- 29Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Klaus Reisenberger
- 30Department of Gynecology and Obstetrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Ákos Sávolt
- 31Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Christian F. Singer
- 32Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Roland Reitsamer
- 33Breast Center, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Jelena Winkler
- 34Breast Center, Bethesda Hospital Basel, Basel, Switzerland
| | | | | | | | - Magdalena Kohlik
- 38Breast Center GSMN, clinique de Genolier, Genolier, Switzerland
| | - Karine Clerc
- 39Brustzentrum Freiburg, Centre du sein Fribourg, Fribourg, Switzerland
| | | | - Florian Fitzal
- 41Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Heidinger
- 42Breast Center, University Hospital of Basel, Basel, Switzerland
| | - Nadia Maggi
- 43Breast Center, University Hospital of Basel, Basel, Switzerland
| | | | - Pagona Markellou
- 45Breast Center, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | | | - Daniel Egle
- 47Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Austria
| | - Jörg Heil
- 48Department of Gynecology and Obstetrics, Breast Unit, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Knauer
- 49Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
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Beltran-Bless AA, Clemons M, Fesl C, Hlauschek D, Soelkner L, Pond GR, Vandermeer L, Greil R, Balic M, Bjelic-Radisic V, Singer CF, Steger G, Helfgott R, Egle D, Gampenrieder SP, Kacerovsky-Strobl S, Suppan C, Ritter M, Rinnerthaler G, Pfeiler G, Fohler H, Hilton J, Gnant M. Abstract P2-02-04: De-escalation of bone-targeted treatment: Does the number of 6-monthly adjuvant zoledronate infusions received affect treatment efficacy for early breast cancer? A sub-study of ABCSG-12. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-02-04] [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: 03/06/2023]
Abstract
Abstract
Background: The results of the Early Breast Cancer Trialist Group (EBCTCG) meta-analysis (Lancet 2015) led to the widespread adoption of bisphosphonates as adjuvant therapy for postmenopausal early-stage breast cancer (EBC). Despite evaluating multiple bisphosphonate agents and regimens, there was no signal of varying efficacy with different agents, routes of administration or dose/dose intensity. We evaluated the question of treatment de-escalation using long-term outcome data from the prospective randomized ABCSG-12 trial.
Patients and methods: Between 1999 and 2006, ABCSG-12 accrued 1803 patients with hormone-receptor positive EBC on ovarian function suppression for three years that were randomized to receive 4 mg zoledronic acid 6-monthly or not (and tamoxifen or anastrozole, in a 2:2 factorial design). In the current retrospective study, we evaluated whether the number of zoledronate infusions actually received had an impact on breast cancer-specific and fragility fracture outcomes. Based on the results of the EBCTCG meta-analysis, we hypothesized that amongst patients who receive less infusions than the planned seven zoledronate infusion in this trial, the number of infusions has no differential effect on these outcomes. Time to event endpoints were analyzed with Cox models and Kaplan Meier curves starting from a 3-year landmark. BMD subset analyses were restricted to patients who participated in the BMD sub-study with available BMD data.
Results: 725 patients who received at least one zoledronate infusion were included in the time-to-event-analysis. There was no statistically significant difference in disease-free survival (adjusted HR 0.83, 95% CI 0.48–1.44, p=0.51) or overall survival (HR 0.97, 95% 0.30-3.11, p=0.96) in patients who received ≤6 zoledronate infusions (n=170) compared to those who received ≥7 zoledronate infusions (n=555) (adjusted HR 0.83, 95% CI 0.48 – 1.44, p=0.51). Both subgroups show stable lumbar spine and total hip BMD measurements across the five years.
Conclusions: Comparable to the metastatic bone disease and fragility fracture settings, there was no evidence observed to indicate that a reduced number of zoledronate infusions is associated with reduced adjuvant efficacy. Further studies to define optimal regimens of adjuvant bone-targeted therapies (prospective evaluation of “how-low-can-you-go”) are required.
Table 1: Multivariate Cox Regression: DFS and OS
Table 2: BMD and percent change from baseline at the total hip and lumbar spine (L1-L4) over 60 months
Citation Format: Ana-Alicia Beltran-Bless, Mark Clemons, Christian Fesl, Dominik Hlauschek, Lidija Soelkner, Gregory R. Pond, Lisa Vandermeer, Richard Greil, Marija Balic, Vesna Bjelic-Radisic, Christian F. Singer, Guenther Steger, Ruth Helfgott, Daniel Egle, Simon P. Gampenrieder, Stephanie Kacerovsky-Strobl, Christoph Suppan, Magdalena Ritter, Gabriel Rinnerthaler, Georg Pfeiler, Hannes Fohler, John Hilton, Michael Gnant. De-escalation of bone-targeted treatment: Does the number of 6-monthly adjuvant zoledronate infusions received affect treatment efficacy for early breast cancer? A sub-study of ABCSG-12 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-02-04.
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Affiliation(s)
| | | | - Christian Fesl
- 3Austrian Breast Cancer and Colorectal Study Group, Vienna, Austria
| | | | | | | | | | - Richard Greil
- 8Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Marija Balic
- 9Divison of Oncology, Department of Internal Medicine, Medical University Graz, Austria
| | | | - Christian F. Singer
- 11Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Guenther Steger
- 12Department of Internal Medicine I, Medical University of Vienna, Wien, Austria
| | - Ruth Helfgott
- 13Department of Surgery, Ordensklinikum Linz - Sisters of Charity, Linz, Austria
| | - Daniel Egle
- 14Breast Cancer Center Tirol, Department of Gynecology, Medical University Innsbruck, Austria
| | - Simon P. Gampenrieder
- 15Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | | | | | | | - Gabriel Rinnerthaler
- 19Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
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Gampenrieder SP, Rinnerthaler G, Tinchon C, Petzer A, Balic M, Heibl S, Sandholzer M, Zabernigg AF, Egle D, Hager C, Pichler P, Roitner F, Andel J, Strasser-Weippl K, Knauer M, Hubalek M, Singer CF, Greil R. Abstract P4-01-27: Prognosis and treatment landscape of HER2-positive metastatic breast cancer (MBC) before the availability of tucatinib and trastuzumab-deruxtecan: Results from the Austrian AGMT_MBC-Registry. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-27] [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: 03/06/2023]
Abstract
Abstract
Background: New anti-HER2 drugs such as tucatinib and trastuzumab deruxtecan (T-DXd) have shown to improve survival of HER2+ MBC in clinical phase III trials. To allow a future confirmation of this survival advantage in real world, we evaluated the prognosis of HER2+ MBC patients before the availability of tucatinib and T-DXd in Austria. Furthermore, we analyzed the treatment landscape and the drop-out rate between subsequent lines of therapy as documented in the MBC-Registry of the Austrian Study Group of Medical Tumor Therapy (AGMT).
Patients and methods: The AGMT-MBC-Registry is a multicenter nationwide ongoing retrospective and prospective registry for MBC patients in Austria. In this analysis, patients with known HER2 status, available survival data, at least one treatment line and diagnosis of metastatic disease after 01/04/2013 (pertuzumab available) were included. Follow-up was censored at Dec 31, 2020, when tucatinib und T-DXd became available.
Results: As of 04/05/2022, 2,235 patients have been included in the registry. Out of 2,000 evaluable patients, 362 (18.1%) were HER2+, of which 171 (47.2%) fulfilled the inclusion criteria. Out of them 69.0% were hormone-receptor positive. In patients with metachronous metastatic disease (53.2%), 61.5% had received trastuzumab-based treatment for early breast cancer. Median overall survival (OS) for all patients was 50.1 months (95%CI 40.7-73.0), and 66.1 months (95%CI 50.1-NA) for those who received a pertuzumab combination as first-line treatment. The drop-out rate from 1st- to 5th-line was 26.9%, 24.4%, 28.3% and 36.7%, respectively. This yields an estimated percentage of patients that received at least 3, 4, and 5 treatment lines for advanced disease of 55.2%, 39.6% and 25.1%, respectively. In first line, 50.9% received trastuzumab plus pertuzumab and 11.1% T- DM1. In second line, 38.9% were treated with T-DM1 and 35.6% with trastuzumab-based chemotherapy or endocrine therapy. In third line, 11.3%, 17.0% and 49.1% received T-DM1, lapatinib-based and trastuzumab-based therapy, respectively. Outcomes according to treatment line are shown in Table 1.
Conclusion: Median overall survival of HER2+ MBC in Austria who received a pertuzumab combination treatment is comparable to the results reported in the registration CLEOPATRA trial. In this analysis, only ~40% of patients are estimated to receive more than three treatment lines and treatment benefit diminished from line to line. This underlines the importance of investigating and ultimately using the most effective compounds in early treatment lines in order to allow more patients to benefit from these life prolonging drugs.
Table 1: Outcome according to treatment line
Citation Format: Simon P. Gampenrieder, Gabriel Rinnerthaler, Christoph Tinchon, Andreas Petzer, Marija Balic, Sonja Heibl, Margit Sandholzer, August F. Zabernigg, Daniel Egle, Christopher Hager, Petra Pichler, Florian Roitner, Johannes Andel, Kathrin Strasser-Weippl, Michael Knauer, Michael Hubalek, Christian F. Singer, Richard Greil. Prognosis and treatment landscape of HER2-positive metastatic breast cancer (MBC) before the availability of tucatinib and trastuzumab-deruxtecan: Results from the Austrian AGMT_MBC-Registry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-27.
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Affiliation(s)
- Simon P. Gampenrieder
- 1Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Gabriel Rinnerthaler
- 2Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Christoph Tinchon
- 3Internal Medicine - Department for Haemato-Oncology, LKH Hochsteiermark, Leoben, Austria
| | - Andreas Petzer
- 4Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern – Elisabethinen, Linz, Austria
| | - Marija Balic
- 5Division of Oncology, Department for Internal Medicine, Medical University Graz, Graz, Austria
| | - Sonja Heibl
- 6Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Margit Sandholzer
- 7Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - August F. Zabernigg
- 8Department of Internal Medicine, County Hospital Kufstein, Kufstein, Austria
| | - Daniel Egle
- 9Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Christopher Hager
- 10Department of Gynecology and Obstetrics, City Hospital, Dornbirn, Austria
| | - Petra Pichler
- 11University Hospital St.Pölten, Department for Internal Medicine 1, St. Pölten, Austria
| | - Florian Roitner
- 12Department of Internal Medicine II, Hospital Braunau, Braunau, Austria
| | - Johannes Andel
- 13Department of Internal Medicine II, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | | | - Michael Knauer
- 15Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Michael Hubalek
- 16Department of Gynecology, Breast Health Center Schwaz, Schwaz, Austria
| | - Christian F. Singer
- 17Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Richard Greil
- 18Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
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Schoberleitner I, Augustin A, Egle D, Brunner C, Amort B, Zelger B, Brunner A, Wolfram D. Is It All about Surface Topography? An Intra-Individual Clinical Outcome Analysis of Two Different Implant Surfaces in Breast Reconstruction. J Clin Med 2023; 12:jcm12041315. [PMID: 36835850 PMCID: PMC9967160 DOI: 10.3390/jcm12041315] [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: 11/30/2022] [Revised: 01/23/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
The most common long-term complication of silicone breast implants (SMI) remains capsular fibrosis. The etiology of this exaggerated implant encapsulation is multifactorial but primarily induced by the host response towards the foreign material silicone. Identified risk factors include specific implant topographies. Of note, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has only been observed in response to textured surface implants. We hypothesize that reduction of SMI surface roughness causes less host response and, hence, better cosmetic outcomes with fewer complications for the patient. A total of 7 patients received the routinely used CPX®4 breast expander (~60 µM Ra) and the novel SmoothSilk® (~4 µM Ra), fixed prepectoral with a titanized mesh pocket and randomized to the left or right breast after bilateral prophylactic NSME (nipple-sparing mastectomy). We aimed to compare the postoperative outcome regarding capsule thickness, seroma formation, rippling, implant dislocation as well as comfortability and practicability. Our analysis shows that surface roughness is an influential parameter in controlling fibrotic implant encapsulation. Compared intra-individually for the first time in patients, our data confirm an improved biocompatibility with minor capsule formation around SmoothSilk® implants with an average shell roughness of 4 µM and in addition an amplification of host response by titanized implant pockets.
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Affiliation(s)
- Ines Schoberleitner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Angela Augustin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44, A-6020 Innsbruck, Austria
| | - Andrea Brunner
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44, A-6020 Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-82050
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22
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Schoberleitner I, Faserl K, Sarg B, Egle D, Brunner C, Wolfram D. Quantitative Proteomic Characterization of Foreign Body Response towards Silicone Breast Implants Identifies Chronological Disease-Relevant Biomarker Dynamics. Biomolecules 2023; 13:biom13020305. [PMID: 36830674 PMCID: PMC9953687 DOI: 10.3390/biom13020305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
The etiology of exaggerated fibrous capsule formation around silicone mammary implants (SMI) is multifactorial but primarily induced by immune mechanisms towards the foreign material silicone. The aim of this work was to understand the disease progression from implant insertion and immediate tissue damage response reflected in (a) the acute wound proteome and (b) the adsorption of chronic inflammatory wound proteins at implant surfaces. An intraindividual relative quantitation TMT-liquid chromatography-tandem mass spectrometry approach was applied to the profile wound proteome formed around SMI in the first five days post-implantation. Compared to plasma, the acute wound profile resembled a more complex composition comprising plasma-derived and locally differentially expressed proteins (DEPs). DEPs were subjected to a functional enrichment analysis, which revealed the dysregulation of signaling pathways mainly involved in immediate inflammation response and ECM turnover. Moreover, we found time-course variations in protein enrichment immediately post-implantation, which were adsorbed to SMI surfaces after 6-8 months. Characterization of the expander-adhesive proteome by a label-free approach uncovered a long-term adsorbed acute wound and the fibrosis-associated proteome. Our findings propose a wound biomarker panel for the early detection and diagnosis of excessive fibrosis that could potentially broaden insights into the characteristics of fibrotic implant encapsulation.
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Affiliation(s)
- Ines Schoberleitner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Klaus Faserl
- Protein Core Facility, Biocenter, Institute of Medical Chemistry, Medical University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Bettina Sarg
- Protein Core Facility, Biocenter, Institute of Medical Chemistry, Medical University of Innsbruck, Innrain 80-82, A-6020 Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-82050
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23
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Beltran-Bless AA, Clemons MJ, Fesl C, Greil R, Pond GR, Balic M, Vandermeer L, Bjelic-Radisic V, Singer CF, Steger GG, Helfgott R, Egle D, Sölkner L, Gampenrieder SP, Kacerovsky-Strobl S, Suppan C, Ritter M, Rinnerthaler G, Pfeiler G, Fohler H, Hlauschek D, Hilton J, Gnant M. Does the number of 6-monthly adjuvant zoledronate infusions received affect treatment efficacy for early breast cancer? A sub-study of ABCSG-12. Eur J Cancer 2023; 180:108-116. [PMID: 36592505 DOI: 10.1016/j.ejca.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The widespread adoption of adjuvant bisphosphonate therapy for postmenopausal early breast cancer (EBC) patients was based on results of the Early Breast Cancer Trialist Group (EBCTCG) meta-analysis. Despite multiple regimens evaluated, there was no signal of varying efficacy with type, dose/dose intensity of bisphosphonate administration. We evaluated the effect of early treatment cessation using long-term outcome data from the ABCSG-12 trial. PATIENTS AND METHODS ABCSG-12 randomized 1803 hormone-receptor positive EBC patients on ovarian suppression between 1999 and 2006 to receive 4 mg zoledronic acid 6-monthly or not (and tamoxifen or anastrozole, 2:2 factorial design). In the current study, we evaluated whether the number of zoledronate infusions had an impact on breast cancer-specific outcomes. We hypothesized that amongst patients who received at least one zoledronate infusion, the number of infusions had no effect on outcomes. Time-to-event endpoints were analysed with Cox models and Kaplan Meier curves starting from a 3-year landmark. BMD analysis was restricted to patients who participated in the BMD sub-study. RESULTS 725 patients who received at least one zoledronate infusion were included in the time-to-event analysis. There was no statistically significant difference in disease-free or overall survival in the patients who received ≤6 zoledronate infusions (n = 170) compared to those who received ≥7 zoledronate infusions (n = 555). CONCLUSIONS Comparable to efforts to de-escalate treatment duration in metastatic bone disease, there was no evidence to indicate that a reduced number of zoledronate infusions is associated with reduced adjuvant efficacy. Further studies to define optimal regimens of adjuvant bone-targeted therapies are required.
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Affiliation(s)
- Ana-Alicia Beltran-Bless
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, Ontario, Canada
| | - Mark J Clemons
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, Ontario, Canada; Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Richard Greil
- Salzburg Cancer Research Institute; 3d Medical Department, Paracelsus Medical University Salzburg; Cancer Cluster Salzburg, Austria
| | - Gregory R Pond
- Ontario Clinical Oncology Group, Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Lisa Vandermeer
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital Wuppertal, Wuppertal Germany, University Witten/Herdecke, Germany; And Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - Christian F Singer
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Guenther G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ruth Helfgott
- Department of Surgery and Breast Health Center, Ordensklinikum Linz, Linz, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lidija Sölkner
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Simon P Gampenrieder
- Salzburg Cancer Research Institute; 3d Medical Department, Paracelsus Medical University Salzburg; Cancer Cluster Salzburg, Austria
| | | | - Christoph Suppan
- Division of Oncology, Department of Internal Medicine and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Magdalena Ritter
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Rinnerthaler
- Ontario Clinical Oncology Group, Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Georg Pfeiler
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hannes Fohler
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | | | - John Hilton
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, Ontario, Canada; Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Gnant
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Chan A, Ruiz-Borrego M, Marx G, Chien AJ, Rugo HS, Brufsky A, Thirlwell M, Trudeau M, Bose R, García-Sáenz JA, Egle D, Pistilli B, Wassermann J, Cheong KA, Schnappauf B, Semsek D, Singer CF, Foruzan N, DiPrimeo D, McCulloch L, Hurvitz SA, Barcenas CH. Final findings from the CONTROL trial: Strategies to reduce the incidence and severity of neratinib-associated diarrhea in patients with HER2-positive early-stage breast cancer. Breast 2022; 67:94-101. [PMID: 36702070 PMCID: PMC9982309 DOI: 10.1016/j.breast.2022.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neratinib is an irreversible pan-HER tyrosine kinase inhibitor approved for HER2-positive early-stage and metastatic breast cancer. Diarrhea is the most frequent side effect and the most common reason for early discontinuation. The phase II CONTROL trial investigated antidiarrheal prophylaxis or neratinib dose escalation (DE) for prevention of diarrhea. We present complete study results including final data for two DE strategies. METHODS Patients who completed trastuzumab-based adjuvant therapy received neratinib 240 mg/day for 1 year. Early cohorts investigated mandatory prophylaxis with loperamide, then additional budesonide or colestipol. Final cohorts assessed neratinib DE over the first 2 (DE1) or 4 weeks (DE2). The primary endpoint was incidence of grade ≥3 diarrhea. Health-related quality of life (HRQoL) was assessed using FACT-B and EQ-5D-5L. RESULTS 563 patients were enrolled into six cohorts. All strategies reduced grade ≥3 diarrhea with the lowest incidence in DE1 (DE1 13%; colestipol + loperamide [CL] 21%, DE2 27%; budesonide + loperamide [BL] 28%; loperamide [L] 31%; colestipol + loperamide as needed [CL-PRN] 33%). Diarrhea-related discontinuations occurred early and were lowest in DE1 (DE1 3%; CL 4%; DE2 6%; CL-PRN 8%; BL 11%; L 20%). More patients stayed on neratinib for the prescribed period versus historical controls. Prior pertuzumab use did not affect rates of grade ≥3 diarrhea, diarrhea-related discontinuations, or treatment duration. Early transient reductions in HRQoL scores were observed. CONCLUSIONS These complete results from CONTROL show improved neratinib tolerability with proactive management at the start of therapy. Two-week neratinib DE with loperamide as needed was particularly effective. CLINICALTRIALS GOV REGISTRATION NUMBER NCT02400476.
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Affiliation(s)
- Arlene Chan
- Breast Cancer Research Centre-WA, Perth & Curtin University, Nedlands, Australia.
| | | | - Gavin Marx
- Sydney Adventist Hospital and Australian National University, Sydney, Australia
| | - A. Jo Chien
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Adam Brufsky
- Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
| | | | | | - Ron Bose
- Washington University School of Medicine, St. Louis, MO, USA
| | - José A. García-Sáenz
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Daniel Egle
- Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | - Dieter Semsek
- Praxis am Diakonie Krankenhaus Onkologische Schwerpunktpraxis, Freiberg, Germany
| | - Christian F. Singer
- Medical University of Vienna and Comprehensive Cancer Center, Vienna, Austria
| | | | | | | | - Sara A. Hurvitz
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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Gnant M, Frantal S, Pfeiler G, Steger GG, Egle D, Greil R, Fitzal F, Wette V, Balic M, Haslbauer F, Melbinger-Zeinitzer E, Bjelic-Radisic V, Artner-Matuschek S, Kainberger F, Ritter M, Rinnerthaler G, Sevelda P, Bergh J, Kacerovsky-Strobl S, Suppan C, Brunner C, Deutschmann C, Gampenrieder SP, Fohler H, Jakesz R, Fesl C, Singer C. Long-Term Outcomes of Adjuvant Denosumab in Breast Cancer. NEJM Evid 2022; 1:EVIDoa2200162. [PMID: 38319865 DOI: 10.1056/evidoa2200162] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Outcomes of Adjuvant Denosumab in Breast CancerIn this long-term report of a prospective, double-blind, placebo-controlled, phase 3 trial of adjuvant aromatase inhibitor in postmenopausal patients with early hormone receptor-positive breast cancer, adjuvant denosumab therapy improved disease-free survival by 3.5 percentage points, bone metastasis-free survival by 2.5 percentage points, and overall survival by 1.0 percentage point at 9 years of follow-up.
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Affiliation(s)
- Michael Gnant
- Medical University of Vienna, Comprehensive Cancer Center, Vienna
- ABCSG (Austrian Breast & Colorectal Cancer Study Group), Vienna
| | - Sophie Frantal
- ABCSG (Austrian Breast & Colorectal Cancer Study Group), Vienna
| | - Georg Pfeiler
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - Guenther G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials; Cancer Cluster Salzburg, Salzburg, Austria
| | - Florian Fitzal
- Department of General Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | | | - Marija Balic
- Division of Oncology, Department of Internal Medicine, and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Ferdinand Haslbauer
- Department of Internal Medicine, Salzkammergut Klinikum Hospital Vöcklabruck, Vöcklabruck, Austria
| | | | - Vesna Bjelic-Radisic
- Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
- Breast Unit, Helios University Hospital Wuppertal, Wuppertal Germany, University Witten/Herdecke, Germany
| | | | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna
| | - Magdalena Ritter
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials; Cancer Cluster Salzburg, Salzburg, Austria
| | - Paul Sevelda
- Department of Gynecology, Karl Landsteiner Institute for Gynecologic Oncology and Senology, Hospital Hietzing, Vienna
| | - Jonas Bergh
- Department of Oncology-Pathology, Cancer Research Karolinska Institutet, Stockholm
| | - Stephanie Kacerovsky-Strobl
- Department of General Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna
- Breast Health Center, St. Francis Hospital Vienna, Vienna
| | - Christoph Suppan
- Division of Oncology, Department of Internal Medicine, and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Deutschmann
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - Simon P Gampenrieder
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials; Cancer Cluster Salzburg, Salzburg, Austria
| | - Hannes Fohler
- ABCSG (Austrian Breast & Colorectal Cancer Study Group), Vienna
| | - Raimund Jakesz
- Department of General Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - Christian Fesl
- ABCSG (Austrian Breast & Colorectal Cancer Study Group), Vienna
| | - Christian Singer
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna
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Brunner C, Egle D, Ritter M, Kofler R, Pichler B, Sztankay M, Schneitter L, Giesinger J, Abdel Azim S, Oberguggenberger A. PRO Hair Safe Study: The patient’s perspective on the effects of scalp cooling on hair preservation. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01512-x] [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: 11/19/2022]
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Morandi EM, Winkelmann S, Pülzl P, Augustin A, Wachter T, Bauer T, Egle D, Brunner C, Wolfram D. Long-Term Outcome Analysis and Technical Refinements after Autologous Breast Reconstruction with PAP Flap: What We Have Learnt. Breast Care (Basel) 2022; 17:450-459. [PMID: 36684404 PMCID: PMC9851068 DOI: 10.1159/000524309] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/23/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction The profunda artery perforator (PAP) flap represents a valuable alternative to the deep inferior epigastric artery perforator flap which, nowadays, is considered the golden standard for autologous breast reconstruction. The goal of this study was to evaluate the long-term satisfaction, functional outcomes of the donor site following PAP flap-based breast reconstruction and to present our personal learning experience along with suggestions for technique refinements. Methods In this prospective single-center appraisal, 18 patients who underwent PAP flap-based breast reconstruction between January 2016 and November 2019 were enrolled. The Patient and Observer Scar Assessment Scale (POSAS) and the Breast-Q questionnaire were employed to evaluate the results 12 months postoperative. Data were analyzed with the Q-Score program. Complications were recorded in the medical database and classified with the Clavien-Dindo classification. Results In the questionable time frame, 164 female patients underwent free flap breast reconstruction. Of those, 18 patients that received PAP flaps (9 bilateral) were included in this study. We recorded one flap loss because of venous failure. Most complications concerned the donor site, including hematoma, seroma, and wound healing problems. Patients' satisfaction was high at 12 months post-surgery, despite critical evaluation of the donor site scar. Conclusion The PAP flap serves as an excellent option for breast reconstruction in patients who do not have abundant abdominal tissue. The overall clinical outcome was good and patients' evaluation showed high satisfaction after 12 months despite high complication rates. Modifications in planning and flap harvesting might improve the donor site outcome and the overall complication rate.
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Affiliation(s)
- Evi M. Morandi
- aDepartment of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Selina Winkelmann
- aDepartment of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Petra Pülzl
- aDepartment of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Angela Augustin
- aDepartment of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanja Wachter
- aDepartment of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Bauer
- aDepartment of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Egle
- bDepartment of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Brunner
- bDepartment of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dolores Wolfram
- aDepartment of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Rinnerthaler G, Singer C, Petru E, Egle D, Petzer A, Pluschnig U, Gampenrieder SP, Pfeiler G, Gnant M, Grünberger B, Krippl P, Strasser-Weippl K, Suppan C, Brunner C, Pusch R, Sandholzer M, Balic M, Bartsch R. Austrian treatment algorithms in HER2-positive metastatic breast cancer: a 2022 update. Wien Klin Wochenschr 2022; 134:683-692. [PMID: 36149495 PMCID: PMC9606043 DOI: 10.1007/s00508-022-02082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
In the past 12 months a plethora of relevant novel data for the treatment of metastatic HER2 positive breast cancer were published. To bring this new evidence into a clinical perspective, a group of Austrian breast cancer specialists updated their previously published treatment algorithm for those patients. For this consensus paper a total of eight scenarios were developed in which treatment strategies appropriate for specific patient profiles were evaluated. Consensus was established by detailed discussions of each scenario and by reaching full consensus.
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Affiliation(s)
- Gabriel Rinnerthaler
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Christian Singer
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Edgar Petru
- Department of Gynecology and Obstetrics, Division of Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Daniel Egle
- Department of Gynecology, Breast Cancer Center Tirol, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Andreas Petzer
- Barmherzige Schwestern, Elisabethinen, Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH, Seilerstätte 4, 4010, Linz, Austria
| | - Ursula Pluschnig
- Department of Internal Medicine and Hematology and Internal Oncology, Klagenfurt Hospital, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Simon Peter Gampenrieder
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Georg Pfeiler
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Birgit Grünberger
- Department of Internal Medicine and Hematology and Internal Oncology, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
| | - Peter Krippl
- Department of Internal Medicine (location Fürstenfeld), Landeskrankenhaus Feldbach-Fürstenfeld, Krankenhausgasse 1, 8280, Fürstenfeld, Austria
| | - Kathrin Strasser-Weippl
- First Medical Department, Center for Oncology and Hematology, Klinik Ottakring, Montleartstr. 36, 1160, Vienna, Austria
| | - Christoph Suppan
- Department of Internal Medicine, Division of Clinical Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Christine Brunner
- Department of Gynecology, Breast Cancer Center Tirol, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Renate Pusch
- Barmherzige Schwestern, Elisabethinen, Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH, Seilerstätte 4, 4010, Linz, Austria
| | - Margit Sandholzer
- Second Medical Department, Center for Oncology and Hematology, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Clinical Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Lanthaler M, Spechtler K, Krapf J, Egle D, Sieb M, Tasch C, Spinelli R, Pierer G, Bauer T. Does the breast reconstruction method have an impact on time delay to adjuvant chemotherapy – A comparison between autologous and expander/implant breast reconstruction. JPRAS Open 2022; 33:131-138. [PMID: 35935516 PMCID: PMC9352396 DOI: 10.1016/j.jpra.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction This study aims to analyze whether autologous breast reconstruction as compared to expander/implant reconstruction has a higher risk of postoperative wound healing problems (WHPs) and thus potentially delays chemotherapy start. Methods Between January 2012 and December 2019, a total of 64 women with NSME/SSME and autologous (Group1, n = 33) or expander/implant reconstruction (Group2, n = 31) and adjuvant chemotherapy were enrolled in this study conducted at Innsbruck Medical University Hospital. Immediate postoperative WHPs in each group were compared, and the time from operation to initiation of chemotherapy was analyzed. If the start of chemotherapy was postponed for more than six weeks postoperatively due to WHP, it was defined as delayed. Statistical analysis was performed with SPSS and Fisher's exact test. Results More postoperative WHP occurred in Group 1 than in Group 2 (51.6% vs. 9.7%, p < 0.001). Due to WHP, chemotherapy start was delayed for more than six weeks postoperatively in 30.3% of Group 1 patients and 3.2% of Group 2 patients. Only small differences in age (Group 1: 47±1 vs. Group 2: 46±2 years) and BMI (Group 1: 24.3 ± 0.6 vs. Group 2: 23.3 ± 0.7 kg/m2) were found. Conclusion Our study shows a far smaller risk for postoperative WHP and delay of chemotherapy start in the expander/implant group in comparison with the autologous group. In some selected patients with high urgency for adjuvant chemotherapy, a bridging operation by means of expander reconstruction prior to chemotherapy could be an oncologically safe pathway.
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30
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Brunner C, Emmelheinz M, Kofler R, Abdel Azim S, Lehmann M, Wieser V, Ritter M, Oberguggenberger A, Marth C, Egle D. Hair safe study: Effects of scalp cooling on hair preservation and hair regrowth in breast cancer patients receiving chemotherapy - A prospective interventional study. Breast 2022; 64:50-55. [PMID: 35569187 PMCID: PMC9112104 DOI: 10.1016/j.breast.2022.04.008] [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: 03/08/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022] Open
Abstract
Scalp cooling significantly reduced chemotherapy-induced-alopecia in breast cancer patients. No significant effect regarding regrowth after chemotherapy in scalp cooling group. Scalp cooling is more effective in preventing alopecia in patients receiving taxane monotherapy.
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Affiliation(s)
- Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Miriam Emmelheinz
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ricarda Kofler
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Samira Abdel Azim
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marlene Lehmann
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Wieser
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Ritter
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Oberguggenberger
- Psychosomatics and Medical Psychology- Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
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Gnant M, Frantal S, Pfeiler G, Steger GG, Egle D, Greil R, Fitzal F, Wette V, Balic M, Haslbauer F, Melbinger-Zeinitzer E, Bjelic-Radisic V, Brunner C, Artner-Matuschek S, Rinnerthaler G, Wimmer K, Bergh JCS, Fesl C, Singer CF. Long-term outcomes of adjuvant denosumab in breast cancer: Fracture reduction and survival results from 3,425 patients in the randomised, double-blind, placebo-controlled ABCSG-18 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
507 Background: State-of-the-art adjuvant endocrine therapy with aromatase inhibitors (AI) compromises bone health in postmenopausal patients with hormone receptor-positive (HR+) breast cancer, increasing fracture incidence. Adjuvant treatment with the anti-RANK ligand denosumab (Dmab) counteracts these side effects and may improve outcomes. We here report the final long-term outcomes of the ABCSG-18 trial (ClinicalTrials.gov NCT00556374). Methods: In this prospective, double-blind, placebo-controlled, phase 3 trial, 3,425 postmenopausal patients with early HR+ breast cancer on AI therapy were randomised in 58 trial centers between 2006 and 2013 to receive either Dmab 60 mg or placebo s.c. every 6 months (q6m). The primary endpoint was time to first clinical fracture, secondary disease outcome-related endpoints were disease-free survival (DFS), bone-metastasis free survival (BMFS), and overall survival (OS). In addition to the main endpoint analyses reported previously, exploratory long-term follow-up was conducted in ABCSG-18. Main time-to-event analyses were based on stratified Cox models. Sensitivity analyses accounting for treatment cross-over associated with a late Dmab open-label phase, as well as for receiving any anti-resorptive agents were performed. Results: For this final protocol-defined analysis, median follow-up is 8 years (Q1,3: 6, 9.6), and all patients had ended their randomly assigned double-blind treatment (Dmab 60mg s.c. q6m n = 1711; placebo s.c. q6m n = 1709) for a median of 5 years. DFS was improved in the Dmab group versus the placebo group (309 versus 368 DFS events, hazard ratio (HR) 0.83, 95% CI 0.71-0.97, p = 0.016), resulting in an absolute 9-year DFS difference of 3.5% (79.4% vs 75.9%, respectively). When censoring for late cross-over and use of anti-resorptive agents, the DFS difference was confirmed (HR 0.82, p = 0.010). BMFS was improved by 19 per cent (HR 0.81, 95% CI 0.65-1.00, p = 0.047) in the Dmab group, and OS was improved by 20 per cent in the uncensored analysis (127 versus 158 OS events, HR 0.80, 95% CI 0.64-1.01, p = 0.065), and 26 per cent after censoring (HR 0.74, 95% CI 0.58-0.94, p = 0.013). The previously reported marked reduction in clinical fractures persisted even long-term, with 201 fractures in the Dmab and 255 fractures in the placebo group (HR 0.76, 95% CI 0.63-0.92, p = 0.004). No new toxicities for this (low) bone-protective dose of adjuvant Dmab were reported, particularly no ONJ occured.. Conclusions: Adjuvant Dmab 60mg every 6 months during AI therapy is safe, and markedly reduces treatment-induced clinical fractures even in the long-term. DFS, BMFS, and OS are improved in this descriptive final long-term analysis of ABCSG-18. Adjuvant denosumab should be considered for routine clinical use in postmenopausal patients with HR+ breast cancer. Clinical trial information: NCT00556374.
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Affiliation(s)
- Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Sophie Frantal
- Austrian Breast and Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology and Center for Breast Health, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Guenther G. Steger
- Department of Internal Medicine and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Gynecology and Gynecological Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Viktor Wette
- Breast Center Carinthia, St.Veit an Der Glan, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Ferdinand Haslbauer
- Department of Internal Medicine, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria
| | | | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Clinic, University Witten-Herdecke, Wuppertal, Germany
| | - Christine Brunner
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | - Kerstin Wimmer
- Department of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Jonas C. S. Bergh
- Department of Oncology-Pathology, Karolinska Institutet and Breast Cancer Centre, Cancer Theme, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Christian F. Singer
- Department of Obstetrics and Gynecology and Center for Breast Health, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Gunda A, Basavaraj C, Serkad V CP, Adinarayan M, Kolli R, Siraganahalli Eshwaraiah M, Saura C, Ruiz F, Gomez P, Peg V, Jimenez J, Sprung S, Fiegl H, Brunner C, Egle D, Bhattacharyya GS, Bakre MM. A retrospective validation of CanAssist Breast in European early-stage breast cancer patient cohort. Breast 2022; 63:1-8. [PMID: 35245746 PMCID: PMC8892025 DOI: 10.1016/j.breast.2022.02.010] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/03/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
CanAssist Breast (CAB), a prognostic test uses immunohistochemistry (IHC) approach coupled with artificial intelligence-based machine learning algorithm for prognosis of early-stage hormone-receptor positive, HER2/neu negative breast cancer patients. It was developed and validated in an Indian cohort. Here we report the first blinded validation of CAB in a multi-country European patient cohort. FFPE tumor samples from 864 patients were obtained from-Spain, Italy, Austria, and Germany. IHC was performed on these samples, followed by recurrence risk score prediction. The outcomes were obtained from medical records. The performance of CAB was analyzed by hazard ratios (HR) and Kaplan Meier curves. CAB stratified European cohort (n = 864) into distinct low- and high-risk groups for recurrence (P < 0.0001) with HR of 3.32 (1.85–5.93) like that of mixed (India, USA, and Europe) (n = 1974), 3.43 (2.34–4.93) and Indian cohort (n = 925), 3.09 (1.83–5.21). CAB provided significant prognostic information (P < 0.0001) in women aged ≤ 50 (HR: 4.42 (1.58–12.3), P < 0.0001) and >50 years (HR: 2.93 (1.44–5.96), P = 0.0002). CAB had an HR of 2.57 (1.26–5.26), P = 0.01) in women with N1 disease. CAB stratified significantly higher proportions (77%) as low-risk over IHC4 (55%) (P < 0.0001). Additionally, 82% of IHC4 intermediate-risk patients were stratified as low-risk by CAB. Accurate risk stratification of European patients by CAB coupled with its similar performance inIndian patients shows that CAB is robust and functions independent of ethnic differences. CAB can potentially prevent overtreatment in a greater number of patients compared to IHC4 demonstrating its usefulness for adjuvant systemic therapy planning in European breast cancer patients. CanAssist Breast risk (CAB) risk stratification is accurate in European breast cancer patients. CAB performance in European cohort was like that of Indian as assessed by low-risk group DMFS, HR and C-index. CAB identified significantly higher proportions as low risk compared to IHC4. Greater number of IHC4 intermediate risk patients were identified as low risk by CAB.
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Affiliation(s)
- Aparna Gunda
- OncoStem Diagnostics, Bengaluru, Karnataka, India
| | | | | | | | - Ramu Kolli
- OncoStem Diagnostics, Bengaluru, Karnataka, India
| | | | - Cristina Saura
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Fiorella Ruiz
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Patricia Gomez
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Vicente Peg
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jose Jimenez
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | | | - Heidi Fiegl
- Medical University of Innsbruck, Innsbruck, Austria
| | | | - Daniel Egle
- Medical University of Innsbruck, Innsbruck, Austria
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Rugo HS, Sohn J, Jerez Gilarranz Y, Gonzalez-Cortijo L, Sonnenblick A, Sabanathan D, Korbenfeld EP, Egle D, Poirier B, Zagouri F, Matikas A, Aksoy S, Demirci U, Ramos-Elias P, Im SA, Cardoso F, Jia L, Baccan C, Tryfonidis K, Schmid P. KEYNOTE-B49: A phase 3, randomized, double-blind, placebo-controlled study of pembrolizumab plus chemotherapy in patients with HR+/HER2- locally recurrent inoperable or metastatic breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps1118] [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
TPS1118 Background: HR+/HER2− advanced breast cancer that progresses on endocrine therapy is treated with chemotherapy (chemo). The phase 1b KEYNOTE-028 trial showed durable activity with pembrolizumab (pembro) monotherapy in previously treated HR+/HER2−, PD-L1–positive (combined positive score [CPS] ≥1) advanced breast cancer. KEYNOTE-B49 (NCT04895358) is a phase 3, randomized, double-blind study of pembro + chemo vs placebo (pbo) + chemo in centrally assessed PD-L1–positive, HR+/HER2− locally recurrent inoperable or metastatic breast cancer (mBC) after progression on prior endocrine therapy. Methods: ∼800 patients (pts) with HR+/HER2− locally recurrent inoperable or mBC who are candidates for chemo (no prior chemo for metastatic disease) with PD-L1 CPS ≥1 and documented progression on prior endocrine therapy will be enrolled. Prior endocrine therapy comprises ≥2 lines (≥1 in combination with a CDK4/6 inhibitor) in the metastatic setting or 1 line with CDK4/6 inhibitor treatment for mBC in pts who had a relapse within 24 mo of primary surgery. Pts without prior CDK4/6 inhibitor treatment may enroll if they had progressed within 6 mo of starting endocrine therapy for metastatic disease and had previously relapsed within 24 mo of primary tumor surgery while on adjuvant endocrine therapy. Pts are randomized 1:1 to receive pembro 200 mg IV or pbo Q3W, each in combination with investigator’s choice of chemo: paclitaxel 90 mg/m2 IV on days 1, 8, and 15 Q4W; nab-paclitaxel 100 mg/m2 IV on days 1, 8, and 15 Q4W; liposomal doxorubicin 50 mg/m2 IV on day 1 Q4W; or capecitabine 1000 mg/m2 PO BID on days 1–14 Q3W. Randomization is stratified by tumor PD-L1 (CPS 1–9 vs ≥10), presence of visceral metastases (yes vs no), and chemo on-study (taxanes vs liposomal doxorubicin vs capecitabine). Treatment is continued until disease progression, unacceptable toxicity, withdrawal, or, for pembro/pbo, completion of 35 cycles (̃2 years); chemo can be continued per investigator discretion. Tumor PD-L1 status is determined centrally using the PD-L1 IHC 22C3 pharmDx assay (Agilent Technologies; Carpinteria, CA, USA). Radiologic assessments are performed Q9W for 54 wk and then Q12W thereafter. AEs occurring from randomization until 30 d after treatment discontinuation (90 d for serious AEs) are graded per NCI-CTCAE v 5.0. Primary endpoints are PFS per RECIST v1.1 by BICR and OS in pts with PD-L1 CPS ≥10 and ≥1 tumors, separately. Enrollment is ongoing at 204 international sites. Clinical trial information: NCT04895358.
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Affiliation(s)
- Hope S. Rugo
- Department of Medicine, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Joohyuk Sohn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Yolanda Jerez Gilarranz
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Medical Oncology Department, Hospital General Universitario Gregorio Marañón; Universidad Complutense de Madrid and CiberOnc, Madrid, Spain
| | | | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dhanusha Sabanathan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Daniel Egle
- Landeskrankenhaus - Universitätskliniken Innsbruck, Innsbruck, Austria and Medizinische Universitaet Innsbruck, Innsbruck, Austria
| | | | - Flora Zagouri
- Alexandra Hospital, Oncology Department, Athens, Greece
| | - Alexios Matikas
- Karolinska Universitetssjukhuset Solna-Tema Cancer - ME Bröst- endokrina tumörer och sarkom, Stockholm, Sweden
| | - Sercan Aksoy
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Umut Demirci
- Memorial Ankara Hastanesi-Medical Oncology, Balgat, Ankara, Turkey
| | | | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Fatima Cardoso
- Champalimaud Foundation-Breast Unit, Lisbon, Lisboa, Portugal
| | - Liyi Jia
- Merck & Co., Inc., Kenilworth, NJ
| | | | | | - Peter Schmid
- Barts Cancer Institute, Centre for Experimental Cancer Medicine, Queen Mary University of London, London, United Kingdom
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Brunner C, Kofler R, Egle D, Wieser V, Ritter M, Abdel Azim S, Lehmann M, Emmelheinz ME, Marth C. Hair Safe Study: Effects of scalp cooling on hair preservation and hair regrowth in breast cancer therapy—A prospective interventional study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12093] [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
12093 Background: Chemotherapy (CT) is a frequent and well established treatment in women with breast and gynecological tumors. Alopecia is one of the most common side effects of CT seriously impairing patient quality of life and body image. While other CT associated side effects can be controlled by supportive treatment strategy, adequate preventive measures for alopecia have been lacking. New evidence supports the efficacy of scalp cooling for alopecia prevention during CT. The aim of this study was to investigate preventive scalp cooling (SC) for chemotherapy-induced-alopecia in breast cancer patients undergoing standard adjuvant or palliative chemotherapy. We also analysed the impact of SC on hair regrowth after chemotherapy-induced-alopecia. Methods: This was a non-randomized, 2-arm interventional study conducted at the Department of Obstetrics and Gynecology, Medical University Innsbruck. Breast cancer patients receiving any chemotherapy associated with alopecia (i.e. taxane or anthracycline-based chemotherapy) were allocated either to an intervention group receiving SC or to a control group (no SC). SC during chemotherapy was applied by the Paxman scalp cooling system. The primary endpoint was hair preservation (HP) which was assessed by experts and patients using the CTCAE score and analysed during and after completion of chemotherapy. The secondary endpoint was hair regrowth (HR) after 3 and 6 to 9 months post chemotherapy. Results: The study population included 128 patients. The majority, namely 88 (69%) patients were assigned to the intervention group (CAP) and received SC, 40 patients were allocated to the control group (NCAP). HP was significantly higher in the group receiving SC than in the NCAP by patients’ self-evaluation (24% vs. 0%; P = 0.001) and experts’ assessment (72% vs. 0%, P ≤ 0.001). HR was comparable between both groups. Using the patients’ evaluation 50% of patients with taxane monotherapy had a grade 1 alopecia compared to 17% of patients with an anthracycline-taxane CT (50% vs 17%, P = 0.018). Drop-out rate was 13% in CAP and 5% in NCAP group. Main reasons for drop-out were hair loss and patients’ requests. Conclusions: Our study demonstrates that SCsignificantly reduced or avoided chemotherapy-induced-alopecia in breast cancer patients undergoing chemotherapy, especially in patients who received taxane-monotherapy. SC was a safe procedure without severe adverse events. Therefore, SC can be highly beneficial for patients receiving specific chemotherapy and the option should be made available to as many patients as possible. No significant effect was noted regarding regrowth after chemotherapy in the SC group.
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Affiliation(s)
- Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ricarda Kofler
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Wieser
- Department og Gynecology and Obstetrics, Innsbruck, Austria
| | - Magdalena Ritter
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Samira Abdel Azim
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marlene Lehmann
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
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Kofler R, Emmelheinz M, Ritter M, Wieser V, Egle D, Brunner C. Hair-Safe Studie: Cool Caps zur Prävention der
Chemotherapie-induzierten Alopezie bei Brustkrebspatient:innen. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1746160] [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 Kofler
- Universitätsklinik für Frauenheilkunde und Geburtshilfe
Innsbruck
| | - M Emmelheinz
- Universitätsklinik für Frauenheilkunde und Geburtshilfe
Innsbruck
| | - M Ritter
- Universitätsklinik für Frauenheilkunde und Geburtshilfe
Innsbruck
| | - V Wieser
- Universitätsklinik für Frauenheilkunde und Geburtshilfe
Innsbruck
| | - D Egle
- Universitätsklinik für Frauenheilkunde und Geburtshilfe
Innsbruck
| | - C Brunner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe
Innsbruck
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36
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Emmelheinz M, Kofler R, Egle D, Ritter M, Wieser V, Brunner C. Einfluss von Scalp Cooling auf Regrowth nach
Chemotherapie-induzierter Alopezie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1746154] [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)
- M Emmelheinz
- Universitätsklinik für Gynäkologie und
Geburtshilfe, Innsbruck
| | - R Kofler
- Universitätsklinik für Gynäkologie und
Geburtshilfe, Innsbruck
| | - D Egle
- Universitätsklinik für Gynäkologie und
Geburtshilfe, Innsbruck
| | - M Ritter
- Universitätsklinik für Gynäkologie und
Geburtshilfe, Innsbruck
| | - V Wieser
- Universitätsklinik für Gynäkologie und
Geburtshilfe, Innsbruck
| | - C Brunner
- Universitätsklinik für Gynäkologie und
Geburtshilfe, Innsbruck
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Minichsdorfer C, Fuereder T, Leutner M, Singer CF, Kacerovsky-Strobl S, Egle D, Greil R, Balic M, Fitzal F, Pfeiler G, Frantal S, Bartsch R, Gnant M. Effect of concomitant statin treatment in postmenopausal patients with hormone receptor-positive early-stage breast cancer receiving adjuvant denosumab or placebo: a post hoc analysis of ABCSG-18. ESMO Open 2022; 7:100426. [PMID: 35334418 PMCID: PMC9058905 DOI: 10.1016/j.esmoop.2022.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Statins are cholesterol-lowering drugs prescribed for the prevention and treatment of cardiovascular disease. Moreover, statins may possess anticancer properties and interact with receptor activator of nuclear factor κB ligand expression. We aimed at evaluating a hypothetical synergistic effect of statins with denosumab in early-stage breast cancer (BC) patients from the Austrian Breast and Colorectal Cancer Study Group (ABCSG) trial 18. Patients and methods ABCSG-18 (NCT00556374) is a prospective, randomized, double-blind, phase III study; postmenopausal patients with hormone receptor-positive BC receiving a nonsteroidal aromatase inhibitor were randomly assigned to denosumab or placebo. In this post hoc analysis, we investigated the effects of concomitant statin therapy on recurrence risk (RR) of BC, fracture risk and bone mineral density (BMD). Results In the study population (n = 3420), statin therapy (n = 824) was associated with worse disease-free survival (DFS) [hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.04-1.75; P = 0.023]. While no significant effect of lipophilic statins (n = 710) on RR was observed (HR 1.30, 95% CI 0.99-1.72; P = 0.062), patients on hydrophilic statins (n = 87) had worse DFS compared with patients not receiving any statins (HR 2.00, 95% CI 1.09-3.66; P = 0.026). This finding was mainly driven by the effect of hydrophilic statins on DFS in the denosumab arm (HR 2.63, 95% CI 1.21-5.68; P = 0.014). However, this effect subsided after correction for confounders in the sensitivity analysis. No association between statin use and fracture risk or osteoporosis was observed. Conclusion According to this analysis, hydrophilic statins showed a detrimental effect on DFS in the main model, which was attenuated after correction for confounders. Our data need to be interpreted with caution due to their retrospective nature and the low number of patients receiving hydrophilic statins. Statin co-medication was initially associated with a worse DFS in hormone receptor-positive early-stage BC patients. This effect was mainly driven by patients on hydrophilic statins. However, this effect subsided after correction for confounders in the sensitivity analysis. No association between statin use and fracture risk or osteoporosis was observed.
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Affiliation(s)
- C Minichsdorfer
- Departments of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - T Fuereder
- Departments of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - M Leutner
- Departments of Medicine 3, Clinical Division of Endocrinology, Medical University of Vienna, Vienna, Austria
| | - C F Singer
- Departments of Gynaecology, Medical University of Vienna, Vienna, Austria
| | | | - D Egle
- Department of Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - R Greil
- Department of Medicine 3, Paracelsus University Salzburg, Salzburg Cancer Research Institute-CCCIT, Cancer Cluster Salzburg, Salzburg, Austria
| | - M Balic
- Department of Medicine, Clinical Division of Oncology, Medical University of Graz, Graz, Austria
| | - F Fitzal
- General Surgery, Medical University of Vienna, Vienna, Austria
| | - G Pfeiler
- Departments of Gynaecology, Medical University of Vienna, Vienna, Austria
| | - S Frantal
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - R Bartsch
- Departments of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria.
| | - M Gnant
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
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Gianni L, Huang CS, Egle D, Bermejo B, Zamagni C, Thill M, Anton A, Zambelli S, Bianchini G, Russo S, Ciruelos EM, Greil R, Semiglazov V, Colleoni M, Kelly C, Mariani G, Del Mastro L, Maffeis I, Valagussa P, Viale G. Pathologic complete response (pCR) to neoadjuvant treatment with or without atezolizumab in triple negative, early high-risk and locally advanced breast cancer. NeoTRIP Michelangelo randomized study. Ann Oncol 2022; 33:534-543. [PMID: 35182721 DOI: 10.1016/j.annonc.2022.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [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: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND High-risk triple negative breast cancers (TNBC) are characterized by poor prognosis, rapid progression to metastatic stage and onset of resistance to chemotherapy, thus representing an area in need of new therapeutic approaches. PD-L1 expression is an adaptive mechanism of tumour resistance to tumour infiltrating lymphocytes, which in turn are needed for response to chemotherapy. Overall, available data support the concept that blockade of PD-L1/PD-1 check-point may improve efficacy of classical chemotherapy. PATIENTS AND METHODS Two-hundred-eighty patients with TNBC were enrolled in this multicentre study (NCT002620280) and randomized to neoadjuvant carboplatin AUC 2 and nab-paclitaxel 125 mg/m2 iv on days 1 and 8, without (N = 142) or with (N = 138) atezolizumab 1200 mg iv on day 1. Both regimens were given q3 weeks for 8 cycles before surgery and 4 cycles of an adjuvant anthracycline regimen. The primary aim of the study is to compare event-free survival, an important secondary aim was the rate of pathological complete remission (pCR defined as absence of invasive cells in breast and lymph nodes). The primary population for all efficacy endpoints is the intention-to-treat population. RESULTS The intention-to-treat analysis revealed that pCR rate after treatment with atezolizumab (48.6%) did not reach statistical significance compared to no atezolizumab [44.4%: odds ratio (OR) 1.18; 95% CI 0.74-1.89; P = 0.48]. Treatment-related adverse events were similar with either regimen except for a significantly higher overall incidence of serious adverse events and liver transaminases abnormalities with atezolizumab. CONCLUSIONS The addition of atezolizumab to nab-paclitaxel and carboplatin did not significantly increase the rate of pCR in women with TNBC. In multivariate analysis the presence of PD-L1 expression was the most significant factor influencing rate of pCR (OR 2.08). Continuing follow up for the event-free survival is ongoing, and molecular studies are under way.
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Affiliation(s)
- L Gianni
- Fondazione Michelangelo, Milano, Italy.
| | - C S Huang
- National Taiwan University Hospital and Taiwan Breast Cancer Consortium, Taipei, Taiwan
| | - D Egle
- Department of Gynecology, Brust Gesundheit Zentrum Tirol, Medical University Innsbruck, Austria
| | - B Bermejo
- Hospital Clinico Universitario, Valencia, Spain
| | - C Zamagni
- Addarii Medical Oncology IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - M Thill
- Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - A Anton
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - S Russo
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - E M Ciruelos
- Hospital Universitario 12 de octubre, Madrid, Spain
| | - R Greil
- 3rd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute-CCCIT; and Cancer cluster Salzburg, Austria
| | - V Semiglazov
- NN Petrov Research Inst of Oncology, St. Petersburg, Russia
| | - M Colleoni
- IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - C Kelly
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - G Mariani
- Istituto Nazionale Tumori, Milano, Italy
| | - L Del Mastro
- IRCCS Ospedale Policlinico San Martino, UO Breast Unit, Genova, Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Genova - Italy
| | - I Maffeis
- Fondazione Michelangelo, Milano, Italy
| | | | - G Viale
- IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy; University of Milan, Milano, Italy
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Dugo M, Huang CS, Egle D, Bermejo B, Zamagni C, Seitz RS, Nielsen TJ, Thill M, Anton A, Russo S, Ciruelos EM, Schweitzer BL, Ross DT, Galbardi B, Greil R, Semiglazov V, Gyorffy B, Colleoni M, Kelly C, Mariani G, Mastro LD, Valagussa P, Viale G, Callari M, Gianni L, Bianchini G. Abstract P2-07-12: Triple negative breast cancer subtypes and early dynamics of the 27-gene IO score predict pCR in the NeoTRIPaPDL1 trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-07-12] [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 A post-hoc of NeoTRIP trial showed that 27-gene IO score assessed on baseline samples is predictive of increased pathological complete response (pCR) with the addition of atezolizumab to carboplatin/nab-paclitaxel, whereas the LAR subtype has the lowest rate of pCR with and without atezolizumab (Bianchini G ESMO 2021). We evaluated 27-gene IO score and TNBC subtypes on biopsies collected during treatment, assessed biomarker dynamics, and studied the association with pCR. Methods In NeoTRIP, patients randomly received 8 cycles of nab-paclitaxel/carbo alone (CT) or with atezolizumab (CT/A). 258 patients were evaluable for pCR (Per-Protocol Population). We assessed IO score as binary and continuous variable, and the five 101-gene TNBC types (BL1, BL2, LAR, M, and MSL; Ring et al 2016) by RNA-seq on biopsies at baseline and day 1 of second treatment cycle (d1c2) (n: baseline 242/258, 94%; d2c2 161/258, 62%; paired 152/258, 59%). Forty-four paired samples were excluded due to lack of tumor cells at d1c2. PD-L1 (Ventana SP142) and sTILs data were available. We evaluated the association with pCR of biomarkers assessed at d1c2 and their dynamics from baseline. Results Frequency of TNBC types at d1c2 showed minor differences between arms (p = 0.055). TNBC type frequencies were 22.9% BL1, 11.4% BL2, 22.9% LAR, 21.4% M, and 21.4% MSL in the CT/A arm and 43.8% BL1, 6.2% BL2, 11.2% LAR, 21.2% M, and 17.5% MSL in the CT arm. Individual TNBC type changes from baseline to d1c2 were observed, but overall, it was not significant. Frequency of IO positive score at d1c2 was similar in CT and CT/A arm (p = 0.75). Only in CT/A, an increase from baseline to d1c2 was observed (30.9% to 49.3%, p = 0.04).Overall, TNBC types at d1c2 were predictive of pCR (p = 0.00002). Compared to BL1, LAR and M were associated with lower pCR rate in CT (OR = 0.09, 95% CI = 0.01-0.83, p = 0.034 for LAR; OR = 0.16, 95% CI = 0.04-0.66, p = 0.011 for M) and CT/A arm (OR = 0.05, 95% CI = 0.01-0.49, p = 0.010 for LAR; OR = 0.28, 95% CI = 0.06-1.28, p = 0.102). pCR rate in LAR was 11.1% and 6.2% in CT and CT/A arm, respectively. TNBC types were predictive of pCR independently of PD-L1 and sTILs.Continuous IO score at d1c2 was predictive of pCR in both CT/A (p = 0.004) and CT arms (p = 0.009). The binary IO score was significantly associated to higher pCR rate in CT/A arm only (OR = 5.42, 95% CI = 1.95-15.07, p = 0.001). A strong predictive value of the highest quartile of IO score compared to the lowest was observed in CT/A (OR = 14.73, 95% CI = 2.97-73.21, p = 0.001) and CT (OR = 4.38, 95% CI = 1.21-15.81, p = 0.024) arms. pCR rates for the highest and lowest quartiles were 72.2% vs 15.0% in CT/A and 65.2% vs 30.0% in CT arm. In CT/A binary IO score at d1c2 retained significance after adjustment for baseline PD-L1 and sTILs (p = 0.036).Combining baseline and d1c2 IO score, only d1c2 assessment was informative in CT arm. In CT/A arm, both biomarkers were informative, with assessment at d1c2 being more informative than baseline IO score when continuous scores were considered. Baseline binary IO score (OR = 25.0, 95% CI = 3.31-188.9, p = 0.002) and ΔIO score (d1c2-baseline) (OR = 11.3, 95% CI = 1.07-120.1, p = 0.044) retained significance. The combination of baseline and d1c2 binary IO score defined four groups with different likelihood of pCR: 73.7% vs 15.2% in positive/positive and negative/negative groups, respectively (OR = 15.68, 95% CI = 3.88-63.32, p = 0.0001). Conclusions Dynamic of IO score early on treatment was linked to likelihood of pCR independently of baseline biomarkers and may be an early surrogate of treatment benefit especially in atezolizumab arm. LAR and M are associated with lower pCR rate, suggesting that different therapeutic strategies may be beneficial. Combining baseline and on-treatment biomarkers can be more informative than baseline only of the complex tumor/immune co-evolution dynamic and of clinical outcome.
Citation Format: Matteo Dugo, Chiun-Sheng Huang, Daniel Egle, Begoña Bermejo, Claudio Zamagni, Robert S. Seitz, Tyler J. Nielsen, Marc Thill, Antonio Anton, Stefania Russo, Eva Maria Ciruelos, Brock L. Schweitzer, Douglas T. Ross, Barbara Galbardi, Richard Greil, Vladimir Semiglazov, Balázs Gyorffy, Marco Colleoni, Catherine Kelly, Gabriella Mariani, Lucia Del Mastro, Pinuccia Valagussa, Giuseppe Viale, Maurizio Callari, Luca Gianni, Giampaolo Bianchini. Triple negative breast cancer subtypes and early dynamics of the 27-gene IO score predict pCR in the NeoTRIPaPDL1 trial [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 P2-07-12.
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Affiliation(s)
| | | | - Daniel Egle
- Medical University of Innsbruck, Innsbruck, Austria
| | - Begoña Bermejo
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Claudio Zamagni
- IRCCS Azienda ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | | | - Marc Thill
- AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany
| | | | - Stefania Russo
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | | | | | | | - Richard Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute-CCCIT; and Cancer Cluster Salzburg, Salzburg, Austria
| | - Vladimir Semiglazov
- N. N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | | | | | | | | | - Lucia Del Mastro
- University of Genova; IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Minichsdorfer C, Fuereder T, Leutner M, Singer CF, Kacerovsky-Strobl S, Egle D, Greil R, Balic M, Fitzal F, Pfeiler G, Frantal S, Bartsch RA, Gnant M. Abstract P1-15-01: Effect of concomitant statin treatment in postmenopausal patients with hormone-receptor positive early-stage breast cancer receiving adjuvant denosumab or placebo: A post-hoc analysis of ABCSG-18. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-15-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Statins are a common class of cholesterol-lowering drugs prescribed for the prevention and treatment of cardiovascular disease. Moreover, it was suggested that statins may possess anti-cancer properties and interact with RANK ligand expression. Therefore, we aimed at evaluating a hypothetical synergistic effect of statins with denosumab in early-stage breast cancer (BC) patients from the Austrian Breast and Colorectal Cancer Study Group (ABCSG) trial 18. Methods ABCSG-18 (NCT00556374) is a prospective, randomized, double-blind, phase III study; postmenopausal patients with hormone receptor (HR) positive BC receiving a non-steroidal aromatase inhibitor were randomly assigned to denosumab or placebo. In this post-hoc analysis, we investigated the potential effects of concomitant statin therapy on recurrence risk of BC, fracture risk and bone mineral density (BMD) using time-dependent Cox proportional hazards models. Sensitivity analyses accounting for immortal time and confounding bias were performed. Results In the analysis of the study population (n=3,420), statin therapy (n=824) was associated with worse disease-free survival (DFS) (HR 1.35, 95%; CI 1.04-1.75; p=0.023). Sensitivity analysis relativized these results (HR 1.22, 95% CI 0.94 - 1.59; p=0.14). While there was no significant effect of lipophilic statins (n=710) on recurrence risk (HR 1.30, 95% CI 0.99 - 1.72; p=0.062), patients on hydrophilic statins (n=87) had worse DFS compared with patients not receiving any statins (HR 2.00, 95% CI 1.09-3.66; p=0.026). This finding was mainly driven by the effect of hydrophilic statins on DFS in the denosumab arm (HR 2.63, 95% CI 1.21 - 5.68; p=0.014). No association between statin use and fracture risk or osteoporosis was observed. Conclusion In this population of early-stage breast cancer patients from a prospective randomized study, an association of hydrophilic statins with increased recurrence risk was observed. According to this retrospective analysis hydrophilic statins may increase recurrence risk especially in patients treated with denosumab. Still, our data need to be interpreted with caution due to their retrospective nature and the low number of patients receiving hydrophilic statins. Therefore, no final conclusion is possible. This hypothesis generating result warrants further exploration.
Citation Format: Christoph Minichsdorfer, Thorsten Fuereder, Michael Leutner, Christian F. Singer, Stephanie Kacerovsky-Strobl, Daniel Egle, Richard Greil, Marija Balic, Florian Fitzal, Georg Pfeiler, Sophie Frantal, Rupert A. Bartsch, Michael Gnant. Effect of concomitant statin treatment in postmenopausal patients with hormone-receptor positive early-stage breast cancer receiving adjuvant denosumab or placebo: A post-hoc analysis of ABCSG-18 [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 P1-15-01.
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Affiliation(s)
| | | | | | | | | | - Daniel Egle
- Medical University of Innsbruck, Insbruck, Austria
| | | | | | | | | | - Sophie Frantal
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | | | - Michael Gnant
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
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Callari M, Huang CS, Egle D, Bermejo B, Zamagni C, Dugo M, Thill M, Anton A, Barreca M, Russo S, Ciruelos EM, Greil R, Zambelli S, Gyorffy B, Smart C, Biasi O, Valagussa P, Viale G, Gianni L, Bianchini G. Abstract P1-04-02: Immune milieu associated with PD-L1 status in TNBC is dependent on time of biomarker assessment and treatment received: A secondary analysis of the NeoTRIPaPDL1 trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-04-02] [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 - In the NeoTRIPaPDL1 phase III trial, triple-negative breast cancer (TNBC) patients were randomized to receive nab-paclitaxel/carboplatin for 8 cycles (CT arm) with or without atezolizumab (CT/A arm). We previously reported that the majority of patients (65%) with PD-L1- at baseline converted to PD-L1+ (the majority with IC2/IC3) after the first cycle of treatment in the atezolizumab arm. Here we studied treatment associated changes in the molecular tumour features and immune microenvironment by PD-L1 expression. Methods – A total of 158 (56.4%) of patients enrolled in the NeoTRIPaPDL1 trial (76 and 82 from CT/A and CT arm, respectively) were included in this analysis by satisfying the following criteria: i) availability of a paired core biopsy at baseline and at day 1 of the second treatment cycle (D1C2); ii) evaluation of stromal TILs (sTILs) and staining for PD-L1 (Ventana SP142); iii) successful RNA-seq gene expression profiling. PD-L1 groups were defined as IC0/IC1 (<5% PD-L1low) vs IC2/IC3 (>=5% PD-L1high). Presence of different immune cell populations was quantified by gene expression profile deconvolution using ConsensusTME R package. Cancer hallmark gene set collection and custom signature activation status were estimated in each sample using singscore R package. Differences in score distribution were evaluated by 2-sided t-test. Results At baseline, both sTILs and immune cell signatures were upregulated in PD-L1high compared to PD-L1low tumours (p<0.001). No significant differences were found between the two treatment arms in the PD-L1high subpopulation. In the PD-L1low cases, both sTILs and immune related signatures were slightly downregulated in the CT/A arm (p<0.05), suggesting a modest unbalance among treatment arms with CT arm being slightly more inflamed than CT/A arm.At D1C2, PD-L1high tumours in the CT arm systematically had high sTILs (median=70%, range=30-90%), while PD-L1low tumours receiving CT/A had low sTILs in a significant proportion of cases (median=30%, range=0-90%; p<0.001). Similarly, at D1C2 several gene expression-estimated immune cell populations and immune-related signatures were upregulated in the CT arm compared to CT/A arm in PD-L1high tumours, with the weakest association observed for M2 macrophages (p=0.058). No tumour-related signatures were differentially expressed among the two treatment arms within groups with PD-L1high, suggesting that different treatment. modulate PD-L1 by engaging a different immune mileau instead of modulating tumor related features.Considering PD-L1low groups at D1C2, in the CT arm 21 tumors had >30% sTILs (n=21/69, 30.4%), while in the CT/A arm only 2 had sTILs >30% (2/27, 7.4%) (p<0.001). Analysis of gene expression data identified IFN-related signatures as the most upregulated in the CT compared to CT/A arm in PD-L1low cases at D1C2 (p<0.05). Conclusions Integrated dynamic analysis of PD-L1 expression and gene expression data highlighted significant treatment-specific changes of the immune landscape according to PD-L1 expression, when this biomarker is assessed during treatment. This indicates that the immune milieu associated with PD-L1 status is strongly dependent on the time of assessment in relationship to treatment received. Such observation may explain why in the NeoTRIP trial, baseline PD-L1 but not on-treatment PD-L1 was predictive of pCR in CT/A arm. In addition, our findings could have implications related to the use of PD-L1 as a predictive biomarker in pre-treated patients, especially when assessed early on during treatment.
Citation Format: Maurizio Callari, Chiun-Sheng Huang, Daniel Egle, Begoña Bermejo, Claudio Zamagni, Matteo Dugo, Marc Thill, Antonio Anton, Marco Barreca, Stefania Russo, Eva Maria Ciruelos, Richard Greil, Stefania Zambelli, Balázs Gyorffy, Chanel Smart, Olivia Biasi, Pinuccia Valagussa, Giuseppe Viale, Luca Gianni, Giampaolo Bianchini. Immune milieu associated with PD-L1 status in TNBC is dependent on time of biomarker assessment and treatment received: A secondary analysis of the NeoTRIPaPDL1 trial [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 P1-04-02.
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Affiliation(s)
| | | | - Daniel Egle
- Medical University of Innsbruck, Innsbruck, Austria
| | - Begoña Bermejo
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Claudio Zamagni
- IRCCS Azienda ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | - Marc Thill
- Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | | | - Stefania Russo
- Fondazione MichelangeloAzienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Richard Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute-CCCIT; and Cancer Cluster Salzburg, Salzburg, Austria
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Dugo M, Huang CS, Egle D, Bermejo B, Zamagni C, Seitz RS, Nielsen TJ, Thill M, Anton A, Russo S, Ciruelos EM, Schweitzer BL, Ross DT, Galbardi B, Greil R, Semiglazov V, Gyorffy B, Colleoni M, Kelly C, Mariani G, Mastro LD, Valagussa P, Viale G, Callari M, Gianni L, Bianchini G. Abstract PD10-06: Predictive value of RT-qPCR 27-gene IO score and comparison with RNA-Seq IO score in the NeoTRIPaPDL1 trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd10-06] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background The identification of biomarkers for optimization of immune checkpoint inhibitors (ICI) treatment is an unmet clinical need. In the Phase III randomized trial, NeoTRIPaPDL1, a post-hoc analysis of whole transcriptome RNA-Seq data, previously showed that the 27-gene IO score is a potential predictive biomarker of increased pathological complete response with the addition of atezolizumab to carboplatin/nab-paclitaxel (Bianchini G ESMO 2021). However, the laboratory implementation of gene-expression signatures measured using RNA-seq is challenging. Therefore, we further assessed the predictive value of the IO score using a twenty-seven gene RT-qPCR assay on NeoTRIP samples, and compared to the previously reported RNA-Seq version of the assay. Methods The NeoTRIP study randomized patients to eight cycles of carboplatin/nab-paclitaxel (CT) with or without atezolizumab (CT/A). 258 patients were evaluable for pCR (breast and nodes) as Per-Protocol Population. We assessed the IO score as binary and continuous variables using the CAP/CLIA validated DetermaIO qPCR test (Saltman et al 2021) on pre-treatment core biopsies (n=220/258; 85.3%), all of which have RNA-Seq data available. We evaluated the association between IO score defined by RT-qPCR and RNA-Seq, and the association of the IO score defined by RT-qPCR test with PD-L1 IHC (Ventana SP142), stromal TILs (sTILs), and pCR. Results Comparison of continuous IO scores between the RT-qPCR assay and the RNA-Seq algorithm had a Pearson’s correlation of 0.94 (p < 0.0001). High agreement between categorical IO scores was also observed (Cohens’ kappa = 0.84; 95% confidence interval [CI] = 0.77-0.91; p < 0.0001). RT-qPCR IO score was balanced in the two arms (p = 0.65) with 44% and 40% positive patients in the CT and CT/A arms, respectively. The RT-qPCR IO score was correlated with both PD-L1 (Pearson’s r = 0.64; p < 0.0001) and sTILs (Pearson’s r = 0.67; p < 0.0001). Continuous IO score was significantly predictive of pCR in CT/A (Odds ratio [OR] = 3.12; 95% CI = 1.20-8.10; p<0.019), but not CT arm (OR = 1.28; 95% CI = 0.54-3.01; p = 0.578). Considering the binary IO score, OR were 2.87 [1.27-6.47] (p = 0.011) and 0.91 [0.43-1.93] (p = 0.812), in CT/A and CT, respectively (interaction test p = 0.043). The pCR rate for CT/A vs CT was 69.8% vs 46.9% in IO score positive [+22.9%, p = 0.046, Chi-squared test] and 44.6% vs 49.2% [-4.6%, p = 0.73] in IO score negative. A significant interaction was found between continuous PD-L1 and continuous IO-score (p = 0.006). Among PD-L1-neg, 9 patients were IO score positive (10.1%). The pCR rate in this group was 3/4 (75%) in the CT/A arm and 1/5 (20%) in CT arm. The predictive value of IO score by RT-qPCR was similar to RNA-Seq. Conclusions We observed a high level of agreement and concordance between IO scores assessed by RT-qPCR and RNA-Seq, indicating that the 27-gene IO assay and algorithm is robust and the choice of platform has limited impact. This finding also demonstrates the high quality of NeoTRIP RNA-Seq data. In this post-hoc analysis, IO score assessment by this CLIA validated RT-qPCR test was confirmed to be predictive of atezolizumab benefit over CT alone in a randomized trial.
Citation Format: Matteo Dugo, Chiun-Sheng Huang, Daniel Egle, Begoña Bermejo, Claudio Zamagni, Robert S. Seitz, Tyler J. Nielsen, Marc Thill, Antonio Anton, Stefania Russo, Eva Maria Ciruelos, Brock L. Schweitzer, Douglas T. Ross, Barbara Galbardi, Richard Greil, Vladimir Semiglazov, Balázs Gyorffy, Marco Colleoni, Catherine Kelly, Gabriella Mariani, Lucia Del Mastro, Pinuccia Valagussa, Giuseppe Viale, Maurizio Callari, Luca Gianni, Giampaolo Bianchini. Predictive value of RT-qPCR 27-gene IO score and comparison with RNA-Seq IO score in the NeoTRIPaPDL1 trial [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 PD10-06.
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Affiliation(s)
| | | | - Daniel Egle
- Medical University of Innsbruck, Innsbruck, Austria
| | - Begoña Bermejo
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Claudio Zamagni
- IRCCS Azienda ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | | | - Marc Thill
- AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany
| | | | - Stefania Russo
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | | | | | | | - Richard Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute-CCCIT; and Cancer Cluster Salzburg, Salzburg, Austria
| | - Vladimir Semiglazov
- N. N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | | | | | | | | | - Lucia Del Mastro
- University of Genova; IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Bianchini G, Wang XQ, Danenberg E, Huang CS, Egle D, Callari M, Bermejo B, Zamagni C, Thill M, Anton A, Dugo M, Zambelli S, Russo S, Ciruelos EM, Greil R, Semiglazov V, Colleoni M, Kelly C, Mariani G, Mastro LD, Győrffy B, Biasi O, Valagussa P, Viale G, Gianni L, Ali HR. Abstract GS1-00: Single-cell spatial analysis by imaging mass cytometry and immunotherapy response in triple-negative breast cancer (TNBC) in the NeoTRIPaPDL1 trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs1-00] [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 Immunecheckpoint inhibitors are effective in early and advanced TNBC, however only aminority of patients benefit making precision immune-oncology a major unmetneed. Imaging mass cytometry (IMC) enables high dimensional tissue imaging atsubcellular resolution for assessment of TNBC ecosystems, providing informationon cell type composition, functional status, and spatial organisation. Methods InNeoTRIP patients with TNBC were randomized to eight cycles ofnab-paclitaxel/carbo (CT) with/without atezolizumab (CTA). Forty-four proteinsspanning cancer cells and the tumor microenvironment (TME) were assessed onpre-treatment biopsies (n=243/280; 86.8% evaluable after QC). FFPE samples werelabelled with antibodies conjugated to isotopically pure rare earth metalreporters and profiled at one micron resolution by IMC. For each sample, wehave generated three high dimensional images that encompass the tumor,tumor-stroma interface and adjacent stroma. We investigated the association ofprotein expression assessed separately for epithelial and TME cells, cellphenotypes, and spatial architectures with PD-L1 status (Ventana SP142),stromal TILs, TNBC types and pathological complete response (pCR). 237 patients(84.6%) have both IMC and RNA-seq available allowing for comparison with genesignatures derived from HALLMARK,ConsensusTME immune cell types, and Nanostring. Results Across243 samples we identify just over one million single cells. By supervised clustering,we defined 37 robust cell phenotypes. PD-L1-positive tumors, high stromal TILsand TNBC type were characterized by extreme heterogeneity and unique cell-type andspatial TME composition. Severalbiomarkers demonstrated a significant test for interaction. Considering proteinexpression, GATA3 and CD20 on TME, HLA-DR in epithelial cells and Ki67 assessedboth in epithelial and TME, had a significant test for interaction (p <0.05). For all these biomarkers, high expression (above median) was associatedwith an increase of pCR of >10% in favour of atezolizumab, whereas lowerexpression group demonstrated a similar pCR rate among arms.Two cellphenotypes, PD-L1+IDO+ antigen presenting cells (APCs) and CD56+ neuroendocrine(NE) epithelial cells, had a significant test for interaction. Higherexpression of these biomarkers was associated with higher likelihood of pCR in CTAarm, but not in CT arm. For example, PD-L1+IDO+APCs in the CTA arm wereassociated with pCR proportions of 64.6% and 24.6% for above- and below-mediangroups respectively (OR4.5 [2.01-10.1], p<0.001).Mostof these tests of interaction retained significance after adjustment by PD-L1status and stromal TILs. Notably, none among 61 gene-expression basedimmune-related pathways and 7 proliferation-related signatures demonstrated a significant test ofinteraction. Resultsof systematic multi-tiered image analysis at the levels of cell-cellinteractions and recurrent higher order multicellular complexes defining TNBC ecosystemsidentified by graph-based methods will be presented at the meeting. Conclusions Imaging mass cytometry provides a morecomprehensive overview of TNBC heterogeneity at a single-cell level withspatial resolution. Bulk protein or gene expression might deliver limitedpredictive information because it does not consider the cell compartment ofexpression. Precise cell phenotyping highlights the predictive role ofPD-L1+IDO+APCs and CD56+NE epithelial cells. Overall, we demonstrated that IMCis feasible in a large, randomized trial and provides independent predictiveinformation on immune checkpoint inhibitors benefit to PD-L1, TILs and gene-expressionprofiles.
Citation Format: Giampaolo Bianchini, Xiao Qian Wang, Esther Danenberg, Chiun-Sheng Huang, Daniel Egle, Maurizio Callari, Begoña Bermejo, Claudio Zamagni, Marc Thill, Anton Anton, Matteo Dugo, Stefania Zambelli, Stefania Russo, Eva Maria Ciruelos, Richard Greil, Vladimir Semiglazov, Marco Colleoni, Catherine Kelly, Gabriella Mariani, Lucia Del Mastro, Balázs Győrffy, Olivia Biasi, Pinuccia Valagussa, Giuseppe Viale, Luca Gianni, H Raza Ali. Single-cell spatial analysis by imaging mass cytometry and immunotherapy response in triple-negative breast cancer (TNBC) in the NeoTRIPaPDL1 trial [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 GS1-00.
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Affiliation(s)
| | - Xiao Qian Wang
- CRUK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Esther Danenberg
- CRUK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Chiun-Sheng Huang
- National Taiwan University Hospital and Taiwan Breast Cancer Consortium, Taipei, Taiwan
| | - Daniel Egle
- Department of Gynecology, BrustGesundheitZentrum Tirol, Medical University Innsbruck, Innsbruck, Austria
| | - Maurizio Callari
- CRUK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Begoña Bermejo
- Hospital Clinico Universitario Valencia and GEICAM, Valencia, Spain
| | - Claudio Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Anton Anton
- Hospital Universitario Miguel Servet and GEICAM, Zaragoza, Spain
| | - Matteo Dugo
- San Raffael Scientific Institute, Milano, Italy
| | | | | | | | - Richard Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute-CCCIT; Cancer Cluster Salzburg, Salzburg, Austria
| | | | | | - Catherine Kelly
- Cancer Trials Ireland & Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Lucia Del Mastro
- Università degli Studi di Genova, Ospedale Policlinico San Martino, Genova, Italy
| | | | - Olivia Biasi
- IRCCS Istituto Europeo di Oncologia, Milano, Italy
| | | | - Giuseppe Viale
- University of Milan, Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | | | - H Raza Ali
- CRUK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
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Shinn E, Zahrieh D, DeMichele A, Zdenkowski N, Lemieux J, Mao J, Bjelic-Radisic V, Naughton M, Pfeiler G, Gelmon K, Mayer I, Egle D, Zoppoli G, Traina T, Jiménez MM, Novoa SA, Haddad T, Chan A, Ring AE, Wolff A, Lorenzo JJ, Sabanathan D, Burstein H, Nowecki ZI, Pristauz-Telsnigg G, Brufsky A, Bellet-Ezquerra M, Foukakis T, Novik Y, Rubovszky G, Muehlbacher K, Metzger O, Goulioti T, Law E, Partridge A, Carey L, Zoroufy A, Hlauschek D, Fesl C, Mayer E, Gnant M. Abstract P4-12-01: Adherence with adjuvant endocrine therapy with or without Palbociclib in the PALLAS trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-12-01] [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: As the development and use of oral anticancer agents increases, it is critical to understand patient adherence to both standard and investigational agents. The open label, phase 3 multicenter PALLAS trial investigates whether adding 2 years of the CDK4/6 inhibitor palbociclib (P) to adjuvant endocrine therapy (ET) improves invasive disease-free survival (iDFS) over adjuvant ET alone in patients (pts) with HR- positive, HR2-negative, stage II-III breast cancer. Pts were randomly assigned to either Palbociclib (125 mg/day, 3 weeks on, 1 week off, in a 28-day cycle) plus ongoing provider/patient-choice adjuvant ET (P+ET) versus ET alone. We examined patient-reported adherence to ET +/- P during the first two years of study treatment. Methods: Adherence outcomes were measured in English-speaking pts in the U.S., UK, Ireland and Australia, Spanish-speaking pts in Spain and Mexico, and German-speaking pts in Germany and Austria. Adherence measures included drug diaries completed at each cycle, pill counts (for P only) collected at each study visit, and the Morisky Medication Adherence Scale-4 item and the McHorney Adherence Estimator questionnaires completed at cycles 2, 3, 6, 12, 18, and 24 (22 months). Mean adherence for each cycle was defined as the average proportion of prescribed pills taken (via drug diary) across all patients who initiated that cycle. Persistence was defined as the duration of drug initiation to treatment cessation (via drug diary). Generalized estimating equations were used to model the “most adherent” pts on the Morisky (score = 5 vs score <5) and “low risk” for adherence problems on the McHorney (score=0 vs score >0) to compare the average difference between arms over time for ET, adjusting for baseline demographic and clinical variables. Results: 81% (N=4688) of PALLAS pts were included in this analysis. Median persistence to ET was 23.6 months in P + ET (n=2169), 23.7 months in ET alone (2136) and 20.4 months for P (n=2194). The number of pts who initiated each cycle for ET declined over time and was similar between arms; the decline was more marked for P (Table 1). Mean adherence range as measured by drug diary was 98.2-99.3% for ET in P+ET and 98.0 - 99.4% in ET alone; and for P, ranged from 93.4 - 98.8%. The adherence and persistence results were nearly identical whether measured by drug diary or pill count for P. The observed percent “most adherent” for P measured by the Morisky scale ranged from 71.9% - 79.6% and the percent “low risk” for adherence problems measured by the McHorney scale, 64.0% - 73.4%. The percent of pts “most adherent” and “low risk” for adherence problems to ET was higher, on average over time, in the P+ET group compared to ET alone (75% vs 68%, p<0.01; 75% vs 72%, p=.05, respectively). Conclusions: Self-reported mean adherence for both P + ET and ET alone was strikingly high for pts who remained on therapy; persistence was also high with ET during the 2-year treatment period. Current analyses suggest that nonadherence to either P or ET was likely not a major contributor to the iDFS results seen in the overall PALLAS trial. These results illustrate the importance of measuring and monitoring patient adherence to oral study agents. Support: AFT, Pfizer; ClinicalTrials.gov (NCT02513394) and EudraCT (2014-005181-30). https://acknowledgments.alliancefound.org
Table 1.Adherence and persistence in PALLAS over the 24 month treatment periodPalbocicilb + ETETPalbociclibETETTreatment cycleMean Adherence (SD)N*Mean Adherence (SD)NMean Adherence (SD)N193.4 (13.8)229098.7 (6.1)230999.0 (5.2)2343294.7 (13.3)218198.8 (6.4)220398.4 (7.1)2206397.4 (10.1)211298.7 (7.3)214298.8 (6.3)2168497.6 (10.2)203598.6 (7.8)211099.0 (5.7)2154597.6 (11.1)197598.3 (7.9)209398.1 (8.3)2148698.1 (8.7)189998.7 (6.6)203798.5 (8.2)2116798.1 (9.3)185599.0 (6.3)201298.6 (7.3)2102898.0 (9.1)181098.2 (8.2)199798.1 (8.2)2092998.4 (7.4)173399.0 (6.4)196298.8 (6.8)20511098.3 (8.6)171499.2 (4.9)194699.0 (5.5)20381198.3 (8.0)169198.5 (7.3)193798.2 (8.2)20311298.7 (6.2)161299.1 (5.3)191098.7 (7.5)19861398.5 (7.7)159698.9 (6.4)189398.8 (7.1)19691497.9 (9.3)157698.4 (7.3)188298.0 (9.1)19611598.5 (6.9)151499.2 (4.6)185499.0 (6.0)19281698.2 (8.7)148699.1 (4.6)183599.1 (5.7)19131798.1 (9.8)147998.3 (7.8)182698.5 (6.4)19031898.7 (6.8)141699.3 (4.1)176899.2 (5.3)18601998.7 (7.3)140899.3 (3.8)175699.4 (3.1)18482098.4 (8.9)139798.9 (5.3)174298.7 (5.8)18382198.5 (7.5)130199.0 (6.1)167698.8 (7.1)17842297.8 (9.7)124698.8 (6.2)164799.2 (5.7)17692398.1 (8.8)118098.2 (8.5)161998.4 (8.0)17552498.8 (7.2)108699.0 (6.3)146898.9 (7.1)16192598.8 (6.7)99699.2 (5.2)143298.8 (7.1)15892697.9 (11.2)84599.1 (5.7)140998.6 (8.8)1578ET=Endocrine therapy * Number of pts who initiated the treatment cycle.
Citation Format: Eileen Shinn, David Zahrieh, Angela DeMichele, Nick Zdenkowski, Julie Lemieux, Jun Mao, Vesna Bjelic-Radisic, Michelle Naughton, Georg Pfeiler, Karen Gelmon, Ingrid Mayer, Daniel Egle, Gabriele Zoppoli, Tiffany Traina, Miguel Martin Jiménez, Silvia Antolin Novoa, Tufia Haddad, Arlene Chan, Alistair Edward Ring, Antonio Wolff, Jose JuanPonce Lorenzo, Dhanusha Sabanathan, Hal Burstein, Zbigniew Ireneusz Nowecki, Gunda Pristauz-Telsnigg, Adam Brufsky, Meritxell Bellet-Ezquerra, Theodoros Foukakis, Yelena Novik, Gabor Rubovszky, Karoline Muehlbacher, Otto Metzger, Theodora Goulioti, Ernest Law, Ann Partridge, Lisa Carey, Alex Zoroufy, Dominik Hlauschek, Christian Fesl, Erica Mayer, Michael Gnant. Adherence with adjuvant endocrine therapy with or without Palbociclib in the PALLAS trial [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 P4-12-01.
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Affiliation(s)
| | | | | | | | | | - Jun Mao
- Memorial Sloan Kettering Cancer Center/AFT, New York, NY
| | - Vesna Bjelic-Radisic
- Helios University Clinic Wuppertal, Breast Unit University Witten/Herdecke, Wuppertal, Germany
| | | | - Georg Pfeiler
- Austrian Breast Cancer Study Group (ABCSG), Vienna, Austria
| | - Karen Gelmon
- University of British Columbia, Vancouver, BC, Canada
| | | | - Daniel Egle
- Medical University Innsbruck, Innsbruck, Austria
| | - Gabriele Zoppoli
- University Hospital San Martino - National Cancer Institute, Genoa, Italy
| | - Tiffany Traina
- Memorial Sloan Kettering Cancer Center/AFT, New York, NY
| | | | | | | | - Arlene Chan
- Breast Cancer Research Centre-WA, Nedlands, WA, Australia
| | | | | | | | - Dhanusha Sabanathan
- Lakeside Specialist Breast Clinic and Nepean Cancer Care Centre, Norwest, NSW, Australia
| | - Hal Burstein
- Dana-Farber Cancer Institute/Alliance, Boston, MA
| | | | | | - Adam Brufsky
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | | | | | | | | | - Otto Metzger
- Dana-Farber Cancer Institute/Alliance, Boston, MA
| | | | | | | | - Lisa Carey
- University of North Carolina/Alliance, Chapel Hill, NC
| | | | | | - Christian Fesl
- Austrian Breast Cancer Study Group (ABCSG), Vienna, Austria
| | - Erica Mayer
- Dana-Farber Cancer Institute/AFT, Boston, MA
| | - Michael Gnant
- Medical University of Vienna, ABCSG, Vienna, Austria
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Chan A, Ruiz-Borrego M, Marx G, Brufsky A, Chien J, Thirlwell M, Trudeau M, Bose R, García-Sáenz JA, Egle D, Pistilli B, Wassermann J, Cheong KA, Singer CF, Hunt D, Foruzan N, McCulloch L, Barcenas CH. Abstract P5-18-02: Final findings from the CONTROL trial of diarrheal prophylaxis or neratinib dose escalation on neratinib-associated diarrhea and tolerability in patients with HER2+ early-stage breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-18-02] [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: Neratinib (NERLYNX®), an irreversible pan-HER tyrosine kinase inhibitor, is approved for the extended adjuvant treatment of early-stage HER2+ breast cancer following adjuvant trastuzumab-based therapy and in combination with capecitabine for HER2+ metastatic breast cancer. Diarrhea is the most frequently reported on-target side effect associated with neratinib; in the ExteNET adjuvant trial, where no mandatory anti-diarrheal prophylaxis was used, 39.8% of patients reported grade 3 diarrhea and 16.8% of patients discontinued neratinib due to diarrhea. The CONTROL trial (Clinicaltrials.gov: NCT02400476) was designed to investigate pre-emptive antidiarrheal prophylaxis (loperamide alone or in combination with budesonide or colestipol) or neratinib dose escalation (DE) for the prevention of neratinib-associated diarrhea. Data for the loperamide, budesonide and colestipol cohorts have been reported previously [Barcenas et al. Ann Oncol 2020]. The final findings for the two DE regimen cohorts are reported here. Methods: CONTROL is an international, multi-cohort, open-label, phase 2 study. Patients ≥18 years of age with stage I-IIIc HER2+ breast cancer received oral neratinib (240 mg/day for 1 year) after trastuzumab-based adjuvant therapy. Patients were enrolled sequentially into separate cohorts investigating: 1) mandatory loperamide prophylaxis; 2) budesonide + loperamide; 3) colestipol + loperamide; 4) colestipol + loperamide PRN; 5) neratinib DE + loperamide PRN (two cohorts). DE1 schedule: neratinib 120 mg/day for week 1, 160 mg/day for week 2, then 240 mg/day from week 3 onwards to complete 12 months of treatment. DE2 schedule: neratinib 160 mg/day for weeks 1&2, 200 mg/day for weeks 3&4, then 240 mg/day from week 5 onwards up to 12 months. Both DE cohorts included loperamide PRN. Adverse events were graded according to NCI-CTCAE v4.0. Primary endpoint: incidence of grade ≥3 diarrhea. Results: A total of 563 patients were enrolled in CONTROL. All preventive strategies reduced the incidence of grade 3 diarrhea compared with that seen in ExteNET (historical control: 39.8%). Median cumulative duration of grade 3 diarrhea ranged from 2-3.5 days across the CONTROL study cohorts for the entire 12-month treatment period (compared with 5.0 days for ExteNET). The proportion of patients discontinuing neratinib because of diarrhea was decreased in all cohorts compared with ExteNET (16.8%), except for loperamide alone. Adoption of neratinib DE, particularly the 2-week DE schedule (DE1), most markedly reduced the incidence, severity, and duration of neratinib-associated diarrhea in CONTROL compared with ExteNET (see Table).
Conclusions: Neratinib DE + loperamide PRN during the first 2 weeks of treatment (DE1 cohort) was associated with the lowest rates of grade 3 diarrhea (13.3%) and diarrhea-related discontinuations (3.3%) compared with all other anti-diarrheal strategies investigated in CONTROL. These final findings from the study show improved tolerability of neratinib with all diarrhea prophylaxis strategies and suggest that neratinib DE1 with loperamide PRN allows patients to stay on treatment longer and receive the full benefit of neratinib therapy.
Table. Patient disposition and diarrhea characteristics: ExteNET vs CONTROL DE cohortsExteNET(n=1408)CONTROL DE1 (n=60)CONTROL DE2 (n=62)Patients completing 1 year of neratinib treatment, %617874Median duration of treatment, months (range)11.6 (2.5–11.9)12.0 (0.2–12.4)11.9 (0.3–14.5)Diarrhea, %Grade 339.813.327.4Grade 4<100Median cumulative duration of grade 3 diarrhea,a days52.52Discontinuations due to diarrhea, %16.83.36.5Dose reductions due to diarrhea, %26311Dose holds due to diarrhea, %341213aNo grade 4 diarrhea was reported in CONTROL.
Citation Format: Arlene Chan, Manuel Ruiz-Borrego, Gavin Marx, Adam Brufsky, Jo Chien, Michael Thirlwell, Maureen Trudeau, Ron Bose, José A García-Sáenz, Daniel Egle, Barbara Pistilli, Johanna Wassermann, Kerry A Cheong, Christian F Singer, Daniel Hunt, Navid Foruzan, Leanne McCulloch, Carlos H Barcenas. Final findings from the CONTROL trial of diarrheal prophylaxis or neratinib dose escalation on neratinib-associated diarrhea and tolerability in patients with HER2+ early-stage breast cancer [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 P5-18-02.
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Affiliation(s)
- Arlene Chan
- Breast Cancer Research Centre-WA, Perth & Curtin University, Nedlands, Australia
| | | | | | | | - Jo Chien
- University of California San Francisco, San Francisco, CA
| | | | | | - Ron Bose
- Washington University School of Medicine, St. Louis, MO
| | | | - Daniel Egle
- University Frauenklinik Innsbruck, Innsbruck, Austria
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Gampenrieder SP, Rinnerthaler G, Tinchon C, Petzer A, Balic M, Heibl S, Zabernigg AF, Egle D, Sandholzer M, Roitner F, Andel J, Pichler P, Hager C, Knauer M, Hubalek M, Singer CF, Greil R. Abstract P1-21-08: Brain metastases (BM) from breast cancer: Real-word data from the Austrian AGMT_MBC-registry. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-21-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: BM are generally associated with poor prognosis and with neurological impairments making BM a major limitation of life expectancy and quality of life in MBC. Real-world data are needed in order to quantify and better characterize this special clinical situation. Here, we present data from the MBC registry of the Austrian Study Group for Medical Tumor Therapy (AGMT-MBC-Registry). Methods: The AGMT-MBC-Registry is an ongoing multicenter registry for MBC patients in Austria. Patients with available hormone receptor and HER2 status and sufficient outcome data were included in this analysis. Unadjusted, univariate overall survival (OS) probabilities were calculated by the Kaplan-Meier method and compared by the log-rank test; multivariable adjusted hazard ratios (HR) were estimated by Cox regression models. HR were estimated with diagnosis of BM as time-dependent variable. Logistic regression was performed to investigate the probability of developing BM. Multivariable analyses included the following parameters: breast cancer subtype (luminal-like vs. HER2+ vs. TNBC), age at diagnosis of metastatic disease (continuous, in Cox regression as interaction with menopausal status), DFS (de novo metastatic or ≥ 24 months vs. < 24 months), visceral disease (yes vs. no) and number of metastatic sites (1 vs 2-3 vs. ≥4) at diagnosis of metastatic disease. Results: As of 15/04/2021, 2024 patients were included in the registry. Out of 1691 evaluable patients, 306 (18.1%) had documented BM. The incidence at diagnosis of metastatic disease and the overall incidence during the course of disease was significantly higher in HER2+ (9.5% [13/137] and 36.5% [50/137]) and triple-negative tumors (11.9% [38/318] and 27.7% [88/318]) compared to luminal-like tumors (3.3% [41/1236] and 13.6% [168/1236]) (both P<0.001). Besides subtype, ≥4 metastatic sites at diagnosis of metastatic disease and age were statistically significant associated with BM in logistic regression analysis.Median time to BM calculated from the date of diagnosis of metastatic disease was 11.3 months (95%CI 9.3-13.3) in the total population with BM, 12.7 months (95%CI 7.3-16.0) in HER2+, 5.2 months (95%CI 1.8-10.3) in triple-negative and 15.4 months (95%CI 8.4-19.5) in luminal disease, respectively. Interestingly, 13.7% of patients (42/306) had BM as first metastatic site without extracranial disease. The median number of systemic therapy-lines before and after diagnosis of BM was 1 (range 0-8) and 1 (range 0-10), respectively. Most of the patients with BM (80.1%) received radiotherapy; 12.7% focal radiotherapy, 69.8% whole brain irradiation and 9.0% both types of radiotherapy (8.5% unknown). After a median follow-up of 72.3 months (95%-CI 68.6-80.0), patients with BM had a significantly shorter median OS (7.5 months) compared to patients without BM (38.4 months) both in univariate (HR 3.58; 95%CI 3.11-4.11; P<.001) and multivariable analysis (HR 3.70; 95%CI 3.18-4.32; P<.001). OS in patients with BM differed significantly between the three breast cancer subtypes with a median OS of 36.3 months (95%CI 30.5-47.9), 33.5 months (95%CI 22.9-45.5) and 13.2 months (95%CI 11.1-18.4) in luminal, HER2+ and TNBC, respectively (overall log-rank P<0.001). Similarly, the time from diagnosis of BM and death was significantly shorter in TNBC (4.1 months; 95%CI 3.4-6.3) compared to luminal (9.7 months; 95%CI 6.8-13.7) and HER2+ breast cancer (10.7 months; 95%CI 9.1-26.2) (overall log-rank P<0.001). Conclusion: Almost 20% of patients with MBC develop BM during their course of disease, with a higher incidence in HER2+ and triple-negative disease. Besides effective prevention strategies improved systemic and local therapies are needed to minimize morbidity and improve outcome in these patients.
Citation Format: Simon Peter Gampenrieder, Gabriel Rinnerthaler, Christoph Tinchon, Andreas Petzer, Marij Balic, Sonja Heibl, August F Zabernigg, Daniel Egle, Margit Sandholzer, Florian Roitner, Johannes Andel, Petra Pichler, Christopher Hager, Michael Knauer, Michael Hubalek, Christian F Singer, Richard Greil. Brain metastases (BM) from breast cancer: Real-word data from the Austrian AGMT_MBC-registry [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 P1-21-08.
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Affiliation(s)
- Simon Peter Gampenrieder
- Department of Internal Medicine III, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph Tinchon
- Internal Medicine - Department for Haemato-Oncology, LKH Hochsteiermark, Leoben, Austria
| | - Andreas Petzer
- Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern – Elisabethinen, Linz, Austria
| | - Marij Balic
- Division of Oncology, Department for Internal Medicine, Medical University Graz, Graz, Austria
| | - Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - August F Zabernigg
- Department of Internal Medicine, County Hospital Kufstein, Kufstein, Austria
| | - Daniel Egle
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Margit Sandholzer
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Florian Roitner
- Department of Internal Medicine II, Hospital Braunau, Braunau, Austria
| | - Johannes Andel
- Department of Internal Medicine II, Landeskrankenhaus Steyr, Steyr, Austria
| | - Petra Pichler
- University Hospital St. Pölten, Department for Internal Medicine 1, St. Pölten, Austria
| | | | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Michael Hubalek
- Department of Gynecology, Breast Health Center Schwaz, Schwaz, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Richard Greil
- Department of Internal Medicine III, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
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Rinnerthaler G, Gampenrieder SP, Tinchon C, Petzer AP, Balic M, Sonja H, Zabernigg AF, Egle D, Sandholzer M, Roitner F, Andel J, Pichler P, Hager C, Hubalek M, Knauer M, Singer CF, Greil R. Abstract P1-16-03: Response pattern to chemotherapy in metastatic breast cancer (MBC): Real-word data from the Austrian AGMT_MBC-Registry. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-16-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Despite the advances by targeted therapies, particularly in HER2-positive and hormone receptor (HR)-positive metastatic breast cancer (MBC), chemotherapy remains a mainstay of the treatment in all breast cancer subtypes. Response probabilities to chemotherapy seem to decrease with increasing lines of treatment, but little is known about the response dependency on the previous therapy line. Here, we present data from the MBC registry of the Austrian Study Group for Medical Tumor Therapy (AGMT-MBC-Registry). Methods: The AGMT-MBC-Registry is an ongoing multicenter registry for MBC patients in Austria. Patients with available hormone receptor and negative HER2 status, at least two consecutive lines of chemotherapy and sufficient progression-free survival (PFS) data were included in this analysis. Multivariable adjusted hazard ratios (HR) for PFS were estimated by Cox regression models and included the following parameters: age, HR status, disease-free survival (de novo metastatic or ≥ 24 months vs. < 24 months), visceral disease, number of involved metastatic sites at diagnosis of MBC, chemotherapy treatment line, and response in previous treatment line. Response was defined as PFS > 4 month and non-response as a PFS ≤ 4 month. Cox model was extended as proposed by Andersen and Gill due to possibility of multiple events per patient and thereby resulting dependencies (Sousa-Ferreira & Abreu, 2019). Results: As of 15/04/2021, 2024 patients were included in the registry. Out of them, 405 patients (20.0%) had documented HER2 negative disease with at least two lines of consecutive chemotherapy. Median PFS for first-, second-, third-, and forth-line chemotherapy were 6.0 months (95% CI 5.5-6.5), 3.7 months (95% CI 3.1-4.3), 2.9 months (95% CI 2.5-3.2), and 2.8 months (95% CI 2.6-3.2), respectively. Median overall survival was 31.8 months (95% CI 27.2-34.8). Median number of chemotherapy lines was 3 (range 2-8). The most commonly used cytotoxic agents were paclitaxel and capecitabine in first- and second-line, and eribulin in third-, and fourth-line chemotherapy. Combinations of more than one cytotoxic drug were given in 36%, 29%, 28% in first-, second-, and third/fourth-line. Patients who did not respond to the previous therapy line, had a response in 43% (95% CI 33-53), 34% (95% CI 25-43), and 30% (95% CI 21-39) to second-, third-, and fourth-line. In those patients, investigator assessed overall response rate (partial remission or complete remission) was 27% (95% CI 13-40), 23% (95% CI 9-37), and 33% (95% CI 16-51), respectively. A response to third-line chemotherapy in patients who did not respond to first- and second-line therapy, was seen in 16.7% of patients. Ratios between PFS of interest and PFS of the previous treatment line were 0.63 (95% CI 0.55-0.68), 0.57 (95% CI 0.41-0.62), and 0.76 (95% CI 0.58-0.9) in second-, third-, and forth-line therapy. In multivariable analysis, responses in second- to fourth-line therapy were statistically significant associated with disease-free survival (HR 0.75, P=0.022), and treatment line (HR 1.17 per increasing treatment line, P=0.004), but not for the response to the previous treatment line (HR 0.85, P=0.068). Conclusion: A continuously decreasing PFS for cytotoxic drugs from treatment line to treatment line was confirmed in our analysis. However, in multivariable analysis, response, defined as PFS > 4 months, was not statistically associated with response to the previous treatment line. Therefore, a lack of response to first, second-, - or third-line chemotherapy should not trigger discontinuation of anticancer therapy in case of further available treatment options.
Citation Format: Gabriel Rinnerthaler, Simon P Gampenrieder, Christoph Tinchon, Andreas Petzer Petzer, Marija Balic, Heibl Sonja, August F Zabernigg, Daniel Egle, Margit Sandholzer, Florian Roitner, Johannes Andel, Petra Pichler, Christophe Hager, Michael Hubalek, Michael Knauer, Christian F Singer, Richard Greil. Response pattern to chemotherapy in metastatic breast cancer (MBC): Real-word data from the Austrian AGMT_MBC-Registry [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 P1-16-03.
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Affiliation(s)
| | | | | | | | | | - Heibl Sonja
- Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | | | - Daniel Egle
- Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | | | | | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | | | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg, Austria
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Zhou Q, Gampenrieder SP, Frantal S, Rinnerthaler G, Singer CF, Egle D, Pfeiler G, Bartsch R, Wette V, Pichler A, Petru E, Dubsky PC, Bago-Horvath Z, Fesl C, Rudas M, Ståhlberg A, Graf R, Weber S, Dandachi N, Filipits M, Gnant M, Balic M, Heitzer E. Persistence of ctDNA in Patients with Breast Cancer During Neoadjuvant Treatment Is a Significant Predictor of Poor Tumor Response. Clin Cancer Res 2022; 28:697-707. [PMID: 34862246 PMCID: PMC9377752 DOI: 10.1158/1078-0432.ccr-21-3231] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 09/07/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Accurate response assessment during neoadjuvant systemic treatment (NST) poses a clinical challenge. Therefore, a minimally invasive assessment of tumor response based on cell-free circulating tumor DNA (ctDNA) may be beneficial to guide treatment decisions. EXPERIMENTAL DESIGN We profiled 93 genes in tissue from 193 patients with early breast cancer. Patient-specific assays were designed for 145 patients to track ctDNA during NST in plasma. ctDNA presence and levels were correlated with complete pathological response (pCR) and residual cancer burden (RCB) as well as clinicopathologic characteristics of the tumor to identify potential proxies for ctDNA release. RESULTS At baseline, ctDNA could be detected in 63/145 (43.4%) patients and persisted in 25/63 (39.7%) patients at mid-therapy (MT) and 15/63 (23.8%) patients at the end of treatment. ctDNA detection at MT was significantly associated with higher RCB (OR = 0.062; 95% CI, 0.01-0.48; P = 0.0077). Of 31 patients with detectable ctDNA at MT, 30 patients (96.8%) were nonresponders (RCB II, n = 8; RCB III, n = 22) and only one patient responded to the treatment (RCB I). Considering all 145 patients with baseline (BL) plasma, none of the patients with RCB 0 and only 6.7% of patients with RCB I had ctDNA detectable at MT, whereas 30.6% and 29.6% of patients with RCB II/III, respectively, had a positive ctDNA result. CONCLUSIONS Overall, our results demonstrate that the detection and persistence of ctDNA at MT may have the potential to negatively predict response to neoadjuvant treatment and identify patients who will not achieve pCR or be classified with RCB II/III.
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Affiliation(s)
- Qing Zhou
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria.,Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, Medical University of Graz, Graz, Austria
| | - Simon P. Gampenrieder
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research (LIMCR) and Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Sophie Frantal
- Department of Statistics, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Gabriel Rinnerthaler
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research (LIMCR) and Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Christian F. Singer
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Pfeiler
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Viktor Wette
- Breast Center, Brustzentrum Kaernten, St. Veit, Austria
| | - Angelika Pichler
- Department of Hemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - Edgar Petru
- Department of Gynaecology and Obstetrics, Medical University Graz, Graz, Austria
| | - Peter C. Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Breast Center St. Anna, Lucerne, Switzerland
| | - Zsuzsanna Bago-Horvath
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian Fesl
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research (LIMCR) and Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Anders Ståhlberg
- Department of Laboratory Medicine, Sahlgrenska Center for Cancer Research, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenberg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Genetics and Genomics, Gothenburg, Sweden
| | - Ricarda Graf
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria
| | - Sabrina Weber
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria
| | - Nadia Dandachi
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Martin Filipits
- Department of Medicine I, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria.,Corresponding Authors: Ellen Heitzer, D&R Institute of Human Genetics, Medical University of Graz, Neue Stiftingtalstrasse 6, Graz, 8010, Austria. E-mail: ; and Marija Balic, Department of Internal Medicine, Division of Oncology, Medical University Graz, Auenbruggerplatz 15, 8010 Graz, Austria. E-mail:
| | - Ellen Heitzer
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria.,Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, Medical University of Graz, Graz, Austria.,Corresponding Authors: Ellen Heitzer, D&R Institute of Human Genetics, Medical University of Graz, Neue Stiftingtalstrasse 6, Graz, 8010, Austria. E-mail: ; and Marija Balic, Department of Internal Medicine, Division of Oncology, Medical University Graz, Auenbruggerplatz 15, 8010 Graz, Austria. E-mail:
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Bartsch R, Gampenrieder SP, Rinnerthaler G, Petru E, Egle D, Petzer A, Balic M, Pluschnig U, Sliwa T, Singer C. Updated Austrian treatment algorithm in HER2+ metastatic breast cancer. Wien Klin Wochenschr 2022; 134:63-72. [PMID: 35089396 PMCID: PMC8813714 DOI: 10.1007/s00508-021-01987-9] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 12/21/2022]
Abstract
A group of Austrian breast cancer specialists met in December 2020 to establish a comprehensive clinical benefit-risk profile of available HER2-targeted therapies based on recent data and to develop an updated treatment algorithm by consensus over several months in 2021. A total of four scenarios were developed in which treatment strategies appropriate for specific patient profiles were evaluated. Consensus was established by detailed discussions of each scenario and by reaching full consensus.
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Affiliation(s)
- Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Simon Peter Gampenrieder
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Edgar Petru
- University Hospital for Gynecology and Obstetrics, Clinical Department of Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Daniel Egle
- Department of Gynecology, Breast Cancer Center Tirol, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Andreas Petzer
- Barmherzige Schwestern, Elisabethinen, Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH, Seilerstätte 4, 4010, Linz, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Clinical Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Ursula Pluschnig
- Department of Internal Medicine and Hematology and Internal Oncology, Klagenfurt Hospital, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Thamer Sliwa
- 3rd Medical Department, Hematology and Oncology, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
| | - Christian Singer
- Department of Gynecology, Breast Cancer Center Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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50
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Gampenrieder SP, Rinnerthaler G, Tinchon C, Petzer A, Balic M, Heibl S, Schmitt C, Zabernigg AF, Egle D, Sandholzer M, Singer CF, Roitner F, Hager C, Andel J, Hubalek M, Knauer M, Greil R. Landscape of HER2-low metastatic breast cancer (MBC): results from the Austrian AGMT_MBC-Registry. Breast Cancer Res 2021; 23:112. [PMID: 34906198 PMCID: PMC8670265 DOI: 10.1186/s13058-021-01492-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background About 50% of all primary breast cancers show a low-level expression of HER2 (HER2-low), defined as immunohistochemically 1+ or 2+ and lack of HER2 gene amplification measured by in situ hybridization. This low HER2 expression is a promising new target for antibody–drug conjugates (ADCs) currently under investigation. Until now, little is known about the frequency and the prognostic value of low HER2-expression in metastatic breast cancer (MBC). Patients and methods The MBC-Registry of the Austrian Study Group of Medical Tumor Therapy (AGMT) is a multicenter nationwide ongoing registry for MBC patients in Austria. Unadjusted, univariate survival probabilities of progression-free survival (PFS) and overall survival (OS) were calculated by the Kaplan–Meier method and compared by the log-rank test. Multivariable adjusted hazard ratios were estimated by Cox regression models. In this analysis, only patients with known HER2 status and available survival data were included. Results As of 11/15/2020, 1,973 patients were included in the AGMT-MBC-Registry. Out of 1,729 evaluable patients, 351 (20.3%) were HER2-positive, 608 (35.2%) were HER2-low and 770 (44.5%) were completely HER2-negative (HER2-0). Low HER2-expression was markedly more frequent in the hormone-receptor(HR)+ subgroup compared to the triple-negative subgroup (40% vs. 23%). In multivariable analysis, low HER2 expression did not significantly influence OS neither in the HR+ (HR 0.89; 95% CI 0.74–1.05; P = 0.171) nor in the triple-negative subgroup (HR 0.92; 95% CI 0.68–1.25; P = 0.585), when compared to completely HER2-negative disease. Similar results were observed when HER2 IHC 2+ patients were compared to IHC 1+ or 0 patients. Conclusion Low-HER2 expression did not have any impact on prognosis of metastatic breast cancer in this real-world population. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01492-x.
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Affiliation(s)
- Simon Peter Gampenrieder
- Department of Internal Medicine III With Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,Laboratory for Immunological and Molecular Cancer Research (LIMCR) and Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III With Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,Laboratory for Immunological and Molecular Cancer Research (LIMCR) and Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Christoph Tinchon
- Internal Medicine - Department for Haemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - Andreas Petzer
- Internal Medicine I for Hematology With Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern - Elisabethinen, Linz, Austria
| | - Marija Balic
- Division of Oncology, Department for Internal Medicine, Medical University Graz, Graz, Austria
| | - Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Clemens Schmitt
- Department of Hematology and Internal Oncology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | | | - Daniel Egle
- Department of Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - Margit Sandholzer
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christian Fridolin Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Roitner
- Department of Internal Medicine II, Hospital Braunau, Braunau, Austria
| | | | - Johannes Andel
- Department of Internal Medicine II, Pyrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Michael Hubalek
- Department of Gynecology, Breast Health Center Schwaz, Schwaz, Austria
| | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Richard Greil
- Department of Internal Medicine III With Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria. .,Laboratory for Immunological and Molecular Cancer Research (LIMCR) and Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg Cancer Research Institute (SCRI), Salzburg, Austria. .,Cancer Cluster Salzburg, Salzburg, Austria.
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