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Journals
Year of Publication
1.  Targeted and Osteo-Oncologic Treatment in Early Breast Cancer: What Is State-of-the-Art and What Might Become so within the Next 5 Years? 
Breast Care  2014;9(3):161-167.
Summary
In 2014, modern strategies of targeted therapies in the adjuvant setting are mainly focused on anti-human epidermal growth factor receptor 2 (HER2) blockade. For the 15% of HER2-enriched tumors, 1 year of treatment with the monoclonal antibody trastuzumab is the standard of care. All patients, regardless of tumor size, nodal status, or age, profit from therapy with risk reduction rates for recurrence of up to 50%. As a consequence, the current guidelines recommend the use of trastuzumab in these patients if additional risk factors lead to the consideration of adjuvant chemotherapy. The concurrent use with taxane-based chemotherapy is preferred. The concept of dual HER2 blockade – already approved in the metastatic setting – shows also significantly improved efficacy in neoadjuvant trials. Dual blockade with trastuzumab and pertuzumab is approved by the Food and Drug Administration (FDA) for neoadjuvant treatment of HER2-overexpressing tumors. However, until approved in Europe, this treatment approach remains off-label for early breast cancer and study participation is highly recommended. Bisphosphonates (BPs) and denosumab are approved in breast cancer as standard therapy for the treatment of bone metastases. In the adjuvant setting, BPs and denosumab can be given to prevent tumor therapy-induced bone loss. The antineoplastic effect of BPs in the adjuvant setting and its role in the prevention of metastatic disease are still under discussion.
doi:10.1159/000365129
PMCID: PMC4132236  PMID: 25177257
Early breast cancer; Targeted therapy; HER2; Osteo-oncology
2.  13th St. Gallen International Breast Cancer Conference 2013: Primary Therapy of Early Breast Cancer Evidence, Controversies, Consensus – Opinion of a German Team of Experts (Zurich 2013) 
Breast Care  2013;8(3):221-229.
Summary
The International Consensus Conference on the treatment of primary breast cancer takes place every two years in St. Gallen, Switzerland. The panel in St. Gallen is composed of international experts from different countries. From a German perspective, it seems reasonable to interpret the voting results in the light of AGO-recommendations and S3-guidelines for everyday practice in Germany. Consequently, a team of eight breast cancer experts, of whom two are members of the international St. Gallen panel, commented on the voting results of the St. Gallen Consensus Conference (2013). The main topics at this year's St. Gallen conference were surgical issues of the breast and axilla, radio-therapeutic and systemic treatment options, and the clinical relevance of tumour biology. The clinical utility of multigene assays for supporting individual treatment decisions was also intensively discussed.
doi:10.1159/000351692
PMCID: PMC3728634  PMID: 24415975
St. Gallen Consensus; Early breast cancer; Adjuvant therapy; Multigene signatures; Targeted therapy
3.  HER2 Dimerization Inhibitor Pertuzumab – Mode of Action and Clinical Data in Breast Cancer 
Breast Care  2013;8(1):49-55.
Summary
The humanized monoclonal antibody pertuzumab prevents the dimerization of HER2 with other HER receptors, in particular the pairing of the most potent signaling heterodimer HER2/HER3, thus providing a potent strategy for dual HER2 inhibition. It binds to the extracellular domain of HER2 at a different epitope than trastuzumab. Pertuzumab and trastuzumab act in a complementary fashion and provide a more complete blockade of HER2-mediated signal transduction than either agent alone. Phase II studies demonstrated that pertuzumab was generally well tolerated as a single agent or in combination with trastuzumab and/or cytotoxic agents, and implied an improved clinical efficacy of the combination of pertuzumab and trastuzumab in early and advanced HER2-positive breast cancer. Results of the pivotal phase III study CLEOPATRA in patients with HER2-positive metastatic breast cancer demonstrated that the addition of pertuzumab to first-line combination therapy with docetaxel and trastuzumab significantly prolonged progression-free and overall survival without increasing cardiac toxicity. Currently, the combination of both antibodies is being explored in the palliative setting as well as in the treatment of early HER2-positive breast cancer. Dual HER2 inhibition with the HER2 dimerization inhibitor pertuzumab and trastuzumab may change clinical practice in HER2-positive first-line metastatic breast cancer treatment.
doi:10.1159/000346837
PMCID: PMC3971793  PMID: 24715843
HER2-positive; Dual inhibition; Breast cancer, metastatic; Pertuzumab; Trastuzumab
5.  Clinical Recommendations of DEGRO and AGO on Preferred Standard Palliative Radiotherapy of Bone and Cerebral Metastases, Metastatic Spinal Cord Compression, and Leptomeningeal Carcinomatosis in Breast Cancer 
Breast Care  2010;5(6):401-407.
Summary
Background
To provide guidance for clinical practice on preferred standard palliative radiotherapy (RT) of different sites of metastasis for breast cancer patients based on current published evidence complemented by expert opinion.
Methods
The breast cancer expert panel of the German Society for Radiation Oncology (DEGRO) and members of the Working Party of Gynecologic Oncology (AGO) Breast Committee formulated recommendations based on the panel's interpretation of the level of evidence referring to the criteria of evidence-based medicine added to the AGO grades of recommendation.
Results
For different types and sites of metastasis, distinct therapeutic goals (alleviation of symptoms, pain relief, local tumor control, prevention or improvement of neurological deficits, stabilization of the spine or other bones) require complex approaches considering individual factors (i.e. life expectancy, tumor progression at other sites). With regard to different therapeutic goals, different dose concepts and fractionation schedules, and single-versus multi-fraction palliative RT should be adapted individually.
Conclusions
RT is an effective tool in palliation treatment of bone metastasis (BM), cerebral metastasis (CM) and metastatic spinal cord compression (MSCC), or leptomeningeal carcinomatosis (LC) and plays a central role in an interdisciplinary approach. Preferred technique, targeting, and different dose schedules are described in detail in the DEGRO guidelines, which are also integrated in the updated 2010 AGO recommendations.
doi:10.1159/000322661
PMCID: PMC3076353  PMID: 21494406
Metastatic breast cancer; Palliative radiation therapy; Bone metastasis; Cerebral metastasis; Metastatic spinal cord compression; Leptomeningeal carcinomatosis

Results 1-6 (6)