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1.  Genomic Profiling in Luminal Breast Cancer 
Breast Care  2013;8(6):414-422.
The developments in gene expression analysis have made it possible to sub-classify hormone receptor-positive (luminal) breast cancer in different prognostic subgroups. This sub-classification is currently used in clinical routine as prognostic signature (e.g. 21-gene Onoctype DX®, 70-gene Mammaprint®). As yet, the optimal method for sub-classification has not been defined. Moreover, there is no evidence from prospective trials. This review explores widely used genomic signatures in luminal breast cancer, making a critical appraisal of evidence from retrospective/prospective trials. It is based on systematic literature search performed using Medline (accessed September 2013) and abstracts presented at the Annual Meeting of American Society of Clinical Oncology and San Antonio Breast Cancer Symposium.
PMCID: PMC3919430  PMID: 24550749
Biomarker; Breast cancer; Gene expression; Prognostic markers; Luminal breast cancer
2.  Association of HER2 Overexpression and Prognosis in Small (T1N0) Primary Breast Cancers 
Breast Care  2013;8(3):208-214.
There is some controversy regarding the precise role and need for adjuvant therapy in patients with pT1a/pT1bN0 breast cancer, although studies have indicated that a HER2-positive status is one of the most powerful poor prognostic factors.
Patients and Methods
We retrospectively evaluated disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) among 960 patients diagnosed between 2000 and 2008 with T1N0 primary breast cancer treated at 3 German centers, and determined prognostic risk factors. Univariate analysis was used to determine associations with potential risk factors.
With a median follow-up of 23 months, DFS was 94.8%, DDFS 96.3%, and OS 97.5%. Risk factors for decreased 1-year DFS were: peritumoral lymphatic invasion (L1) (p = 0.031), negative hormone receptor status (p = 0.003), non-use of hormonal therapy (p = 0.001), and a positive HER2 status (p = 0.003). Amongst the HER2-positive patients only 2.7% (n = 1/37) of those treated with trastuzumab had a DFS event compared with 20% (n = 10/50) without trastuzumab.
Patients with HER2-positive T1 breast cancer should be considered for inclusion in prospective trials of trastuzumab in combination with chemotherapy to determine the risk-to-benefit ratio and association with other prognostic factors.
PMCID: PMC3728630  PMID: 24415972
Trastuzumab; High-risk breast cancer; Adjuvant treatment; HER2/neu; Disease-free survival
3.  Patient's Anastrozole Compliance to Therapy (PACT) Program: Baseline Data and Patient Characteristics from a Population-Based, Randomized Study Evaluating Compliance to Aromatase Inhibitor Therapy in Postmenopausal Women with Hormone-Sensitive Early Breast Cancer 
Breast Care  2013;8(2):110-120.
The Patient's Anastrozole Compliance to Therapy (PACT) program is a large randomized study designed to assess whether the provision of educational materials (EM) could improve compliance with aromatase inhibitor therapy in postmenopausal women with early, hormone receptor-positive breast cancer.
Patients and Methods
The PACT study presented a large, homogeneous dataset. The baseline analysis included patient demographics and initial treatments and patient perceptions about treatment and quality of life.
Overall, 4,923 patients were enrolled at 109 German breast cancer centers/clinics in cooperation with 1,361 office-based gynecologists/oncologists. 4,844 women were randomized 1:1 to standard therapy (n = 2,402) or standard therapy plus EM (n = 2,442). Prior breast-conserving surgery and mastectomy had been received by 76% and 24% of the patients, respectively. Radiotherapy was scheduled for 85% of the patients, adjuvant chemotherapy for 38%. Reflecting the postmenopausal, hormone-sensitive nature of this population, only 285 patients (7%) had received neoadjuvant chemotherapy.
A comparison with epidemiological data from the West German Breast Center suggests that the patients in the PACT study are representative of a general postmenopausal early breast cancer population and that the findings may be applicable to ‘real-world’ Germany and beyond. Compliance data from PACT are eagerly anticipated.
PMCID: PMC3683950  PMID: 24419247
Breast cancer; Compliance; Aromatase inhibitors; Breast-conserving surgery; Mastectomy
4.  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.
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.
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.
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.
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.
PMCID: PMC3076353  PMID: 21494406
Metastatic breast cancer; Palliative radiation therapy; Bone metastasis; Cerebral metastasis; Metastatic spinal cord compression; Leptomeningeal carcinomatosis
5.  Perspectives: Other ErbB2-Targeted Therapies 
Breast Care  2010;5(Suppl 1):25-27.
Despite the success of individualized targeted therapies in women with breast cancer with current available compounds, new drugs – especially with different mechanisms of resistance – are under development. A range of novel targeted agents for women with tumors that overexpress ErbB2 (HER2) and progress on trastuzumab and lapatinib have entered clinical studies. Most of these agents are monoclonal antibodies or multifunctional tyrosine kinase inhibitors. Recently published data even showed encouraging synergistic effects of several new substances, which in the future could pose as a chemotherapy-free treatment option in the metastatic setting.
PMCID: PMC2931098  PMID: 20847930
Neratinib; Pertuzumab; Trastuzumab DM-1; ErbB dimerization inhibitor; Multifunctional tyrosine; kinase inhibitors; ErB2 antibody-drug conjugate therapy
6.  Zurich Consensus: German Expert Opinion on the St. Gallen Votes on 15 March 2009 (11th International Conference at St. Gallen: Primary Therapy of Early Breast Cancer) 
Breast Care  2009;4(2):109-116.
A German working group of 23 breast cancer experts discussed the results from the vote at this year's St. Gallen Consensus Conference on Primary Therapy for Early Breast Cancer (March 11–14, 2009) and came up with some concrete recommendations for day-to-day therapeutic decisions in Germany. Due the fact that the concept of the St. Gallen Consensus Conference merely allows for a minimal consensus, the objective of the working group was to provide practice-related recommendations for day-to-day clinical decisions in Germany. One area of emphasis at St. Gallen was tumor biology as a starting point for reaching individual therapeutic decisions. Intensive discussion was necessary with respect to the clinical relevance of predictive and prognostic factors. A new addition to the area of systemic therapy was a first-ever discussion of the adjuvant administration of bisphosponates and the fact that therapy with trastuzumab in HER2 overexpressing breast cancer has been defined as the standard for neoadjuvant therapy. The value of taxanes as a component of (neo)adjuvant chemotherapy as well as the value of aromatase inhibitors for the endocrine adjuvant treatment of postmenopausal patients were affirmed.
PMCID: PMC2931071  PMID: 21049070

Results 1-7 (7)