Klinik fur Gynakologie und Gynakologische Onkologie

Essen, Germany

Klinik fur Gynakologie und Gynakologische Onkologie

Essen, Germany
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Pfisterer J.,Zentrum fur Gynakologische Onkologie Kiel | Hilpert F.,Universitatsklinikum Schleswig Holstein Campus Kiel | Mahner S.,Universitatsklinikum Hamburg Eppendorf | Harter P.,Klinik fur Gynakologie und Gynakologische Onkologie | Du Bois A.,Klinik fur Gynakologie und Gynakologische Onkologie
Gynakologe | Year: 2013

Standard primary systemic treatment of patients with advanced ovarian cancer comprises six courses of intravenously administered carboplatin and paclitaxel. In patients with FIGO stage IIIB-IV disease, additional treatment with bevacizumab is possible. Primary, neoadjuvant treatment without prior debulking surgery should be avoided. Intraperitoneal treatments, including HIPEC, should only be given within controlled clinical trials. © 2013 Springer-Verlag Berlin Heidelberg.


Mahner S.,Universitatsklinikum Hamburg Eppendorf | Woelber L.,Universitatsklinikum Hamburg Eppendorf | Harter P.,Klinik fur Gynakologie und Gynakologische Onkologie | Hilpert F.,Universitatsklinikum Schleswig Holstein Campus Kiel | And 3 more authors.
Gynakologe | Year: 2013

Despite optimal primary oncologic management most patients with advanced ovarian cancer develop a recurrence with a subsequent shift from the therapeutic intention to a palliative approach. Symptom control and quality of life gain in importance as treatment goals and further management is primarily influenced by the response to the preceding platinum-based chemotherapy. Two main subgroups can be distinguished with platinum-resistant (recurrence less than 6 months after last platinum-based chemotherapy) and platinum-sensitive disease (recurrence more than 6 months after last platinum-based chemotherapy). In cases of platinum-resistant recurrence the initial concept of cytoreductive surgery in combination with platinum-based combination chemotherapy apparently failed and many patients still have to recover from persisting side effects of the previous therapy. Therefore, mono-chemotherapy was up till now the therapy of choice for this patient cohort. In contrast, patients with platinum-sensitive recurrence usually receive another platinum-based chemotherapy. According to recently published data some patients with recurrent disease might additionally benefit from antiangiogenic therapy by the addition of bevacizumab. In selected cases of platinum-sensitive recurrence secondary cytoreductive surgery appears to be an option although a prognostic impact of this procedure has not yet been proven through prospective randomized studies. In this review recent developments in the oncologic management of recurrent ovarian cancer are discussed and current evidence considering therapeutic approaches is highlighted to give a concise overview of clinically relevant therapeutic aspects. © 2013 Springer-Verlag Berlin Heidelberg.


Eichbaum M.,University of Heidelberg | Mayer C.,University of Heidelberg | Eickhoff R.,Alcedis GmbH | Bischofs E.,University of Heidelberg | And 10 more authors.
BMC Cancer | Year: 2011

Background: The prognosis of patients with recurrent, platinum-resistant epithelial ovarian cancer (EOC) is poor. There is no standard treatment available. Emerging evidence suggests a major role for antiangiogenic treatment modalities in EOC, in particular in combination with the metronomic application of low dose chemotherapy. The novel, investigational oral antiangiogenic agent pazopanib targeting vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor (PDGFR) and c-kit is currently being studied in different tumour types and is already used as first line therapy in recurrent renal cell carcinoma. A combined therapy consisting of pazopanib and metronomic oral cyclophosphamide may offer a well-tolerable treatment option to patients with recurrent, pretreated EOC.Methods/design: This study is designed as a multicenter phase I/II trial evaluating the optimal dose for pazopanib (phase I) as well as activity and tolerability of a combination regimen consisting of pazopanib and metronomic cyclophosphamide in the palliative treatment of patients with recurrent, platinum-resistant, pre-treated ovarian cancer (phase II). The patient population includes patients with histologically or cytologically confirmed diagnosis of EOC, cancer of the fallopian tube or peritoneal cancer which is platinumresistant or -refractory. Patients must have measurable disease according to RECIST criteria and must have failed available standard chemotherapy. Primary objectives are determination of the optimal doses for pazopanib (phase I) and the overall response rate according to RECIST criteria (phase II). Secondary objectives are time to progression, overall survival, safety and tolerability. The treatment duration is until disease progression or intolerability of study drug regimen (with a maximum of 13 cycles up to 52 weeks per subject).Discussion: The current phase I/II trial shall clarify the potential of the multitargeting antiangiogenic tyrosinkinaseinhibitor GW 786034 (pazopanib) in combination with oral cyclophosphamide as salvage treatment in patients with recurrent, pretreated ovarian cancer.Trial registration: ClinicalTrials.gov: NCT01238770. © 2011 Eichbaum et al; licensee BioMed Central Ltd.


Denschlag D.,Frauenklinik | Thiel F.C.,Frauenklinik | Ackermann S.,Frauenklinik | Harter P.,Klinik fur Gynakologie und Gynakologische Onkologie | And 12 more authors.
Geburtshilfe und Frauenheilkunde | Year: 2015

Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Due to their rarity and their heterogeneous histopathology uterine sarcomas remain challenging tumors to manage and need a multidisciplinary approach. To our knowledge so far there is no evidence-based guideline on the appropiate management of these heterogeneous tumors. Methods: This S2k-guideline is the work of an representative committee of experts from a variety of different professions who were commissioned by the DGGG to carry out a systematic literature review of uterine sarcoma. Members of the participating scientific societies developed a structured consensus in a formal procedure. Recommendations: 1. The incidence and histopathologic classification of uterine sarcoma. 2. The clinical manifestations, diagnosis and staging of uterine sarcoma. 3. The management of leiomyosarcoma. 4. The management of endometrial stromal sarcoma and undifferentiated uterine sarcoma. 5. The management of adenosarcoma as well as carcinosarcomas. 6. The management of morcellated uterine sarcoma.


Maass N.,Universitatsfrauenklinik Aachen | Harbeck N.,Ludwig Maximilians University of Munich | Mundhenke C.,Universitatsklinikum Schleswig | Lerchenmuller C.,Gemeinschaftspraxis Dres. Wehmeyer | And 16 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2013

Purpose: Everolimus has shown to stop formation and activity of osteoclasts. Breast cancer patients with bone metastases only are candidates for effective but low toxic treatment. Patients and methods: We evaluated everolimus in a double-blind, placebo-controlled, phase II, randomized discontinuation study in breast cancer patients with HER2 negative breast cancer patients with bone metastases only. After being stable on 8 weeks of everolimus 10 mg/day, patients were randomized to everolimus-continuation or placebo. Primary outcome was time (from randomization) to progression (TTP). Seventy-six patients would have had to be randomized to show a hazard ration (HR) of 0.5 for everolimus-continuation. Results: Eighty-nine patients were enrolled in 4 years. Thirty-nine patients with SD after 8 weeks on everolimus were randomized to everolimus-continuation or placebo. TTP in patients with everolimus- continuation was 37.0 (95 % CI 16.7-40.3) versus 12.6 weeks (95 % CI 7.1-17.9) with placebo [HR 0.554 (95 % CI 0.282-1.09) p = 0.0818], adjusted for endocrine therapy [HR 0.464 (95 % CI 0.226-0.954) p = 0.037]. TTP in everolimus responders (n = 6) was 86 weeks. Conclusion: The RADAR study is mainly hypothesis generating. It suggests that everolimus has single-agent activity, and patients with bone metastases only may retrieve long-term benefit from everolimus if they do not progress within 8 weeks of treatment. © 2013 Springer-Verlag Berlin Heidelberg.


Ewald-Riegler N.,Klinik fur Gynakologie und Gynakologische Onkologie | Du Bois O.,Klinik fur Gynakologie und Gynakologische Onkologie | Fisseler-Eckhoff A.,Dr. Horst Schmidt Klinik GmbH | Kommoss F.,Institute For Pathologie | And 4 more authors.
Onkologie | Year: 2012

Background: The prognosis in borderline tumors of the ovary (BOT) is generally favorable. However, some patients experience recurrence, and mortalities occur. There is a need to better characterize prognostic factors to be considered for individualized treatment planning. Patients and Methods: The data of 158 consecutive patients who underwent surgery for BOT at a tertiary referral center for gynecologic oncology between 1997 and 2008 were retrospectively analyzed. Results: Most patients had early stage disease, and advanced stages FIGO II/III only occurred in 23.4%. Serous histology was most frequent (68%), followed by mucinous histology (22%). All patients received surgery as initial treatment with no adjuvant systemic therapy. 37 patients (40.7% of the patients under the age of 50) had fertility-sparing surgery (FSS). Recurrent disease occurred in 18 (11.4%) patients, and 4 (2.5%) patients died. Independent risk factors for recurrence were FIGO stages > I (hazard ratio (HR) 37.1; 95% confidence interval (CI) 4.5-155.5), tumor rupture (HR 12.4; 95% CI 1.5-61.5), incomplete staging (HR 5.9; 95% CI 1.6-21.3), and FSS in patients < 50 years (HR 8.0; 95% CI 2.0-31.6). Conclusion: Intraoperative tumor rupture, incomplete staging, and FSS - all influenced by the surgeon - may impose a substantial recurrence risk. Therefore, careful counseling and balancing of risk and benefit are mandatory before therapy is applied, especially if FSS is planned. Copyright © 2012 S. Karger AG, Basel.


Hauptmann S.,Institute For Pathologie | du Bois A.,Klinik fur Gynakologie und Gynakologische Onkologie | Meinhold-Herlein I.,RWTH Aachen | Pfisterer J.,Zentrum fur Gynakologische Onkologie | Avril S.,TU Munich
Pathologe | Year: 2014

Histological grading of ovarian cancer has prognostic relevance and implications for treatment decisions. No standardized grading system has been established so far. Several grading systems are currently being used, including the FIGO, WHO, and Silverberg grading systems which cannot be directly translated into each other. Furthermore, individual grading criteria are not uniformly applicable to different histological subtypes. For serous ovarian cancer a binary grading system is now in use as the distinction between low-grade versus high-grade carcinomas reflects the different pathogenesis of these entities. Uniform guidelines for grading ovarian cancer are necessary and should ideally reflect the prognosis. This article provides an overview of commonly used grading systems and their prognostic value. The article demonstrates that a type-specific grading of ovarian cancer should be performed and recommendations for grading the various histological subtypes are given. © 2014, Springer-Verlag Berlin Heidelberg.


Schneider S.,Klinik fur Gynakologie und Gynakologische Onkologie | Heitz F.,Klinik fur Gynakologie und Gynakologische Onkologie | Harter P.,Klinik fur Gynakologie und Gynakologische Onkologie | Beutel B.,Klinik fur Gynakologie und Gynakologische Onkologie | And 2 more authors.
Gynakologe | Year: 2013

Prognosis in ovarian cancer is determined by the tumor stage at the time of diagnosis and the completeness of tumor resection achieved during primary surgery. The surgical outcome is the only prognostic factor that is capable of being influenced. The present article provides recommendations for surgical treatment of primary ovarian cancer based on the current guidelines AGO-OVAR: "Diagnostics, Therapy and post-operative Care of malignant Ovarian Tumors." Patients who are treated on the basis of the guidelines have a significantly better outcome than patients who are treated differently. Staging laparotomy including systematic pelvic and para-aortic lymphadenectomy in early ovarian cancer (FIGO I-IIA) is indispensable. In advanced ovarian cancer, multivisceral resection should be performed (depending on the patient's general condition) if a complete resection of the tumor can be achieved. © 2013 Springer-Verlag Berlin Heidelberg.


PubMed | Klinik fur Gynakologie und Gynakologische Onkologie
Type: Journal Article | Journal: Onkologie | Year: 2012

The prognosis in borderline tumors of the ovary (BOT) is generally favorable. However, some patients experience recurrence, and mortalities occur. There is a need to better characterize prognostic factors to be considered for individualized treatment planning.The data of 158 consecutive patients who underwent surgery for BOT at a tertiary referral center for gynecologic oncology between 1997 and 2008 were retrospectively analyzed.Most patients had early stage disease, and advanced stages FIGO II/III only occurred in 23.4%. Serous histology was most frequent (68%), followed by mucinous histology (22%). All patients received surgery as initial treatment with no adjuvant systemic therapy. 37 patients (40.7% of the patients under the age of 50) had fertility-sparing surgery (FSS). Recurrent disease occurred in 18 (11.4%) patients, and 4 (2.5%) patients died. Independent risk factors for recurrence were FIGO stages > I (hazard ratio (HR) 37.1; 95% confidence interval (CI) 4.5-155.5), tumor rupture (HR 12.4; 95% CI 1.5-61.5), incomplete staging (HR 5.9; 95% CI 1.6-21.3), and FSS in patients < 50 years (HR 8.0; 95% CI 2.0-31.6).Intraoperative tumor rupture, incomplete staging, and FSS - all influenced by the surgeon - may impose a substantial recurrence risk. Therefore, careful counseling and balancing of risk and benefit are mandatory before therapy is applied, especially if FSS is planned.


Reinartz S.,Universitatsklinikum | Pfisterer J.,Frauenklinik | du Bois A.,Klinik fur Gynakologie und Gynakologische Onkologie | Jackisch C.,Klinikum Offenbach GmbH | And 2 more authors.
Human Immunology | Year: 2010

The results of several clinical trials have clearly demonstrated the potential of the anti-idiotype (anti-Id) vaccine abagovomab to induce cancer antigen 125 (CA-125)-specific immunity in ovarian cancer patients. Because of the central role of regulatory T cells (Tregs) in tumor immunology, we analyzed the frequency and suppressive activity of CD25+FoxP3+ Tregs in 16 patients treated with abagovomab. During vaccination, mean frequencies of peripheral Treg with a CD4+CD25+FoxP3+ CD127- phenotype were enhanced but returned to baseline levels in the follow-up phase. Despite increasing Treg counts, the suppressive activity of Tregs was diminished in a subset of patients treated with abagovomab. Reduced Treg activity was associated with increasing polyclonal and CA-125-specific T-cell proliferation in these patients. Interestingly, CA-125-specific T-cell activation could not be further improved by Treg depletion in vitro, as CA-125 induced a suppressive CD4+CD25+FoxP3+ CD127- T cell subset derived from the originally Treg-depleted T-cell fraction. These CA-125-induced Tregs (iTregs) efficiently blocked polyclonal and tumor-specific T-cell activation. Further elimination of iTregs resulted in detectable CA-125-specific T-cell responses in a subset of patients. Based on our results, the suppressive potential rather than the frequency of natural and CA-125-induced Tregs is an important issues to consider for refinement of current anti-Id vaccination. © 2010 American Society for Histocompatibility and Immunogenetics.

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