Universitares Cancer Center Hamburg

Hamburg, Germany

Universitares Cancer Center Hamburg

Hamburg, Germany
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Schilling G.,Universitares Cancer Center Hamburg | Arnold D.,Universitares Cancer Center Hamburg
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2012

Multimodal treatment modalities enable an increasing number of patients with malignant diseases to become candidates for a cu-ratively intended treatment strategy. Furthermore, for numerous patients with incurable cancer disease, new therapeutic developments (including molecular "target-ed" agents) allow control of further progression of tumor growth for months up to years - and therefore, even those patients may be regarded as having a "chronic" disease. Taken together, both patient groups increase the number of "long-term cancer survivors" markedly. However, complex interdisciplinary therapeutic strategies and the increasing number of options for sequential treatments also result in higher rates of acute and chronic toxicities and sequelae. Even years after completion of the initial treatment, many cancer survivors still suffer from sequelae of both malignant disease and therapy. This refers to both psychosocial and somatic involvement. In consequence, a focus of (future) oncology care - beyond successful oncology treatment rates - is to carefully investigate the somatic and psychosocial aspects of long-term sequelae in order to treat them, or - using appropriate preventative measures - to limit or even prevent their occurrence. © Springer-Verlag 2012.

Saller R.,Universitatsspital | Melzer J.,Universitatsspital | Rostock M.,Universitatsspital | Rostock M.,Universitares Cancer Center Hamburg
Forschende Komplementarmedizin | Year: 2011

The active components of herbal drugs and substances are pleiotropic multi-ingredient compounds with multitarget properties including antiinflammatory effects. A pleiotropic inhibition of inflammation could play an important role in tumor patients as an attempt of prevention or retardation of metastasis. A large number of experimental data for European and non-European herbal drugs as well as various herbal drug combinations suggest such a possibility. Despite the so far small number of clinical studies, such an experimental herbal treatment could appear to be reasonable and acceptable, provided that there are data available on quality and safety of these herbal drugs by treatments of patients without cancer and provided that an application of these data seems to be justified. Besides, herbal drugs and substances play a growing role in supportive therapy. Many of these herbal drugs have antiinflammatory effects beside their symptomatic efficacy in supportive therapy. The specific selection of herbal drugs that are efficacious in supportive therapy and additionally showed antiinflammatory effects offers the possibility of simultaneous antiinflammatory and antitumor efficacy beside the symptomatic relief for tumor patients as personalized herbal treatment. However, at present there is still a great need and demand for therapy-oriented clinical research. © 2011 S. Karger GmbH, Freiburg.

Dicke C.,Universitares Cancer Center Hamburg | Langer F.,Universitares Cancer Center Hamburg
Hamostaseologie | Year: 2015

Clinically relevant clotting abnormalities in cancer patients are referred to as Trousseau's syndrome. While thrombotic complications such as venous thromboembolism are most frequent in every day's practice, cancer patients may also experience severe bleeding symptoms due to complex systemic coagulopathies, including disseminated intravascular coagulation, haemolytic thrombotic micro - angiopathy, and hyperfibrinolysis. The pathophysiology of Trousseau's syndrome involves all aspects of Virchow's triad, but previous basic research has mainly focused on the cellular and molecular mechanisms underlying blood hypercoagulability in solid cancers and haematological malignancies. In this regard, over-expression of tissue factor (TF), the principal initiator of the extrinsic coagulation pathway, by primary tumour cells and increased shedding of TF-bearing plasma microparticles are critical to both thrombus formation and cancer progression. However, novel findings on intrinsic contact activation in vivo, such as the release of polyphosphates or DNA by activated platelets and neutrophils, respectively, have pointed to additional pathways in the complex pathophysiology of Trousseau's syndrome. © Schattauer 2015.

Langer F.,Universitares Cancer Center Hamburg
Hamostaseologie | Year: 2015

The clinical link between cancer and thrombosis has been recognized by Armand Trousseau in 1865. It has become clear that activation of coagulation and fibrinolysis plays an important role not only in the pathophysiology of Trousseau's syndrome, but also in the progression of solid malignancies. In particular, tissue factor is critical for both primary tumour growth and haematogenous metastasis. Haemostatic perturbations in cancer patients are, at least in part, controlled by defined genetic events in molecular tumourigenesis, including activating and inactivating mutations of oncogenes and tumour suppressor genes, respectively. While long-term treatment with low-molecular-weight heparin (LMWH) is considered standard therapy for established venous thromboembolism (VTE), pharmacological VTE prophylaxis in ambulatory cancer patients and the management of complex systemic coagulopathies remain a challenge and have to be decided on an individual basis and in a risk-adapted manner. Experimental and preclinical studies further suggest that LMWH may be beneficial in cancer therapy, but this innovative concept has not yet been proven beyond doubt in rigorously designed clinical trials. © Schattauer 2015.

De Santis M.,3. Medizinische Abteilung | Albers P.,Universitatsklinikum Dusseldorf | Bokemeyer C.,Universitares Cancer Center Hamburg
Onkologe | Year: 2012

The incidence of bladder cancer in Europe was estimated to be 133,700 cases in 2008 (104,600 males and 29,100 females) corresponding to 6.2 % of tumors in men and 1.9 % in women. The incidence of these tumors has therefore not substantially changed in 5 years (WHO Globocan project 2008). Cisplatin-containing combination chemotherapy has been the standard of care in the treatment of urothelial cancer (UC) since the late 1980s. Gemcitabine/cisplatin, MVAC, high-dose MVAC and the new triplet paclitaxel/cisplatin/gemcitabine are possible treatment options with different toxicity profiles. However, up to 50% of patients are unfit for cisplatin-containing chemotherapy, either due to a poor performance status (PS) and/or impaired renal function or due to co-morbidities that prevent high-volume hydration. These conditions increase with age. There is controversy about the definition of fit or unfit for cisplatin therapy. An international survey revealed five factors to be crucial: decreased PS, renal function impairment, peripheral neuropathy, hearing loss and heart failure. A standard chemotherapy has not yet been established for patients ineligible for cisplatin-based standard chemotherapy. Trials with clearly defined unfit patients or patients with multiple adverse prognostic factors are rare. The first randomized phase II/III trial in this setting compared carboplatin/vinblastin/methotrexate (M-CAVI) and carboplatin/gemcitabine (CG) in patients unfit for cisplatin. Overall survival (OS) was not statistically significantly different between the two treatment regimens with a median OS of 9.3 and 8.1 months for CG and M-CAVI, respectively. Severe acute toxicity was higher for the M-CAVI arm and therefore carboplatin/gemcitabine is the preferred treatment option in cisplatin ineligible patients. © Springer-Verlag Berlin Heidelberg 2012.

Langer F.,Universitares Cancer Center Hamburg | Bokemeyer C.,Universitares Cancer Center Hamburg
Hamostaseologie | Year: 2012

Cancer is characterized by bidirectional interrelations between tumour progression, coagulation activation, and inflammation. Tissue factor (TF), the principal initiator of the coagulation protease cascade, is centrally positioned in this complex triangular network due to its pleiotropic effects in haemostasis, angiogenesis, and haematogenous metastasis. While formation of macroscopic thrombi is the correlate of cancer-associated venous thromboembolism (VTE), a major healthcare burden in clinical haematology and oncology, microvascular thrombosis appears to be critically important to blood-borne tumour cell dissemination. In this regard, expression of TF in malignant tissues as well as shedding of TFbearing microparticles into the circulation are thought to be regulated by defined genetic events relevant to pathological cancer progression, thus directly linking Trousseau's syndrome to molecular tumourigenesis. Because pharmacological inhibition of the TF pathway in selective tumour types and patient subgroups would be in line with the modern concept of individualized, targeted anti-cancer therapy, this review will focus on the role of TF in tumour biology and cancer-associated VTE. © Schattauer 2012.

Stein A.,Universitares Cancer Center Hamburg | Arnold D.,Universitares Cancer Center Hamburg
Viszeralmedizin: Gastrointestinal Medicine and Surgery | Year: 2011

Although metastases of colorectal cancer indicate the systemic dissemination of the disease, localized oligometastatic presentation - mainly in a disease limited to the liver - still allows a curative approach. Multimodal treatment concepts include surgical resection, ablative techniques and pre- and/or postoperative systemic treatment. Combination of systemic treatment with chemotherapy and monoclonal antibodies impacts on the patients' prognosis in terms of progression-free survival and overall survival, without relevantly increasing perioperative complications. Definition of resectability remains complex, and despite all improvements in surgical techniques as well as due to the relevant number of patients being 'borderline' resectable, the 'conversion' treatment approach remains a feasible option to enable potentially curative resections. Copyright © 2011 S. Karger AG.

Langer F.,Universitares Cancer Center Hamburg
Viszeralmedizin: Gastrointestinal Medicine and Surgery | Year: 2013

Background: Venous thromboembolism (VTE), a composite of deep vein thrombosis and pulmonary embolism, is a preventable cause of morbidity and mortality in surgical patients. Method: National and international treatment guidelines and major clinical trials on mechanical or pharmacological VTE prophylaxis in surgical patients were reviewed. Results: The risk of perioperative VTE is dependent on patient-and surgery-related risk factors. Based on a thorough and individualized risk assessment, each surgical patient should be assigned a low, intermediate, or high risk of VTE. Whereas basic (e.g. early mobilization and avoidance of dehydration) and mechanical (i.e. graduated compression stockings) measures are appropriate for most low-risk patients, visceral surgical patients at intermediate or high risk of VTE should receive pharmacological thromboprophylaxis for at least 7-10 days. The risk of VTE should be balanced against the risk of bleeding. Low-molecular-weight heparin (LMWH) offers several advantages over lowdose unfractionated heparin and should be administered for prolonged periods in patients undergoing particularly high-risk (i.e. cancer) surgery. Conclusion: Perioperative VTE prophylaxis should be carried out in an individualized and risk-adapted manner. In visceral surgical patients with a moderate-to-high risk of VTE and a low risk of bleeding, pharmacological thromboprophylaxis with LMWH is a standard of care. © 2013 2013 S. Karger GmbH, Freiburg.

Approximately one third of patients with colorectal cancer (CRC) present with metastases confined to the liver only. In 15 % of these patients the metastases are primarily resectable. After resection of colorectal liver metastases the 5-year survival rate is 25 - 40 %. The EORTC trial of Nordlinger et al. has examined the role of perioperative/neoadjuvant chemotherapy of resectable liver metastases and found in the subgroup of resected patients a significant improvement in disease-free survival through chemotherapy. The results were not significant in the intent-to-treat population. Possible arguments pro neoadjuvant therapy of resectable liver metastases are the early eradication of disseminated tumour cells, the identification of a worse prognosis tumour biology in the individual patient and the higher dose density which can be achieved preoperatively versus postoperatively. Arguments against preoperative chemotherapy are the chemotherapy-induced hepatotoxicity and related increase in perioperative morbidity, the risk of achieving a complete remission of lesions which then cannot be detected intraoperatively and the uncertain optimal duration of chemotherapy. Especially surgical oncologists in Germany do not consider the neoadjuvant treatment of resectable liver metastases as a standard of care. In summary, because of the lack of level 1 evidence, patients with resectable liver metastases of colorectal cancer should be discussed within interdisciplinary tumour boards together with surgeons, gastroenterologists and medical oncologists. Potentially, overall survival data of the EORTC trial which is expected for late 2010 could change the level of evidence. © Georg Thieme Verlag KG Stuttgart · New York.

At the Annual Meeting of the American Society of Clinical Oncology (ASCO) 2015, results of current trials dealing with nonsurgical primary treatment of locally advanced head and neck cancer were presented. Regarding concomitant chemoradiotherapy (CRT), studies focused on the dosage and sequence of cisplatin administration are currently particularly featured. Amongst these, a study on dosage reduction in human papilloma virus (HPV)-positive patients was presented. Other investigations addressed substances as alternatives for cisplatin, particularly carboplatin and targeted therapeutic agents. The comparison of concomitant and sequential CRT (induction chemotherapy (ICT) prior to CRT) is still one of the main topics. In addition, studies modifying the ICT regimen or combining subsequent radiotherapy (RT) with the epidermal growth factor receptor (EGFR) antibody cetuximab were presented. A selection of the most important trials are summarized in this article. © 2015, Springer-Verlag Berlin Heidelberg.

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