Pathologic complete response after neoadjuvant chemotherapy plus trastuzumab predicts favorable survival in human epidermal growth factor receptor 2-overexpressing breast cancer: Results from the TECHNO Trial of the AGO and GBG study groups
Untch M.,Helios Klinikum Berlin Buch |
Untch M.,Frauenklinik des Universitatsklinikums Erlangen |
Untch M.,Ludwig Maximilians University of Munich |
Untch M.,Technical University Mu Nchen |
And 186 more authors.
Journal of Clinical Oncology | Year: 2011
Purpose: To evaluate efficacy and safety of epirubicin and cyclophosphamide followed by paclitaxel and trastuzumab as neoadjuvant treatment in patients with human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer. Patients and Methods: Patients with centrally confirmed HER2-overexpressing breast cancer (≥ 2 cm or inflammatory) received four 3-week cycles epirubicin and cyclophosphamide (90/600 mg/m2) followed by four 3-week cycles paclitaxel (175 mg/m2) and trastuzumab (6 mg/kg) before surgery. Trastuzumab was continued after surgery to complete 1 year of treatment. Primary end point was pathologic complete response (pCR) defined as no residual invasive tumor in breast and lymphatic tissue. Results: Thirty-nine percent of 217 enrolled patients achieved a pCR. Breast conservation was possible in 64% of patients. Three-year disease-free survival (DFS) was 88% in patients with pCR compared to 73% in patients without pCR (P = .01). Three-year overall survival (OS) was 96% in patients with pCR compared to 86% in patients without pCR (P = .025). pCR was the only significant prognostic factor for DFS (hazard ratio [HR] 2.5; 95% CI, 1.2 to 5.1; P = .013) and OS (HR, 4.9; 95% CI, 1.4 to 17.4; P = .012) in multivariable analysis. Cardiac toxicity was reported in eight patients (3.7%) of whom six presented with an asymptomatic left ventricular ejection fraction decrease and two with symptomatic chronic heart failure. Conclusion: Neoadjuvant combination of trastuzumab and chemotherapy resulted in a high pCR rate in HER2-overexpressing primary breast cancer. Patients with a pCR after neoadjuvant anti-HER2 therapy in combination with chemotherapy followed by maintenance trastuzumab have an improved long-term outcome. Patients without a pCR had an increased risk for relapse and death. © 2011 by American Society of Clinical Oncology.
Schneider U.,Universitatsfrauenklinik Jena |
Kunze A.,Universitatsklinikum |
Schleussner E.,Universitatsfrauenklinik Jena |
Hagemann G.,Klinikfur Neurologie
Gynakologe | Year: 2011
Epileptic disorders are the most common neurologic diseases among women of childbearing age. Both an optimized preconceptual therapeutic regimen to minimize the number of seizures and a targeted selection of the antiepileptic drugs used are a prerequisite for a favorable pregnancy outcome. Therefore, the opportune re-evaluation of the diagnosis and therapeutic options once a patient reaches childbearing age and an interdisciplinary and prospective approach to fulfill the patient's desire to have children are of utmost importance. A pregnant patient with epilepsy has a more than 90% chance of delivering a healthy baby. While delivery in an obstetric unit will substantially reduce the risk of serious complications during labor, delivery and the early postnatal period, there is no reason to deny women with epilepsy normal spontaneous delivery under continuous administration of medication or to breastfeed the newborn infant. © Springer-Verlag 2011.
Weiss J.M.,Universitatsfrauenklinik Jena
Gynakologische Endokrinologie | Year: 2010
This review deals with relevant aspects of ovarian germ cell tumors. Malignant ovarian germ cell tumors are rare, aggressive, and chemosensitive tumors of young women. The chances for cure are close to 100% for lower stages and approximately 80% for higher stages. Prognostic factors include staging, residual tumor after surgery, histological type, and tumor markers like AFP and HCG: fertility-sparing surgery followed by polychemotherapy containing platinum is currently the state of treatment. In stage I and in completely resected tumors two to three courses of chemotherapy are recommended. In higher stages and in residual disease after surgery, four courses could be applied. Even in higher stages a fertility-sparing surgical approach is feasible. In stage IA disease surveillance is a safe option. If the patient relapses, chemotherapy will then be commenced. Even in this case the chances of survival are high. Second-look surgery is not necessary. © 2010 Springer-Verlag.
Hancke K.,Universitatsfrauenklinik Ulm |
Weiss J.M.,Universitatsfrauenklinik Jena
Austrian Journal of Clinical Endocrinology and Metabolism | Year: 2012
Hyperprolactinemia may occur idiopathically, during pregnancy, lactation, stress, sleep, or physical activity, but also in pathologic situations such as prolactinoma, interaction with other drugs, hypopituitarism or chronical renal failure. The symptoms may range from minor symptoms to oligo- and amenorrhea, galactorrhea, or infertility. This review shows the different aspects of hyperprolactinemia in a gynaecological setting.