Search

Background Atezolizumab (an anti–PD-L1 antibody) has shown clinical activity alone or in combination with nab-paclitaxel in patients (pts) with first-line metastatic TNBC who have PD-L1 expression on their tumour-infiltrating immune cells (IC). We analysed the performance of 4 PD-L1 IHC assays for PD-L1 IC expression in TNBC. Methods Thirty archival TNBC tissue specimens were selected from a set of 107 based on PD-L1 IC expression per VENTANA SP142 ( 5%: 8 cases), to represent the distribution of PD-L1 IC–positivity in the pivotal atezolizumab studies (Emens et al., SABCS 2018; JAMA Oncol 2019). Serial histologic sections were stained with VENTANA SP142 and SP263, and DAKO 22C3 and 28-8, per manufacturer protocols. Slides were blinded for both assay and sample information and scored by trained readers at 7 sites for PD-L1 IC expression (% per tumour area), as well as tumour cell expression (≥1% vs Results Adjusted means of PD-L1 IC staining ranged from 3.7% to 7.8% (Table); SP263 stained more IC than the other assays. Pairwise comparison of adjusted means showed small, non-significant differences (–1.2% to 0.6%) between SP142, 22C3 and 28-8, but a significant increase in PD-L1 staining for SP263 vs the other assays (3.0% to 4.2%). Intra-class correlations (ICC) for the assays showed moderate (0.460) to excellent (0.805) reader concordance (Table). Pre-specified allocation to a 1% binary IC cut-off revealed good-to-high inter-reader agreement (Kappa 0.589 to 0.789). Table . 359P Assay PD-L1 on IC, % (95% CI) * Reader ICC (95% CI) † SP263 7.8 (7.1–8.6) 0.616 (0.477–0.758) SP142 4.3 (3.5–5.0) 0.805 (0.710–0.887) 22C3 3. 7 (2.9–4.4) 0.605 (0.474–0.755) 28-8 4.9 (4.1–5.6) 0.460 (0.319–0.636) * Sample and reader adjusted means; † Between 7 readers Conclusions The results of this first multicentre PD-L1 assay comparison study in TNBC indicate good-to-high reproducibility and concordance of PD-L1 IC expression between the SP142, 22C3 and 28-8 assays, while higher PD-L1 IC expression levels were detected with SP263. Hence, SP142, 22C3 and 28-8 may be considered analytically interchangeable for PD-L1 IC testing. Clinical trial identification Roche study ID SL41336. Editorial acknowledgement Support for third-party writing assistance for this abstract, furnished by Katie Wilson, PhD, of Health Interactions, was provided by Roche Pharma AG, Grenzach-Wyhlen, Germany. Legal entity responsible for the study F. Hoffmann-La Roche Ltd. Funding Roche Pharma AG, Grenzach-Wyhlen, Germany. Disclosure A. Noske: Travel / Accommodation / Expenses: Roche; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. J. Ammann: Full / Part-time employment: Roche Pharma AG, Germany; Shareholder / Stockholder / Stock options: Roche; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. D. Wagner: Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. C. Denkert: Honoraria (institution): Teva; Honoraria (self): Roche; Honoraria (self): Celgene; Honoraria (self): Amgen; Advisory / Consultancy: Daiichi; Advisory / Consultancy: MSD; Shareholder / Stockholder / Stock options: Sividon Diagnostics; Shareholder / Stockholder / Stock options: Myriad; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG. A. Lebeau: Advisory / Consultancy: Roche Pharma AG, Germany; Advisory / Consultancy: Novartis; Research grant / Funding (self): Roche Pharma AG, Germany; Research grant / Funding (self): Sysmex Europe; Research grant / Funding (self): BioNTech Diagnostics; Travel / Accommodation / Expenses: Roche Pharma AG, Germany; Travel / Accommodation / Expenses: Novartis; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. P. Sinn: Honoraria (self), Research grant / Funding (self), Travel / Accommodation / Expenses: Roche; Honoraria (institution), Travel / Accommodation / Expenses: Nanostring; Honoraria (self), Travel / Accommodation / Expenses: Genomic Health; Research grant / Funding (self): Dietmar-Hopp-Stiftung; Full / Part-time employment: Univ. Heidelberg; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. H. Kreipe: Advisory / Consultancy: Roche Pharma AG, Germany; Advisory / Consultancy: Novartis; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Genomic Health; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. G. Baretton: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: BMS; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): MSD; Honoraria (self), Advisory / Consultancy: AstraZeneca; Honoraria (self), Advisory / Consultancy: Pfizer; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. K. Steiger: Research grant / Funding (institution): Roche; Research grant / Funding (institution): BMS; Research grant / Funding (institution): MSD; Research grant / Funding (institution): Bruker Daltonics; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. M. Kiechle: Honoraria (self), Travel / Accommodation / Expenses: AstraZeneca; Honoraria (self), Travel / Accommodation / Expenses: Myriad; Research grant / Funding (self): German Cancer Aid; Research grant / Funding (self): DFG; Shareholder / Stockholder / Stock options: Therawis Diagnostics GmBH; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. S. Hieke-Schulz: Full / Part-time employment: Roche Pharma AG, Germany; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. W. Roth: Honoraria (self): Roche; Honoraria (self): AstraZeneca; Honoraria (self): MSD; Honoraria (self): Merck; Honoraria (self): Bayer; Honoraria (self): Novartis; Honoraria (self): Chugai; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany. W. Weichert: Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): MSD; Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): BMS; Advisory / Consultancy, Speaker Bureau / Expert testimony: AstraZeneca; Advisory / Consultancy: Pfizer; Advisory / Consultancy: Merck; Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Roche; Advisory / Consultancy, Speaker Bureau / Expert testimony: Novartis; Advisory / Consultancy: Celgene; Speaker Bureau / Expert testimony: Boehringer; Speaker Bureau / Expert testimony: Lilly; Speaker Bureau / Expert testimony: Takeda; Speaker Bureau / Expert testimony: Amgen; Research grant / Funding (institution): Bruker Daltonics; Non-remunerated activity/ies, Support for third-party medical writing assistance: Roche Pharma AG, Germany.

For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives during surgical staging of the axilla in pN+

The "lean" umbilical cord (also known as thin-cord syndrome) is a comparatively rare anomaly of the umbilical cord, which has seldom been described in the medical literature. We report on a 35-year-old women who presented to us at 29 + 4 weeks gestation with vaginal bleeding and cervical incompetence subsequently complicated not only by premature rupture of membranes but also acute placental insufficiency requiring emergency caesarean section under general anaesthesia at 31 + 2 weeks gestation. At surgery no obvious cause for the acute placental insufficiency - such as placental abruption, cord prolapse or true knot of the umbilical cord - was found. Other possible causes such as vasa praevia or placenta praevia had previously been excluded sonographically on admission for vaginal bleeding. The only notable intraoperative finding was a macroscopically extremely thin umbilical cord.Der sogenannte Thin-Cord-Komplex ist eine relativ seltene Nabelschnurpathologie, die bisher in der Literatur nur wenig beschrieben wurde. Wir berichten über eine 35-jährige Patientin, die sich seit der 29 + 4 Schwangerschaftswoche in unserer stationären Behandlung bei vaginaler Blutung sowie Zervixinsuffizienz befand und bei der es im klinischen Verlauf nicht nur zu einem vorzeitigen Blasensprung, sondern auch zu einer akuten Plazentainsuffizienz mit Entbindung per Notsectio in Intubationsnarkose in der 31 + 2 Schwangerschaftswoche kam. Intraoperativ zeigte sich kein Anhaltspunkt für Ursachen einer akuten Plazentainsuffizienz wie vorzeitige Plazentalösung, Nabelschnurvorfall bei vorzeitigem Blasensprung oder Nabelschnurknoten. Andere Ursachen wie Vasa praevia oder Placenta praevia bei vaginaler Blutung als Aufnahmegrund wurden bereits im Vorfeld sonografisch ausgeschlossen. Lediglich fiel intraoperativ eine makroskopisch äußerst dünne Nabelschnur auf.

The St. Gallen International Consensus Conference on the treatment of patients with primary breast cancer has been held regularly (every second year in the last six years) for more than 30 years. This year, the findings of the International St. Gallen Consensus Panel and their implications for clinical practice were again discussed by a German working group of leading breast cancer specialists. Five of the breast cancer specialists from Germany were also members of this year's St. Gallen panel. A comparison between the St. Gallen recommendations and the annually updated treatment guidelines of the Gynecologic Oncology Group (AGO 2017) and the S3-guideline agreed upon in 2017 is useful. The recommendations of the St. Gallen panel represent an international cross-section of opinions of experts from different countries and different disciplines, while the S3-guideline and AGO guidelines are evidence-based. The motto of this year's 15th St. Gallen Conference was "Escalating and De-Escalating". The rationale behind this concept was to promote more individualized treatment and thereby reduce overtreatment as well as undertreatment.Seit über 30 Jahren findet regelmäßig (in den letzten 6 Jahren alle 2 Jahre) die internationale St. Gallen-Konsensuskonferenz zur Behandlung von Patientinnen mit primärem Mammakarzinom statt. Die Ergebnisse des internationalen St. Gallen-Konsensus-Panels wurden auch dieses Jahr wieder von einer deutschen Arbeitsgruppe führender Brustkrebsexperten für den Klinikalltag in Deutschland diskutiert. Fünf der Brustkrebsexperten aus Deutschland sind zugleich Mitglieder des diesjährigen St. Gallen-Panels. Der Vergleich der St. Gallen-Empfehlungen mit den jährlich aktualisierten Therapieempfehlungen der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO-Mamma 2017) und der aktuell im Jahre 2017 abgestimmten S3-Leitlinie ist sinnvoll. Die Empfehlungen des St. Gallen-Panels stellen ein Meinungsbild von Experten unterschiedlicher Länder und Fachdisziplinen dar, wohingegen S3-Leitlinie und AGO-Empfehlungen evidenzbasiert sind. Die diesjährige 15. St. Gallen-Konsensuskonferenz stand unter dem Motto „Escalating and De-Escalating“, das sich durch alle Therapiebereiche zog, die zur Abstimmung standen. Ziel war es, Patientinnen individuellere Therapieoptionen anzubieten und das Risiko einer Über- bzw. Untertherapie zu vermeiden.

Introduction: Substitution of estrogenes and progestins is the most common therapy and prophylaxis for postmenopausal discomforts like hot flushes, osteoporosis, etc. However in the majority of studies long term HRT has been associated with an slightly increased risk of breast cancer. On the other hand patients with preoperative HRT have a lower mortality and a longer overall-survival. Material and Methods: For further investigation we examined 544 patients between 45 and 60 years at time of first diagnosis of breast cancer with and without HRT with regard to the incidence of bone metastases. 154 patients were premenopausal (mean 48.0±2.7 y), 390 were postmenopausal (54.5±3.5 y), 208 of them received HRT (group HRT+) and 182 patients not (group HRT-). Patients of group HRT+ received estrogenes over a minimum of 12 months (mean 5.5 ±4.0y). Results: Although tumor size and grading of group HRT- were significantly higher than in group HRT+ (p = 0.024), nodal status, S-phase fraction, and hormone-receptor status showed no significant differences. Adjuvant treatment in the postmenopausal groups were also not significantly different. In regard to the incidence of metastases patients without HRT have significantly (p

Gene signatures which are based on multigene profiling assays have been developed for the purpose to better define the prognosis and prediction of therapy results in early-stage breast cancer. These assays were designed to be more specific than conventional clinico-pathologic parameters in the selection of patients for (neo-)adjuvant treatment and in effect help to avoid unnecessary cytotoxic treatment. In this review we describe molecular risk scores, for which tests are commercially available (PAM50®, MammaTyper®, MammaPrint®, Oncotype DX®, Endopredict®, Genomic Grade Index®) and IHC risk scores (Mammostrat® and IHC4), and discuss the current evidence of their clinical use.In den letzten Jahren wurden eine Reihe verschiedener Gensignaturen, die auf Multigenassays basieren, für die Abschätzung der Prognose und Prädiktion beim frühen Mammakarzinom entwickelt. Die Zielsetzung dieser Assays ist die Verbesserung der Spezifität gegenüber konventionellen klinisch-pathologischen Parametern für die Therapieplanung, speziell für die Optimierung der Selektion von Patienten für die (neo-)adjuvante Therapie und zur Vermeidung überflüssiger zytotoxischer Therapien. In diesem Review beschreiben wir wichtige molekulare Risikoscores, für die Tests kommerziell angeboten werden (PAM50®, MammaTyper®, MammaPrint®, Oncotype DX®, Endopredict®, Genomic Grade Index®), sowie vergleichbare immunhistochemische (IHC) Risikoscores (Mammostrat®, IHC4), und diskutieren die wissenschaftliche Evidenz dieser Tests und deren klinischen Anwendungsbereich.