Elena Laakmann

Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review

Objective: The systematic review examines whether Cimicifuga racemosa (CR), Hypericum perforatum (HP), Agnus castus, vitamins and minerals, either as monotherapy or in combination, have an evidence-based impact on vasomotor, genital and psychological climacteric complaints. Data sources and methods of study selection: We searched in the databases EMBASE, OVID and PubMed using the keywords “vasomotor symptoms, hot flashes, vaginal atrophy, psychological problems, endometrium, sleep, concentration, cognition in combination with vitamins, multivitamins, minerals, multiminerals, black cohosh, Cimicifuga, Agnus castus, chasteberry, chaste tree, monk’s pepper and menopause” for randomized controlled trials (RCT). Relevant studies were reviewed by four independent reviewers qualitatively. Results: Most of the studies with a comparison of CR vs. placebo do not show an evidence-based significant effect of CR on climacteric symptoms. The combination of CR and HP shows an improvement of climacteric complaints in comparison to placebo. In some RCTs, there was no significant difference between CR and hormone-replacement therapy. The combination of HP and Agnus castus showed no significant difference in the treatment of climacteric complaints. Conclusion: CR monotherapy as well as HP and Agnus castus showed no better effect than placebo. The combination of CR with HP demonstrated a positive effect on climacteric complaints.

Systemic Treatment Options for HER2-Positive Breast Cancer Patients with Brain Metastases beyond Trastuzumab: A Literature Review

Background: The incidence of brain metastases (BM) in breast cancer patients has increased. Many retrospective analyses have shown that first-line treatment with trastuzumab prolongs survival in patients with HER2-positive BM. In contrast, the evidence for other therapies targeting HER2 for patients with BM is rare. Methods: The aim of this review is to update the reader about current systemic treatment options in patients with HER2-positive metastatic breast cancer with BM who had already received trastuzumab. A literature search was performed in the PubMed database in June 2016. 30 relevant reports concerning the efficacy of trastuzumab emtansine (T-DM1), lapatinib and its combination with other cytotoxic agents, pertuzumab and novel HER2-targeting substances were identified. Results: There is limited but promising evidence for the use of T-DM1 and pertuzumab in the treatment of BM. Up to now, most reported studies used lapatinib as treatment of HER2-positive breast cancer with BM, a treatment with only a modest effect and a high toxicity profile. The combination of lapatinib with cytotoxic agents seems to result in better response rates. Conclusion: Further prospective investigations are needed to investigate the efficacy of the established and novel HER2-targeting agents on BM in HER2-positive breast cancer patients.

Efficacy of Liposomal Cytarabine in the Treatment of Leptomeningeal Metastasis of Breast Cancer

Background: Breast cancer is one of the most frequent causes of leptomeningeal metastasis (LM) among solid tumors in adults. The prognosis of patients with LM is poor. A treatment option is the intrathecal administration of liposomal cytarabine. Case Reports: The first case represents a 53-year-old woman with LM of breast cancer. A neurological response was achieved shortly after the start of the multimodal treatment including intrathecal liposomal cytarabine. The response duration reached 79 days. The second case represents a 48-year-old woman with LM of breast cancer treated with intrathecal liposomal cytarabine as a part of a multimodal treatment approach. A neurological response was achieved in the first 2 weeks of treatment and is still lasting after 18 months. Conclusion: These cases suggest that a rapid response to a prompt start of treatment with intrathecal liposomal cytarabine in patients with LM of breast cancer is feasible. In 1 case an extremely long progression-free survival (18+ months) was achieved. The cases support the efficacy of liposomal cytarabine in the management of LM in breast cancer patients as a part of a multimodal treatment approach and underline the need for further investigations in this specific cohort.

Brain Metastases in Breast Cancer Network Germany (BMBC, GBG 79): aktueller Stand und Analyse der Patientendaten des Hirnmetastasenregisters

Zielsetzung: Die Inzidenz der Hirnmetastasierung bei Mammakarzinom-Patienten steigt in den letzten Jahren. Bisher gibt es wenige evidenzbasierte therapeutische Ansatze bei cerebralen Metastasen eines Mammakarzinoms. Die Datenlage zu den tumorbiologischen Aspekten ist ebenfalls unzureichend. Im Hirnmetastasenregister Brain Metastases in Breast Cancer Network (BMBC) werden deshalb multizentrisch deutschlandweit klinische Daten der Patienten mit Hirnmetastasen eines Mammakarzinoms retrospektiv und prospektiv erfasst. Translationale Forschungsprojekte an vorhandenem Tumorgewebe der Patienten werden initiiert. Materialien und Methoden: Aktuell sind im Register klinische Daten von 1.105 Patienten erfasst (Stand 1/2016). Es wird angestrebt, klinische Daten von insgesamt 2000 Patientinnen zu dokumentieren und Tumorgewebe von 400 Hirnmetastasen auf Tissue Microarrays zusammenzufuhren. Ergebnisse: Die aktuell laufende Zwischenauswertung wird die Uberlebensdaten der Patientinnen in Abhangigkeit von tumorbiologischen Subtypen sowie unterschiedlichen Therapieregimen beinhalten. Zusatzlich wird in einem Subprojekt die Rolle der zusatzlichen Ganzhirnbestrahlung nach einer OP bzw. stereotaktischen Bestrahlung der Hirnmetastasen ausgewertet. Es werden die Morbiditat und Mortalitat der Patientinnen in den jeweiligen Gruppen analysiert. Zusammenfassung: In der aktuell laufenden Zwischenauswertung des BMBC Registers wird im besonderen die Rolle der Ganzhirnbestrahlung im Rahmen des Behandlungskonzeptes analysiert.