G. von Minckwitz

Topotecan Chemotherapy in Patients with Breast Cancer and Brain Metastases: Results of a Pilot Study

Background: Symptomatic brain metastases occur in approximately 10–15% of patients suffering from breast cancer and are linked to a clear deterioration of the patient’s condition. Although radiotherapy is recommended as a primary therapy, the optimal management remains controversial. To evaluate the role of topotecan as a primary chemotherapy for brain metastases, we performed a pilot study in patients with metastatic breast cancer. Patients and Methods: 24 patients with newly diagnosed, bidimensionally measurable brain metastases received topotecan, 1.5 mg/m2 day, 30-min infusion for 5 days every 3 weeks. A total of 93 courses of therapy were administered (range 1–11, median 3 courses per patient). Prior radiotherapy was excluded. Most of the patients had received prior adjuvant or palliative chemotherapy. Results: 3/24 patients were withdrawn from the study for various reasons, 16/24 patients could be evaluated in terms of their response to therapy; 1 and 5 patients showed complete and partial response to therapy, respectively, and 5 patients had a stable condition. The median time of survival was 6.25 months. Hematologic toxicity was the major side effect, nonhematologic side effects occurred rarely and were tolerable. Conclusions: Our results demonstrate that primary chemotherapy with topotecan is an effective and well-tolerated treatment for patients with breast cancer and CNS metastases. Based on this pilot study, future clinical protocols should be developed including multimodal treatment strategies (i.e. radiotherapy).

Taxane in der primären systemischen Therapie des Mammakarzinoms

Taxanes in Primary Systemic Treatment of Breast Cancer Primary systemic treatment today represents a new option for patients with operable breast cancer and is equally effective asTaxanes in Primary Systemic Treatment of Breast Cancer Primary systemic treatment today represents a new option for patients with operable breast cancer and is equally effective as conventional adjuvant chemotherapy. Improving surgical options is the most important indication for choosing this approach. The highest chance for breast conserving surgery can be obtained when a sequence of adriamycin and cyclophosphamide (AC) is followed by docetaxel. This has been shown in the Geparduo and NSABP-B27 trial. New approaches are considering individual tailoring of treatment according to either early response of the primary breast tumor (Gepartrio) or pharmacogenetic testing on the tumor tissue. Schlüsselwörter Primäre Chemotherapie ⋅ Mammakarzinom ⋅ Docetaxel

CYCLINS AND BREAST CANCER

Proliferation of mammalian cells is controlled through interactions between extracellular agents and intrinsic control mechanisms, eventually resulting in either progression through the G1, S, G2 cell cycle phases followed by mitosis or, alternatively, in cell cycle arrest, quiescence, differentiation, or cell death. Three important cell cycle control points, sometimes referred to as checkpoints, have been described: G1/S, G2/M, and M checkpoint (fig. 1). The G1/S checkpoint, also called restriction point, is the most important in tumorigenesis because at this level interactions between extrinsic, mitogenic signals and cell cycle control mechanisms occur. Cell cycle control is exerted by both positive (cyclins, cyclin-dependent kinases) (Cdk) and negative signals (Cdk inhibitors (CKI) such as p16, p21 Cyclins and Breast Cancer Review Article · Übersichtsarbeit

HER2-Diagnostik: Standard und zukünftige Entwicklungen / Neuere Therapiekonzepte beim metastasierten Mammakarzinom / Therapieentscheidung – Einfluss durch Patienten?

Wer sich mit dem Onkogen HER2/neu beschäftigt, fühlt sich gelegentlich wie jemand, der die Tür zu einem Raum öffnet, um sich sogleich drei weiteren ungeöffneten Türen gegenüber zu sehen. Immer neue Perspektiven tun sich für die Behandlung auf, und von einem umfänglichen Wissen über die Diagnostik von HER2/neu sind wir noch weit entfernt. Wir sitzen heute hier, um die eine oder andere Tür ein bisschen zu öffnen, hinein zu schauen, und unser Wissen zu vertiefen. Vielleicht werden wir Denkanstöße geben und die Richtung ein wenig mitbestimmen können, die die Onkologie auf dem Gebiet der HER2/neu Expression und der dadurch determinierten Therapie nehmen wird. J. Hilfrich, Hannover F. Jänicke, Hamburg

Bericht über die NIH Consensus Development Conference zur adjuvanten Therapie von Mammakarzinomen

Report on the NIH Consensus Development Conference on Adjuvant Therapy of Breast Carcinoma Zum 4. Mal fand vom 1. bis 3. November 2000 in Bethesda, Maryland, USA, eine Konferenz zur Erstellung eines Konsensus-Statements zur adjuvanten Therapie des Mammakarzinoms statt. Diese vom National Institute of Health (NIH) und dem National Institute of Cancer (NCI) der Vereinigten Staaten von Amerika zuletzt vor 10 Jahren organisierte und unterstützte Veranstaltung soll eine unabhängige Darstellung der derzeitigen Datenlage und der sich hieraus ableitenden Therapieempfehlungen geben. Die Mitglieder des Konsensus-Ausschusses sind sämtlich nicht als Experten auf dem Gebiet des Mammakarzinoms tätig, sondern Onkologen mit Schwerpunkt auf anderen Tumorerkrankungen, Statistiker, Gesundheitswissenschaftler und eine selbst betroffene Richterin. Das NIH hat dem Panel bereits im Vorfeld eine Bibliographie von 1200 Artikeln zu dem Thema zur Verfügung gestellt. Anlässlich der Konferenz wurden internationale Experten gebeten, zu gewünschten Themen vorzutragen und gezielte Fragen zu beantworten. ...

Laudatio: Prof. Dr. med. Dr. h.c. Wolfgang Wilmanns

founded the journal ONKOLOGIE in 1978. As a member of the editorial board and later, until 1994, a member of the scientific advisory board, he had a formative influence on the journal ONKOLOGIE over a period of sixteen years. He realized very early the importance of medical oncology within cancer treatment and emphasized the importance of establishing this new field as a subspeciality of internal medicine. As early as 1975 he observed administrative duties in the EORTC. From 1976 until 1984 he was chairman of the section Oncology of the ‘German Paul Ehrlich Society’, and from 1978 until 1984 he chaired the section ‘Hematology and Medical Oncology’ within the ‘Berufsverband Deutsche Internisten’. In the latter function, in a tough struggle over many years, he fought for the acceptance of medical oncology as a subspeciality in Germany. Not until the early nineties, however, ‘Hematology and Medical Oncology’ became officially approved. On occasion of his ‘emeritation’ we would like to acknowledge his merits. Wilmanns was born on May 20, 1929 as the tenth child of Dr. med. Richard Wilmanns, Head of the Surgical Hospital in Bethel/Bielefeld and his wife Marie. After his schooldays in Bielefeld, he studied medicine in Mainz, Innsbruck and Marburg from 1949 to 1955. 1957, after returning from an oneyear internship (1955/56) in Passaic/New Jersey, USA, he worked in pathology and surgery. From 1958 until 1960 he was a DFG stipendiary at the Department of Biochemistry of the University of Munich (Prof. Dr. F. Lynen). In 1960, he became a coworker of Prof. Dr. Dr. h.c. H. E. Bock, first as an assistant at the Medical University Clinic Marburg, and on October 1, 1960 he moved with his academic teacher to the Medical University Hospital Tübingen. His ‘habilitation’ in internal medicine followed in 1966, he was appointed ‘Oberarzt’ in 1967 and Professor in 1971. Tübingen was the starting point for his exemplary professional career. From 1973 to 1977 Wilmanns was Head of the Department of Internal Medicine II (Hematology, Oncology, Immunology) of the Robert Bosch Hospital in Stuttgart, after rejecting a call to a position as Full Professor and Head of the Medical Research Program at the University of Southern California, Los Angeles, USA. 1974 he was appointed Chair of Internal Medicine (with focus on Hematology) at the Universtity of Laudatio: Prof. Dr. med. Dr. h.c. Wolfgang Wilmanns Editorial