Rachel Wuerstlein

Ludwig-Maximilians-University of Munich, München, Bavaria, Germany

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Publications (39)33.79 Total impact

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    ABSTRACT: We aimed to define the patient subgroups with tumors <1 cm which would benefit from adjuvant systemic chemotherapy.•We analyzed their risk of BC-recurrence and survival using population-based cancer registry data.•Prognosis of nodal negative tumors <1 cm is excellent, especially if they are HR-positive.•No need for chemotherapy in pT1a tumors, in pT1b chemotherapy may be considered.•In pT1c guideline-based adjuvant therapy using all therapeutic options seems to be warranted.
    The Breast. 11/2014;
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    ABSTRACT: To identify (1) how frequently patients are invited to take part and actually do take part in multidisciplinary tumor conferences (MTCs), (2) which patient characteristics affect whether they are invited to MTCs and whether they decide to participate, (3) the extent to which invitation and participation depend on the specific hospital.
    Breast (Edinburgh, Scotland) 10/2014; · 2.09 Impact Factor
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    ABSTRACT: Purpose: The aim of this study was to evaluate the quality standard of the nationwide breast ultrasound training program of the German Society of Ultrasound in Medicine (DEGUM) through objective parameters. Materials and Methods: 10 quality criteria, based on the recommendations of The National Association of Statutory Health Insurance Physicians (KBV), were defined for this study. All training units of the DEGUM received a questionnaire. The questionnaires and training material were analyzed. Results: All units met the required criteria pertaining to the trainer's qualification, duration per training course and the maximum number of participants per ultrasound machine. Only 1 course did not fulfill the required 50 % practical training time. The requirements to participate in the graduate course (200 self-made and documented cases) were not clearly conceived and a defined training log could be improved. Conclusion: DEGUM breast ultrasound training offers trainees a high level of education based on the requirements of the KBV. Despite the high quality of training, the content of course announcements could be improved and an official and structured educational index could be meaningful.
    Ultraschall in der Medizin 02/2014; · 4.12 Impact Factor
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    ABSTRACT: The Advanced Breast Cancer Second International Consensus Conference (ABC2) on diagnosis and treatment of advanced breast cancer took place in Lisbon, Portugal, on November 7-9, 2013. The focus of the conference was inoperable, locally advanced breast cancer. The diagnosis and treatment of metastatic breast cancer had already been discussed 2 years before at the ABC1 Consensus and were only updated regarding special issues as part of this year's ABC2 Consensus. Like 2 years ago, a working group of German breast cancer experts commented on the voting results of the ABC panelists, with special consideration of the German guidelines for the diagnosis and treatment of breast cancer (German Gynecological Oncology Working Group (AGO) recommendations, S3 Guideline) in order to adapt them for daily clinical practice in Germany. The goal of both the ABC Consensus and the German comments is to facilitate evidence-based therapy decisions.
    Breast Care 02/2014; 9(1):52-9. · 0.68 Impact Factor
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    ABSTRACT: The developments in gene expression analysis have made it possible to sub-classify hormone receptor-positive (luminal) breast cancer in different prognostic subgroups. This sub-classification is currently used in clinical routine as prognostic signature (e.g. 21-gene Onoctype DX®, 70-gene Mammaprint®). As yet, the optimal method for sub-classification has not been defined. Moreover, there is no evidence from prospective trials. This review explores widely used genomic signatures in luminal breast cancer, making a critical appraisal of evidence from retrospective/prospective trials. It is based on systematic literature search performed using Medline (accessed September 2013) and abstracts presented at the Annual Meeting of American Society of Clinical Oncology and San Antonio Breast Cancer Symposium.
    Breast Care 12/2013; 8(6):414-422. · 0.68 Impact Factor
  • Nadia Harbeck, Rachel Wuerstlein
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    ABSTRACT: With the advent of the monoclonal antibody trastuzumab over 2 decades ago for breast cancer therapy, the outcome of patients with human epidermal growth factor receptor (HER) 2-positive disease has improved dramatically. Based on its substantial efficacy and good tolerability, trastuzumab has become the therapeutic gold standard for early as well as advanced breast cancer. Nevertheless, despite adjuvant trastuzumab, patients do experience recurrence and require further anti-HER2-targeted therapy. Next to the small molecule tyrosine kinase inhibitor lapatinib, which was the first approved therapy option after trastuzumab failure, several new anti-HER2 agents are currently already available for clinical use [i.e. pertuzumab, T-DM1 (trastuzumab emtansine)] or are still being evaluated (e.g. afatinib, neratinib). Recent evidence from neoadjuvant as well as metastatic therapy suggests that dual blockade may be superior to single-agent HER2 blockade. While the number of available or potential therapies has increased considerably, no additional predictive biomarkers beyond HER2 have been validated for the use of the different anti-HER2 therapies. Moreover, novel therapeutic concepts such as the antibody-drug conjugate T-DM1 warrant excellent determination methodology for HER2 and suggest re-evaluation of tumor biology upon first metastasis. The clinical challenge remains to optimally choose, utilize, and sequence anti-HER2 therapy in early as well as metastatic breast cancer. This article will provide evidence-based guidance for sequencing anti-HER2 therapy throughout the continuum of breast cancer therapy.
    Drugs 10/2013; · 4.13 Impact Factor
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    ABSTRACT: In early breast cancer (eBC), established clinicopathological factors are not sufficient for clinical decision making particularly regarding adjuvant chemotherapy since substantial over- or undertreatment may occur. Thus, novel protein- and molecular markers have been put forward as decision aids. Since these potential prognosis and/or predictive tests differ substantially regarding their methodology, analytical and clinical validation, this review attempts to summarize the essential facts for clinicians. This review focuses on those markers which are the most advanced so far in their development towards routine clinical application, i.e. two protein markers (i.e. uPA/PAI-1 and IHC4) and six molecular multigene tests (i.e. Mammaprint®, Oncotype DX®, PAM50, Endopredict®, the 97-gene genomic grade, and 76 gene Rotterdam signatures). Next to methodological aspects, we summarized the clinical evidences, in particular the main prospective clinical trials which have already been fully recruited (i.e. MINDACT, TAILORx, WSG PLAN B) or are still ongoing (i.e. RxPONDER/SWOG S1007, WSG-ADAPT). Last but not least, this review points out the key elements for clinicians to select one test among the wide panel of proposed assays, for a specific population of patients in term of level of evidence, analytical and clinical validity as well as cost effectiveness.
    Cancer Treatment Reviews 09/2013; · 6.02 Impact Factor
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    ABSTRACT: Background: Almost 70% of early BC are endocrine responsive, as defined by estrogen receptor (ER) expression; however roughly 30% of ER+ BC patients will relapse despite adjuvant ET. Moreover, 10 to 20% of BC metastases lose ER expression. The upfront administration of ET in ER+ women with MBC is recommended by major guidelines. However, the early identification of endocrine resistance might improve systemic treatment options, sparing unnecessary toxicities and inactive drugs. 18F-FES, an oestradiol analogue labeled with 18F, may allow to test the performance of ERs, by testing their in vivo linkage ability. In MBC, 18F-FES uptake has been proposed to be a better predictor of response to ET than ER expression itself. The aim of the ET-FES study is to validate the predictive value of 18F-FES uptake at PET/CT scan in metastatic ER+ patients. Methods: This is aphase II, multicentric european comparative study of first line ET vs CT in ER+ MBC with low 18F- FES uptake. The primary endpoint is disease control rate (DCR). Correlative studies include: 1. Optimization of 18F-FES production; 2. Association between gene alterations in ESR1/ESR2 genes and 18F- FES uptake; 3. Development of a predictive score of endocrine responsiveness based on 18F-FES SUV value and clinical and biological information. All patients with ER+ MBC candidate to first line ET will receive a 18F-FES CT/PET at baseline, in addition to standard staging. Patients with 18F-FES uptake (SUV) > 2 will receive ET. Patients with 18F-FES SUV < 2 will be randomized to ET until disease progression (control arm) or CT (single agents) until PD. A total of 220 patients with ER+ MBC will be enrolled. Of these, approximately 50% (n=110) will show a 18F-FES SUV < 2 and will be randomized to ET or CT. The study will have 85% power to detect an absolute 20% difference in the DCR between arms after 3 months of therapy, assuming a 5% two-sided alpha level and a 10% drop-out rate. Current status: The ET-FES study was approved for funding by the ist Join TRANSCAN European call. 18F-FES production is currently on final development (GMP), and the clinical protocol is being finalized for EC approval in the different EU countries. Clinical trial information: 2013-000287-29.
    2013 ASCO Annual Meeting, Chicago, Illinois-US; 06/2013
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    ABSTRACT: Invasion factors uPA/PAI-1 are guideline-recommended (ASCO, AGO) biomarkers for decision support regarding adjuvant chemotherapy (CTX) in women with primary breast cancer. They define a high-risk group with strong benefit from adjuvant CTX and a low-risk group with uncertain benefit and excellent survival without CTX. In a target population (age > 35/N0/G2/HR+/HER2-), administration of adjuvant CTX is not mandatory in Germany and other countries. Based on existing data, this economic model was developed to determine for the first time health economic impact of uPA/PAI-1 testing. Incremental cost-effectiveness ratio (ICER) resulting from uPA/PAI-1 testing was estimated for the target population by Markov modeling and sensitivity analysis. Survival data, CTX-uPA/PAI-1 interactions, and uPA/PAI-1 hazard ratios were derived from the Chemo N0 trial and other evidence. Incremental costs were computed from a payer's perspective appropriate to the German setting. Incremental effectiveness in life years (ly) was estimated taking into account age-adjusted life expectancy, disease-free survival (with/without CTX), and 2 years post-relapse survival. Sensitivity analysis was performed by varying residual adjuvant CTX benefit in the low-risk group, denoted HR_CTX(LR), in range 0.8-0.99. All patients receive adjuvant endocrine therapy. Test is restricted to patients willing to forgo CTX if both markers are below specific cut-off values and to undergo CTX otherwise. For a typical 55-year-old patient, comparing to an "all-CTX" strategy without the test, ICER (all-CTX vs. test) > 50,000 if HR_CTX(LR) > 0.85, with savings of 18,500 per low-risk patient attributable to the test. The cost-effectiveness of forgoing CTX is very high as HR_CTX(LR) approaches one. Conversely, comparing to a "no-CTX" strategy (e.g., patients who initially refuse CTX) without the test, the test is very cost-effective at all ages in the target group if high-risk patients are willing to undergo CTX: ICER (test vs. no-CTX) < 6,000 at age 55 and even better at younger ages, remaining < 25,000 up to age 75. The main determinants of cost utility are age and residual CTX benefit in low-uPA/PAI-1 patients. The uPA/PAI-1 test is cost-effective in the target group compared to either an "all-CTX" or a "no-CTX" scenario. This model thus lends health economic support to current guideline recommendations that uPA/PAI-1 testing is beneficial for BC patients with no lymph node involvement.
    Breast Cancer Research and Treatment 04/2013; · 4.47 Impact Factor
  • N Harbeck, R Wuerstlein
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    ABSTRACT: Personalized medicine in the sense of individualized therapy concepts plays an important role in breast cancer. In early breast cancer the molecular subtypes luminal A and B and basal-like are important for planning adjuvant systemic therapy. Prognostic and predictive markers, such as hormone receptor status, HER2, Ki-67, uPA/PAI-1 or multiple gene tests, such as Oncotype DX® currently allow avoidance of an over therapy or under therapy. In early and also advanced breast cancer there are an increasing number of new targeted therapies which represent an augmentation of standard endocrine and chemotherapy and in the future could at least partially replace them. As a whole the therapy regimens for breast cancer have become more complex due to the inclusion of molecular information, new therapies and the withdrawal of conventional treatment concepts. Decisive for the future will be the confirmation of this development by modern study concepts contemporarily with adequate evidence. It could then be expected that a personalized therapy for early breast cancer and in particular adjuvant chemotherapy would only be used for those patients for whom it is really necessary. In advanced stage disease there is justified hope that the survival time in the sense of a chronic disease can be improved by the use of targeted therapy.
    Der Internist 02/2013; · 0.33 Impact Factor
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    ABSTRACT: Validated prognostic and predictive factors currently play an important role in treatment planning for patients with early-stage breast cancer. The role of personalized medicine has led to the search for markers that can be applied to individual patients to optimize treatment regimens. In addition to traditional clinicopathologic measures, scores and gene tests have been developed to independently predict risk of patients in the neoadjuvant and adjuvant settings. The discovery of these markers provides the opportunity to identify patients at such low risk of recurrence that toxic therapy side effects are not justified. Selection and management of patients with early-stage, hormone receptor-positive breast cancer who are appropriately treated with endocrine therapy alone after receiving locoregional therapy but do not necessarily require adjuvant chemotherapy is currently problematic. This article reviews the current state-of-theart biomarker assessment methods and discusses the potential role for the prediction of chemotherapy benefit focusing on endocrine sensitive disease.
    Reviews in obstetrics and gynecology 01/2013; 6(3-4):165-73.
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    ABSTRACT: The term filariasis comprises a group of parasitic infections caused by helminths belonging to different genera in the superfamily Filaroidea. The human parasites occur mainly in tropical and subtropical regions, but filariae are also found in temperate climates, where they can infect wild and domestic animals. Humans are rarely infected by these zoonotic parasites. A 55-year-old patient presented with a new-onset, subcutaneous, non-tender palpable mass in the right axilla. Ultrasonography showed a 1.3-cm, solid, singular encapsulated node. Sonography of the breast on both sides, axilla and lymphatic drainage on the left side, lymphatic drainage on the right side, and mammography on both sides were without pathological findings. The node was excised under local anesthesia as the patient refused minimal invasive biopsy. On histopathological examination, the tail of a parasite of the group of filariae was found. The patient revealed that she had stayed in Africa and Malaysia for professional reasons. 6 months before the time of diagnosis, she had also suffered from a fever and poor general condition after a trip abroad. The patient was referred for further treatment to the Institute for Tropical Medicine at the University of Dusseldorf, where a treatment with ivermectin was conducted on the basis of positive staining with antibodies against filariae. Our case demonstrates the importance of interdisciplinary collaboration between breast center, pathology, and other specialties such as microbiology and tropical medicine.
    Breast Care 12/2012; 7(6):487-9. · 0.68 Impact Factor
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    ABSTRACT: The objective of this study is to investigate health-related quality of life (HRQoL) in male breast cancer patients. Data of 20,673 patients diagnosed with primary breast cancer (male: n = 84) who completed a questionnaire after discharge from hospital were analysed. HRQoL (SF-36), age, sex, education, native language, insurance status, and partnership status were measured. Cancer staging, treatment (partial mastectomy vs. radical mastectomy), and cancer site were indicated by the clinicians. The HRQoL scores of male breast cancer patients were compared with reference populations. Differences in HRQoL scores between men and women were compared using t tests and regression analysis. Compared to female breast cancer patients, male patients scored significantly higher on seven of eight subscales (physical functioning, role functioning-physical and emotional, bodily pain, vitality, social functioning, and mental health) in the regression analysis. Compared to the reference populations (general male population, men aged 61-70, and the cancer-affected population), male breast cancer patients scored lower on SF-36 subscales on average, with major differences in emotional and physical role functioning. The results suggest that male breast cancer patients may need early interventions that specifically target role functioning, which is severely impaired compared to the male reference population. Future research needs to assess HRQoL with cancer-specific questionnaires and longitudinal designs also focussing on male patients in breast centres.
    Breast Cancer Research and Treatment 02/2012; 133(2):753-7. · 4.47 Impact Factor
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    Breast Care 12/2011; 6(6):482-484. · 0.68 Impact Factor
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    ABSTRACT: To comply with patients' needs as well as ASCO and WHO recommendations, our institution aims to integrate palliative care (PC) early in the course of breast cancer (BC) therapy. The evaluation of relevant pilot project data revealed that these recommendations were too vague to trigger PC integration. Therefore, a standard operating procedure (SOP) was developed by our interdisciplinary working group to provide disease-specific information to overcome the ambiguity of the WHO recommendations and guide PC integration. Literally, the SOP states that 'Specialized PC is recommended regularly for all BC patients without curative treatment options, specifically for patients with i) metastasized and inoperable, or ii) locally advanced and inoperable, or iii) relapsing BC, who are receiving intravenous chemotherapy'. This SOP for the first time presents disease-specific guidelines for PC integration into comprehensive BC therapy by defining 'green flags' for early integration of PC and delineating PC from senology assignments. Although disease-specific SOPs have also been developed by this working group for other malignancies, the decision when to first integrate PC into BC therapy differs substantially because of the different clinical characteristics of the disease.
    Breast Care 10/2011; 6(3):240-244. · 0.68 Impact Factor
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    ABSTRACT: Only a few studies have investigated the association between hospital characteristics and breast cancer patients' satisfaction with nursing staff. The aim of this study was to determine whether the satisfaction of newly diagnosed breast cancer patients with nursing staff correlates with hospital characteristics after taking the relevant patient characteristics into account. Multilevel regression analysis was applied, combining survey data from newly diagnosed breast cancer patients regarding their characteristics and satisfaction with nursing staff with data on the characteristics of the hospitals in which the patients were treated. Data from 2945 patients from 81 hospitals were analyzed in multilevel logistic regression models. The patients were significantly more likely to be satisfied with the nursing staff in hospitals that employed breast care nurses (BCNs) at the time of the survey. At the patient level, patients were significantly more likely to be satisfied with nursing staff if the patients were native speakers and rated their own health more highly. Cross-level interaction analysis suggested that the increased patient satisfaction with nursing staff that resulted from employing BCNs was largely limited to native German-speaking patients. The results demonstrate that patient satisfaction with nursing staff is higher if BCNs are employed in the treatment hospital. However, only the satisfaction of native speakers was significantly higher when BCNs were employed. These findings suggest that hospitals should invest in employing specialist nurses. Special attention should be paid to the care of non-native-speaking patients.
    Cancer nursing 09/2011; 35(3):221-8. · 1.88 Impact Factor
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    Rachel Wuerstlein, Ingo Bauerfeind
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    ABSTRACT: SUMMARY: Metastatic breast cancer (MBC) is a chronic and incurable disease which can be kept steady for a long time with continuous oncologic therapy. There are various treatment options. Disease-free as well as overall survival were prolonged in many pharmaceutical studies. The therapist focuses on these oncologic parameters as well as the patient's quality of life. One central point of the communication between doctor and patient is the prediction by the medical team of how long to continue oncologic therapy and when to start palliative medicine in terms of best palliative care. Treatment options currently available for MBC as well as the importance of this difficult communication between the involved parties are pointed out. The end of tumor-specific oncologic therapy does not necessarily mean the end of therapeutic measures for the individual patient.
    Breast Care 01/2011; 6(1):35-41. · 0.68 Impact Factor
  • Geburtshilfe und Frauenheilkunde 01/2011; 71(01). · 0.85 Impact Factor
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    ABSTRACT: BACKGROUND: To comply with the World Health Organization (WHO) recommendations, our institution's administrative directives were adopted to advocate the provision of palliative care (PC) early in the disease trajectory of breast cancer (BC). To assess the outcome of this recommendation, this study evaluated the effects of this approach. METHODS: A retrospective systematic chart analysis of a 2-year period was performed. The first PC consultation of patients was analyzed according to (a) physical condition, (b) symptom burden of the patients, and (c) reasons for PC consultation. RESULTS: Many patients were already in a reduced physical state and experienced burdening symptoms when first counselled by PC. After a 1-year experience with PC consultations, the number of burdening symptoms identified at first PC consultation decreased and senologists increasingly requested PC support also for non-somatic issues. CONCLUSIONS: A development towards a better understanding of PC competencies after a 1-year initiation period could be demonstrated, but BC patients continued to be in late stages of the disease at the time of first PC contact. Disease-specific guidelines may facilitate and optimize the integration of PC into breast cancer therapy.
    Breast Care 01/2011; 6(3):215-220. · 0.68 Impact Factor
  • Breast. 01/2011; 20.

Publication Stats

21 Citations
33.79 Total Impact Points


  • 2013–2014
    • Ludwig-Maximilians-University of Munich
      München, Bavaria, Germany
    • Paracelsus Medical University Salzburg
      Salzburg, Salzburg, Austria