Bei 164 Magensaftanalysen wurde Pentagastrin in einer Dosis von 0,5 mg verwendet. Nach einer Vorperiode von zweimal 15 Minuten wurde nach Pentagastrinreiz der Magensaft in vier 15-Minuten-Perioden gesammelt. Bei Gesunden finden sich nach Pentagastrinreiz HC1-Werte in 60 Minuten zwischen 20 und 30 mval. Die Höhe der Säurewerte läßt in etwa Beziehungen zur Körperoberfläche erkennen. Eine über diesen Parameter weit hinausgehende Säurebildung findet man meist bei Patienten mit einem Ulcus duodeni. Bei der Oberflächengastritis ist die sekretorische Magenleistung kaum in Mitleidenschaft gezogen. Bei der chronischen Gastritis sieht man eine eindçutige Verminderung des Säurebildungsvermögens. Mit schweren sekretorischen Ausfällen geht die chronische, mit Atrophie und Umbau verbundene Gastritis einher. Nebenwirkungen beobachtet man nach Pentagastrin-Injektion im allgemeinen nicht. Auch kreislauf labilen und herzkranken Patienten kann man derartige Untersuchungen, soweit der Sondenreiz nicht eine besondere Belästigung darstellt, durchaus zumuten.
Background: In an ongoing, prospective observation study, treatment pattern of HER2 antibody-based treatment in metastatic breast cancer (MBC) in clinical routine is evaluated in Germany since 2001. Material and methods: A total of 1.687 patients (pts), presenting with Her2neu overexpressing MBC either pretreated (39%) or naïve to palliative chemotherapy (CT), were recorded in 202 German institutions. The median duration of fully documented therapy was 51 weeks. Additional information on trastuzumab (T) treatment beyond progression (TBP) was retrieved, as well as long-term outcomes, progression-free and overall survival (PFS, OS) in a subgroup of 940 pts, in which the treatment documentation had been finalized before July 2007. Results: According to the most recent recommendations the majority of pts received T concurrently with chemotherapy (74%), 14% received T in combination with endocrine therapy (ETO). and 12% T as single agent therapy (SAT). In a multivariate logistic model, the choice of a non-cytotoxic regimen (ETO/SAT) was independently associated with the following pts characteristics: no visceral metastasis (p = 0.0000002), and positive hormone receptor status (p = 0.0018), while higher patient age (> 65 y) (p = 0.061), and number of metastatic sites < 2 showed a clear trend. No major correlation was observed between administration of cytotoxic treatment and relapse-free interval after initial diagnosis of breast cancer, adjuvant chemotherapy, adjuvant hormone therapy, and metastatic disease at initial diagnosis. After a median follow-up of more than 30 months (mo), median PFS (840 events) was 11.1, 9.9 and 19.1 mo and median OS (530 deaths) was 32.7, 39.6 and 48.8 mo in the CT, SAT and ETO group, respectively. Overall best response rates were 64%, 47%, and 45%. Trastuzumab TBP was applied with a growing tendency over time and could be analyzed in a subgroup of 376 first-line patients with progression within approximately one year. The prolongation of trastuzumab remains to be strongly associated with longer survival after first progression in this updated analysis (medians: 15.1 vs. 20.6 mo; HR = 0.66, 95% CI: 0.49 - 0.88; p = 0.0045). Conclusion: This large non-interventional trial reveals that 74% of all included patients were treated with trastuzumab plus CT which is considered standard of care for 1stline HER2+ MBC. The decision for not choosing a CT-based regimen was associated with good prognostic factors (no visceral metastasis, positive hormone receptor status, only one metastatic site) or higher age. Trastuzumab beyond progression is used increasingly in routine clinical practice and results in a prolonged survival. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-12-04.
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