Up to 90% of pregnant women experience nausea and vomiting. When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening. In this article the aetiology, diagnosis and treatment strategies will be presented based on a selective literature review. Treatment strategies range from outpatient dietary advice and antiemetic drugs to hospitalization and intravenous (IV) fluid replacement in persistent or severe cases. Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect.In most cases, the condition is self limiting and subsides by around 20 weeks gestation. More severe forms require medical intervention once other organic causes of nausea and vomiting have been excluded. In addition, a psychosomatic approach is often helpful.In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal.

#3135 Background:
 Detection of DTC in bone marrow of breast cancer patients is correlated with both increased risk of recurrence and reduced survival. Cytological examination of DTC showed overexpression or amplification of Her2 disconcordantly to the HER2-status of the primary tumor in a subgroup of patients. Aim of the present study is to evaluate therapeutic effects of Trastuzumab on persistent HER2-positive DTC in bone marrow of early breast cancer patients having completed primary treatment.
 Patients and Methods:
 Detection of DTC was performed using the monoclonal pan-cytokeratin antibody A45-B/B3 and the APAAP technique for immunocytochemical staining. In 129 breast cancer patients without evidence for local or distant recurrence and detection of DTC in the bone marrow the HER2-status of these DTC was determined by chromogenic in situ hybridisation (CISH). Patients were followed prospectively for a median of 21 months (std 36,9) after the first bone marrow aspiration.
 12 of the patients with HER2 positive DTC received Trastuzumab at 6mg/kg q3w x 12mon (8mg/kg loading dose) as part of an interventional pilot trial. All patients had underwent surgery, leading to R0 resection of the tumor, and adjuvant chemotherapy was completed at least 6 month ago.
 Results:
 All of the 129 patients showed DTC at the first time of bone marrow aspiration. (range 1-256, median 2).
 Looking at primary histo-pathological findings, most of the patients' tumors were small (60,3% T1, 30,1% T2, 6,6% T3, 2,9% T4) but of intermediate or unfavourable grade (9,6% G1, 44,9% G2, 45,6% G3). 61% of the patients were node-negative (61,0% N0, 24,3% N1, 14,7% N2-3) and in 78,7% a positive hormone receptor status was seen. 26,4% of the tumors showed overexpression of Her2. 38.2% of the detected DTC showed a positive Her2-status at first bone marrow aspiration. The Her2-status of the primary tumor and of the DTC was concordant in 87 patients (67,6%, p=0.004), whereas 9.6% showed a positive status on the tumor but Her2-negative DTC. In 22.8% DTC were Her2-positive despite a negative Her2-status of the tumor. After Trastuzumab therapy in only 5 (41.7%) of the 12 treated patients DTC were present. The reduction in cell numbers between aspiration before and after Trastuzumab treatment showed a statistical trend (p= 0.51). Two (16.7%) of the treated patients developed distant metastases and 1 of them died for the disease .
 Trastuzumab treatment was generally well tolerated without severe cardiotoxicity.
 Conclusions:
 Identification of Her2-overexpressing DTC might proof as a useful objective for targeted therapies thus meliorating the prognosis of patients with DTC by eradicating these cells. If Trastuzumab shows a therapeutic effect in these patients, even if the Her2-Status of the primary tumor is negative, will have to be evaluated in further prospectively randomized studies. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3135.

Background: The use of anthracycline based chemotherapy in early breast cancer (EBC) patients has been well established. However, adverse effects like cardiotoxicity and efficacy in certain subgroups continue to be subjects of discussion. Based on data suggesting a limited benefit of anthracyclines in HER2-negative patients, the German SUCCESS C study randomly assigned patients with EBC to be treated with either anthracycline-containing or anthracycline-free chemotherapy. Since the prognostic value of CTCs in EBC has already been demonstrated in several trials, we compared the prevalence of CTCs after the completion of chemotherapy between both treatment arms. Methods: The SUCCESS C trial was a randomized, open-label, Phase III study comparing disease free survival (DFS) in patients with HER2-negative EBC. Treatments were either 3 cycles epirubicin, 5-fluorouracil and cyclophosphamide followed by 3 cycles of docetaxel (FEC–DOC), or 6 cycles of an anthracycline-free regimen with docetaxel and cyclophosphamide (DOC-C). The CTC status at chemotherapy cycle 6 was prospectively evaluated using the FDA-approved CellSearch System (Veridex, USA). Results: Data on CTC status after chemotherapy are available for 1757 patients. Overall, CTCs were found in 220 (12.5%) patients (median 1, range 1 – 18 CTCs). One CTC was detected in 123 (55.9%), two CTCs in 53 (24.1%), three to five CTCs in 37 (16.8%), and more than five CTCs in 7 (3.2%) of these patients. Univariate analyses revealed that CTC prevalence was not significantly associated with tumor size (pT1, pT2, pT3, pT4), nodal stage (pN0, pN1, pN2, pN3), grading (G1, G2, G3), histological type (invasive ductal, invasive lobular, other), estrogen-receptor status, or progesterone-receptor status (Chi-square tests, all p > 0.1). There was no significant difference with respect to the prevalence of CTCs after chemotherapy between the two treatment arms (Chi-square test, p = 0.23), as CTCs were detected in 11.6% (103 out of 889) of patients treated with the anthracycline-containing chemotherapy regimen and in 13.5% (117 out of 868) of patients treated with the anthracycline-free chemotherapy regimen. In addition, there was no significant difference between the two treatment arms with regard to the number of CTCs detected after chemotherapy in CTC-positive patients (FEC-DOC: median = 1, range 1 – 18; DOC-C: median = 1, range 1 – 8; Mann-Whitney U test, p = 0.30). Conclusions: The comparable prevalence and number of CTCs after the completion of chemotherapy may indicate that anthracycline-free chemotherapy is not inferior to anthracycline-containing chemotherapy in this study. This however, has to be confirmed by survival analyses, which will be available in 2014. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-12-09.

Background: Recent studies in the US showed a relationship between the state of social or health insurance of cancer patients and their overall survival. [1-3] In Germany 91% of all women are estimated to have a compulsory health insurance whereas 9% have private health coverage. There are no patients without any health insurance in Germany. Patients and Methods: In a retrospective analysis of 1846 german patients with early breast cancer the correlation between state of social and health insurance and overall survival was investigated. 59.6% of the patients had a social insurance whereas 40.4% had none. 69.1% of the patients carried compulsory health insurance while 30.9% had private coverage. Among the patients with compulsory health insurance 56.6% had had a professional education and 41.5% were employed whereas among the patients with private coverage 66.2% were professionally experienced and 43.9% were working. Age, tumor size, lymph node metastases, grading and both hormone and her2-status were well balanced between the two groups. 25.4% of all patients had undergone mastectomy and 72.6% had had a breast conserving therapy. In 2.0% of the patients no surgery was performed. 33.6% of all patients received adjuvant chemotherapy while endocrine therapy or radiotherapy was administered to 40.1% and 61.1% respectively. Results: Overall survival as expected was strongly correlated to established prognostic factors such as age, tumor size, lymph node status, and grading (p< 0.001) respectively. However, overall survival of the patients did not correlate to either social (p= 0.110) or health (p= 0.659) insurance state. Neither did the professional education of the patients play a role concerning overall survival (p= 0. 217.. Conclusions: Unlike the American results there was no correlation seen between state of social or health insurance for german early breast cancer patients. Thus, although patients with private coverage are supposed to receive more intensive medical care, outcome for these patients concerning overall survival is not better than for patients with compulsory insurance. Literature: 1. Banerjee M, George J, Yee C, Hryniuk W, Schwartz K.: Disentangling the effects of race on breast cancer treatment. Cancer. 2007 Nov 15;110(10):2169-77. 2. Griggs JJ, Culakova E, Sorbero ME, Poniewierski MS, Wolff DA, Crawford J, Dale DC, Lyman GH. Social and racial differences in selection of breast cancer adjuvant chemotherapy regimens. J Clin Oncol. 2007 Jun 20;25(18):2522-7. 3. Brookfield KF, Cheung MC, Lucci J, Fleming LE, Koniaris LG. Disparities in survival among women with invasive cervical cancer : a problem of access to care. Cancer. 2008 Dec 18. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-10-11.