Efficacy and tolerability of bevacizumab plus capecitabine as first-line therapy in patients with advanced hepatocellular carcinoma

Background:

Molecularly targeted agents with anti-angiogenic activity, including bevacizumab, have demonstrated clinical activity in patients with advanced/metastatic hepatocellular carcinoma (HCC). This multicentre phase II study involving patients from several Asian countries sought to evaluate the safety and efficacy of bevacizumab plus capecitabine in this population.

Methods:

Histologically proven/clinically diagnosed advanced HCC patients received bevacizumab 7.5 mg kg^–1 on day 1 and capecitabine 800 mg m^–2 twice daily on days 1–14 every 3 weeks as first-line therapy.

Results:

A total of 45 patients were enrolled; 44 (96%) had extrahepatic metastasis and/or major vessel invasion and 30 (67%) had hepatitis B. No grade 3/4 haematological toxicity occurred. Treatment-related grade 3/4 non-haematological toxicities included diarrhoea (n=2, 4%), nausea/vomiting (n=1, 2%), gastrointestinal bleeding (n=4, 9%) and hand–foot syndrome (n=4, 9%). The overall response rate (RECIST) was 9% and the disease control rate was 52%. Overall, median progression-free survival (PFS) and overall survival (OS) were 2.7 and 5.9 months, respectively. Median PFS and OS were 3.6 and 8.2 months, respectively, for Cancer of the Liver Italian Programme (CLIP) score ⩽3 patients, and 1.4 and 3.3 months, respectively, for CLIP score 4 patients.

Conclusion:

The bevacizumab–capecitabine combination shows good tolerability and modest anti-tumour activity in patients with advanced HCC.

Efficacy and tolerability of bevacizumab plus capecitabine as first-line therapy in patients with advanced hepatocellular carcinoma

BACKGROUND

Molecularly targeted agents with anti-angiogenic activity, including bevacizumab, have demonstrated clinical activity in patients with advanced/metastatic hepatocellular carcinoma (HCC). This multicentre phase II study involving patients from several Asian countries sought to evaluate the safety and efficacy of bevacizumab plus capecitabine in this population.

METHODS

Histologically proven/clinically diagnosed advanced HCC patients received bevacizumab 7.5 mg kg(-1) on day 1 and capecitabine 800 mg m(-2) twice daily on days 1-14 every 3 weeks as first-line therapy.

RESULTS

A total of 45 patients were enrolled; 44 (96%) had extrahepatic metastasis and/or major vessel invasion and 30 (67%) had hepatitis B. No grade 3/4 haematological toxicity occurred. Treatment-related grade 3/4 non-haematological toxicities included diarrhoea (n=2, 4%), nausea/vomiting (n=1, 2%), gastrointestinal bleeding (n=4, 9%) and hand-foot syndrome (n=4, 9%). The overall response rate (RECIST) was 9% and the disease control rate was 52%. Overall, median progression-free survival (PFS) and overall survival (OS) were 2.7 and 5.9 months, respectively. Median PFS and OS were 3.6 and 8.2 months, respectively, for Cancer of the Liver Italian Programme (CLIP) score < or =3 patients, and 1.4 and 3.3 months, respectively, for CLIP score 4 patients.

CONCLUSION

The bevacizumab-capecitabine combination shows good tolerability and modest anti-tumour activity in patients with advanced HCC.

Prevalence of body dysmorphic features in patients undergoing cosmetic procedures at the National Skin Centre, Singapore

BACKGROUND

Body dysmorphic disorder (BDD) is characterised by an obsessive preoccupation with a slight defect in appearance, and recognition is essential.

OBJECTIVE

To screen by a previously developed questionnaire the prevalence of BDD in an aesthetics clinic in Singapore. This questionnaire has a positive predictive value of 70% and a negative predictive value of 100%; patients answering that they were preoccupied with their appearance and having answered 'yes' in part A, answered 8 further questions (part B) grading the degree of distress (B4) and impairment (B5) of social functioning.

METHODS

The questionnaire was given to 396 patients: 198 attending Mandalay Aesthetics Clinic and 198 controls at a general outpatient clinic. The screen was considered suggestive of BDD if the patients: were preoccupied by their defect (question A) and qualified the degree of stress (question B4) or impairment of functioning (question B5) as moderate to severe.

RESULTS

58.1% of patients undergoing cosmetic procedures answered 'yes' to question A (odds ratio = 18.21, 95% confidence interval = 9.87-33.59). 41.74 and 26.96% of those qualified the distress (question B4) and impairment (question B5) as moderate to severe.

CONCLUSION

A calculated prevalence of 29.4% in an aesthetics centre warrants systematic screening for BDD.

Efficient nonviral Sleeping Beauty transposon-based TCR gene transfer to peripheral blood lymphocytes confers antigen-specific antitumor reactivity

Genetically engineered lymphocytes hold promise for the treatment of genetic disease, viral infections and cancer. However, current methods for genetic transduction of peripheral blood lymphocytes rely on viral vectors, which are hindered by production and safety-related problems. In this study, we demonstrated an efficient novel nonviral platform for gene transfer to lymphocytes. The Sleeping Beauty transposon-mediated approach allowed for long-term stable expression of transgenes at approximately 50% efficiency. Utilizing transposon constructs expressing tumor antigen-specific T-cell receptor genes targeting p53 and MART-1, we demonstrated sustained expression and functional reactivity of transposon-engineered lymphocytes on encountering target antigen presented on tumor cells. We found that transposon- and retroviral-modified lymphocytes had comparable transgene expression and phenotypic function. These results demonstrate the promise of nonviral ex vivo genetic modification of autologous lymphocytes for the treatment of cancer and immunologic disease.

A phase II study of bevacizumab (B) and erlotinib (E) in combination for Asian patients (pts) with advanced/metastatic hepatocellular carcinoma (HCC): An interim safety report

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Background: Asian pts with advanced HCC have a poor prognosis, and a median survival of 2–4 months with best supportive care (ph III). As HCCs are highly vascular tumors, dual inhibition of VEGF and EGFR with B plus E is an attractive combination strategy. B has demonstrated promising phase II results in 34 HCC patients, with 75% non-progression at 16 weeks (wks) (65% in Caucasians) (Thomas et al., 2007). However, 6–11% of pts had variceal bleeding, some cases of which were fatal. This study was initiated to investigate the safety and efficacy of B+E in Asian HCC pts. Methods: Screening esophagogastroduodenoscopy (EGD) was used to exclude pts with high risk of variceal bleeding. Asian pts with advanced/metastatic, measurable HCC who were unsuitable for surgery or other loco-regional therapies received B 5mg/kg q2w i.v. and E 150mg/day orally. The primary endpoint was PFS at 16 wks. Responses were evaluated using RECIST. Tumor tissue samples were collected for biomarker analysis. Results: Baseline characteristics of the 51 pts enrolled between March and October 2008 were median age: 58 years (range 26–84); male/female: 44/7; ECOG PS 0/1/2: 30/20/1; Child-Pugh A/B: 50/1; BCLC stage C n=44 (88%); hepatitis B/C/B+C/nonB+nonC: 42/4/3/2; grade I/II varices n=16 (none with red sign). Pts received a median 8 wks of study treatment. No variceal bleeding was observed; 3 pts had upper GI bleeding (grade 1/2; 2 peptic ulcer, 1 gastritis). See table for most common toxicities. 7/10 deaths were due to disease progression, none were due to study treatment. At the time of analysis, 2 pts had a confirmed partial response (PR; duration 24+ and 8+ wks). 1 pt with an unconfirmed PR continued on treatment. Data for the primary analysis were immature. Conclusions: Bevacizumab plus erlotinib was well tolerated. Screening EGD was feasible and reduced the risk of variceal bleeding. Follow-up is ongoing.

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A phase II trial of thalidomide plus tegafur/uracil for patients with advanced/metastatic hepatocellular carcinoma (HCC): Final report

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Background: Thalidomide (T) is an anti-angiogenic agent with modest activity in advanced/metastatic HCC. Tegafur/uracil (UFT) is an oral prodrug of 5-fluorouracil with activity against various gastrointestinal cancers. Metronomic chemotherapy has been shown to have anti-angiogenic and anti-cancer effect in preclinical and clinical models. This study evaluated the efficacy and safety of the combination of T and metronomic UFT as first-line therapy for advanced HCC. Methods: Patients (Pts) with advanced HCC not treatable by surgery or other loco-regional therapies received T 100mg bid and UFT 125mg/m2 (based on tegafur) bid continuously. Treatment was continued in the absence of disease progression or unacceptable toxicity. Primary endpoint was response rate (RR) by RECIST; secondary endpoints were disease control rate (CR+PR+SD), progression-free survival (PFS), overall survival (OS), and safety. Results: Between Jul 2006 and Jul 2008, 43 intent-to-treat pts (M/F 41/2, median age 55) were enrolled. Baseline characteristics were HBsAg(+)/anti-HCV(+)/both(+) /both(-) 31/6/1/7; AJCC stage II/III/IV 2/18/23; BCLC stage B/C 1/42; CLIP score ≤3/4 27/16; portal vein thrombosis 65%; extrahepatic metastasis 58%; prior local treatment 72%. There were 4 PR (9.3%) and 10 SD (23.3%), with a disease control rate of 32.6%. Median OS was 4.6 (95% CI, 3.5–7.3) months and median PFS was 1.9 (95% CI, 1.8–2.6) months. The OS and PFS for pts with CLIP score ≤3 were 7.6 and 2.6 months, respectively. Grade 3 leucopenia developed in 1 (2.3%) pt. The most common treatment-related grade 3 non-hematologic toxicities were somnolence (n=4, 9.3%), GI bleeding (n=3, 7.0%), and elevated transaminase (n=2, 4.7%). No grade 4 toxicities occurred. Conclusions: The combination of T with metronomic UFT is a well-tolerated regimen with moderate activity for advanced HCC, and worth further exploration in pts with CLIP score ≤3.

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Induction chemotherapy followed by concurrent chemoradiotherapy with/without esophagectomy for locally advanced esophageal squamous cell carcinoma

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Background: To assess the feasibility of preoperative induction chemotherapy in addition to concurrent chemoradiotherapy (CCRT) followed by esophagectomy if possible for locally advanced esophageal squamous cell carcinoma (ESCC) with a special emphasis on M1a or nodal M1b disease. Methods: Patients who had histologic proof of T3N1M0, M1a, or nodal M1b ESCC first received up to 3 courses of induction chemotherapy (paclitaxel 70 mg/m2 or docetaxel 40 mg/m2 IV 1-hr D 1, 8; cisplatin 35 mg/m2 IV 2-hr D 1, 8; 5-fluorouracil 2000 and leucovorin 300 mg/m2 IV 24-hr D 1, 8; repeated every 28 days). This was followed by CCRT (paclitaxel 35 mg/m2 1-hr D 1, 4 /wk, cisplatin 15 mg/m2 1-hr D 2, 5/wk, and radiotherapy 2 Gy D 1–5 /wk) (Lin CC et al. Ann Oncol 18:93–8,2007). When the accumulated radiation dose reached 40 Gy, the feasibility of esophagectomy was evaluated in all patients. In patients for whom esophagectomy was not feasible, CCRT was continued to a dose of 60 Gy. Results: Fifty-six patients (M:F = 51:5, median age 58, range 41–78) with locally advanced (T3N1M0:M1a:M1b[nodal] = 30:7:19) ESCC (upper:mid:lower = 15:25:16) were enrolled from June 22, 2006 to December 17, 2008. By December 31, 2008, 10 patients are still under protocol treatment. Eighteen (T3N1:M1a:M1b[nodal] = 14:3:1) (40%) and 20 of 46 patients underwent surgery and continued CCRT up to 60 Gy, respectively. Nine (T3N1:M1a:M1b[nodal] = 7:2:0) (20%) and 5 patients had pathologic complete response and microscopic residual disease, respectively. With a median follow-up of 8.4 months (range 0.5–30.8), 17 (T3N1:M1a:M1b[nodal] = 9:2:6) patients had relapse. Four and 13 patients had local recurrence and distant metastasis, respectively. The median progression-free survival was 20.3 months. The median overall survival had not reached yet with 1- and 2-year overall survival being 76 and 57%, respectively. There was no difference in progression- free or overall survival among patients with T3N1M0, M1a, or nodal M1b disease. Conclusions: Three-step strategy of preoperative taxane-based induction chemotherapy then CCRT followed by esosphagectomy if possible appears quite active in locally advanced ESCC patients with 46% having M1a or nodal M1b disease.

No significant financial relationships to disclose.