Abstract PD08-05: Longitudinal Change of Pain and Other Symptoms in Breast Cancer Patients with Anastrozole Treatment

Background About one in three breast cancer patients undergoing treated with aromatase inhibitors report problems with joint pain, some times interfering with work and other activities. We conducted a longitudinal study to characterize the course and impact of arthralgia and other symptoms during anastozole therapy by following how pain and other symptoms change during anastrozole treatment, and the impact of symptoms on patient's functioning, health-related quality of life (HRQoL), and work productivity.

Methods Two cohorts of patients were included: Cohort I recruited patients at the start of anastrozole therapy: Cohort II recruited patients at the beginning of their third year of treatment. Brief Pain Inventory and MD Anderson Symptom Inventory were used to monthly assess patients’ pain, multiple symptoms, and functioning. A single item of quality of life question and the Work Productivity and Activity Impairment Questionnaire: General Health V2.0 were used to measure patient's HRQoL and impairment of working productivity every 6 months. A joint pain self-assessment kit was used to locate the affected joints. Statistical analyses were based on the one-year follow-up data and t-test, mixed effects models, linear regression models, and correlation coefficients were used.

Results At this point in the study, thirty-eight patients have finished the one year assessment in cohort I and 37 patients in cohort II. Cohort I patients reported no or mild pain and symptoms before they started therapy. Compared to baseline, pain ratings on 0 to 10 scales significantly increased at the 5th month (4.17±3.66 vs. 1.52±2.38, p=.015) and then decreased to baseline levels at the 9th month. Similarly, patients reported higher level of distress (3.5±3.63 vs. 1.00±2.07, p=.014) and hot flashes (4.0±4.57 vs. 1.45±2.36, p=.039) at month 5 and decreased to baselines levels at month 9. Mixed effects model with the total symptom interference as the dependent variable identified that among all symptoms, pain had the greatest impact on patient functioning (p<.0001). Patients with 4 or greater pain at month 5 reported poorer HRQoL at month 6 than those reported 3 or lower pain level (5.40±1.82 vs. 8.25±2.14, p=.020). Severity of pain at month 5 was positively correlated with working productivity: impairment at work (r=.80, p=.010), overall work productivity loss (r=.81, p=.014), and activity impairment (r=.84, p=.005). During the third year of anastrozole treatment, no symptom reaches the peak level at month 5 and no significant change was found over time, as well their HRQoL and working productivity. For cohort I patients, right knee was the most affected joint and right wrist as the most affected one for cohort II patients.

Conclusion Breast cancer patients beginning analstrozole therapy reported increased pain, distress, and hot flashes at the first year of treatment, worsening around the 5th month. Increased pain negatively impacted functioning, HRQoL, and work productivity. This study indicates that symptoms related to starting anastrozole develop over the first several months of therapy and have a functional impact on patients. Symptoms emerge when patients may be less actively followed clinically. Methods of managing these symptoms need to be investigated.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD08-05.

Proapoptotic Bid mediates the Atr-directed DNA damage response to replicative stress

Proapoptotic BH3 interacting domain death agonist (Bid), a BH3-only Bcl-2 family member, is situated at the interface between the DNA damage response and apoptosis, with roles in death receptor-induced apoptosis as well as cell cycle checkpoints following DNA damage.(1, 2, 3) In this study, we demonstrate that Bid functions at the level of the sensor complex in the Atm and Rad3-related (Atr)-directed DNA damage response. Bid is found with replication protein A (RPA) in nuclear foci and associates with the Atr/Atr-interacting protein (Atrip)/RPA complex following replicative stress. Furthermore, Bid-deficient cells show an impaired response to replicative stress manifest by reduced accumulation of Atr and Atrip on chromatin and at DNA damage foci, reduced recovery of DNA synthesis following replicative stress, and decreased checkpoint kinase 1 activation and RPA phosphorylation. These results establish a direct role for the BH3-only Bcl-2 family member, Bid, acting at the level of the damage sensor complex to amplify the Atr-directed cellular response to replicative DNA damage.

Effect of the ratios of diameter of silo to bead on the pressure screening in granular columns

We present the apparent mass measurements at the bottom of granular packings for different bead and silo sizes. The redirection parameter K in Janssen theory is found to increase with the ratios of the diameter of the silo to the bead. We attribute this feature to the friction between the beads and the confining wall of silo; it is the role of friction that leads to variations in the shielding of vertical stresses as well as pressure screening.

The glycoprotein Ibalpha-von Willebrand factor interaction induces platelet apoptosis

BACKGROUND

The interaction of glycoprotein (GP) Ibalpha with von Willebrand factor (VWF) initiates platelet adhesion, and simultaneously triggers intracellular signaling cascades leading to platelet aggregation and thrombus formation. Some of the signaling events are similar to those occurring during apoptosis, however, it is still unclear whether platelet apoptosis is induced by the GPIbalpha-VWF interaction.

OBJECTIVES

To investigate whether the GPIbalpha-VWF interaction induces platelet apoptosis and the role of 14-3-3zeta in apoptotic signaling.

METHODS

Apoptotic events were assessed in platelets or Chinese hamster ovary (CHO) cells expressing wild-type (1b9) or mutant GPIb-IX interacting with VWF by flow cytometry or western blotting.

RESULTS

Ristocetin-induced GPIbalpha-VWF interaction elicited apoptotic events in platelets, including phosphatidylserine exposure, elevations of Bax and Bak, gelsolin cleavage, and depolarization of mitochondrial inner transmembrane potential. Apoptotic events were also elicited in platelets exposed to pathologic shear stresses in the presence of VWF; however, the shear-induced apoptosis was eliminated by the anti-GPIbalpha antibody AK2. Furthermore, apoptotic events occurred in 1b9 cells stimulated with VWF and ristocetin, but were significantly diminished in two CHO cell lines expressing mutant GPIb-IX with GPIbalpha truncated at residue 551 or a serine-to-alanine mutation at the 14-3-3zeta-binding site in GPIbalpha.

CONCLUSIONS

This study demonstrates that the GPIbalpha-VWF interaction induces apoptotic events in platelets, and that the association of 14-3-3zeta with the cytoplasmic domain of GPIbalpha is essential for apoptotic signaling. This finding may suggest a novel mechanism for platelet clearance or some thrombocytopenic diseases.

Gene expression profiling in the developing rat brain exposed to ketamine

Ketamine, a non-competitive N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with accelerated neuronal apoptosis in the developing rodent brain. In this study, postnatal day (PND) 7 rats were treated with 20 mg/kg ketamine or saline in six successive doses (s.c.) at 2-h intervals. Brain frontal cortical areas were collected 6 h after the last dose and RNA isolated and hybridized to Illumina Rat Ref-12 Expression BeadChips containing 22,226 probes. Many of the differentially expressed genes were associated with cell death or differentiation and receptor activity. Ingenuity Pathway Analysis software identified perturbations in NMDA-type glutamate, GABA and dopamine receptor signaling. Quantitative polymerase chain reaction (Q-PCR) confirmed that NMDA receptor subunits were significantly up-regulated. Up-regulation of NMDA receptor mRNA signaling was further confirmed by in situ hybridization. These observations support our working hypothesis that prolonged ketamine exposure produces up-regulation of NMDA receptors and subsequent over-stimulation of the glutamatergic system by endogenous glutamate, triggering enhanced apoptosis in developing neurons.

Novel anti-prostate cancer curcumin analogues that enhance androgen receptor degradation activity

The androgen receptor (AR) plays a crucial role in the physiological and pathological functions of androgen. As a transcription factor, the AR modulates androgen activity by regulating the transcription of target genes that are involved in numerous physiological functions and pathological disorders, such as acne vulgaris, androgenetic alopecia, benign prostate hyperplasia (BPH), and prostate cancers. Although many natural and synthetic curcumin analogues have been reported to possess anticancer activity through a common cytotoxic property against proliferating tumor cells, none has been reported to inhibit cancer cell growth through a more specific mechanism or target in the cancer cells. Recently, new curcumin analogues were studied extensively regarding their synthesis, structure-activity (i.e., anticancer activity) relationships, and mechanism of action. These compounds, such as ASC-J9 and its analogues (3 and 4), have now been shown to inhibit prostate cancer proliferation through a novel mechanism of enhancing AR degradation.

Use of two-year disease-free survival (DFS) as a primary endpoint in stage III adjuvant colon cancer trials with fluoropyrimidines with or without oxaliplatin or irinotecan: New data from 12,676 patients from MOSAIC, X-ACT, PETACC-3, NSAPB C-06 and C-07, and C89803

4011

Background: The ACCENT group previously validated DFS with 3 years (yr) median follow-up (f-up) based on 20,898 pts from trials testing 5-FU based regimens (rx) (3yr DFS) as an endpoint to predict overall survival with 5 yr median f-up (5yr OS) (Sargent, JCO 2005). ACCENT further proposed (1) 2yr DFS predicts 5yr OS, (2) a stronger relationship between DFS and OS in stage III pts (Sargent JCO 2007) and (3) 6 or 7 yrs are necessary to demonstrate DFS and OS association in future trials due to extended survival following recurrence (de Gramont ASCO 2008). The relationship between endpoints in more recent trials with oral fluoropyrimidines, oxaliplatin, and irinotecan is unknown. Methods: Concordance between 2 and 3yr DFS, and 5 and 6yr OS was examined in 6 randomized phase III trials from 1997–2002. Individual data for 12,676 pts was analyzed; 2 trials tested oxaliplatin, 2 irinotecan, and 2 oral rx vs 5-FU/LV control. Association between DFS and OS hazard ratios (HRs) via weighted least squares (WLS), and concordance between predicted and actual within-trial HRs, were calculated overall and for stage III pts. Results: Overall association between 3 yr DFS and 5 yr OS HRs was reduced compared to the prior ACCENT analysis (Table). In stage III pts, the association between DFS and OS HRs remained strong. Observed 5 and 6yr OS HRs were predicted accurately by 2yr DFS overall and in stage III pts (within 95% prediction limits in all trials). In all pts, DFS HRs were more highly associated with 6 vs 5yr OS HRs. Conclusions: In recent trials in stage III pts, DFS HRs based on 2yr median f-up are highly predictive of 5 and 6yr OS HRs. In all pts the association between DFS and OS HRs is stronger for 6yr OS, but 7yr follow-up may be required. These data support 3yr DFS as a primary endpoint for modern stage III trials, and indicate that 2yr DFS would also be an appropriate primary endpoint.

[Table: see text]

[Table: see text]

Symptom burden in cancer survivors: A report from the American Cancer Society's studies of cancer survivors

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Background: Cancer survivors may have persistent symptoms as a result of the cancer or the late effects of cancer treatment, although few studies have assessed symptom burden after completion of cancer therapy. We described symptom burden and risk factors for high symptom burden in a population-based sample of cancer survivors. Methods: Cancer survivors were drawn from 11 state cancer registries and surveyed by telephone or mail approximately 1 year after diagnosis; 3697 respondents completed the Modified Rotterdam Symptom Checklist (RSCL-M) and Profile of Mood States-37 (POMS-37). Factor analyses were used to generate composite scores from RSCL-M and POMS-37.Two-step cluster analyses using these composite scores were performed to identify cancer survivors with high symptoms. Results: Six composite scores (pain, nausea/vomiting, fatigue, poor bowel and bladder control, weight loss, and unspecified symptoms) were generated for physical symptoms (RSCL-M). Five composite scores (anxious/depressed, miserable, energetic, exhausted, and annoyed) were generated for mental symptoms (POMS-37). Cluster analyses revealed that 20% of survivors reported both high physical and high mental symptoms. Multivariate logistic regression revealed risk factors associated with high physical and high mental symptoms: younger than 55, household income lower than $40,000, high school or lower education level, unemployed when diagnosed with cancer, lack of health insurance, distant cancer, one or more comorbid conditions, diagnosis of lung cancer, and previous chemotherapy. Conclusions: One of five cancer survivors in this survey belonged to a group with high physical and mental symptoms, which were associated with certain risk factors. These findings will help clinicians and researchers identify subgroups of survivors most likely to report high symptoms and therefore most in need of symptom management. The high symptoms reported by survivors without insurance may have policy implications.

No significant financial relationships to disclose.

Health-related quality of life indicators and overall quality of life: Results from a cluster analysis on baseline EORTC QLQ-C30 data from 6,739 cancer patients

e20576

Background: Increasingly randomized controlled trials in cancer research include Health-related Quality of Life (HRQoL) alongside traditional biomedical outcome measures. The majority of these trials focus on a general cancer HRQoL measure. The objective of this meta-analysis was to identify which HRQoL indicators influence a patient's overall quality of life, in order to better understand the changes in such a generic scale. Methods: Retrospective pooling of 29 European Organisation for Research and Treatment of Cancer (EORTC) clinical trials, among 10 cancer sites, yielded baseline EORTC QLQ-C30 data for a total of 6,739 patients. A cluster analysis, using Ward's method, was performed to determine how the 15 HRQoL indicators, and the Global Health scale (GH) in particular, cluster overall and by cancer characteristics. Cronbach's alpha coefficient (α) was used to measure internal consistency. Dendrograms of the HRQoL indicators were plotted for each cancer type. Results: Three main clusters emerged: a physical function related cluster (physical functioning, role functioning, fatigue and pain, α = 0.83), a psychological function related cluster (emotional functioning, cognitive functioning and insomnia, α = 0.64) and a gastrointestinal cluster (nausea and vomiting and appetite loss, α = 0.68). The GH scale was found to be part of the physical function cluster in the overall dataset (α = 0.85). This result was reproduced for both metastatic and non-metastatic patients. When looking across the 10 different cancer sites, the GH scale was mainly linked with a physical component in brain, head and neck, lung, melanoma, ovarian, pancreatic and prostate cancer. However, in breast and testicular cancer, GH was more strongly associated with the emotional scales. Conclusions: This study shows that the GH scale of the EORTC QLQ-C30 is most strongly linked with a patient's physical status. This result is consistent across stage of disease and most cancer sites. The different results seen in patients with breast and testicular cancer deserve additional investigation.

No significant financial relationships to disclose.

A sperm GPI-anchored protein elicits sperm-cumulus cross-talk leading to the acrosome reaction

The acrosome reaction has long been thought to be induced by the zona pellucida. Here we report the identification and function of a novel human sperm glycosylphosphatidylinositol (GPI)-anchored membrane protein, NYD-SP8. The release of the protein during sperm-egg interaction and its binding to the cumulus, the first layer of egg investment, elicits cross-talk between the gametes and produces calcium dependant release of progesterone, which lead to the acrosome reaction. An in vivo mouse model of NYD-SP8 immunization is also established showing a reduced fertility rate. Thus, contrary to accepted dogma, our study demonstrates for the first time that, prior to reaching the zona pellucida, sperm may release a surface protein that acts on the cumulus cells leading to the acrosome reaction, which may be important for determining the outcome of fertilization.

IGF-1 regulation of type II collagen and MMP-13 expression in rat endplate chondrocytes via distinct signaling pathways

OBJECTIVE

Abnormal maturation and ossification of the endplate chondrocytes play a central role in the pathogenesis of degenerative disorders of the cervical spine. It is widely held that insulin like growth factor-1 (IGF-1) stimulates chondrocyte proliferation and inhibits chondrocyte terminal differentiation both in vitro and in vivo. However, the mechanism underlying such regulation is not fully understood. The present study aimed to determine the role of IGF-1 on the mRNA expression of collagen type II, alpha 1 (Col2a1) and matrix metallopeptidase 13 (MMP-13) in rat endplate chondrocytes. The possible pathways that transduce IGF-1 effects such as phosphatidylinositol-3 (PI-3)-kinase (PI3K) and mitogen activated protein kinase (MAPK) were also investigated in these cells.

METHODS

Cultured endplate chondrocytes harvested from rat cervical spines were treated with IGF-1 (100ng/ml), and the changes in Col2a1 and MMP-13 mRNA were monitored with real-time polymerase chain reaction (PCR). MMP-13 activity was also assayed. Activation of signaling proteins was evaluated by western blot analysis. Cells were also treated with pharmacological agents that block PI3K and MAPK signaling pathways.

RESULTS

IGF-1 increased Col2a1 mRNA expression in rat endplate chondrocytes in a time- and dose-dependent manner. IGF-1 treatment resulted in a fourfold increase of Col2a1 mRNA with the effect maximizing at 24h. In contrast, IGF-1 treatment for 24h caused a roughly 50% reduction in MMP-13 mRNA. Similar effects were seen on the protein levels of type II collagen (col2) and MMP-13. Consistent with these results, IGF-1 also repressed MMP-13 activity. IGF-1 activated both the PI3K and the extracellular signal-regulated kinase (ERK) pathways as evidenced by phosphorylation of either Akt or ERK1/2 (respectively). The PI3K inhibitor Wartmannin significantly inhibited the IGF-1 effect on Col2a1 mRNA expression but did not affect IGF-1-induced repression of MMP-13 expression. In contrast, the ERK/MAPK inhibitor PD98059 significantly inhibited the effect of IGF-1 on MMP-13 mRNA repression and enhanced IGF-1-induced Col2a1 mRNA expression.

CONCLUSIONS

In rat endplate chondrocytes the PI3K pathway mainly transduces IGF-1 effect on col2 expression while the ERK pathway mediates IGF-1 effect on MMP-13 expression.