Quality of life in advanced non-small cell lung cancer patients receiving first-line gefitinib monotherapy

9614

Background: Gefitinib is a potential first-line treatment option for patients with advanced non-small cell lung cancer (NSCLC), especially for patients with activating mutations in the EGFR gene. However, little is known about patient-reported health-related quality of life (HRQOL) in this patient population. The aims of this study were to explore the prognostic values of baseline HRQOL for time-to-treatment failure (TTF), as well as the predictors of repeatedly measured posttreatment HRQOL, in advanced NSCLC patients receiving first-line gefitinib. Methods: A total of 106 chemonaive patients with advanced NSCLC were enrolled in a phase II trial. Gefitinib was given at a dose of 250 mg/d. HRQOL was assessed monthly with the EuroQoL instrument (EQ-5D) and the Lung Cancer Symptom Scale (LCSS) questionnaire. Baseline HRQOL and clinical/molecular predictors of TTF were jointly examined by multiple Cox's proportional hazards model. The associations between the clinical/molecular factors and repeatedly measured posttreatment HRQOL were analyzed by fitting marginal linear regression model using the generalized estimating equations (GEE) method. Results: In this prospective study, HRQOL data were obtained from 94 patients. Baseline EQ-5D index (estimated hazard ratio = 0.286, 95% C.I.: 0.135–0.603, p = 0.001) and the presence of L858R EGFR mutation in adenocarcinoma (estimated hazard ratio = 0.520, 95% C.I.: 0.307–0.880, p = 0.015) were retained as independent prognostic factors in the final multiple Cox's proportional hazards model for TTF. According to preliminary GEE analysis of repeatedly measured posttreatment HRQOL, the patients with wild-type EGFR consistently had worse HRQOL in EQ-5D index (p < 0.0001), EQ-5D VAS score (p = 0.0002), and LCSS global score (p < 0.0001), respectively. Conclusions: In advanced NSCLC patients receiving first-line gefitinib, better baseline EQ-5D index and L858R EGFR mutation in adenocarcinoma predict longer TTF. In addition, patients with wild-type EGFR had worse posttreatment HRQOL.

No significant financial relationships to disclose.

Prognostic factors of survival in 236 advanced hepatocellular carcinoma patients enrolled in prospective clinical trials of systemic therapy

e15632

Background: Hepatocellular carcinoma (HCC) is a common malignant disease. Promising results of prospective clinical trials using systemic therapy for patients with advanced HCC are emerging. The aim of this study was to explore prognostic factors of survival in advanced HCC patients eligible for clinical trials of systemic therapy. Methods: From December 1990 to July 2005, 236 patients with unresectable HCC were enrolled into 6 phase II trials of systemic therapy using the following regimens: (1) oral etoposide + tamoxifen, (2)doxorubicin + tamoxifen, (3)IFN-α2b + doxorubicin + tamoxifen, (4)pegylated liposomal doxorubicin, (5)thalidomide, and (6)arsenic trioxide. Univariate and multivariate analyses of 23 relevant clinical characteristics/staging systems were used to identify prognostic factors of survival. Results: Baseline characteristics: median age 55; male/female: 192/44; HBsAg(+) 71%; anti-HCV(+) 30%; Okuda stage I/II/III: 42%/55%/3%; AJCC stage III/IV: 30%/61%; BCLC stage B/C/D: 1%/94%/5%; CLIP score 0–3/4–6: 70%/30%; portal vein thrombosis 53%; extrahepatic metastasis 59%; prior chemoembolization 46%. The objective response rate according to WHO criteria was 11.4%. The median overall survival was 118 days (95% CI, 103–133). In the multivariate analysis, significant predictors of a shorter overall survival were: HBsAg(+) with a hazard ratio (HR) = 1.808 (95% CI, 1.121–2.916; P= 0.015), symptomatic with HR = 1.745 (95% CI, 1.072–2.840; P= 0.025), ECOG≥2 with HR = 1.763 (95% CI, 1.040–2.988; P= 0.035), and high BCLC stage with HR = 3.282 (95% CI, 1.129–9.541; P= 0.029). Conclusions: Patients with advanced HCC who are eligible for systemic therapeutic trials have patient- and disease-related prognostic factors. Positive HBsAg, symptomatic, ECOG performance≥2, and high BCLC stage predict a shorter overall survival.

No significant financial relationships to disclose.

A phase II study of sorafenib in combination with tegafur/uracil (UFT) for Asian patients with advanced hepatocellular carcinoma (HCC)

4589

Background: Sorafenib, a multikinase inhibitor with antiangiogenic activity, has recently been approved for the treatment of unresectable HCC. Combination of sorafenib with metronomic chemotherapy has theoretic advantage in improving antitumor activity without increasing toxicities. UFT (tegafur: uracil = 4:1 in molar ratio), an oral fluoropyrimidine, is active in various gastrointestinal cancers. We conducted a phase II study to evaluate the efficacy and safety of sorafenib plus low-dose UFT in advanced HCC patients (pts). Methods: Pts with histologically or cytologically proven unresectable/metastatic HCC, ECOG PS 0–2, Child-Puch class A, platelets ≥ 100 K/μl, transaminases ≤ 5 × ULN, bilirubin ≤ 3 mg/dl, INR ≤ 2.3 and creatinine ≤ 1.5 × ULN were enrolled. Prior systemic therapy for advanced disease is not allowed. Sorafenib (400 mg bid) and UFT (125 mg/m2 based on tegafur bid) were taken per os continuously. Tumor assessment was performed q8w by RECIST criteria. Primary endpoint is progression-free survival (PFS). Results: Between April 2007 and April 2008, 53 pts were enrolled. Baseline pts characteristics were: M/F, 47/6; median age 57 (range, 31–83); CLIP score 0–3/4, 48/5; extrahepatic spread/macroscopic vascular invasion, 33/30; and HBsAg(+)/anti-HCV(+)/both(+), 38/13/4. 89% of pts were BCLC stage C. Pts received a median of 3.7 (range 0.3- 18.9+) months of treatment. There were 3 (6%) PR and 27 (51%) SD. The median PFS and OS were of 3.7 months (95% C.I., 1.9- 5.5) and 7.4 months (95% C.I., 3.4- 11.4), respectively. Adverse events (AEs) were summarized in Table . Hand-foot skin reaction (HFSR), fatigue, and diarrhea were most common AEs. HFSR was the major AE resulting in dose reduction (19%) or treatment delay (21%). Grade 3/4 neutropenia occurred in 2 pts (4%). Conclusions: Adding metronomic UFT chemotherapy to sorafenib may improve therapeutic efficacy of the latter in pts with advanced HCC. The toxicity profile of the combination is similar to that of sorafenib alone.

[Table: see text]

[Table: see text]

[Effect of liposomal albendazole on the ultrastructure of Echinococcus granulosus cysts in mice]

AIM

To observe the histopathological changes of Echinococcus granulosus cysts in mice treated with liposomal albendazole and co-administration with cimetidine by light microscopy and electron microscopy.

METHODS

An oral dose of liposomal ABZ with different formulations was given at 200 mg/kg.d. Cimetidine was administered daily at an oral dose of 100 mg/kg.d. Sixty-seven mice were orally given different drugs six days per week for a total of twelve weeks.

RESULTS

The histopathological changes indicated that there were significant differences (P < 0.01) between treated groups and control group. The degeneration and necrosis of E. granulosus cysts were marked in liposomal albendazole combined with cimetidin group.

CONCLUSION

Liposomal albendazole was more effective against E. granulosus cyst than albendazole. Cimetidine had an apparent synergistic effect when given in combination with liposomal albendazle.

Association of misconceptions about HIV transmission and discriminatory attitudes in rural China

This study examined HIV-related knowledge and attitudes among 524 randomly selected adult residents from 12 rural Chinese communities where HIV infection among plasma donors has been reported. Most participants were familiar with the main routes of HIV transmission but had substantial misconceptions about risk of HIV transmission through casual social contacts. Higher score of misconception and being older and married independently predicted stronger discriminatory attitude. Intervention programs with focus on eliminating misconceptions about HIV transmission may reduce stigma.

P53 gene codon 72 polymorphism and risk of esophageal squamous cell carcinoma: a case/control study in a Chinese population

The aims of this study were to investigate whether p53 gene codon 72 polymorphism was a biomarker associated with esophageal squamous cell carcinoma (ESCC) and its relationship with smoking status in China. The p53 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism among 673 patients with ESCC and 694 healthy controls. The association between p53 genotypes and risk of developing ESCC was estimated by odds ratios (OR) and their 95% confidence intervals (CIs) computed by logistic regression. Compared with Arg/Arg homozygotes, Pro/Pro homozygotes had a nearly twofold increased risk (adjusted OR, 1.83; 95% CI, 1.35-2.48). For the Pro/Arg heterozygotes, there was no evident increased risk (adjusted OR, 1.01, 95% CI, 0.78-1.30). Furthermore, the risk associated with the Pro/Pro variant genotype was more pronounced in younger patients at diagnosis (= 45 years) (OR, 7.4; 95% CI, 1.44-37.89, P = 0.02), in women (OR, 3.15; 95% CI, 1.52-4.53, P = 0.02) and in non-smokers (OR, 2.49; 95% CI, 1.58-3.94) and light smokers (OR, 2.13; 95% CI, 1.15-3.93). But tests for homogeneity between smoking-related OR showed no significant differences (P = 0.4). The p53 gene codon 72 Pro/Pro genotype was significantly associated with the increased risk of ESCC in a Chinese mainland population and may be an independent factor in susceptibility to ESCC. The association was especially noteworthy in women and in younger patients.

The UL31 to UL35 gene sequences of Duck enteritis virus correspond to their homologs in herpes simplex virus 1

Five ORFs in the genome of Duck enteritis virus (DEV) corresponding to UL31, UL32, UL33, UL34, and UL35 genes of Herpes simplex virus 1 (HSV-1) were amplified by a modified "targeted gene walking" PCR, cloned, and sequenced. UL33, UL34, and UL35 genes were oriented from the left to the right of genome, while UL31 and UL32 had an opposite orientation. A comparison of deduced amino acid sequences of the DEV ORFs with their alphaherpesvirus homologs showed well-conserved regions except for the UL34 and UL35 genes. Phylogenetic analysis revealed that DEV was closer to the genus Mardivirus than to any other genus of the subfamily Alphaherpesvirinae. Based on this evidence, we proposed to assign DEV to the subfamily Alphaherpesvirinae.

Evaluation of thermal properties of food materials at high pressures using a dual-needle line-heat-source method

Thermal properties of food systems at high pressure (HP) are important in the design and operation of HP processing equipment. Available techniques for thermal property evaluation under HP conditions are still very limited. In this study, a dual-needle line-heat-source (DNL) device was installed in an HP vessel to evaluate thermal conductivity (k), diffusivity (alpha), and volumetric heat capacity (C(pV)) of foods at high pressure. The DNL probe was calibrated using glycerin (0.1 MPa) and 2% (w/w) agar gel (0.1 to 350 MPa) at 5 and 25 degrees C. Calibration results showed a good correlation with the reference data of pure water: R(2)= 0.966 for thermal conductivity and R(2)= 0.837 for diffusivity, and a small standard deviation of relative error (3.18%) for the volumetric heat capacity. Fresh potato and cheddar cheese were used as test samples at 5 degrees C at selected pressure levels (0.1 to 350 MPa). The potato samples gave thermal properties very close to those of pure water, but much higher than those of the cheese. The k and alpha values of both potato and cheese increased with pressure and a 2nd-order polynomial well fitted their pressure dependency. The volumetric heat capacity data did not show a clear pressure-dependency trend. The experimental system worked well for the evaluation of thermal properties at pressures up to 350 MPa.

Soil organic carbon decomposition and carbon pools in temperate and sub-tropical forests in China

Decomposition of soil organic carbon (SOC) is a critical component of the global carbon cycle, and accurate estimates of SOC decomposition are important for forest carbon modeling and ultimately for decision making relative to carbon sequestration and mitigation of global climate change. We determined the major pools of SOC in four sites representing major forest types in China: temperate forests at Changbai Mountain (CBM) and Qilian Mountain (QLM), and sub-tropical forests at Yujiang (YJ) and Liping (LP) counties. A 90-day laboratory incubation was conducted to measure CO(2) evolution from forest soils from each site, and data from the incubation study were fitted to a three-pool first-order model that separated mineralizable soil organic carbon into active (C(a)), slow (C(s)) and resistant (C(r)) carbon pools. Results indicate that: (1) the rate of SOC decomposition in the sub-tropical zone was faster than that in the temperature zone, (2) The C(a) pool comprised approximately 1-3% of SOC with an average mean residence time (MRT) of 219 days. The C(s) pool comprised approximately 25-65% with an average MRT of 78 yr. The C(r) pool accounted for approximately 35-80% of SOC, (3) The YJ site in the sub-tropical zone had the greatest C(a) pool and the lowest MRT, while the QLM in the temperature zone had the greatest MRT for both the C(a) and C(s) pools. The results suggest a higher capacity for long-term C sequestration as SOC in temperature forests than in sub-tropical forests.

Tests of soil organic carbon density modeled by InTEC in China's forest ecosystems

The integrated terrestrial ecosystem C-budget model (InTEC) developed by Chen and co-workers has been used successfully to predict carbon dynamics of forests in Canada. It was tested here for forest soil organic carbon (SOC) density of China's northern temperate zone and southern subtropical zone. The results show that the simulated SOC density is highly correlated and in broad agreement with observations in Liping and in Changbaishan, representing the southern subtropical zone and the northern temperate zone in China, respectively. SOC density ranged from 2.2 to 11.2 kg/m(2) in Liping and from 3.4 to 14.8 kg/m(2) in Changbaishan. The correlation coefficients (r(2)) are 0.63 (N=16) and 0.76 (N=14) between the simulated and measured data in Liping and Changbaishan, respectively. The SOC densities under different vegetation types in Liping decrease in the order of mixed forest, broadleaf forest, Chinese fir, couch grass, and Chinese redpine, and in Changbaishan in the order of mixed forest, silver fir, larch forest, and birch forest.

Expression of serotonin transporters by peripheral blood mononuclear cells of rhesus monkeys (Macaca mulatta)

It has been well established that serotonin (5-hydroxytryptamine, 5-HT) plays a key role in neuro-endocrine-immune networks, mostly through its receptors and/or transporters. Although the presence of 5-HT receptor mRNAs in peripheral blood mononuclear cells (PBMCs) of rhesus monkeys has been reported, there is little information about serotonin transporter (SERT) expression by these cells. To examine SERT expression at the transcription and translation level, one-step RT-PCR, confocal microscopy and flow cytometry were used to detect SERT mRNA and protein expression by rhesus monkey PBMCs. It was found that SERT mRNA could be detected by RT-PCR from all of the rhesus macaque PBMC RNA samples and the nucleotide sequence of the amplicons was identical to the published SERT mRNA sequence. Low level SERT immunoreactivity was also demonstrated on the surface of rhesus PBMCs by confocal microscopy. Almost all lymphocytes and most monocytes were positive for SERT by flow cytometry. In the 2 rhesus macaques examined by multicolor flow cytometry, SERT(bright) cells were more than 84%, 94%, and 96% among CD20+, CD3+, and CD3+CD4+ lymphocytes respectively. These data demonstrate expression of SERT by rhesus macaque PBMCs, and indicate that rhesus macaques would be suitable models to test the in vivo immune regulatory effects of 5-HT or drugs targeting SERT.

Imiquimod: A TLR-7 agonist as adjuvant for a recombinant protein cancer vaccine

8545

Purpose: This clinical trial evaluates the safety and adjuvant activity of imiquimod, a toll-like receptor (TLR)-7 agonist, when given with a NY-ESO-1 protein vaccine. Imiquimod, by locally activating and recruiting dendritic cells (DCs) into the skin, is expected to stimulate antigen uptake by DCs, induce maturation and migration to draining lymph nodes, and to induce antigen-specific T and B cell immunity. Methods: Pilot study; 9 patients with resected stage 2B-3C malignant melanoma. Four 21 day cycles consisted of topical imiquimod cream (250 mg) on days 1–5 and id. injected NY-ESO-1 protein (100 mcg) into the site on day 3. Blood was drawn at several time points for immune monitoring; skin punch biopsies were obtained from control, imiquimod and vaccination sites 48 hours after the last vaccination. Results: The regimen was tolerated well, all patients completed four vaccinations. AEs were mild and transient and included injection site reactions (8/9 patients), fatigue (4/9 patients) and fever (2/9 patients). Significant levels of antigen-specific CD4+ or CD8+ T cell responses were not detected in ex-vivo ELISPOT assays. However, intracellular cytokine staining assays after in vitro pre-stimulation indicated that 6 of 8 subjects developed NY-ESO-1 CD4+ T cell responses. Humoral immunity was manifest by the induction of anti-NY-ESO-1 antibodies in 7/9 patients post-vaccination. Histochemistry of skin sections showed significant dermal mononuclear cell infiltrates in Imiquimod treated skin, whereas none were seen in untreated skin (p<0.01). IHC revealed markedly increased numbers of CD3+ (T-cells), CD68+ (macrophages/monocytes), CD123+ (plasmacytoid DCs) and DC-LAMP+ (mature myeloid DCs) immune cells in Imiquimod treated skin when compared with control skin of the same patients (p<0.05). Conclusion: Imiquimod, a topical immune response modifier, generated clear inflammatory infiltrates in the dermis, with significant increases in antigen-presenting cells and T cells. Imiquimod was well tolerated when used as an adjuvant to an NY-ESO-1 protein vaccine. Systemic immunity of both humoral and cellular types was induced in the majority of patients; however, responses were weak and the vaccine combination needs to be optimized in future studies.

No significant financial relationships to disclose.

Analysis of HIV-1 CRF07_BC gag p6 sequences indicating novel deletions in the central region of p6

We amplified gag sequences from 66 individuals infected with HIV-1 CRF07_BC during 2003-2005 in the Xinjiang region of China. A novel deletion of 7aa (including a KELY motif) in the central region of the CRF07_BC gag p6 domain was detected, which has not been reported in other HIV-1 subtypes. Further deletions of up to 13aa (including KQE and KELY motifs) was also found in this domain, representing the biggest natural deletion up to now. Moreover, the CD4+ count and viral load level indicated that 1-13aa deletions in CRF07_BC gag p6 do not have a significant effect on viral replication and fitness.

Renal histopathology of stone-forming patients with distal renal tubular acidosis

To define the renal tissue changes in stone-forming patients with distal renal tubular acidosis (dRTA), we performed intra-operative papillary and cortical biopsies in five patients. The main abnormalities were plugging of inner medullary collecting ducts (IMCD) and Bellini ducts (BD) with deposits of calcium phosphate in the form of apatite; epithelial cell injury and loss was marked. Plugged ducts were surrounded by interstitial fibrosis, but the fibrosis was generalized, as well, and was a main feature of the histopathology even when plugging was not present. In contrast, common idiopathic calcium oxalate stone formers (SF) never manifest intra-tubule crystals or interstitial fibrosis. Patients with brushite (calcium monohydrogen phosphate) stones and those with cystine stones have many fewer IMCD and BD plugged with apatite (or cystine, in cystinuria), and interstitial fibrosis is limited to the regions around plugged ducts. Patients with dRTA often present a radiographic picture of nephrocalcinosis. Our direct surgical observations reveal that these may be surgically removable stones, especially in patients with well preserved renal function. In all, dRTA SF have a more diffuse papillary renal disease than other SF thus studied, and are also unusual for the degree of interstitial fibrosis.

Localization and activity of calmodulin is involved in cell–cell adhesion of tumor cells and endothelial cells in response to hypoxic stress

Adhesion of tumor cells to endothelial cells is known to be involved in the hematogenous metastasis of cancer, which is regulated by hypoxia. Hypoxia is able to induce a significant increase in free intracellular Ca2+ levels in both tumor cells and endothelial cells. Here, we investigate the regulatory effects of calmodulin (CaM), an intracellular calcium mediator, on tumor cell-endothelial cell adhesion under hypoxic conditions. Hypoxia facilitates HeLa cell-ECV304 endothelial cell adhesion, and results in actin cytoskeleton rearrangement in both endothelial cells and tumor cells. Suppression of CaM activation by CaM inhibitor W-7 disrupts actin cytoskeleton organization and CaM distribution in the cell-cell contact region, and thus inhibits cell-cell adhesion. CaM inhibitor also downregulates hypoxia-induced HIF-1-dependent gene expression. These results suggest that the Ca2+ -CaM signaling pathway might be involved in tumor cell-endothelial cell adhesion, and that co-localization of CaM and actin at cell-cell contact regions might be essential for this process under hypoxic stress.

A prospective, blinded analysis of thymidylate synthase and p53 expression as prognostic markers in the adjuvant treatment of colorectal cancer

BACKGROUND

Despite previous studies, uncertainty has persisted about the role of thymidylate synthase (TS) and p53 status as markers of prognosis in colorectal cancer (CRC).

PATIENTS AND METHODS

A total of 967 patients accrued to a large adjuvant trial in CRC were included in a prospectively planned molecular substudy, and of them, 59% had rectal cancer and about 90% received adjuvant chemotherapy (either systemically or randomly allocated to intraportal 5-fluorouracil infusion or both). TS and p53 status were determined, blinded to any clinical data, by immunohistochemistry using a validated polyclonal antibody or the DO-7 clone, respectively, and their relationships with overall survival were examined.

RESULTS

High TS expression was observed in 58% and overexpression of p53 in 60% of tumours. TS expression correlated with tumour stage, and p53 overexpression, with rectal cancers. There was no evidence that either marker was significantly associated with survival by either univariate (TS hazard ratio (HR) = 0.94, 95% CI 0.76-1.18 and P = 0.6 and p53 HR = 0.98, 95% CI 0.78-1.23 and P = 0.9) or multivariate analyses (TS HR = 0.99, 95% CI 0.79-1.25 and P = 0.9 and p53 HR = 0.98, 95% CI 0.78-1.23 and P = 0.8).

CONCLUSIONS

Neither TS nor p53 expression has significant prognostic value in the adjuvant setting of CRC.