Treatment with peginterferon versus interferon in Chinese patients with chronic hepatitis C

Higher sustained virological response (SVR) rates after treating with peginterferon than after treating with interferon have been obtained in some randomized clinical trials (RCTs) in Chinese patients with chronic hepatitis C (CHC). However, the numbers of patients included in these clinical trials were too small to draw a clear conclusion. Therefore, a new meta-analysis including a large number of patients was needed to compare peginterferon with interferon in the treatment of Chinese CHC patients. A search of Medline, the China National Knowledge Infrastructure, the Wanfang Database, and the China Biomedical Database for relevant articles published between 1966 and 2009 was performed. RCTs comparing the use of peginterferon and interferon for the treatment of Chinese patients with CHC were assessed. Of the 236 studies screened, 18 RCTs including 1,148 patients (659 treated with peginterferon therapy and 489 treated with interferon therapy) were analyzed. The total SVR rates obtained in patients treated with peginterferon were significantly higher than those obtained in patients treated with interferon (64% vs. 40%; relative risk, 1.56; 95% confidence interval: 1.28-1.91; p < 0.01), but the difference between the peginterferon α-2b and interferon α-2b treatments was not significant. Withdrawal rates were similar between patients treated with peginterferon and interferon. Chinese patients with CHC have a greater likelihood of achieving an SVR with peginterferon α-2a.

Higher moments of net proton multiplicity distributions at RHIC

We report the first measurements of the kurtosis (κ), skewness (S), and variance (σ2) of net-proton multiplicity (Np-Np) distributions at midrapidity for Au+Au collisions at square root of s(NN)=19.6, 62.4, and 200 GeV corresponding to baryon chemical potentials (μB) between 200 and 20 MeV. Our measurements of the products κσ2 and Sσ, which can be related to theoretical calculations sensitive to baryon number susceptibilities and long-range correlations, are constant as functions of collision centrality. We compare these products with results from lattice QCD and various models without a critical point and study the square root of s(NN) dependence of κσ2. From the measurements at the three beam energies, we find no evidence for a critical point in the QCD phase diagram for μB below 200 MeV.

Jak/STAT signaling is involved in the inflammatory infiltration of the kidneys in MRL/lpr mice

Cytokines are known to play an important role in the pathogenesis of lupus nephritis (LN) and the Jak/STAT (Janus kinase-signal transducer and activator of transcription factor) pathway is important in mediating signal transduction of cytokines. This study examined the pathogenic role of Jak/STAT signaling in LN. MRL/lpr mice were either treated with a selective Jak2 inhibitor tyrphostin AG490 or with vehicle alone from 12 weeks of age until being sacrificed at week 20. AG490 significantly inhibited the phosphorylation of Jak2 and STAT1 (p < 0.05). Compared with the vehicle-treated mice, AG490 treatment significantly reduced proteinuria, improved renal function and suppressed histological lesions of the kidneys and salivary glands (p < 0.05). AG490 treatment significantly inhibited the renal expression of monocyte chemotactic protein (MCP)-1, interferon (IFN)-gamma and class II MHC, which was accompanied by reduced renal infiltration of T cells and macrophages (p < 0.05). In addition, AG490 treatment resulted in a decrease in serum anti-double-stranded DNA (anti-dsDNA) antibody and attenuated the deposition of IgG and C3 in the kidneys (p < 0.05). This study demonstrated that Jak/STAT pathway is implicated in the progression of renal inflammation in MRL/lpr mice and targeting this pathway may provide a potential therapeutic approach for LN.

Radiation dose and cancer risk in retrospectively and prospectively ECG-gated coronary angiography using 64-slice multidetector CT

This study aimed to estimate the radiation dose and cancer risk to adults in England, the USA and Hong Kong associated with retrospectively and prospectively electrocardiogram (ECG)-gated coronary computed tomography angiography (CTA) using currently practised protocols in Hong Kong. The doses were simulated using the ImPACT spreadsheet. For retrospectively ECG-gated CTA with pitches of 0.2, 0.22 and 0.24, the effective doses were 27.7, 23.6 and 20.7 mSv, respectively, for males and 23.6, 20.0 and 18.8 mSv, respectively, for females. For prospectively ECG-gated CTA, the effective dose was 3.7 mSv for both males and females. A table of lifetime attributable risks (LAR) of cancer incidence was set up for the English population for the purpose of estimating cancer risk induced by low-dose radiation exposure, as previously reported for US and Hong Kong populations. From the tables, the LAR of cancer incidence for a representative 50-year-old subject was calculated for retrospectively ECG-gated CTA to be 0.112% and 0.227% for English males and females, respectively, 0.103% and 0.228% for US males and females, respectively, and was comparatively higher at 0.137% and 0.370% for Hong Kong males and females, respectively; for prospectively ECG-gated CTA, the corresponding values were calculated to be 0.014% and 0.035% for English males and females, respectively, and 0.013% and 0.036% for US males and females, respectively, and again were higher at 0.017% and 0.060% for Hong Kong males and females, respectively. Our study shows that prospectively ECG-gated CTA reduces radiation dose and cancer risks by up to 87% compared with retrospectively ECG-gated CTA.

Incidence, management and mortality of acute hypoxemic respiratory failure and acute respiratory distress syndrome from a prospective study of Chinese paediatric intensive care network

AIM

To investigate the incidence, clinical management, mortality and its risk factors, major outcome and costs of acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) in a Chinese network of 26 paediatric intensive care unit (PICU).

METHODS

In a consecutive 12-month period, AHRF and ARDS were identified and followed up for 90 days or until death or discharge.

RESULTS

From a total of 11 521 critically ill patients, 461 AHRF were identified in which 306 developed ARDS (66.4%), resulting in incidences of 4% and 2.7%, respectively, with pneumonia (75.1%) and sepsis (14.7%) as main underlying diseases and 83% were 5 years and 1 month-old. In-hospital mortality of AHRF was 41.6% (44.8% for ARDS), accounted for 15.5% of all PICU deaths. For those of pneumonia or sepsis with AHRF and ARDS, mortality and its relative risk were significantly higher than those without. Relatively lower tidal volume and total fluid balance, adequate upper limit of PaCO(2) in the early PICU days, and family affordability, tended to result in better outcome.

CONCLUSION

In this prospective study, AHRF had high possibilities to develop ARDS and death risk, as impacted by ventilation settings and fluid intake in the early treatment, as well as socioeconomic factors, which should be considered for implementation of standard of care in respiratory therapy.

Measurements of h(c)(1P(1)) in psi' decays

We present measurements of the charmonium state h(c)(1P(1)) made with 106x10(6) psi' events collected by BESIII at BEPCII. Clear signals are observed for psi'-->pi0 h(c) with and without the subsequent radiative decay h(c)-->gamma eta(c). First measurements of the absolute branching ratios B(psi'-->pi0 h(c)) = (8.4+/-1.3+/-1.0) x 10(-4) and B(h(c)-->gamma eta(c)) = (54.3+/-6.7+/-5.2)% are presented. A statistics-limited determination of the previously unmeasured h(c) width leads to an upper limit Gamma(h(c))<1.44 MeV (90% confidence). Measurements of M(h(c)) = 3525.40+/-0.13+/-0.18 MeV/c2 and B(psi'-->pi0 h(c)) x B(h(c)-->gamma eta(c)) = (4.58+/-0.40+/-0.50) x 10(-4) are consistent with previous results.

Phase I dose escalation trial of tremelimumab plus sunitinib in patients (pts) with metastatic renal cell carcinoma (mRCC)

5115

Background: Sunitinib (SU) is an oral multitargeted tyrosine kinase inhibitor that has antitumor activity in mRCC. Recent data show sunitinib reduces levels of myeloid-derived suppressor cells and prevents T-cell suppression in pts with mRCC. CTLA4 blockade with tremelimumab is an immunotherapy that enhances T-cell activation and proliferation, and is associated with durable objective responses in metastatic melanoma. It was hypothesized that combination therapy could safely be administered. Methods: The primary endpoint was to assess maximum tolerated dose (MTD) of tremelimumab Q12W in combination with 2 schedules of SU (50 mg/day for 4 weeks followed by 2 weeks off or 37.5 mg QD continuous) in pts with ≤1 prior treatment. Tremelimumab doses were 6, 10, and 15 mg/kg. Secondary objectives included best overall response (RECIST), duration of response, safety, and pharmacokinetics. Results: Twenty-one pts were enrolled. Two of 5 pts in the SU 50 mg (4/2 schedule) plus tremelimumab 6 mg/kg cohort experienced dose-limiting toxicities (DLTs): 1) G5 ruptured diverticula; 2) prolonged G3 mucositis and fatigue. Further exploration of this schedule for SU was excluded. In the SU 37.5 mg QD continuous cohorts, no DLTs were observed at 6 mg/kg tremelimumab (n = 3), 1 of 6 pts treated with 10 mg/kg tremelimumab in the protocol-defined cohort suffered sudden death, and 3 of 6 pts treated with 15 mg/kg tremelimumab + SU experienced DLTs, including: 1 pt with G3 acute renal failure and G3 lymphopenia, 1 pt with G3 elevated creatinine, and 1 pt with worsening G3 dyspnea. Therefore, SU 37.5 QD + tremelimumab 10 mg/kg Q12W was considered the MTD. Five pts achieved partial response: 1 at SU 50 (4/2) + tremelimumab 6 mg/kg; 3 at SU 37.5 + tremelimumab 10 mg/kg; and 1 at SU 37.5 QD + tremelimumab 15 mg/kg. Six pts stayed on study ≥11 mo. An expansion cohort is enrolling another 12 patients at the MTD to further define toxicity and clinical activity. Conclusions: Tremelimumab 10 mg/kg Q12W + SU 37.5 mg QD was tolerable and associated with antitumor activity in pts with mRCC. Further exploration of this combination is warranted.

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Randomized phase II clinical trial comparing tremelimumab (CP-675,206) with best supportive care (BSC) following first-line platinum-based therapy in patients (pts) with advanced non-small cell lung cancer (NSCLC)

8071

Background: Pts diagnosed with advanced NSCLC with good performance status typically receive platinum-based chemotherapy; however, no approved maintenance therapy exists. Tremelimumab, a fully human anti-CTLA4 mAb, is associated with durable responses in some pts with metastatic melanoma. Methods: This open-label, randomized, multicenter, phase II clinical trial evaluating efficacy and safety of tremelimumab as maintenance therapy was conducted in pts with locally advanced or metastatic NSCLC with ECOG performance status ≤1. Pts treated with ≥4 cycles of first-line platinum-based therapy resulting in either stable disease (SD) or response per RECIST were eligible and were randomized 3–6 weeks after prior therapy. Pts received 15 mg/kg IV tremelimumab Q90D or BSC until disease progression. Primary endpoint was progression-free survival (PFS) at 3 months. Secondary endpoints included safety, objective response rate, and 1-year survival. Results: Eighty-seven pts received tremelimumab (n=44) or BSC (n=43). Nine (20.9%; 90% CI: 11.4%, 33.7%) pts receiving tremelimumab and 6 (14.3%; 90% CI: 6.4%, 26.3%) pts receiving BSC were progression free at 3 months. Among pts receiving tremelimumab, there were 2 (4.8%) partial responses and 7 (16.6%) SDs, compared with 0 and 6 (14.3%) pts receiving BSC, respectively. Treatment-related adverse events (AEs) were observed in 27 (61.4%) pts receiving tremelimumab and 3 (7.0%) receiving BSC. Nine pts (20.5%) receiving tremelimumab reported grade 3 or 4 AEs compared with 0 patients receiving BSC. The most common grade 3 or 4 AEs attributed to tremelimumab were diarrhea and colitis (n=4, 9.1%). Conclusions: In pts with advanced NSCLC and good performance status receiving platinum-based first-line therapy, single-agent tremelimumab was tolerable, with safety consistent with prior studies. Although PFS analysis did not demonstrate superiority of tremelimumab over BSC, the 4.8% objective response rate seen only in the investigational arm may support future combination studies. Analysis of 1-year survival is forthcoming.

[Table: see text]

Phase I clinical experience of a targeted TCR-IL2 fusion protein in patients with metastatic malignancies

3040

Background: ALT-801 is recombinant human interleukin-2 (IL-2) genetically fused to a single-chain T-cell receptor specific to a peptide antigen of human p53 presented in the context of HLA-A2 positivity. In tumor xenografts in animal models, this fusion protein demonstrated potent and targeted antitumor activity. Methods: A phase I/IIa multicenter clinical study was initiated to assess safety and clinical response of ALT-801 in patients with various metastatic malignancies. Patients screened positively for HLA-A2 and tumors expressed p53 peptide/HLA-A2 complex. In this dose escalation trial, patients received ALT-801 as a daily intravenous infusion for 4 days followed by a 10-day rest period and 4 additional daily doses. Results: Data from three dosing cohorts (0.015, 0.04, and 0.08 mg/kg/dose) indicate that ALT-801 is well-tolerated up to 0.04 mg/kg/dose. The half-life of ALT-801 is 2.5–4 hours per pharmacokinetic analysis, depending on the dose. Even at the 0.015 mg/kg level, there were sufficient concentrations of ALT-801 in the patients’ serum to fully activate cell lytic activity in vitro. Treatment with ALT-801 also led to immune activation in patients as demonstrated by elevated serum IFN-γ levels as well as an increase in IFN-γ-producing immune cells in patients’ blood. Interestingly, serum TNF-α, a major inducer of hypotension in patients receiving high-dose IL-2 treatment, was not induced in patients receiving ALT-801. Evidence of antitumor activity (i.e., stable disease, tumor shrinkage) was observed in some patients after one or two courses of ALT-801. Conclusions: At a dose of 0.04 mg/kg, ALT-801 is a well-tolerated agent that generated a vigorous immune response and demonstrated clinical efficacy in a group of patients with various metastatic malignancies. An expansion cohort of patients is in progress at 0.04 mg/kg.

[Table: see text]

Safety and tolerability of 1-hour intravenous infusion of tremelimumab (CP-675,206) in patients with surgically incurable stage III or IV melanoma

e20016

Background: In previous tremelimumab clinical trials, monoclonal antibody was infused over 3–5 hours. Shorter infusion times would be more convenient. Therefore, this study assessed safety and tolerability of tremelimumab 1-hr infusion. Methods: This ongoing study is an open-label, multicenter, phase I clinical trial evaluating safety and tolerability of tremelimumab (15 mg/kg 1-hr infusion every 90 days for up to 4 doses) in patients with surgically incurable stage III or IV melanoma. Primary endpoint was any tremelimumab-related adverse events (AEs) that occur from start of infusion to 1 hr post-end of infusion of Dose 1 and either prevented full dose from being administered or were ≥ grade 3. Results: Forty-five patients (71% male; median age, 59 years) were enrolled and received ≥ 1 dose of tremelimumab. Patients experienced no AEs during first infusion that met criteria for the primary endpoint. With a 1-sided exact binomial test at 10% significance level (α=0.10), p value was 0.099 (<0.10). Therefore, the null hypothesis (H0: infusion-related reaction rate ≥ 5%) was rejected. Four (9%) patients reported a mild to moderate AE during or within 1 hr after first infusion. These included 1 patient each who experienced grade 2 hypertension (considered unrelated to tremelimumab by the investigator), grade 1 hypotension, grade 2 hypersensitivity, and grade 1 transient flushing. Mean (SD) Cmax (n=32) was 325 (66) μg/mL, mean (SD) AUC (N=16) was 102,000 (35,000) μg×h/mL, and mean half-life was 20 days. These single-dose PK results were similar to those from previous studies using 3- to 5-hr infusion times, suggesting that 1-hr infusion of tremelimumab did not significantly alter PK. No human-anti-human antibodies were detected in any patients. Conclusions: In patients with advanced melanoma, 1-hr infusion of tremelimumab resulted in a safety profile during infusion that was consistent with tremelimumab studies using longer infusion times, and single-dose PK analysis did not reveal any perturbations in tremelimumab distribution or clearance. Therefore, a more convenient 1-hr infusion is a reasonable option for administration of tremelimumab.

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Migration of a swallowed toothpick into the liver: the value of multiplanar CT

Foreign body ingestion is not an uncommon problem encountered in clinical practice. However, the associated complication of bowel perforation and migration of the foreign body to the liver is rare. We report two cases of hepatic foreign bodies identified intra-operatively as toothpicks, with the alimentary tract being the presumed origin.