Abstract P4-12-24: Phase I trial of S-222611, a dual tyrosine kinase inhibitor of EGFR and HER2, with preliminary evidence of efficacy in patients (pts) with heavily-pretreated HER2-positive metastatic breast cancer

Background and rationale: S-222611 is a novel, oral, reversible inhibitor of EGFR, HER2 and HER4 with an improved preclinical profile compared with first-generation pan-HER inhibitors.

Research objectives: We conducted a phase I study to determine safety, maximum tolerated dose (MTD), pharmacokinetics (PK), pharmacodynamics (PD) and preliminary efficacy in pts with solid tumors expressing EGFR or HER2.

Patients and methods: Pts with advanced solid tumors and biopsies confirming EGFR and/or HER2 expression were treated with continuous daily oral doses of S-222611. The dose of S-222611 was escalated in cohorts of at least 3 pts from 100mg to 1600mg. PK profiles were obtained in all pts, and PD assays for pEGFR, pHER2 and pHER3 were performed on paired tumor biopsies in selected pts.

Results: A total of 50 pts have been treated to-date; age 25-80y; 20 female; 13 with HER2-positive metastatic breast cancer (HER2+ MBC). S-222611 was generally well tolerated with two dose-limiting toxicities in the dose-escalation phase: rash at 1200mg; diarrhea at 1600mg. MTD was not defined. Diarrhea was the most frequent toxicity, but was rarely worse than grade 1/2. Nausea, rash, anorexia and fatigue were also seen. Bilirubin rises with normal transaminases were observed. Plasma concentrations of S-222611 increased with dose up to 800mg, which was the dose selected for the expansion phase. Steady state values of Cmax and AUC0-24 at this dose were in the effective range of concentrations in mouse models. Average t½ of 33h was consistent with once daily dosing. Tumor responses were seen over the full dose range tested (100-1600mg), with four pts on treatment for >12 months. Out of 13 HER2+ MBC pts, one clinical complete response (CR) was observed for >12 months, and four partial responses (PRs) were also seen (2 confirmed, 2 unconfirmed), yielding an overall response rate of 38% in this small group (Table 1). All 5 responding patients had previously progressed on trastuzumab (T); 4 of them had also progressed on lapatinib (L); and one patient had progressed on T, L and T-DM1. Out of 6 breast patients with PD results available, the 3 pts with a decrease in pHER3 all responded, whereas the 3 pts with no change or increase in pHER3 all had disease progression.

Conclusion: S-222611 was well tolerated in doses up to 1600mg daily with diarrhea, nausea and rash being readily manageable. Significant antitumor activity has been observed in patients with heavily pre-treated HER2+ MBC, including those progressing on prior T, L and T-DM1. Rates of grade 3 diarrhea appear markedly lower than those reported for other second-generation pan-HER TKIs. The recommended phase 2 dose, based on PK and clinical activity, is 800mg/day.

Table 1. HER2+ MBC pts with tumor shrinkage after S-222611 treatmentPatient numberPrior progression on trastuzumab-based regimenPrior progression on lapatinib-based regimenBest responseMonths on treatment (at time of data lock)S01014YYclinical CR20.3m (ongoing)S03034YNconfirmed PR11.5m (ongoing)S04046YYconfirmed PR6.0m (ongoing)S01030YYunconfirmed PRwithdrawn at 3.7m with progressionS01047YYunconfirmed PR4.8m (ongoing)

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-12-24.

Screening and further analyzing differentially expressed genes in acute idiopathic pulmonary fibrosis with DNA microarray

BACKGROUND

Acute idiopathic pulmonary fibrosis (IPF) is a serious and progressive form of lung disease, and millions of people suffer from this disease in the world. To provide clues for getting a better understanding of the mechanism of this disease, we identified and further analyzed the differential expressed genes in IPF.

METHOD

In this study, we downloaded the gene expression microarray (GSE10667) from Gene Expression Omnibus (GEO) database. The dataset contained a total of 23 samples, including 15 normal controls and 8 diseases samples (IPF). Then, we identified the differentially expressed genes between normal and disease samples with packages in R language. Consequently, the PPI network was also constructed for the products of these DEGs, and modules in the network were analyzed by Cytoscape's plug-in Mcode and Bingo. Furthermore, enrichment analysis was performed by DAVID to illustrate the altered pathways in IPF. The drug compounds for PLK1 were screened in DrugBank.

RESULTS

Atotal of 349 genes were identified as differentially expressed genes between normal and disease samples, and we constructed a protein-protein interaction network which included 200 pairs of proteins. Then three modules were identified in our network. Function of these modules were predicted to be related to protein kinase binding, extracellular matrix structural and structural constituent of cytoskeleton, respectively. Finally, we focused on module A including 18 DEGs.

CONCLUSIONS

PLK1 (Polo like kinge-1) in this module was predicted as a marker gene in IPF, which was related to cell cycle pathway. Several compounds were found which may be the potential drug for IPF.

Improving the in vivo persistence, distribution and function of cytotoxic T lymphocytes by inhibiting the tumor immunosuppressive microenvironment

Adoptive cell transfer immunotherapy of malignant tumors has the problem of symbiosis between effector cells and tumor cells, a short in vivo residence time, and a poor killing efficiency of effector cells. Thus, releasing effector cells from the cancer immunosuppressive microenvironment and improving their effective time and functional status in vivo would seem to be ideal strategies for facilitating immunotherapy. Low-dose cyclophosphamide administration can effectively break immunotolerance by inhibiting regulatory T cells. In the present study, in order to verify whether the persistence, distribution and function of effector cells can be improved by inhibiting immunosuppressive microenvironment, low-dose cyclophosphamide was previously intraperitoneally injected into melanoma-bearing C57BL/6 mice, thereafter, CFSE-labeled cytotoxic T lymphocytes were transfused intravenously, and their effective time, distributive pattern, and killing efficiency in different groups were observed by measuring the fluorescence intensity and cell cycle of cytotoxic T lymphocytes distributed in various organs, in comparison with tumor growth. We found down-regulating Tregs in vivo can simultaneously reduce the levels of interleukin-10 and transforming growth factor-β. Migration and distribution of cytotoxic T lymphocytes in vivo was found to vary with time. Inhibition of immunotolerance can significantly improve the persistence, distribution, and function of cytotoxic T lymphocytes. Correspondingly, significantly higher secretion of perforin, granzyme B, IL-2, and IFN-γ in tumor tissues with decreased tumor growth was seen in the cyclophosphamide injection group than in the control group. Our study may provide useful information on the cyclophosphamide-mediated mechanism for facilitating tumor immunotherapy by inhibiting the immunosuppressive tumor microenvironment.

A randomized, double-blind, phase II study of erlotinib with or without sunitinib for the second-line treatment of metastatic non-small-cell lung cancer (NSCLC)

BACKGROUND

Combined inhibition of vascular, platelet-derived, and epidermal growth factor receptor (EGFR) pathways may overcome refractoriness to single agents in platinum-pretreated non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

This randomized, double-blind, multicenter, phase II trial evaluated sunitinib 37.5 mg/day plus erlotinib 150 mg/day versus placebo plus erlotinib continuously in 4-week cycles. Eligible patients had histologically confirmed stage IIIB or IV NSCLC previously treated with one or two chemotherapy regimens, including one platinum-based regimen. The primary end point was progression-free survival (PFS) by an independent central review.

RESULTS

One hundred and thirty-two patients were randomly assigned, and the median duration of follow-up was 17.7 months. The median PFS was 2.8 versus 2.0 months for the combination versus erlotinib alone (HR 0.898, P = 0.321). The median overall survival (OS) was 8.2 versus 7.6 months (HR 1.066, P = 0.617). Objective response rates (ORRs) were 4.6% and 3.0%, respectively. Sunitinib plus erlotinib was fairly well tolerated although most treatment-related adverse events (AEs) were more frequent than with erlotinib alone: diarrhea (55% versus 33%), rash (41% versus 30%), fatigue (31% versus 25%), decreased appetite (30% versus 13%), nausea (28% versus 14%), and thrombocytopenia (13% versus 0%).

CONCLUSIONS

The addition of sunitinib to erlotinib did not significantly improve PFS in patients with advanced, platinum-pretreated NSCLC.

Plasmon resonances and strong electric field enhancements in side-by-side tangent nanospheroid homodimers

The plasmon resonance and electric field enhancement in a side-by-side tangent nanospheroid homodimer (TNSHD) have been investigated theoretically by using DDA and FDTD methods, respectively. The simulation results indicate that this side-by-side TNSHD has its novel optical properties. We find that the plasmon resonance with a distinct Fano lineshape can be achieved and the electric field intensity can be enhanced strongly. The tunability of the Fano resonance could provide important applications in biosensing. The obtained electric field enhancement might open a promising pathway for surface-enhanced Raman scattering (SERS) and light trapping in solar cells.

Limits on spin-dependent WIMP-nucleon cross sections from 225 live days of XENON100 data

We present new experimental constraints on the elastic, spin-dependent WIMP-nucleon cross section using recent data from the XENON100 experiment, operated in the Laboratori Nazionali del Gran Sasso in Italy. An analysis of 224.6 live days×34 kg of exposure acquired during 2011 and 2012 revealed no excess signal due to axial-vector WIMP interactions with 129Xe and 131Xe nuclei. This leads to the most stringent upper limits on WIMP-neutron cross sections for WIMP masses above 6 GeV/c², with a minimum cross section of 3.5×10(-40) cm² at a WIMP mass of 45 GeV/c², at 90% confidence level.

The presence of programmed death 1 (PD-1)-positive tumor-infiltrating lymphocytes is associated with poor prognosis in human breast cancer

Programmed death 1 (PD-1) is a co-inhibitory receptor in the CD28/CTL-4 family, and functions as a negative regulator of the immune system. Tumor-infiltrating lymphocytes (TIL) in many epithelial cancers express PD-1, suggesting that antitumor immunity may be modulated by the PD-1/PD-L1 signaling pathway, and promising results from two recent clinical trials with monoclonal antibodies targeting PD-1 or PD-L1 confirm the clinical relevance of this pathway in human cancer. To explore the role of PD-1(+) TIL in human breast cancer, we performed immunohistochemistry studies on a tissue microarray encompassing 660 breast cancer cases with detailed clinical annotation and outcomes data. PD-1(+) TIL were present in 104 (15.8 %) of the 660 breast cancer cases. Their presence was associated with tumor size, grade, and lymph node status, and was differentially associated with the intrinsic subtypes of breast cancer. In univariate survival analyses, the presence of PD-1(+) TIL was associated with a significantly worse overall survival (HR = 2.736, p < 0.001). In subset analyses, the presence of PD-1(+) TIL was associated with significantly worse overall survival in the luminal B HER2(-) subtype (HR = 2.678, p < 0.001), the luminal B HER2(+) subtype (HR = 3.689, p < 0.001), and the basal-like subtype (HR = 3.140, p < 0.001). This is the first study to demonstrate that the presence of PD-1(+) TIL is associated with poor prognosis in human breast cancer, with important implications for the potential application of antibody therapies targeting the PD-1/PD-L1 signaling pathway in this disease.

Optimal time window of myelotomy in rats with acute traumatic spinal cord injury: a preliminary study

OBJECTIVES

Pathophysiological mechanisms underlying spinal cord injury (SCI) partially involve edema and formation of a hematoma. Myelotomy seems to be a promising intervention. However, the appropriate timing of myelotomy is still unknown in SCI. Here we aimed to determine the timing of microsurgical myelotomy in an animal model of SCI.

METHODS

The SCI model was contusion-induced with a new york university impactor. Sixty-five adult female rats were randomly divided into the following groups: laminectomy alone (the 'sham group', SG), laminectomy plus contusion (the 'contusion group', CG) or laminectomy plus contusion followed by myelotomy at 8, 24 or 48 h (8 h-MTG [myelotomy-treated group], 24 h-MTG or 48 h-MTG). Functional recovery was evaluated via the open field test and the inclined plane test every week after SCI. The percentage of spared white matter area (SWMA) and ultrastructure characteristics of the injured dorsolateral spinal cord were determined on the 42nd day after SCI.

RESULTS

Compared with the CG, myelotomy at 8 h-MTG or 24 h-MTG greatly improved the BASSO-BEATTIE- BRESNAHAN scores (P<0.008), whereas the 48 h-MTG showed less efficacy (P=0.023). All myelotomy groups showed higher mean angle values in an inclined plane test (P<0.005) and had greater percentages of SWMA than the CG. Rats in the 24 h-MTG showed a higher intra-axonal fraction and myelin fraction than those in 48 h-MTG (P<0.005).

CONCLUSION

Myelotomy up to 48 h after SCI improves recovery in rats. The potential time window of myelotomy may be between 8 and 24 h after SCI.

Injection Velocity Control Using A Self-tuning Adaptive Controller

The injection velocity dynamics are found to be both time-varying and non-linear and therefore difficult to control using a conventional fixed parameter controller. In this work, an adaptive injection velocity control system with some special features such as anti-estimation windup, adaptive feed-forward, profile shifting and cycle-to-cycle adaptation is designed, implemented, and experimentally tested. The developed system is demonstrated to have excellent control performance with very good robustness for a wide range of operating conditions.

Dynamics and Control of Surface and Mold Temperatures in Injection Molding

Mold temperature control in injection molding is very important for control of production rate and product quality. However, mold temperature is a complex function of machine design, process variables, machine settings and ambient conditions. Data were obtained regarding the variability in both space and time (in-cycle and cycle-to-cycle) of mold metal and mold surface temperatures and heat flux. In view of this variability, it is necessary to define variables which may be useful for control purposes. The following variables were evaluated: cycle average temperature, peak temperature, and partial cooling time. Dynamic models were developed, on the basis of experimental data, to determine the process gains, time constants and time delays for the above variables with regard to coolant temperature, coolant flowrate, and melt temperature as the possible manipulated variables. In view of the dynamic studies, the cycle average surface temperature was selected as the controlled variable for control system design and simulation. The regulating abilities of PI, PID, and Dahlin controllers were evaluated. The results indicate that Dahlin control caused the controlled variable to follow the set-point closely, even when the process parameters vary, thus showing good robustness. However, the Dahlin algorithm achieves this advantage via large variations in the manipulated variable. This may cause difficulty in some circumstances.

In-mold Melt Front Rate Control Using a Capacitive Transducer in Injection Molding

In the filling phase of injection molding process, melt-front rate plays a particularly important role in determining the part quality. Prior researches recommend a constant melt-front rate for this phase. A measurement device based on a capacitor principle has been developed. It has been shown that this sensor is effective to measure online and continuously melt-front position in mold cavity. Based on this sensor, this work develops and tests closed-loop control system of direct in-mold melt-front rate control. Several advanced control algorithms, Generalized Predictive Control (GPC), Iterative Learning Control (ILC), and Generalized 2D Model Predictive Iterative Learning Control (2D-GPILC), are designed, implemented, and tested with different mold inserts. The results show that 2D-GPILC, a combination scheme of feedback and iterative learning scheme, gives the best control results.

Overall Control System for Injection Molding Process

A multi-layer injection molding machine control system is proposed in this paper. The first layer, an advanced process parameter control layer, provides accurate and robust control of key process variables. The second layer consists of two modules, a profile setting layer determining the shapes of set-point profiles for the key process variables, to achieve an evenly distributed part quality along the flow directions; and a process fault detection and diagnoses system monitoring the operation of injection molding process. The third layer, a quality control layer, consists of a quantitative quality prediction model and a quality controller. This final layer provides a mechanism for closed-loop control of certain part quality. The related work that has been conducted on these three layers is discussed extensively in this paper, and the future work is introduced as well.

Lipid goal attainment and prescription behavior in asian patients with acute coronary syndromes: experience from a tertiary hospital

Lipid goal attainment studies in Asian patients with acute coronary syndrome (ACS) are limited. The objectives of this study were to determine low-density lipoprotein cholesterol (LDL-C) goal attainment rate at 4 months, and to examine prescription behavior influencing lipid goal attainment in Asian patients with ACS. A retrospective analysis of 267 patients with ACS was performed. The mean follow-up duration was 41.2±10.7 months. LDL-C goal attainment rate was highest at 4 months (36.7%) but declined progressively throughout follow-up. More than 85% of patients were discharged with equipotent statin dose of 2 (equivalent to simvastatin 20 mg) or less. In patients who did not attain LDL-C goals, the statin dose remained low throughout follow-up because of a lack in responsive dose titration. Aggressive lipid-lowering therapy should be initiated early to improve goal attainment in these high-risk patients.