First-line bevacizumab-containing therapy for breast cancer: results in patients aged≥70 years treated in the ATHENA study

BACKGROUND

There are limited data on treatment outcomes in the growing population of elderly patients with locally recurrent/metastatic breast cancer (LR/mBC). To gain information on first-line bevacizumab combined with chemotherapy in the elderly, we analyzed data from the ATHENA trial in routine oncology practice.

PATIENTS AND METHODS

Patients with human epidermal growth factor receptor-2-negative LR/mBC received first-line bevacizumab with standard chemotherapy until disease progression, unacceptable toxicity, or physician/patient decision. We carried out a subgroup analysis of safety and efficacy in patients aged≥70 years. Possible correlations between tolerability and baseline comorbidities or Eastern Cooperative Oncology Group status were explored.

RESULTS

Bevacizumab was combined with single-agent paclitaxel in 46% of older patients. Only hypertension and proteinuria were more common in older than in younger patients (grade≥3 hypertension: 6.9% versus 4.2%, respectively; grade≥3 proteinuria: 4.0% versus 1.5%, respectively). Grade≥3 arterial/venous thromboembolism occurred in 2.9% versus 3.3%, respectively. Further analysis revealed no relationship between baseline presence and severity of hypertension and risk of developing hypertension during bevacizumab-containing therapy. Median time to progression was 10.4 months in patients aged≥70 years.

CONCLUSIONS

These findings suggest that bevacizumab-containing therapy is tolerable and active in patients aged≥70 years. Hypertension was more common than in younger patients but was manageable. We find no evidence precluding the use of bevacizumab in older patients, including those with hypertension, although age may influence chemotherapy choice.

P1-09-08: Association of Hypoxia-Inducible Factor-1 with Breast Cancer Risk: A Meta-Analysis of Published Studies

Background: Hypoxia-inducible factor-1 (HIF-1) plays an important role in the development and progression of breast cancer. However, conflicting results have been yielded for the association between HIF-1 polymorphisms and breast cancer risk. Therefore, we carried out a meta-analysis to assess the association of HIF-1 1772 C/T and 1790 G/A polymorphisms with breast cancer.

Material and methods: Computerized and manual searches were performed to identify eligible studies comparing allelic and genotypic frequency between cases and controls in breast cancer. Odds ratios (ORs) were used to estimate the association between HIF-1 polymorphisms and breast cancer risk. The fixed-effects or random-effects model was used to combine data. Subgroup analyses by ethnicity were also performed.

Results: This meta-analysis for 1772 C/T polymorphism included 1934 breast cancer cases and 1848 controls, and for 1790 G/A polymorphism included 602 breast cancer cases and 479 controls. We found that 1772C/T polymorphism increased the risk of breast cancer in the recessive model (OR = 2.273, 95% CI: 1.061−4.872, P = 0.035), whereas similar effect failed to be observed in the dominant model (OR = 1.075, 95% CI: 0.717−1.613, P = 0.725). There was a significant increase in breast cancer risk among Asian women (OR = 4.162, 95% CI: 1.508−11.484, P = 0.006) but not Turkish patients in the recessive model. For the 1790G/A polymorphism, we found that it had no exact effect on the decreased risk of breast cancer in both recessive and dominant model.

Discussion: This meta-analysis indicates that the polymorphism of HIF-1 1772C/T rather than 1790G/A polymorphism might be one of the high risk factors for breast cancer. The effect of the 1772C/T polymorphism on breast cancer risk is completely generated by the Asian women.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-09-08.

P5-13-13: The Role of Topoisomerase IIa in Predicting Sensitivity to Anthracyclines in Breast Cancer Patients: A Meta-Analysis of Published Literatures

Topoisomerase IIα is not only a proliferation marker of tumor cells but also a target for anthracycline-based chemotherapy. Both in vitro and in vivo studies have shown that there was a relationship between topo IIα and chemosensitivity to anthracyclines, but the predictive role of topo IIα is still controversial in breast cancer patients. A meta-analysis based on published studies was performed with the aim of obtaining an accurate evaluation of the association between topo IIα and sensitivity to anthracycline-based chemotherapy. A total of 13 eligible studies including 2,633 cases and 2,118 controls were identified. Topo IIα was associated with sensitivity to anthracyclines in locally advanced breast cancer patients who received neoadjuvant chemotherapy (RR = 1.93, 95%CI: 1.27−2.94, P=0.002; RR =1.98, 95%CI: 1.37−2.86, P<0.001). In early breast cancer patients who received anthracycline-based adjuvant chemotherapy compared with non-taxane-based polychemotherapy, amplification(HR = 0.64, 95%CI: 0.49−0.83, P=0.001; HR = 0.59, 95% CI: 0.35−1.01, P=0.056) or deletion (HR = 0.82, 95%CI: 0.67−1.00, P=0.051; HR =0.58, 95%CI: 0.35−0.97, P=0.036) of topo IIα was significantly associated with better RFS and OS. The subgroup analysis in the early breast cancer patients indicated that taxane could be an interference for evaluation of the predictive role of topo IIα. In summary, the present meta-analysis suggests that topo IIα is a predictive factor for breast cancer patients who received anthracycline-based chemotherapy. Larger and well-designed prospective studies are required to further evaluate the predictive role of topo IIα in clinical practice.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-13-13.

ENTPD5, an endoplasmic reticulum UDPase, alleviates ER stress induced by protein overloading in AKT-activated cancer cells

PI3 kinase (PI3K) and tensin homolog (PTEN) lipid phosphatase control the level of cellular phosphatidylinositol (3,4,5)-trisphosphate, an activator of AKT kinase that promotes cell growth and survival. Gain-of-function mutations in PI3K and loss-of-function mutations in PTEN that activate AKT are commonly observed in human cancers. The activation of AKT causes increased protein translation and the influx of proteins into the endoplasmic reticulum (ER). The expression of ENTPD5, an ER enzyme, is up-regulated in cancer cell lines and primary human tumor samples in which AKT is activated. ENTPD5 hydrolyzes UDP in the ER to promote protein N-glycosylation and refolding. The elevation of ENTPD5 activity therefore protects AKT-active cancer cells from protein-overloading-induced ER stress and the resulting growth arrest and apoptosis.

Influence of consumption of probiotics on the plasma lipid profile: a meta-analysis of randomised controlled trials

AIMS

Human clinical studies have yielded mixed results on the effects of consumption of probiotics on the plasma lipid profile. We conducted a meta-analysis of randomised controlled trials that evaluated the effects of probiotics consumption on blood lipids.

DATA SYNTHESIS

A systematic literature search of Embase, Web of Science, PubMed and Cochrane Controlled Trials Registry was conducted for studies that investigated the efficacy of probiotics on the plasma lipid profile of subjects. With the help of Review Manager 4.2, data from 13 trials, which included 485 participants with high, borderline high and normal cholesterol levels, were examined. The pooled mean net change in total cholesterol for those treated with probiotics compared to controls was -6.40 mg dl(-1) (95% confidence interval (CI), -9.93 to -2.87), mean net change in low-density lipoprotein (LDL) cholesterol was -4.90 mg dl(-1) (95% CI, -7.91 to -1.90), mean net change in high-density lipoprotein (HDL) cholesterol was -0.11 mg dl(-1) (95% CI, -1.90-1.69) and mean net change in triglycerides was -3.95 mg dl(-1) (95% CI, -10.32-2.42).

CONCLUSION

These results indicate that a diet rich in probiotics decreases total cholesterol and LDL cholesterol concentration in plasma for participants with high, borderline high and normal cholesterol levels.

Proteomic divergence in Arabidopsis autopolyploids and allopolyploids and their progenitors

Autopolyploidy and allopolyploidy are common in many plants and some animals. Rapid changes in genomic composition and gene expression have been observed in both autopolyploids and allopolyploids, but the effects of polyploidy on proteomic divergence are poorly understood. Here, we report quantitative analysis of protein changes in leaves of Arabidopsis autopolyploids and allotetraploids and their progenitors using isobaric tags for relative and absolute quantitation (iTRAQ) coupled with mass spectrometry. In more than 1000 proteins analyzed, the levels of protein divergence were relatively high (~18%) between Arabidopsis thaliana and Arabidopsis arenosa, relatively low (~6.8%) between an A. thaliana diploid and autotetraploid and intermediate (~8.3 and 8.2%) in F(1)- and F(8)-resynthesized allotetraploids relative to mid-parent values, respectively. This pattern of proteomic divergence was consistent with the previously reported gene expression data. In particular, many non-additively accumulated proteins (61-62%) in the F(1) and F(8) allotetraploids were also differentially expressed between the parents. The differentially accumulated proteins in functional categories of abiotic and biotic stresses were overrepresented between an A. thaliana autotetraploid and diploid and between two Arabidopsis species, but not significantly different between allotetraploids and their progenitors. Although the trend of changes is similar, the percentage of differentially accumulated proteins that matched previously reported differentially expressed genes was relatively low. Western blot analysis confirmed several selected proteins with isoforms the cumulative levels of which were differentially expressed. These data suggest high protein divergence between species and rapid changes in post-transcriptional regulation and translational modifications of proteins during polyploidization.

Early diagnostic value of plasma PCT and BG assay for CRBSI after OLT

AIM

The aim was to evaluate the role of procalcitonin (PCT) and (1-3)-β-D-glucan (BG) tests for early detection or exclusion of central venous catheter-related bloodstream infections (CRBSI) in patients after orthotopic liver transplantation (OLT).

METHODS

Fifty-five patients with clinically suspected CRBSI were assessed after OLT in this prospective study. On the day of clinical suspicion of CRBSI, blood samples were obtained from central venous catheters and a peripheral vein for blood cultures and from a peripheral vein for PCT and BG tests. Plasma PCT and BG values were measured by using an immunoluminometric assay and Fungitell BG assay, respectively. No prisoners or organs from prisoners were used in this study.

RESULTS

Twenty-five patients (45%) were diagnosed with CRBIS. Among them, 13 (52%) displayed gram-positive bacteriemia, 11 (44%) gram-negative bacteriemia, and 1 (4%) fungemia. The PCT values were higher in CRBSI than in non-CRBSI patients (P = .003). CRBSI patients did not show significant increases in plasma BG values compared with non-CRBSI subjects (P = .051). PCT and BG area under receiver operating characteristic curves were 0.840 and 0.486, respectively. Sensitivity, specificity, and positive and negative predictive values of a PCT of ≥ 3.1 ng/mL for the diagnosis of CRBSI were 0.72, 0.87, 0.82, and 0.79, respectively. The figures for a BG of ≥ 83 pg/mL were 0.32, 0.90, 0.73, and 0.61, respectively. Among the 24 patients with bacteria infections, PCT was higher in patients with gram-negative than those with gram-positive bacterial infections (P = .022).

CONCLUSION

We concluded that the PCT assay may be a useful rapid diagnostic adjunct for the diagnosis of suspected CRBSI in OLT patients.

Immunoregulation effect by overexpression of heme oxygenase-1 on cardiac xenotransplantation

OBJECTIVE

This study was designed to investigate the effect of the overexpression of heme oxygenase-1 (HO-1) on the immunoregulation in the model of abdominal cardiac xenotransplantation from the guinea pig to the rat.

MATERIALS AND METHODS

To increase the expression of HO-1, both donors and recipients were injected with heme through the abdomen before the operation. The donors (guniea pigs) and the recipients (Sprague-Dawley [SD] rats) were divided randomly into three groups: group A, the heart from a guinea pig transplanted into the abdomen of an SD rat; group B, the recipients were injected with Chinese cobra venom factor (CVF) into the abdomen (40 μg/kg and 60 μg/kg 24 hours later) prior to transplantation; group C, CVF + HO-1 high-expression group: donors and recipients were abdominally injected with heme (75 μmol/kg for 2 days before transplantation). The mean survival time (MST), pathological changes, the positive area of HO-1 in the grafted hearts, as well as the expressions of C-C chemokine receptor 5 (CCR5), intercellular adhesion molecule-1 (ICAM-1), and natural killer (NK) cell activity in recipients.

RESULTS

1. The MST was longest in group C treated with heme. 2. The pathologic changes of hyperacute rejection were showed on the donor heart in group A, while delayed xenograft rejection changes took place on donor heart in other groups. 3. Compared with group B, The HO-1 positive area in the donor hearts of group C was significantly higher. (P < .05). 4. The lever of ICAM-1 and CCR5 in the peripheral blood of recipients (pg/mL) was attenuated in group C injected with heme. 5. Compared with group B, the activity of NK cell in the peripheral blood of recipients was much lower in group C (P < .05).

CONCLUSION

The MST was prolonged by increasing expressions of HO-1, but acute vascular rejection was not completely overcome. Activation of vascular endothelial cells could be decreased by strengthening the expression of HO-1. NK cell activity was weakened by reinforced expression of HO-1.

Origination of new immunological functions in the costimulatory molecule B7-H3: the role of exon duplication in evolution of the immune system

B7-H3, a recently identified B7 family member, has different isoforms in human and mouse. Mouse B7-H3 gene has only one isoform (2IgB7-H3) with two Ig-like domains, whereas human B7-H3 has two isoforms (2IgB7-H3 and 4IgB7-H3). In this study a systematic genomic survey across various species from teleost fishes to mammals revealed that 4IgB7-H3 isoform also appeared in pigs, guinea pigs, cows, dogs, African elephants, pandas, megabats and higher primate animals, which resulted from tandem exon duplication. Further sequence analysis indicated that this duplication generated a new conserved region in the first IgC domain, which might disable 4IgB7-H3 from releasing soluble form, while 2IgB7-H3 presented both membrane and soluble forms. Through three-dimensional (3D) structure modeling and fusion-protein binding assays, we discovered that the duplicated isoform had a different structure and might bind to another potential receptor on activated T cells. In T cell proliferation assay, human 2IgB7-H3 (h2IgB7-H3) and mouse B7-H3 (mB7-H3) both increased T cell proliferation and IL-2, IFN-γ production, whereas human 4IgB7-H3 (h4IgB7-H3) reduced cytokine production and T cell proliferation compared to control. Furthermore, both h2IgB7-H3 and mB7-H3 upregulated the function of lipopolysacharide (LPS)-activated monocyte in vitro. Taken together, our data implied that during the evolution of vertebrates, B7-H3 exon duplication contributed to the generation of a new 4IgB7-H3 isoform in many mammalian species, which have carried out distinct functions in the immune responses.

Association of Toll like receptor 9 expression with lymph node metastasis in human breast cancer

The toll like receptor 9(TLR9) has been suggested to play an important role in the invasion and metastasis of cancer cells in vitro. However, the expression of TLR9 in human cancer specimens has never been characterized. In this study, we investigated the expression of TLR9 in breast cancer specimens and determined the association between its expression and the clinicopathological features observed. We found that TLR9 expression was significantly higher in patients with breast cancers displaying large tumor size (P = 0.040), lymph node metastasis (P < 0.001) or advanced pathological stage (P = 0.006). TLR9 expression was also increased in ER negative breast cancer specimens (P = 0.043). Logistic regression analysis revealed that pathological stage (P = 0.007) and TRL9 (P = 0.001) expression were independent factors that influenced axillary lymph node metastasis of breast cancer. Patients with positive TLR9 expression had a higher progress free survival compared with the TLR9-negative cohort (P = 0.037). Therefore we concluded that Lymph node metastasis more likely occur in breast cancer patients with a positive TLR9 status and its expression might serve as an indicator of poor prognosis in patients with breast cancer.

Intron-1 rs3761548 is related to the defective transcription of Foxp3 in psoriasis through abrogating E47/c-Myb binding

Foxp3 is a master transcription factor (TF) for development and function of CD4(+)CD25(+)Foxp3(+) regulatory T cells (Treg cells) and is critical for the transcription of target genes. But the transcriptional regulation of Foxp3 itself has not been fully understood until now. Here, we aimed to demonstrate the hypothesis that upstream single nucleotide polymorphism(s) (SNPs) of Foxp3 was/were responsible for the defective transcription of Foxp3 in psoriasis and to explore the mechanism behind this hypothesis. In this study, SNP of large sample was investigated for risk analysis. Mature algorithms, electrophoretic mobility shift and chromatin immunoprecipitation assays were used to identify TF binding site variations. Loss-of-function and overexpression assays and cell cycle blocker assay were performed to identify when and what kind of possible roles the candidate factors play. Our results showed that intron-1 rs3761548 was correlated with a significant susceptibility to psoriasis. The rs3761548 contributed to the decreased resting Foxp3 transcription and impaired acceleration of Foxp3 transcription levels after stimulation in psoriatic patients with genotype AA. We analysed and demonstrated potent new E47/c-Myb -dependent regulation elements in rs3761548, oppositely controlling Foxp3 gene transcription at G1 and G2/M phases of Treg cells in psoriatic patients. For patients with rs3761548 AA, the polymorphism causes loss of bindings to the E47 and c-Myb factors, leading to defective transcription of Foxp3 gene. Further identification of the networks and molecular mechanisms underlying Foxp3 transcription may provide new insights into Foxp3 transcriptional regulation and alternative therapeutic strategies to improve characteristics of autoimmune disorders.

Significance and relationship between DJ-1 gene and surviving gene expression in laryngeal carcinoma

This study aimed at exploring the correlation between DJ-1 gene and survivin gene in laryngeal squamous cell carcinoma by analyzing their gene expression levels and their relationship with clinicopathologic parameters. The expression of DJ-1 gene and survivin gene in 82 laryngeal carcinoma tissues from patients and 82 negative surgical margin tissue samples were detected by immunohistochemistry, respectively. The correlation of their expression levels and patients' clinical parameters were then analyzed by Pearson correlation analysis. The positive detection rates of DJ-1 and survivin in laryngeal carcinoma tissues were 71.95% and 60.98%, which were higher than those of the normal control that were 29.27% and 0.00%, respectively (P<0.01). The positive detection rates of DJ-1 and survivin were found associated with tumor stages (P<0.05), but not with lymph node metastasis. The DJ-1 gene expression level was related to cell differentiation (P<0.05). Finally, a positive correlation between DJ-1 and survivin gene expression in laryngeal carcinoma was found. The overall survival rate of patients was 51.2%, and disease-free survival (DFS) was 39.0%. DFS in DJ-1 negative-expression group was 87.0%, and 20.3% in DJ-1 positive-expression group. The negative expression of DJ-1 was associated with a shorter mean patient DFS time (44.643±1.417 months), whereas positive expression of DJ-1 was associated with a longer mean DSF time (25.943±;1.297 months). DJ-1 and survivin play a vital role in the occurrence and development of laryngeal carcinoma. DJ-1 may promote the carcinogenesis of laryngeal cells by up-regulating the survivin gene expression.

Melt Intercalation of PMMA into Organically-Modified Layered Silicate

Organic-inorganic hybrid nanocomposite materials of poly(methyl methacrylate) (PMMA) and organically-modified silicate (B34) systems have been prepared via melt intercalation with variation of tacticity and molecular weight as the main molecular variables. Only two of the PMMA samples (with the lowest glass transition temperatures) were able to undergo large-scale intercalation into B34, as seen by X-ray diffraction (XRD) and Infrared spectroscopy. The saturation weight ratio of PMMA to B34 was about 25:75 (wt%), deduced by a controlled differential scanning calorimetry (DSC) experiment. Two new absorption bands of PMMA-B34 hybrid in Fourier transform-infrared spectrometry (FTIR) were demonstrated for first time in this system and show a change in molecular interaction of bulk and intercalated PMMA. The degradation temperature of the PMMA-B34 hybrid is higher than that of PMMA alone, or a physical mixture of PMMA and silicate under an air or a nitrogen flow.

Immune suppression produced by intrathymic inoculation with xenogeneic antigen and whole-body γ-irradiation in a pig-to-monkey heart transplantation model

OBJECTIVE

To validate the use of pig-to-monkey transplantation as an experimental animal model for study of the induction of immune suppression of cardiac xenografts via intrathymic inoculation with xenogeneic spleen cells and whole-body γ-irradiation.

MATERIALS AND METHODS

Donors (Meishan pigs) and recipients (Rhesus monkeys) were randomized into 3 groups. Group 2 was the control group; group 2 received whole-body irradiation, and group 3 received whole-body irradiation and intrathymic inoculation. In each group, survival time of heterotopic heart xenografts in monkeys were observed. A mixed lymphocyte reaction assay with (3)H thymidine was used to examine changes in lymphocyte function in all groups on the day of transplantation. In each group, recipient serum was harvested for analysis of IL-2 and IL-10 concentrations.

RESULTS

Mean (SD) survival time of donor hearts in group 3 was significantly longer (91.1 [22.8] hours) than in group 1 (36.6 [5.8] hours) (P < .01). The results of mixed lymphocyte reaction assay demonstrated a significant reduction in the stimulation index in group 3 compared with groups 1 and 2 (P < .01) when recipient splenocytes responded to the donor stimulator. The IL-2 concentration in recipients in all groups was much higher during rejection of xenografts than before transplantation (P < .01).

CONCLUSION

These results suggest that pretreatment with intrathymic inoculation or whole-body irradiation induces T-cell immunosuppression. The IL-2 concentration is closely correlated with xenograft rejection.

MPprimer: a program for reliable multiplex PCR primer design

BACKGROUND

Multiplex PCR, defined as the simultaneous amplification of multiple regions of a DNA template or multiple DNA templates using more than one primer set (comprising a forward primer and a reverse primer) in one tube, has been widely used in diagnostic applications of clinical and environmental microbiology studies. However, primer design for multiplex PCR is still a challenging problem and several factors need to be considered. These problems include mis-priming due to nonspecific binding to non-target DNA templates, primer dimerization, and the inability to separate and purify DNA amplicons with similar electrophoretic mobility.

RESULTS

A program named MPprimer was developed to help users for reliable multiplex PCR primer design. It employs the widely used primer design program Primer3 and the primer specificity evaluation program MFEprimer to design and evaluate the candidate primers based on genomic or transcript DNA database, followed by careful examination to avoid primer dimerization. The graph-expanding algorithm derived from the greedy algorithm was used to determine the optimal primer set combinations (PSCs) for multiplex PCR assay. In addition, MPprimer provides a virtual electrophotogram to help users choose the best PSC. The experimental validation from 2x to 5x plex PCR demonstrates the reliability of MPprimer. As another example, MPprimer is able to design the multiplex PCR primers for DMD (dystrophin gene which caused Duchenne Muscular Dystrophy), which has 79 exons, for 20x, 20x, 20x, 14x, and 5x plex PCR reactions in five tubes to detect underlying exon deletions.

CONCLUSIONS

MPprimer is a valuable tool for designing specific, non-dimerizing primer set combinations with constrained amplicons size for multiplex PCR assays.