Results of a phase II trial of single-agent amrubicin (AMR) in patients with extensive disease small cell lung cancer (ED-SCLC) refractory to first-line platinum-based chemotherapy: An update

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Background: Amrubicin (AMR), a third-generation synthetic anthracycline and potent topoisomerase II inhibitor, is approved in Japan for the treatment of lung cancer. Patients (pts) with SCLC, who are refractory to first-line chemotherapy or progress within 3 months (mos) of treatment completion, are less likely to respond to additional chemotherapy and have an expected median survival of 3–5 mos. Here, we investigate the efficacy and safety of single-agent AMR in the treatment of Western pts with refractory ED-SCLC. Methods: In this phase II trial, pts with ED-SCLC refractory to prior 1st-line platinum-based chemotherapy (defined as progression (PD) while on therapy or relapse within 90 days of treatment completion) and ECOG performance status (PS) ≤2 were eligible. Patients were treated with intravenous AMR 40 mg/m2/day x 3 days every 21 days until PD or intolerable toxicity. The primary endpoint was response rate (ORR, by RECIST), with a goal to demonstrate an ORR ≥18% (point estimate). Secondary endpoints included progression-free survival (PFS) and overall survival (OS). Results: In all, 75 pts were enrolled with a median age of 63 years (range 43–88), 52% female, 17% PS 2. Response to 1st-line therapy was 5% complete remission (CR), 36% partial remission (PR) and 28% PD. Median time from completion of 1st-line therapy to PD was 1.3 mos. Sixty-nine pts received AMR for a median of 4 cycles (range 1–12). Six pts died or discontinued before receiving treatment. The primary endpoint was met with an ORR of 21% (16/75, 95% confidence interval [CI] 13.6% - 31.9%), including CR in 1 pt (1%) and PR in 15 pts (20%). Stable disease was achieved in 40% of pts. Two pts with PD as best response to 1st line chemotherapy achieved a PR. Median OS was 6.0 mos (95% CI 4.8–7.1 mos). Median PFS was 3.2 mos (95% CI 2.4–4.0 mos). The most common grade 3 or 4 adverse events were neutropenia (65%), thrombocytopenia (39%), and leukopenia (35%). Seven (10%) patients experienced febrile neutropenia. Dose reductions were required in 26 patients (38%). Conclusions: AMR shows promising activity, with an ORR of 21%, and an acceptable safety profile in patients with refractory ED-SCLC, and warrants further study in these pts.

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Lymphoplasmacyte-rich meningioma at the foramen magnum

We report a case of lymphoplasmacyte-rich meningioma (LPM) in a 22-year-old woman who presented with headache, hemiparesis and hypoaesthesia. MRI revealed a meningioma at the foramen magnum region that was resected by far-lateral approach. This case represents the second LPM to be reported at this site and highlights the importance of distinguishing it from other lesions that may have significant population of lymphocytes and plasma cells.

Fine mapping of loci involved with glucosinolate biosynthesis in oilseed mustard (Brassica juncea) using genomic information from allied species

Fine mapping of six seed glucosinolate QTL (J2Gsl1, J3Gsl2, J9Gsl3, J16Gsl4, J17Gsl5 and J3Gsl6) (Ramchiary et al. in Theor Appl Genet 116:77-85, 2007a) was undertaken by the candidate gene approach. Based on the DNA sequences from Arabidopsis and Brassica oleracea for the different genes involved in the aliphatic glucosinolate biosynthesis, candidate genes were amplified and sequenced from high to low glucosinolate Brassica juncea lines Varuna and Heera, respectively. Of the 20 paralogues identified, 17 paralogues belonging to six gene families were mapped to 12 of the 18 linkage groups of B. juncea genome. Co-mapping of candidate genes with glucosinolate QTL revealed that the candidate gene BjuA.GSL-ELONG.a mapped to the QTL interval of J2Gsl1, BjuA.GSL-ELONG.c, BjuA.GSL-ELONG.d and BjuA.Myb28.a mapped to the QTL interval of J3Gsl2, BjuA.GSL-ALK.a mapped to the QTL interval of J3Gsl6 and BjuB.Myb28.a mapped to the QTL interval of J17Gsl5. The QTL J9Gsl3 and J16Gsl4 did not correspond to any of the mapped candidate genes. The functionality and contribution of different candidate genes/QTL was assessed by allelic variation study using phenotypic data of 785 BC(4)DH lines. It was observed that BjuA.Myb28.a and J9Gsl3 contributed significantly to the base level glucosinolate production while J16Gsl4, probably GSL-PRO, BjuA.GSL-ELONG.a and BjuA.GSL-ELONG.c contributed to the C3, C4 and C5 elongation pathways, respectively. Three A genome QTL: J2Gsl1harbouring BjuA.GSL-ELONG.a, J3Gsl2 harbouring both BjuA.GSL-ELONG.c and BjuA.Myb28.a and J9Gsl3, possibly the 'Bronowski genes', were identified as most important loci for breeding low glucosinolate B. juncea. We observed two-step genetic control of seed glucosinolate in B. juncea mainly effected by these three A genome QTL. This study, therefore, provides clues to the genetic mechanism of 'Bronowski genes' controlling the glucosinolate trait and also provides efficient markers for marker-assisted introgression of low glucosinolate trait in B. juncea.

A phase I study of tipifarnib combined with conventional induction and consolidation therapy for previously untreated patients with acute myeloid leukemia aged 60 years and over

Patients aged 60 years and over with previously untreated acute myeloid leukemia were enrolled in a Phase I study combining tipifarnib with standard induction therapy. The regimen consisted of cytarabine 100 mg/m(2)/day continuous intravenous (i.v.) infusion on days 1-7, daunorubicin 60 mg/m(2)/day i.v. push x 3 on days 6-8 and tipifarnib twice daily on days 6-15. Tipifarnib was escalated over four dose levels (200, 300, 400 and 600 mg). Patients achieving complete response (CR) were eligible to receive one consolidation using the same regimen. The following dose-limiting toxicities (DLTs) were identified during induction: dose level I: 2/6 (hyperbilirubinemia, respiratory arrest), level II: 0/3, level III: 0/3 and level IV: 4/10 (one each of diarrhea, neutropenic enterocolitis, arrhythmia and delayed hematologic recovery post-consolidation). There were no DLTs due to delayed hematologic recovery post-induction. Of 22 evaluable patients, there were 10 CR, 2 morphologic leukemia-free state (MLFS), 2 partial remission (PR) and 8 non-responders. Of seven patients with adverse risk cytogenetics, there were four CR/MLFS and one PR. In summary, this regimen was well tolerated and the maximum tolerated dose was not reached, although somewhat more severe gastrointestinal toxicity was seen at dose level IV. Tipifarnib 600 mg b.i.d. is considered the recommended dose for further study using this regimen.

Coil embolization of very small (2 mm or smaller) berry aneurysms: feasibility and technical issues

BACKGROUND AND PURPOSE

The very small size of cerebral aneurysms is considered to be one of the limitations for endovascular treatment, with a high risk for intraoperative rupture. We report on treatment of very small saccular ruptured cerebral aneurysms by coil embolization. All the cases were of 2-mm aneurysms with at least 1 of the dimensions being less than 2 mm.

MATERIALS AND METHODS

We performed retrospective analysis of 7 consecutive cases of very small aneurysms treated by coil embolization in our institution between July 2006 and April 2008.

RESULTS

3D rotational angiography (3DRA) was found to be most accurate in the detection of these aneurysms; in 2 cases, 3DRA revealed the aneurysms after results on digital subtraction angiography (DSA) were considered to be negative. Coil embolization was successfully performed in 6 cases, whereas in 1 case, spontaneous thrombosis occurred after microcatheter placement. Complete (n = 5) or near complete (n = 2) immediate occlusion was seen. A single soft coil was used in all cases with the shortest available length. Balloon assistance was used in 3 cases. Although minimal coil projection in the parent vessel was seen in 3 cases, no untoward clinical complication was seen. Follow-up DSA and MR angiography in 4 patients demonstrated persistent occlusion (n = 3) or progressive thrombosis (n = 1) of the aneurysms. All of the patients with available follow-up are independent in day-to-day activities with a modified Rankin Score (mRS) of 0 or 1.

CONCLUSIONS

Coil embolization of very small ruptured cerebral aneurysms is feasible. Careful consideration of the technical issues in treatment of these cases is essential to achieve technical success while avoiding complications.

A study of clinico-haematological profiles of pancytopenia in children

We report on the clinico-haematological profile of pancytopenia in children from the Departments of Pediatrics and Pathology, Institute of Medical Sciences, Banaras Hindu University, India, over a period of 30 months. Pancytopenia was defined as: haemoglobin <10 g/dL, absolute neutrophil count 1.5 × 109/L and platelet count <100 × 109/L. A detailed history, clinical examination and haematological parameters were recorded. Bone marrow aspiration and trephine biopsy were carried out in all cases. One hundred and five cases aged 1.5–18 years, with a mean age of 8.6 years, were included in the study. Aplastic anaemia was the most common cause of pancytopenia (43%) followed by acute leukaemia (25%). Infections were the third most common cause of pancytopenia of which kala azar was the most common. Megaloblastic anaemia was seen in 6.7%.

Angioinvasive pulmonary mucormycosis presenting as multiple bilateral pulmonary nodules in a patient without obvious predisposing factors

Pulmonary mucormycosis is a rare, frequently fatal, fungal infection. It is usually seen in the presence of various immunocompromised states, such as diabetes mellitus, haematological malignancy or renal transplantation. In the absence of underlying predisposing conditions, presentation with infiltrates, consolidation, cavitation and mass lesion have been reported. We describe a 50-year-old man who presented with cough and chest pain for six months. Chest radiograph and computed tomography showed bilateral multiple pulmonary nodules. Surgical lung biopsy revealed angioinvasive mucormycosis. He had complete recovery with amphotericin therapy.

Use of CT angiography for anatomic localization of arteriovenous malformation Nidal components

We report a case of diffuse arteriovenous malformation (AVM) in basal ganglia and an internal capsule associated with venous aneurysms. The patient was treated by embolization guided by CT angiography to target the basal ganglionic portion of the AVM while sparing the internal capsule. Our case demonstrates that it is possible to obtain good quality intranidal angiograms by using CT angiography, which can be useful for exact localization of the catheterized part of the nidus.

Rare presentation of a common disease of tropics

A 19 years male presented with fever, oliguria and purpuric lesions involving both hands. The patient was diagnosed as a case of purpura fulminans with disseminated intravascular coagulation due to complicated falciparum malaria. The case is presented to sensitize the physicians to keep malaria as a differential in cases of fever with purpura fulminans.

Complete resolution of stage IIIB juvenile nasopharyngeal angiofibroma with radiation therapy

Juvenile nasopharyngeal angiofibroma is a benign, locally aggressive, vascular tumour of adolescent males. Extension to intracranial cavity is not uncommon and presents difficulties in management. Here we report a patient who had Radkowsky stage IIIB lesion, with blood supply from internal carotid artery. In view of anticipated problems with surgery, the patient was treated with 30 Gy in 15# external beam radiotherapy. On follow up, tumour was noted to disappear gradually overtime and at 3 years complete disappearance was noted with normal return of vision. Hence we are re-affirming the earlier studies than angiofibroma mass regresses gradually after completion of radiotherapy. Radiotherapy is a useful way of treating angiofibroma with significant intracranial extension.

Myelodysplastic syndrome

Pediatric myelodysplastic syndrome (MDS), though rare, constitutes a distinct entity quite different from adult MDS. They have unique clinical features, aggressive clinical course with an overall mean survival of only 9.9 months. A pediatric approach to the WHO classification has become necessary since the WHO classification of MDS has failed to address the uniqueness of pediatric MDS. A new prognostic system also needs to be evolved since the international prognostic system has limited prognostic impact in children. Intensive chemotherapy such as the one used in de novo-acute myeloid leukemia (AML) leads to complete remission in some children and this may be the treatment of choice in pediatric MDS.