A phase 1 study of OSI-930 in combination with erlotinib in patients with advanced solid tumours

AIM

To determine the maximum tolerated dose (MTD) of OSI-930 that can be combined with erlotinib, and establish recommended phase 2 doses when both agents are administered daily in patients with advanced solid tumours.

PATIENTS AND METHODS

Eligible patients with advanced solid tumours were enrolled into this standard "three+three" dose escalation study. Study treatment commenced on day 1 with OSI-930, and erlotinib was introduced on day 8. PK profiles of OSI-930, erlotinib and its active metabolite, OSI-420, were determined. Changes in sVEGFR2 as a pharmacodynamic biomarker of OSI-930 activity were assessed.

RESULTS

Twenty one patients were enrolled to 1 of 3 cohorts: 200 mg OSI-930 BID+100 mg erlotinib QD; 200 mg OSI-930 BID+150 mg erlotinib QD; 300 mg OSI-930 BID+150 mg erlotinib QD. The most common adverse events were anorexia (85%), diarrhoea (75%), rash (70%) and lethargy (65%). The MTD was not reached but the onset of cumulative toxicity necessitating dose modification after the 28-d DLT assessment period was common at the highest dose level. A PK interaction was identified with co-administration of both agents resulting in a two-fold increase in OSI-930 exposure. Pharmacodynamic activity was observed with a decline in sVEGFR levels detected in all patients. Ten patients had disease stabilization (median duration 119 d).

CONCLUSIONS

200 mg OSI-930 BID+150 mg erlotinib QD were the recommended doses for further evaluation of this combination.

Cognitive function in postmenopausal women receiving adjuvant letrozole or tamoxifen in the Breast International Group (BIG) 1–98 trial

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Background: Hormonal therapy for breast cancer (BC) may affect cognition. Methods: Post-menopausal women with hormone receptor positive, early-stage BC were randomized to receive either: A) tamoxifen for 5 years; B) letrozole for 5 years; C) tamoxifen for 2 years followed by letrozole for 3 years; or D) letrozole for 2 years followed by tamoxifen for 3 years, as adjuvant endocrine treatment. During the fifth year of trial treatment, objective cognitive function (speed of psychomotor function, visual attention, working and verbal memory, learning) was evaluated by computerized tests. The difference in the composite score for patients taking letrozole (B+C; N= 65) versus tamoxifen (A+D; N = 55) at the time of testing was the primary comparison. Scores for each domain were standardized according to age-specific norms. Two-way ANOVA controlling for language was used to test the effect of treatment on cognitive function. Self-reported subjective cognitive function, psychological distress, fatigue and quality of life were also assessed. Results: Patient characteristics were balanced between groups. Both groups performed below age norms on most domains. The group taking letrozole had better overall cognitive function than the tamoxifen group (difference in mean composite scores = 0.278, p = 0.038, 95% CI: 0.015–0.540) and outperformed patients on tamoxifen for all domains (n.s.). Comparison of monotherapy arms A versus B supported better cognitive function among letrozole patients. Subjective cognitive function, psychological distress, fatigue, and quality of life did not differ between groups. Conclusions: Although letrozole results in lower circulating estrogen levels than tamoxifen, in this study BC patients taking adjuvant letrozole during the fifth year of treatment had better cognitive functioning than those taking tamoxifen.

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Second female case of Myhre syndrome

Myhre syndrome is a rare disorder characterized by low birthweight, short stature, mental retardation, facial dysmorphism (blepharophimosis, midfacial hypoplasia, prognathism), heart anomalies, muscle hypertrophy, decreased joint mobility and deafness. To date 11 male cases and only one female case have been reported. This paper describes the second female case and compares the clinical and radiological findings between female and male patients.

Inactivation of DsbA alters the behaviour of Shigella flexneri towards murine and human-derived macrophage-like cells

The mutants of Shigella flexneri, Sh4 (dsbA::kan) and Sh42 (dsbA33G), behave differently towards murine and human-derived macrophage-like cells in vitro. Sh4 was trapped in the phagocytic vacuoles of the murine J774 cells as evidenced by its colony forming units plus and minus chloroquine exposure in a gentamicin protection assay, and by light and transmission electron microscopy (TEM). Sh42, similar to the wild-type M90TS, was able to escape from the vacuoles and kill host cells presumably by inducing apoptosis. In U937 cells, unlike M90TS that was free in the cytosol, both Sh4 and Sh42 grew poorly. TEM revealed that Sh4 and Sh42 were trapped within the U937 phagocytic vacuoles. Furthermore, the two mutants induced different patterns of interleukin-1beta and tumour necrosis factor-alpha expression, which might explain why they possess different immunogenic properties in vivo.

Level of lung function required to use the Camic Datamaster breath alcohol testing device

In the UK a person who, without reasonable excuse, fails to provide a breath specimen when required to under the 1988 Road Traffic Act, is guilty of an offense. In the past many suspects claim to have experienced difficulty providing breath samples for evidential machines. This paper describes experiments carried out on human subjects, both healthy and suffering a variety of respiratory illness. The experiments were designed to assess the level of respiratory performance required to provide a satisfactory breath sample for the Camic Datamaster. In this study it was found that both actual spirometry values and the percentage of predicted values were both important indicators.

Tackling latex allergy with a product database

Health care professionals, hospital patients and rubber industry workers have noted a marked increase in allergic reactions to natural rubber latex.

Gene-targeted therapeutic strategies--Royal Pharmaceutical Society Symposium. 9-10 December 1999, London, UK

This meeting highlighted the approaches that are currently available for gene-targeted therapeutics. The meeting focused on two strategies: antigene and anti-message. Polyamides (an example of antigene targeting) have exhibited significant antiviral activity, particularly against AIDS. The design of these agents and the mechanisms by which these compounds interact with DNA were discussed. Antisense oligonucleotides and ribozymes, agents used in the anti-message strategies, are proving to be attractive drug candidates for cancer chemotherapy. Antisense technology has been used for patients with B-cell lymphomas, resulting in complete remission of the disease in some cases. The unavailability of appropriate delivery systems for these DNA-targeting drugs continues to limit their widespread use. As was emphasized in this meeting, DNA-targeting drugs will continue to play an important role in clinical medicine for the foreseeable future.

Can wine tasting be used as a defence to a charge of excess alcohol?

Wine-tasting has been used as a defence in the UK to charges of driving with excess alcohol on the breath. There is little scientific data to support this explanation. The authors carried out an experimental wine-tasting using twelve volunteer subjects. Breath alcohol samples were taken at the start of the experiment and fifteen minutes after the end. All subjects after wine-tasting had breath alcohol levels below the instrumental limit of detection. The authors conclude that the wine-tasting defence is not credible.