Phase II trial of docetaxel and oxaliplatin in patients with advanced gastric cancer and/or adenocarcinoma of the gastroesophageal junction

BACKGROUND

Platinum-based chemotherapy is the standard treatment for advanced gastric cancer (GC). This trial explored the efficacy and tolerability of combined docetaxel (Taxotere) + oxaliplatin (DOCOX) in GC patients.

PATIENTS AND METHODS

Patients with untreated stage IV GC or adenocarcinoma of the gastroesophageal junction (AGEJ) received docetaxel 60 mg/m(2) followed by oxaliplatin 130 mg/m(2) on day 1 of each 21-day cycle until progression or unacceptable toxicity. The primary end points were response rate (RR), toxicity, progression-free survival (PFS), and overall survival (OS).

RESULTS

Baseline characteristics (N = 71): median age 59 years, 72% male, 51% esophagogastric junction cancer, and Eastern Cooperative Oncology Group performance status of zero, one, two were 42%, 51%, 7%, respectively. The median number of cycles was 6 (range, 1-19). Grades 3-4 toxic effects: neutropenia (70%); vomiting (17%); nausea (16%); dehydration, fatigue, or diarrhea (13%, each); and thrombocytopenia or febrile neutropenia (7%, each). Sixty-six patients completed >/=2 cycles. The RR was 36% with 25 partial response (PR) and no complete responses (CRs); stable disease (SD) was 49%. Clinical benefit rate (CBR = CR + PR + SD >/=6 months) was 40%; median PFS was 4.3 months, and OS was 8.5 months.

CONCLUSIONS

DOCOX produced manageable toxicity in patients with advanced GC and AGEJ. The confirmed RR of 36%, CBR of 40%, and median survival of 8.5 months are encouraging and comparable to standard front-line regimens.

In vivo changes in gene expression profiles (GEP) after bortezomib (V) for multiple myeloma (MM): Differential effects on plasma cells (PC) and micro-environment (ME)

7603

Introduction: V, a proteasome inhibitor with potent anti-myeloma activity, is thought to act through effects on malignant PC and the ME. However, the in vivo effects of this drug have never been examined at the molecular level. Methods: Serial GEP analyses were performed of paired purified PC and bone marrow biopsies from 46 patients, obtained prior to and 48hr following administration of a single V dose at 1mg/m2. RNA was isolated from whole biopsies and purified PCs from each sample, converted to cRNA, and hybridized to Affymetrix U133 Plus2 microarrays. SAM analysis with 5% false discovery rate was employed to identify drug-altered genes. Results: Following V, 36 ME-associated genes (MAGs) were up-regulated, among them the osteoinductive factor osteoglycin (OGN), consistent with a V effect on osteoblastogenesis; CYR61, an angiogenesis inducer, significantly over-expressed in myeloma relative to normal marrow, was one of only 3 significantly down-regulated genes. V is known to induce expression of proteasome genes and PSMA6, PSMA1, and PSMA14 were among 15 genes up-regulated in PC. In contrast, early growth response (EGR1, EGR2, and EGR3), Krupple-like factor (KLR4, KLR5, KLR6, and KLR7) and nuclear receptor (NR4A1, NR4A2, and NR4A3) family members were down-regulated in PC by V. These differential PC and ME expression changes were only noted in low-risk MM, lacking over-expression of CKS1B. Conclusion: We report here, for the first time, on the differential molecular consequences of a single in-vivo dose of V on both tumor cells and cells of the microenvironment. The clinical implications of these findings are being further investigated and will be presented.

[Table: see text]

Phase II multicenter trial of docetaxel+oxaliplatin in stage IV gastroesophageal and/or stomach cancer

4071

Background: The treatment of adenocarcinoma of the gastroesophageal junction /stomach (AGEJ/S) remains a therapeutic challenge. This study was conducted to explore the efficacy and safety profile of the combination of docetaxel+oxaliplatin in patients with previously untreated advanced AGEJ/S. Docetaxel has shown significant single-agent activity and has recently been shown to increase response rates and overall survival when combined with cisplatin plus 5-FU. Oxaliplatin is associated with a more favorable safety profile compared to other platinum-based drugs (ie, cisplatin). Methods: Patients with metastatic (Stage IV) AGEJ/S were eligible. Treatment consisted of docetaxel 60 mg/m2 over 1 hour IV followed by oxaliplatin 130 mg/m2 over 2 hours on Day 1 of each 21-day cycle. Patients were treated until disease progression or unacceptable toxicity; primary endpoints are response rate, toxicity, and progression free and overall survival. Results: We have enrolled all planned eligible patients (N = 71). Baseline characteristics include a median age of 59.5 years, 72% male patients, 76% white, and ECOG PS scores 0/1/2 of 45%/49%/6%, respectively. 32.8% of patients had distal gastric cancer (fundus or pylorus). The median number of cycles delivered to date is 6 (range, 1–14). Twenty patients (31%) have required dose reductions primarily due to neutropenia. Grade 3–4 toxicities include neutropenia (69%); vomiting (17%); nausea (16%); dehydration, fatigue, and diarrhea (13%, each), and thrombocytopenia and febrile neutropenia (7%, each). Sixty-six patients have completed ≥2 cycles. The best overall confirmed response rate, by RECIST, was 24 PR (35.6%) for an overall response rate of 35.6%. Median time to response was 2.4 months and median duration of response was 4.1 months. Median survival was 9.2 months and median PFS was 4.4 months. Conclusions: The combination of docetaxel and oxaliplatin is associated with manageable toxicity in this group of patients with AGEJ/S. The best overall response rate of 35% and median survival of 9.2 months is encouraging and comparable to other standard front-line regimens. This research was supported, in part, from a research grant from sanofi-aventis.

[Table: see text]

Gene expression fingerprint of uterine serous papillary carcinoma: identification of novel molecular markers for uterine serous cancer diagnosis and therapy

Uterine serous papillary cancer (USPC) represents a rare but highly aggressive variant of endometrial cancer, the most common gynecologic tumour in women. We used oligonucleotide microarrays that interrogate the expression of some 10 000 known genes to profile 10 highly purified primary USPC cultures and five normal endometrial cells (NEC). We report that unsupervised analysis of mRNA fingerprints readily distinguished USPC from normal endometrial epithelial cells and identified 139 and 390 genes that exhibited >5-fold upregulation and downregulation, respectively, in primary USPC when compared to NEC. Many of the genes upregulated in USPC were found to represent adhesion molecules, secreted proteins and oncogenes, such as L1 cell adhesion molecule, claudin-3 and claudin-4, kallikrein 6 (protease M) and kallikrein 10 (NES1), interleukin-6 and c-erbB2. Downregulated genes in USPC included SEMACAP3, ras homolog gene family, member I (ARHI), and differentially downregulated in ovarian carcinoma gene 1. Quantitative RT-PCR was used to validate differences in gene expression between USPC and NEC for several of these genes. Owing to its potential as a novel therapeutic marker, expression of the high-affinity epithelial receptor for Clostridium perfringens enterotoxin (CPE) claudin-4 was further validated through immunohistochemical analysis of formalin-fixed paraffin-embedded specimens from which the primary USPC cultures were obtained, as well as an independent set of archival USPC specimens. Finally, the sensitivity of primary USPC to the administration of scalar doses of CPE in vitro was also demonstrated. Our results highlight the novel molecular features of USPC and provide a foundation for the development of new type-specific therapies against this highly aggressive variant of endometrial cancer.

Discrimination between uterine serous papillary carcinomas and ovarian serous papillary tumours by gene expression profiling

High-grade ovarian serous papillary cancer (OSPC) and uterine serous papillary carcinoma (USPC) represent two histologically similar malignancies characterised by markedly different biological behavior and response to chemotherapy. Understanding the molecular basis of these differences may significantly refine differential diagnosis and management, and may lead to the development of novel, more specific and more effective treatment modalities for OSPC and USPC. We used an oligonucleotide microarray with probe sets complementary to >10 000 human genes to determine whether patterns of gene expression may differentiate OSPC from USPC. Hierarchical cluster analysis of gene expression in OSPC and USPC identified 116 genes that exhibited >two-fold differences (P<0.05) and that readily distinguished OSPC from USPC. Plasminogen activator inhibitor (PAI-2) was the most highly overexpressed gene in OSPC when compared to USPC, while c-erbB2 was the most strikingly overexpressed gene in USPC when compared to OSPC. Overexpression of the c-erbB2 gene and its expression product (i.e., HER-2/neu receptor) was validated by quantitative RT-PCR as well as by flow cytometry on primary USPC and OSPC, respectively. Immunohistochemical staining of serous tumour samples from which primary OSPC and USPC cultures were derived as well as from an independent set of 20 clinical tissue samples (i.e., 10 OSPC and 10 USPC) further confirmed HER-2/neu as a novel molecular diagnostic and therapeutic marker for USPC. Gene expression fingerprints have the potential to predict the anatomical site of tumour origin and readily identify the biologically more aggressive USPC from OSPC. A therapeutic strategy targeting HER-2/neu may be beneficial in patients harbouring chemotherapy-resistant USPC.

High-level expression of cancer/testis antigen NY-ESO-1 and human granulocyte-macrophage colony-stimulating factor in dendritic cells with a bicistronic retroviral vector

Tumor-specific genes delivered to dendritic cells (DCs) have been used for the generation of cytotoxic T cells (CTLs), but their application has been limited on the one hand by low viral titers resulting in low transduction efficiency and poor protein production, and on the other hand by immunogenicity of the selectable marker and poor viability of the DCs. We addressed these limitations by creating a multipurpose master vector (pMV) and cloning the tumor gene NY-ESO-1, which is highly expressed in more than 50% of advanced myeloma patients. pMV was constructed from a Moloney murine leukemia virus (Mo-MuLV)-based retroviral backbone with the following features: (1) an extended packaging signal to achieve high viral titers, (2) a splice acceptor region to facilitate protein production, (3) a nonimmunogenic selectable marker, dihydrofolate reductase-L22Y (DHFR(L22Y)), to exclude the generation of CTLs against the selectable marker, (4) an internal ribosomal entry site between the tumor-specific gene (NY-ESO-1) and the selectable marker DHFR(L22Y) for coexpression of two heterologous gene products from a single bicistronic mRNA, minimizing the possibility of differential expression of these two genes, and (5) human granulocyte-macrophage colony-stimulating factor (hGM-CSF) cDNA driven by the human T-lymphotropic virus promoter to enhance DC function and viability. Recombinant virus of pMV-NY-ESO-1 was generated with vesicular stomatitis virus G envelope protein (VSV-G) in the GP2-293 cell line for efficient transduction. We present evidence that the DC phenotype is unaltered after transduction and that more than 85% of DCs express NY-ESO-1, which secrete approximately 40 ng of GM-CSF per 10(6) DCs.

[Differentially expressed cDNA sequences homologous with known genes in human nasopharyngeal carcinoma]

In order to search the tumor suppressor genes correlated with pathogenesis of human nasopharyngeal carcinoma(NPC), we applied the PCR-based subtractive hybridization technique of representational difference analysis (RDA) to the primary culture cells of normal human nasopharyngeal epithelial and HNE1, a poorly differentiated NPC cell line. Following four successive subtractions of HNE1 complementary DNA from normal human nasopharyngeal epithelial cells complementary DNA, difference products were cloned into pGEM-T easy vector and nucleotide sequences determined. Comparison of cDNA sequences against the databases identified 9 known genes. Known genes included TRIP1(TGF beta receptor interacting protein), TAF, ezrin, MHC II, actinin, Histone H1 zero, Cytokeratin 13, Squalene Synthetase and RNA Synthetase-like. Some of them have an effective suppressive ability on the tumor. In this study, we have demonstrated that cDNA RDA is an effective strategy for systematically isolating differences in gene expression between two related but functionally distinct cells. Our results also indicated that the NPC includes interaction of multigenes and this experiment offers a new route for NPC research.

The effect of sildenafil on nitric oxide-mediated vasodilation in healthy men

BACKGROUND

Sildenafil, a treatment for erectile dysfunction, is a specific phosphodiesterase type 5 (PDE 5) inhibitor that enhances nitric oxide (NO)-mediated vasodilation in the corpus cavernosum by inhibiting cyclic guanosine monophosphate breakdown. Since PDE 5 is widely expressed in the vasculature, we examined the hypothesis that sildenafil could enhance NO-mediated vasodilation in other vascular beds and improve endothelial function.

METHODS

NO-mediated responses to acetylcholine (endothelium-dependent) and nitroglycerin (endothelium-independent) were measured in healthy men in the dorsal hand vein (n = 13), after the administration of either sildenafil 50 mg or placebo. Flow-mediated dilation of the brachial artery and forearm postischemic reactive hyperemia were measured before and after sildenafil 50 mg, isosorbide dinitrate 5 mg, and placebo in a double-blind, randomized, crossover study (n = 11).

RESULTS

In the hand vein, sildenafil administration increased sensitivity to local nitroglycerin. The 50% effective dose decreased approximately 4-fold from 13.5 ng/min (range, 6.9-26.6 ng/min) to 2.7 ng/min (range, 1.1-6.4 ng/min) (P =.025). Sildenafil decreased the maximum venoconstriction induced by phenylephrine from 81% +/- 3% to 74% +/- 3% (P =.025). Sildenafil did not significantly affect the maximal venodilatory response to acetylcholine (35% +/- 7% after placebo versus 32% +/- 8% after sildenafil) (P =.7). In the arterial vasculature, flow-mediated dilation before (2.4% +/- 1%) and after (2.8% +/- 1.4%) sildenafil (P =.8) and postischemic reactive hyperemia area under the curve before (1807 +/- 393 mL. min. s/100 mL) and after (1467 +/- 257 mL. min. s/100 mL) sildenafil were not different (P =.8). Resting heart rate, blood pressure, and resting brachial artery diameter were unchanged after sildenafil administration. Isosorbide dinitrate, an endothelium-independent vasodilator, caused a significant increase in resting brachial artery diameter from 0.53 +/- 0.01 cm to 0.56 +/- 0.02 cm (P =.005), without altering flow-mediated dilation.

CONCLUSIONS

In healthy men sildenafil increased sensitivity to nitroglycerin, an exogenous NO donor, approximately 4-fold but did not affect endothelium-dependent, NO-mediated responses in either the hand vein or forearm vasculature. Differential vascular responses to sildenafil may localize its enhancement of endogenous NO-mediated vasodilation to vascular beds such as the corpus cavernosum.

Cyclin D3 at 6p21 is dysregulated by recurrent chromosomal translocations to immunoglobulin loci in multiple myeloma

Reciprocal chromosomal translocations, which are mediated by errors in immunoglobulin heavy chain (IgH) switch recombination or somatic hypermutation as plasma cells are generated in germinal centers, are present in most multiple myeloma (MM) tumors. These translocations dysregulate an oncogene that is repositioned in proximity to a strong IgH enhancer. There is a promiscuous array of nonrandom chromosomal partners (and oncogenes), with the 3 most frequent partners (11q13 [cyclin D1]; 4p16 [FGFR3 and MMSET]; 16q23 [c-maf]) involved in nearly half of MM tumors. It is now shown that a novel t(6;14)(p21;q32) translocation is present in 1 of 30 MM cell lines and that this cell line uniquely overexpresses cyclin D3. The cloned breakpoint juxtaposes gamma 4 switch sequences with 6p21 sequences that are located about 65 kb centromeric to the cyclin D3 gene. By metaphase chromosome analysis, the t(6;14) (p21;q32) translocation was identified in 6 of 150 (4%) primary MM tumors. Overexpression of cyclin D3 messenger RNA (mRNA) was identified by microarray RNA expression analysis in 3 of 53 additional primary MM tumors, each of which was found to have a t(6;14) translocation breakpoint by interphase fluorescence in situ hybridization analysis. One tumor has a t(6;22)(p21;q11) translocation, so that cyclin D3 is bracketed by the IgL and IgH breakpoints. These results provide the first clear evidence for primary dysregulation of cyclin D3 during tumorigenesis. It is suggested that the initial oncogenic event for most MM tumors is a primary immunoglobulin translocation that dysregulates cyclin D1, cyclin D3, and other oncogenes to provide a proliferative stimulus to postgerminal center plasma cells.

[Effect of various cavity design, lining and restorative materials on the fracture resistance of teeth]

OBJECTIVE

To evaluate the influence of various cavity designs, lining and restorative materials on fracture resistance of teeth in vitro.

METHODS

Factorial design with three factors and various levels was used. 36 extracted human maxillary premalors were prepared for occlusal cavity, MO cavity and MOD cavity. Various base material and restorations were used. All teeth were thermocycled and mounted for testing and then were loaded until fracture. The results were analyzed by a three-way ANOVA. Fracture patterns were observed at the same time.

RESULTS

There was significant difference in fracture resistance among various cavity designs and restorations. The fracture patterns were different.

CONCLUSIONS

The different classes of cavities and various restorations have significantly influence upon fracture resistance of teeth. There are interactions between cavities and restorations.

c-myc gene inactivation during induction of nasopharyngeal carcinoma cells with retinoic acid

OBJECTIVE

To investigate the effects of retinoic acid (RA) on the growth, morphology, oncogene expression and regulation of nasopharyngeal carcinoma cells.

METHODS

Nasopharyngeal carcinoma cell line (HNE1) was induced by RA. The RA-treated and control cells were established and cellular morphology and growth patterns were defined. Oncogene expression and regulation were detected by Northern hybridization and DNase-I hypersensitive site analysis.

RESULTS

RA markedly inhibited cell growth. The growth of HNE1 cells was reduced to 50% of the control level on the 4th day of RA (10(-4) mol/L) treatment. After 4 days of treatment, the rapidly growing polygonal cells were reversed into a slow growing phenotype, with flattened morphology similar to fibroblast-like cells. Northern hybridization showed that c-myc and c-Ha-ras expression was high in HNE1 cells and undetectable in normal blood cells. c-myc was down-regulated at 48 h of RA treatment. In contrast, the c-Ha-ras was not affected. DNase I hypersensitive site analysis detected changes in the regulatory elements of c-myc and c-Ha-ras genes. 5 hypersensitive sites were found in the c-myc of HNE1 cells, while 3 hypersensitive sites disappeared upon HNE1 induction. However, only 1 hypersensitive site was found in c-Ha-ras of RA treated cells and controls. In normal peripheral white blood cells, no DNase I hypersensitive sites were found in the inactive c-myc and c-Ha-ras gene.

CONCLUSION

RA can induce differentiation in a nasopharyngeal carcinoma cell line at high concentration of RA; HNE1 shows some similar patterns of DNase I hypersensitive sites with the common one in other types of cells expressing c-myc. The repression of c-myc expression with induction is accompanied by the loss of 3 DNase-I hypersensitive sites; c-myc has more than one inactive conformation.

[Molecular cloning of a novel gene located on chromosome 3p25.3 and an analysis of its expression in nasopharyngeal carcinoma]

OBJECTIVE

To obtain the novel genes associated with human nasopharyngeal carcinoma(NPC) on chromosome 3p24-26.

METHODS

Twenty epithelial-derived expressed sequence tags(EST) were selected from chromosome 3p24-26 where loss of heterozygosity(LOH) frequently occurs in NPC tissues. Primers were designed based on the sequences of these ESTs. RT-PCR was used to amply their corresponding cDNA fragments from NPC cell line HNE1 and primary cultures of normal nasopharyngeal epithelial cells. The differential expression of two ESTs, T93093 and R41598, was confirmed by Northern blot. Then, expression of EST T93093 was further detected in 7 normal nasopharyngeal and 19 NPC biopsies. cDNA library screening was used to get its full cDNA sequence and the sequence of this novel gene was analyzed by bioinformatics.

RESULTS

Thirteen ESTs(T62511, N39155, N68660, R61275, T95314, R06143, H52697, H66521, AA128685, AA284537, N52379, AA054180, and H98090) showed the similar expression level and 5 ESTs(R00732, R07573, R98052, H91759, H17566) showed no expression in both types of cells. EST T93093 was down-expressed, whereas EST R41598 up-expressed in NPC HNE1 cells. The EST T93093 was also found to be down-expressed in 26.3%(5/19) of NPC biopsies. The full length cDNA of this gene was obtained and named NAG-7, which is located at chromosome 3p25.3. Its 1677 bp full length cDNA has a potential open reading frame(ORF) predicting a 94 amino acid protein with a molecular weight of 11023.87 Dalton. Bioinformatics analysis of the NAG-7 gene shows that it is a transmembrane protein containing a protein kinase C(PKC) phosphorylation site and a myristyl site. It has no significant homology to any reported genes in database of GenBank(AF086709).

CONCLUSION

NAG-7 is a novel gene down-expressed in NPC, which may be involved in the development of NPC.

A cDNA located on chromosome 7q32 shows loss of expression in epithelial cell line of nasopharyngeal carcinoma

OBJECTIVE

To isolate and clone the tumor suppressor gene on chromosomal region 7q32 correlated with the carcinogenesis of human nasopharyngeal carcinoma (NPC).

METHODS

The genotypes of polymorphic microsatellite markers on 7q32 in DNA from 24 biopsies of nasopharyngeal carcinoma and matched normal blood cells were identified. The expression levels of 20 expressed sequence tags (ESTs) on 7q32 between human nasopharyngeal carcinoma epithelial 1 (HNE1) and primary cultures of normal nasopharyngeal epithelial (PNNE) cells were compared using differential RT-PCR and Northern hybridization. The quantity of AA070437 DNA and mRNA was detected by differential PCR and differential RT-PCR, respectively.

RESULTS

Loss of heterozygosity (LOH) was found in 25%-46% of NPC biopsies. AA070437 EST expression was down-regulated in HNE1 cell compared to PNNE cells. The down-regulation of AA070437 was found in 30.7% of NPC biopsies and allelic loss of AA070437 was observed in 29.1% of NPC biopsies.

CONCLUSION

Our results show that AA070437 EST is negatively related with the occurrence of human NPC and may represent a candidate tumor suppressor gene of NPC on 7q32.

[The expression in situ of transforming growth factor beta s, their receptors and TGF beta-receptor interacting protein-1 in nasopharygneal carcinoma]

OBJECTIVE

To study the expression of transforming growth factor(TGF) beta s, their receptors and TGF beta-receptor interacting protein-1 (TRIP-1) in nasopharygneal carcinoma.

METHODS

Immunohistochemical technology and in situ hybridization methods were adopted to detect the TRIP-1 mRNA and 3 kinds of TGF beta isoforms and 2 kinds of TGF beta receptors protein in the same biopsy specimen.

RESULTS

The positive expression of TGF beta 1, TGF beta 2, TGF beta 3, TGF beta R I and TGF beta R II was stronger in the tumor adjacent epithelium than in the tumor itself, which were 65.79%, 66.67%, 55.26%, 48.57% and 63.16% higher than those in the tumor itself respectively(P < 0.01). The level of TRIP-1mRNA measured in the epithelial cells was also higher than that in the tumor cells (19.32 +/- 10.70 versus 11.96 +/- 5.85, P < 0.05).

CONCLUSION

The signal transmission of TGF beta family is diminished in the poorly differentiated squamous cell carcinoma of nasopharynx. It may be a factor for the development of nasopharygneal carcinoma.