Association between FAS polymorphism and prostate cancer development

The role of FAS polymorphisms in prostate cancer has not been studied. Using the PCR-based restriction fragment-length polymorphism methodology, we evaluated FAS gene locus -670 genotypes in DNA from 904 men: 657 prostate cancer patients and 247 healthy controls. We found that carriers of AG or GG genotypes have a statistically significant protection (odds ratio (OR)=0.30; confidence interval (CI): 0.20-0.44 and OR=0.22; CI: 0.12-0.74, respectively) for disease with extra-capsular invasion. Taken together, a 72% protection was found for G allele carriers (OR=0.28; CI: 0.19-0.41). Fas exist as membrane-bound and soluble forms and with opposite roles. They derive from the same gene by alternative splicing. Membrane Fas receptors trigger apoptosis whereas, on the other hand, soluble Fas (sFas) bind to Fas ligand antagonizing Fas-Fas ligand apoptotic pathway. Our results suggest that G allele may reduce sFas levels preventing the apoptotic inhibition caused by the soluble form.

Current controversies in the management of early breast cancer

Medical professionals in general, and medical oncologists in particular, have highly stressful practices because they are under constant pressure to have the highest-quality, up-to-date evidence available in order to make the right decision for each individual patient. From a practical point of view, being updated on oncological and other medical specialties may seem an insurmountable task because the number of scientific publications has increased dramatically. The use of systematic reviews of randomised controlled trials or the application of results obtained from high-quality randomised controlled trials are some of the most common ways to address this need. Unfortunately, they do not cover all complex clinical situations that the majority of medical oncologists face in their outpatient consultations. In this review, we report the conclusions achieved in a multiexpert meeting where five important controversies in the treatment of breast cancer were analysed. Five highly experienced medical oncologists were required to defend an affirmative answer and another five were required to defend a negative answer for each of the clinical questions. After that, a one-day meeting was organised to debate each clinical question and to reach a consensus. We report here the content of this multi-expert meeting along with the conclusions drawn.

Biweekly docetaxel and gemcitabine as neoadjuvant chemotherapy followed by adjuvant doxorubicin and cyclophosphamide therapy in stage II and III breast cancer patients: results of a phase II study

INTRODUCTION

The purpose of this phase II study was to evaluate the efficacy and safety of neoadjuvant docetaxel/gemcitabine treatment in a biweekly regimen.

MATERIALS AND METHODS

Patients with stage II/III breast cancer were treated with docetaxel (65 mg/m(2)) followed by gemcitabine (2500 mg/m(2)) every 2 weeks for 6 cycles. Patients with a clinical response or stable disease underwent mastectomy or breast-conserving surgery plus axillary dissection. After surgery, patients received 4 cycles of standard doxorubicin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) every 21 days.

RESULTS

Thirty-five patients were included in the trial. The overall response rate was 71.4% (95% CI: 53.7-85.4), with 8 complete and 17 partial responses. Breast conservation was possible in 59% of the patients. Toxicity was manageable.

CONCLUSIONS

We consider biweekly docetaxel and gemcitabine could be an active and tolerable regimen option in the neoadjuvant setting sequentially with standard adjuvant doxorubicin-cyclophosphamide in patients with stage II or III breast cancer.

Evaluation of sensitivity to change of the MPAC scale, validated in Spanish, in pain measurement in cancer patients

19567

Background: The Memorial Pain Assessment Card (MPAC) allows an easy measurement of oncologic pain in the clinical practice. In 2004, a Spanish version of the MPAC scale was validated in cancer pain. The goal of the present work was to evaluate the sensitivity to change of the validated Spanish version by oncologic patients. Methods: Epidemiological, prospective, 2-months multicenter study, conducted at 4 services of oncology. The included patients suffered continuous chronic cancer pain and were in a susceptible situation of change (pain intensity ≥ 3 in a Visual Analogue Scale). The MPAC card was administered at baseline and at 1 and 2 months, including the 4 subscales (pain relief [VASPR], pain intensity measured by VAS [VASPI] and by an 8-items descriptors subscale [Tursky], and psychological distress [VASMOOD]). Data about clinical situation and satisfaction of the patient and the health care professionals with the MPAC card was also collected. Sensitivity to change was evaluated by comparing 2-months versus baseline results in the MPAC subscales. Results: Fifty-four patients with oncologic pain (76% men) with a mean (SD) age of 57(11) years were included. 74% of patients presented metastasis, and in 80% of cases the treatment was palliative. All the MPAC VAS subscales showed sensitivity to change across the 2-months period: mean VASPI at baseline 6.6(1.7) vs 3.5(2.0) at 2 months (p<0.0001, Wilcoxon test [WX]); VASPR 4.5(1.9) vs 6.3(2.3) (p<0.0001 [WX]); VASMOOD 5.5(2.1) vs 4.0(2.1) (p=0.0008 [WX]). Furthermore, 90.5% of patients showed changes in Tursky subscale (78.6% less pain, 11.9% increased pain), being these changes significantly associated with VASPI scores (p=0.0006, Kruskal-Wallis test). Both patients and medical personnel agreed in the card use facility (63% and 71% of cases, respectively). Conclusions: The Spanish MPAC version has demonstrated sensitivity to change in all the MPAC subscales (pain relief, pain intensity and psychological distress). Its facility of administration may allow a useful and quick evaluation of the cancer pain in the clinical practice.

No significant financial relationships to disclose.

First efficacy assessment of a phase II study with cyclophosphamide, vincristine, liposomal doxorubicin, and prednisone plus rituximab, administered every two weeks (R-COMP-14) as primary treatment for NHL

18519

Background: R-CHOP is the standard treatment for CD20+ aggressive B-cell non-Hodgkin lymphoma (DLBCL). Dose dense regimens have shown better outcome and acceptable tolerability compared to standard. Liposomal doxorubicin has demonstrated significant less cardiotoxicity and acute toxicity when compared with standard doxorubicin. The aim of the study is to assess the efficacy and safety of the R- COMP-14 (Myocet™-modified CHOP) in newly diagnosed aggressive DLBCL. Pegfilgrastim was used to provide prophylactic bone marrow support. Methods: Patients (Pts) with stages III, IV or I, II (IPI = 1) were included in this single arm, multicentric, 2-step (Simon design) phase II trial. Treatment: eight biweekly cycles of liposomal doxorubicin 50 mg/m2, cyclophosphamide 750mg/m2, vincristine 1.4 mg/m2 (max. 2mg), rituximab 375 mg/m2 and prednisone 100 mg/d d1–5. Pegfilgrastim was administered on day 2 at standard dose. Interim analysis shows: Twenty-six out of 28 Pts were evaluable for efficacy. Median age: 51 y (28 - 64). Ann Arbor stage: I-II (IPI = 1) 42%, III 29%, IV 29%. Extranodal involvement: 50%. Median basal LVEF was 66% (range 44 - 80). Results: The overall response rate was 84% (CR 64% and PR 20%). Three (12%) Pts had PD and 1 (4%) SD. Median n° cycles was 8 (2-8); the median relative dose intensity per week was 93.5%. Only 4.8% of cycles were delayed and 4.2% of the cycles were administered with dose reduction due to related adverse events. Grade 3–4 neutropenia and thrombocytopenia were observed in 4.0% and 0.6% of cycles respectively. Febrile neutropenia experienced in 3.3% of cycles. Non-hematological G3–4 toxicities per cycles were hepatic (1.7%), emesis (1.2%) and G3 neurotoxicity, asthenia and infection (0.6% each). No other relevant toxicities were observed. Median LVEF after completion of treatment was 63% (range 52 - 76), there was no cardiac clinical event related to the treatment, nor irreversible toxicities. Conclusions: This Interim analysis confirmed the efficacy and safety of the dose-dense regimen in order to continue with the second step of the study. R-COMP-14 treatment with pegfilgrastim bone marrow support warrants further exploration.

No significant financial relationships to disclose.

Fas-670 polymorphism and prostate cancer

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Background: The FAS/FASL system is one of the major pathways in apoptosis and is important to regulate cell proliferation and tumor cell growth. Functional promoter polymorphisms of FAS gene (FAS -670 A/G) alter the transcriptional activity. The role of FAS polymorphisms in prostate cancer has not been studied. Methods: DNA extracted from peripheral blood from 529 prostate cancer patients and from 247 healthy controls was analysed by Polymerase Chain Reaction - Restriction Fragment Length Polymorphism (PCR-RFLP) for FAS gene locus -670 genotypes. Results: We found that the AG and GG genotypes represent significantly protection (OR=0.41; confidence interval (CI): 0.26–0.65 and OR=0.39; CI: 0.21–0.74, respectively) for extracapsular invasion. Taken this genotypes together, a significantly protection was found for G allele carriers (OR=0.41; CI: 0.27–0.63). Conclusions: It is well known that G allele reduces the transcriptional activity of FAS gene. Fas exist as membrane bound and soluble forms and with opposite roles. They derive from the same gene by alternative splicing. Membrane Fas receptor trigger apoptosis and in other hand soluble Fas (sFas), which lacks transmembrane domain, binds to Fas ligand antagonizing Fas-Fas ligand apoptotic pathway. It is reported that serum sFas is elevated in prostate cancer and associated with advanced disease. Our results suggest that G allele may reduce sFas levels preventing the apoptotic inhibition caused by the soluble form.

No significant financial relationships to disclose.

Phase II study of capecitabine (X) in combination with vinorelbine (N) in patients (pts) with pretreated metastatic breast cancer (MBC)

10693

Background: X monotherapy is consistently effective and very well tolerated in pretreated MBC. N is also commonly used in this indication. In several studies, the combination of X + N led to response rates ranging from 43–67% in first-line MBC. As there are few data on the combination in pts with pretreated MBC, we evaluated the efficacy and safety of X + N in a multicenter phase II trial of pts previously treated with anthracycline- and taxane-containing regimens. Methods: Women >18 years of age with pretreated MBC, PS 0–2 and adequate organ function were enrolled to receive a 3-weekly regimen of XN: X 1000mg/m2 twice daily on days 1–14 and N 25mg/m2 on days 1&8, every 3 weeks up to a maximum of 6 cycles, disease progression or unacceptable toxicities. Results: A total of 32 pts were enrolled, median age 58 years (range 41–77), PS 0(74%), 1(19%), postmenopausal (61%). The most frequent sites of metastases were: liver (68%), nodes (36%), lung (36%). 58% of pts had ≥2 metastatic sites. 27 patients (87%) previously failed on anthracycline and taxane chemotherapy regimens. 152 cycles were administered with a median of 3 cycles/pt (range 1–10). Median relative dose intensity was 0.86 (0.51–1.01] for N and 0.85 (0.26–1.03] for X. All pts were evaluable for safety. The most common grade 3/4 clinical adverse events were vomiting (15%), asthenia (9%), and hand-foot syndrome (6%). Grade 3/4 hematological toxicities were: neutropenia (47%), leucopenia (9%), thrombocytopenia (3%). One pt died due to septic shock after the first cycle. 29 pts are evaluable for efficacy: the overall response rate was 52% (4 CR, 11 PR), with stable disease in 8 pts (28%). Median TTP was 7.5 months [95% CI, 5.7–9.8]. Conclusions: Our preliminary data indicate that the combination of X and N has promising clinical activity and good safety in pts with MBC who have failed prior taxane- and anthracycline-containing regimens.

No significant financial relationships to disclose.

R-CHOP-14 in patients with diffuse large-B-cell lymphoma (DLBCL) younger than 70 years: A multicentric and prospective study

7592

Background: Several studies have shown that the addition of rituximab (R) to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisona), or shortening the interval between cycles of chemotherapy to two weeks, improves survival of patients with DLBCL. These studies prompted our group (GOTEL) to evaluate in a prospective study, the feasibility and efficacy of R-CHOP-14 in patients (pts) with DLBCL. Methods: Patients (younger than 70 years) with stage II bulky, III or IV DLBCL, and no significant co-morbidities were included in the study. R was administered on day 1 before chemotherapy. R-CHOP was recycled every 14 days. No antimicrobial prophylaxis was administered. All pts received filgrastim (5 μg/kg) from day +3 to +10. Pts received 6 cycles if CR was achieved after 3 cycles; those in PR, and those pts with bone marrow disease at diagnosis, received 8 cycles. Involved field radiation therapy was permitted for pts with stage II bulky disease. Results: From May 2002 to august 2004, 77 pts were included. Median age was 54 years (range, 15–70); 55 patients were younger than 60 years. According to the age adjusted International Prognostic Index (aaIPI), 13 pts (17%) had low risk disease, 27 pts (35%) low-intermediate risk, 29 pts (38%) high-intermediate risk, and 8 pts (10%) high risk disease. Grade 3–4 toxicity occurred as follow: neutropenia in 15 pts (19%), anaemia in 7 pts (9%), thrombocytopenia in 4 pts (5%), mucositis in 4 pts (5%) and peripheral neurotoxicity in 4 pts (5%). Ten pts were hospitalized (febrile neutropenia: 8 cases, one case of gastric perforation and one pulmonary embolism). After therapy, 61 pts (79%) achieved a CR/CRu (C.I. 95%: 57%-90%) and 14 pts (18%) a PR. 2 pts (3%) had refractory disease. With a median follow-up of 20 months, progression-free and overall survival at 24 months were 68% and 87%, respectively. Conclusions: Administration of R-CHOP-14 (with filgrastim support) is feasible and effective in patients younger than 70 years.

[Table: see text]

The effect of a remifentanil bolus on the bispectral index of the EEG (BIS) in anaesthetized patients independently from intubation and surgical stimuli

BACKGROUND AND OBJECTIVE

Remifentanil boluses are used in different clinical situations and the effects on bispectral index monitoring are unclear. We analysed the effect of a remifentanil bolus on the bispectral index of the electroencephalogram (bispectral index) under total intravenous anaesthesia with propofol and remifentanil.

METHODS

ASA I-III patients were included in this study. All patients received a 2 microg k g-1 remifentanil bolus in a period free from stimuli. Bispectral index and haemodynamic data were collected from an A-2000XP bispectral index monitor (every second) and an AS/3 Datex monitor (every 5 s). Bispectral index data were analysed using the area under the curve. Mean arterial pressure and heart rate were averaged at each 30-s period and analysed using analysis of variance.

RESULTS

A total of 240 bispectral index values were obtained per patient. The area under the curve between 90 and 120 s after the bolus was significantly lower than the basal area under the curve (average of all areas before the bolus, P < 0.05). Mean arterial pressure and heart rate were significantly reduced from 96.4 +/- 19.9 mmHg at the time of the bolus to 74.2 +/- 16.6 mmHg 120 s after, and from 70 +/- 16.4 bpm at the time of the bolus to 61 +/- 13.6 bpm after (P < 0.001), respectively.

CONCLUSIONS

There was a significant reduction in the areas under the curve between 90-120 s following the bolus. Heart rate and blood pressure also showed significant reductions. Thus, remifentanil bolus given under total intravenous anaesthesia with propofol and remifentanil decreases bispectral index, an effect independent of intubation and surgical stimuli.

Practical aspects of the use of target controlled infusion with remifentanil in neurosurgical patients: predicted cerebral concentrations at intubation, incision and extubation

Remifentanil has important side effects and it is not easy to know what remifentanil concentrations should be used during different endpoints of anaesthesia. We analyzed the remifentanil predicted effect-site concentrations (RemiCe) at different events during neurosurgical procedures and assessed if the concentrations used were clinically adequate. BIS and haemodynamic parameters were collected every 5 seconds. Predicted cerebral concentration of propofol (PropCe) and RemiCe were analyzed immediately prior to respective stimulus, and 30, 60 and 90 seconds after. RemiCe were 2.2 +/- 0.3, 6 +/- 2.6 and 2.2 +/- 0.9 ng ml(-1) at intubation, incision and extubation, respectively. PropCe observed in the same periods were 5 +/- 1, 2.6 +/- 0.9 and 1 +/- 0.3 microg ml(-1), also respectively. The remifentanil concentrations used in our patients were lower than reported concentrations, while being clinically adequate to minimize the haemodynamic response to stimulation.

Aberrant cellular retinol binding protein 1 (CRBP1) gene expression and promoter methylation in prostate cancer

AIMS

Retinoids are involved in cell growth, differentiation, and carcinogenesis. Their effects depend on cytosolic transport and binding to nuclear receptors. CRBP1 encodes a protein involved in this process. Because altered CRBP1 expression and promoter hypermethylation occur in several tumours, these changes were investigated in prostate tumorigenesis.

METHODS

The CRBP1 promoter was assessed by methylation specific polymerase chain reaction on tissue samples from 36 radical prostatectomy specimens (paired normal tissue, adenocarcinoma, and high grade prostatic intraepithelial neoplasia (HGPIN)), 32 benign prostatic hyperplasias (BPHs), and 13 normal prostate tissue samples from cystoprostatectomies. Methylation of DNA extracted from microdissected tissue was examined blindly. CRBP1 expression was assessed by immunohistochemistry on formalin fixed, paraffin wax embedded tissue.

RESULTS

Loss of CRBP1 expression was seen in 15 of 36 adenocarcinomas and 18 of 36 HGPINs. Fifteen adenocarcinomas and nine HGPINs showed overexpression, whereas the remainder showed normal expression. BPH displayed normal expression. No significant associations were found between CRBP1 expression and Gleason score or stage. CRBP1 promoter hypermethylation was found in 17 of 36 adenocarcinomas, three of 35 HGPINs, one of 36 normal prostate tissues from the same patients, none of 32 BPHs, and none of 13 normal prostate tissues from cystoprostatectomies. Loss of expression and hypermethylation of CRBP1 were not significantly associated.

CONCLUSIONS

Altered CRBP1 expression and hypermethylation are common in prostate carcinoma, although CRBP1 hypermethylation is not an early event in tumorigenesis. Moreover, both adenocarcinoma and HGPIN show frequent CRBP1 overexpression. The molecular mechanisms underlying altered CRBP1 expression in prostate cancer deserve further study.

Neovascularisation is a prognostic factor of early recurrence in T1/G2 urothelial bladder tumours

BACKGROUND

Of patients with superficial bladder cancer, a group are still at risk of disease recurrence, progression and death from their cancer after curative treatment. Angiogenesis is a crucial pathogenic mechanism for this type of urothelial cell carcinoma (UCC), and is a potential therapeutic target. However, the selection of the appropriate patients remains a dilemma.

PATIENTS AND METHODS

Vascular endothelial growth factor (VEGF) expression and the presence of angiogenesis and occurrence of CD31, CD34, endoglin and factor VIII immunoexpression, were evaluated in 66 superficial papillary UCCs of the bladder and were correlated with classical histopathological factors and disease outcome.

RESULTS

VEGF immunoreactivity was observed in 100% of cases, and more intensely in the luminal surface. The presence of microvessel clusters independently of a fibrovascular core was observed in 22.7% of cases. Of these, the T1/G2 subgroup had an independent and significantly lower recurrence-free survival (P = 0.0002).

CONCLUSIONS

These results indicate that the presence of angiogenesis in tumour urothelium is a potential prognostic factor in superficial UCC, particularly in T1/G2 tumours, and may be used to select patients for anti-angiogenic treatments.

Gemcitabine/vinorelbine in metastatic breast cancer patients previously treated with anthracyclines: results of a phase II trial

This phase II study was designed to evaluate the response rate (RR) and toxicity of gemcitabine/vinorelbine in patients with metastatic breast cancer. All patients had previously received anthracyclines. Treatment consisted of gemcitabine 1200 mg/m2 and vinorelbine 30 mg/m2 on days 1 and 8, every 3 weeks. Twenty-five patients were enrolled. Median age was 59 years (range, 33-73 years). Ten patients had received only adjuvant therapy with anthracyclines. The remaining 15 patients had received chemotherapy for metastatic disease, including taxanes in 11 cases. Four patients could not be evaluated for response. By intent-to-treat analysis, the overall RR was 44% (95% CI, 24.4%-65%). Median duration of response and median time to treatment failure were 21 and 17 weeks, respectively. The main toxicity was hematologic, with grade 3/4 neutropenia occurring in 13 patients and 1 patient developing febrile neutropenia. Two deaths from pneumonia occurred. These results reveal an encouraging activity with a reasonable toxicity profile in a patient population with an unfavorable prognosis. Our group is conducting a randomized study to compare this combination with vinorelbine alone in patients with metastatic breast cancer after failure to respond to anthracyclines and taxanes

Gemcitabine and carboplatin for patients with advanced non-small cell lung cancer

The survival of patients with advanced non-small cell lung cancer remains poor. Cisplatin-based chemotherapy produces a modest benefit in survival compared with that observed with best supportive care. Gemcitabine (Gemzar; Eli Lilly and Company, Indianapolis, IN), a novel nucleoside antimetabolite, is active and well tolerated. The combination of gemcitabine/cisplatin has shown a significant improvement in response rate and survival over cisplatin alone. Phase III trials comparing gemcitabine/cisplatin with older combinations such as cisplatin/etoposide or mitomycin/ifosfamide/cisplatin have shown a higher activity for gemcitabine/cisplatin; however, the best way to combine these drugs remains unclear. In addition, the 3-week schedule has obtained a higher dose intensity with less toxicity and similar efficacy as the 4-week schedule. The role of carboplatin in combination with new drugs is still under evaluation. Gemcitabine/carboplatin seems to be a good alternative, with the advantage of ambulatory administration and lower nonhematologic toxicity. The 4-week schedule has produced frequent grade 3/4 neutropenia and thrombocytopenia in some studies. The 3-week schedule, using gemcitabine on days 1 and 8 and carboplatin on day 1, is a convenient and well-tolerated regimen. The toxicity profile is acceptable without serious symptoms. This schedule could be considered a good option as a standard regimen. Semin Oncol 28 (suppl 10):4-9.