Recombinant human TSH increases the efficacy of a fixed activity of radioiodine for treatment of multinodular goitre

CONTEXT

High doses of (131)I are usually needed in the treatment of multinodular goitre (MNG) for effective thyroid volume (TV) reduction. Recombinant human thyroid-stimulating hormone (rhTSH) is an adjuvant to enhance (131)I uptake, allowing a decrease in radiation activity and enhancing (131)I efficacy.

OBJECTIVE

To evaluate whether rhTSH increases the efficacy of a fixed activity of (131)I for the treatment of MNG.

DESIGN

Two-year, observational, placebo-controlled study.

SETTING

Patients received 0.1 mg rhTSH (A), 0.005 mg rhTSH (B) or placebo (C). A fixed activity of 1.11 GBq of (131)I was administered 24 h after rhTSH or placebo.

PATIENTS

A total of 28 outpatients (26 females and two males) with MNG.

MEASUREMENTS

TSH, free T4, T3, thyroglobulin (Tg) and TV.

RESULTS

Basal radioactive iodine uptake and TV values were comparable among all groups. After rhTSH or placebo, peak levels of TSH, free T4, T3 and Tg were higher in A than in B or in C (p < 0.05). Hyperthyroidism was observed in A (n = 2), B (n = 6) and C (n = 4). Thyroid enlargement was reported in A (n = 3) and B (n = 6). After 24 months, 10 patients developed hypothyroidism (four in A, three in B and three in C). TV reduction was similar between A and B (37.2 +/- 25.5% vs. 39.3 +/- 27.9%, p = 0.88), but different from the non-significant reduction in C (15.3 +/- 28.3%, p = 0.08).

CONCLUSIONS

Followed by 1.11 GBq, a very low dose of 0.005 mg rhTSH was equally safe and effective as 0.1 mg rhTSH. Both doses increased the efficacy of radioiodine. Adverse events were mild, transient and readily treatable.

Chemoembolization combined with pravastatin improves survival in patients with hepatocellular carcinoma

BACKGROUND/AIMS

Pravastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, has been shown to inhibit growth and to induce apoptosis in human hepatocellular carcinoma (HCC) cells. However, the potential benefit of pravastatin in HCC patients has still not been characterized, which prompted us to test the efficacy of pravastatin in patients with advanced HCC.

METHODS

We investigated prospectively a cohort of 183 HCC patients who had been selected for palliative treatment by transarterial chemoembolization (TACE). Fifty-two patients received TACE combined with pravastatin (20-40 mg/day) and 131 patients received chemoembolization alone. Six independent predictors of survival according to the Vienna survival model for HCC were equally distributed in both groups.

RESULTS

During the observation period of up to 5 years, 31 (23.7%) out of 131 patients treated by TACE alone and 19 (36.5%) out of 52 patients treated by TACE and pravastatin survived. Median survival was significantly longer in HCC patients treated by TACE and pravastatin (20.9 months, 95% CI 15.5-26.3, p = 0.003) than in HCC patients treated by TACE alone (12.0 months, 95% CI 10.3-13.7).

CONCLUSION

Combined treatment of chemoembolization and pravastatin improves survival of patients with advanced HCC in comparison to patients receiving chemoembolization alone.

CA 27.29 as a tumour marker for risk evaluation and therapy monitoring in patients with primary breast cancer

Abstract #2004

Background:&#x2028; Several trials show that the use of tumor markers leads to an early diagnosis of tumor dissemination in breast cancer patients. Whether this improves the prognosis is still under discussion. In the SUCCESS Trial CA27.29 has been examined before and after adjuvant chemotherapy (n=3754).&#x2028; Methods:&#x2028; The SUCCESS Trial compares FEC-Docetaxel (Doc) vs. FEC-Doc-Gemcitabine (Doc-G) regime and two vs. five year treatment with Zoledronat in patients with primary breast cancer (N+ or high risk). CA27.29 has been measured with ST AIA-PACK Ca27.29 reagent using MUC-1 for AIA-600II (Tosoh Bioscience, Tessenderlo, Belgium). The cutoff for positivity of CA27.29 is 24 U/ml.&#x2028; Results:&#x2028; 2669 patients have been examined prospectively before and after chemotherapy. 22% of patients had a marker &gt;24 U/ml (n=587, mean 19.00, range 3.04-410.00) before and 40% (n=1058, mean 23.34, range 2.70-330.76) after chemotherapy. The correlation between both values was significant (p&lt;0.0005).&#x2028; While 17% showed elevated CA27.29 before and after therapy, 5% patients changed from positive to negative for CA27.29 afterwards. 55% were negative before and after therapy whereas 23% became positive after treatment.&#x2028; &#x2028; Before treatment the prevalence of elevated CA27.29 was equally distributed between the FEC-Doc and the FEC-Doc-G arm. After treatment 34.1% in the FEC-Doc arm showed an increased level vs. 45.6% in the FEC-Doc-G arm. The correlation analysis showed no significant coherence between hormonal status (ER: p&lt;0.323; PR: p&lt;0.078), HER2/neu status (p&lt;0.308), Grading (p&lt;0.565) and CA27.29 level. However, tumor size (p&lt;0.020) and the nodal status (p&lt;0.022) were significant associated with Ca27.29 levels.&#x2028; Conclusion:&#x2028; These results might indicate a close relation between Ca27.29 and tumour mass at primary diagnosis. Whether this marker will be useful for treatment monitoring will be shown by further follow-up in the Success-trial.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2004.

Postprandial intradialytic dysglycaemia and diabetes in maintenance haemodialysis patients

BACKGROUND

Although the risk of developing dysglycaemia has been investigated in different communities this incidence is poorly studied in patients on maintenance haemodialysis (MHD).

MATERIALS AND METHODS

In a multicentre observational cohort study the occurrence of dysglycaemia was assessed in 239 primary normoglycaemic end stage renal disease (ERSD) patients on MHD. Dysglycaemia (fasting blood glucose > 110 mg dL(-1), > 140 mg dL(-1) 2 h after food intake) or diabetes (fasting blood glucose > 126 mg dL(-1) or > 200 mg dL(-1) at any time) were defined according to WHO criteria and cases were compared with age matched controls within the cohort.

RESULTS

Dysglycaemia was found in 82 primary normoglycaemic ESRD patients (34%) within 31 months after initiation of MHD. In 31 of these patients type 2 diabetes was diagnosed. When compared with matched control MHD patients differences in body mass index (BMI), HbA1c and postprandial blood glucose were detectable (P < 0.05). Increments in 0.1% of HbA1c were related with 11% higher odds for dysglycaemia (P = 0.002). In a subgroup of 36 primary normoglycaemic MHD patients who developed dysglycaemia event-free survival was 64%, 53%, 31%, 17% and 11% after 1, 2, 3, 4 and 5 years of haemodialysis treatment.

CONCLUSION

Onset of dysglycaemia or diabetes is frequent in ESRD patients after onset of chronic haemodialysis. Routine measurement of blood glucose before and after haemodialysis should be implemented as a standard of care during MHD.

High Resolution MR Perfusion Imaging of the Kidneys at 3 Tesla without Administration of Contrast Media

PURPOSE

The feasibility of high-resolution arterial spin labeling (ASL) perfusion imaging of the kidneys was tested and proven at 3 Tesla using a flow-sensitive alternating inversion recovery (FAIR) true fast imaging in steady precession (TrueFISP) technique.

MATERIALS AND METHODS

Kidney perfusion maps of six healthy volunteers and two patients were acquired using a clinical 3-Tesla whole-body scanner. An ASL sequence with FAIR spin preparation and a TrueFISP signal detection strategy was adapted for high-resolution perfusion imaging of the kidneys at 3 Tesla. To avoid banding artifacts in TrueFISP images, which are generally prominent at 3 Tesla, a frequency scout was implemented. Perfusion maps with an in-plane resolution of 1.5 mm were recorded in transverse and coronal orientation. For fast mapping of whole-kidney perfusion, an in-plane resolution of 2 mm was applied.

RESULTS

In all volunteers and patients, high-resolution perfusion images with excellent image quality were able to be obtained in a measuring time of approximately 10 minutes. The whole kidney was able to be mapped with good image quality in less than 10 minutes. For all slices, a suitable frequency offset made it possible to reproduce the kidneys without TrueFISP artifacts. Perfusion values of the renal cortex ranged from 250 ml/100 g/min up to 400 ml/100 g/min (mean cortical perfusion right kidney 316 +/- 43, left 336 +/- 40).

CONCLUSION

High-resolution ASL perfusion images of the whole kidney were able to be obtained with good image quality by means of a 3 Tesla MR setting within a clinically applicable measuring time, thus providing an alternative to conventional perfusion imaging involving potentially nephrotoxic contrast media.

Recombinant human thyrotropin as adjuvant in the treatment of multinodular goiters with radioiodine

The use of 131I in the treatment of multinodular goiters (MNG) is well established. We evaluated the effect of 30 microCi 131I (1.11 GBq) in 18 patients with MNG with the aid of two injections of 0.1 mg recombinant human TSH (rhTSH), given on d 1 and 2. A dose of 30 microCi 131I was given on d 3. TSH, T3, free T4, and thyroglobulin were measured on d 1, 2, 3, 5, 10, 30, 60, 90, and 180, and antithyroid antibodies were measured on d 1, 30, 90, and 180. Twenty-four-hour 131I uptake measured 1-3 months before rhTSH increased from 12.3 +/- 6.2 to 53.5 +/- 10.9% (P < 0.0001), free T4 from 1.3 +/- 0.2 to peak 3.2 +/- 1.1 ng/dl levels (P < 0.0001), T3 from 113.9 +/- 35.0 to peak 332.2 +/- 123.0 ng/dl levels (P < 0.0001), TSH from 0.76 +/- 0.71 to peak 18.9 +/- 5. 3 mU/liter levels (P < 0.0001), and thyroglobulin from 280.9 +/- 370.0 to peak 1838.5 +/- 1360.7 ng/dl levels (P = 0.001). Painful thyroiditis (33%) and mild thyrotoxicosis (39%) constituted minor side effects. There were no changes in echocardiographic parameters, done before and after rhTSH administration, on d 3. Hypothyroidism developed in 65%. Mean goiter size, measured by computed tomography, decreased from 97.9 +/- 45.4 to 65.5 +/- 47.3 ml (P < 0.0001; reduction: 39 +/- 19%) after 6 months. We conclude that rhTSH is a safe and efficient therapeutic tool in the treatment of MNG allowing the use of outpatient therapeutic 131I doses.