Retinyl retinoate, a novel hybrid vitamin derivative, improves photoaged skin: a double-blind, randomized-controlled trial

BACKGROUND

All-trans-retinoic acid (RA) and all-trans-retinol (ROL) are not widely used as anti-wrinkle agents due to their irritancy and photo-stability, respectively. Therefore, the safety and photo-stability in the development of RA or ROL derivatives have been an important issue.

AIM

To identify the efficacy of retinyl retinoate as an anti-aging agent of cosmetics in treating females over 30 years old with periorbital wrinkles.

METHODS

The clinical study was a prospective, double-blind, randomized, and controlled study with a total of 11 Korean women. At every 4 weeks, the effectiveness was assessed with a global photodamage score, photographs, and image analysis using replicas and visiometers. The dermal distance and intensity was also evaluated using Dermascan C.

RESULTS

A statistically significant improvement in facial wrinkles (P<0.05) in eleven volunteers was observed in a clinical trial. The successive application of 0.06% retinyl retinoate cream for 3 months showed decreased depth and area of wrinkles in comparison with 0.075% retinol cream. The visual wrinkle improvement and the maximum roughness improvement rate (R2) for retinyl retinoate cream were 22% higher than that of retinol cream after 12 weeks. A statistically significant increase was observed after 8 and 4 weeks for dermal distance and dermal intensity, respectively (P<0.05).

CONCLUSIONS

Retinyl retinoate had characteristic features of new anti-aging agents, and effectively improved facial wrinkle conditions.

Phase II study of fixed-dose-rate infusion of gemcitabine and UFT combination chemotherapy in patients with advanced bile duct cancer: Daegu Gyeoungbuk Oncology Group

280

Background: This phase II study evaluated efficacy of fixed dose rate (FDR) infusion of gemcitabine (10mg/m2/min) and UFT combination in chemo-naïve patients with advanced bile duct cancer.

Methods: This was an open-label, single-arm, multicenter, phase II study with a Simon two-stage minimax design. Patients received the FDR gemcitabine 1,000mg/m2 for 3 consecutive weeks and UFT 400 mg/m2 on days 1-21. The cycle was repeated every 28 days. The primary end point was Response Evaluation Criteria in Solid Tumors (RECIST) -defined objective response rate. Secondary end points included clinical benefit response (CBR), safety, progression-free survival (PFS), and overall survival (OS). Clinical characteristics including four single nucleotide polymorphisms in DNA repair genes (RecQ1, RAD54L, XRCC1, ATM) were evaluated whether these influence the overall survival.

Results: Between December 2006 and February 2008, fifty-one patients were enrolled, with a median age of 58 years. The majority of patients (76%) had intra-hepatic disease. Fourteen patients (27%) had a RECIST investigator-assessed, partial response (PR); disease control rate (PR + stable disease) was 55%. CBR was 14% among 37 evaluable patients. Hematologic toxicity was main grade 3 or 4 treatment-related adverse events. Median PFS was 4.0 months (95% CI, 2.9 to 5.1 months). Median OS was 7.0 months (95% CI, 3.5 to 10.5 months). Intrahepatic disease, poor performance, and, XRCC1 R194W C/C type were predictive markers of poor overall survival.

Conclusions: FDR gemcitabine and UFT demonstrated apparent activity in patients with advanced bile duct cancer. However, this activity did not translate to prolong survival. The location of disease, performance status, and, polymorphic variants of DNA repair genes may affect clinical outcome of patients with advanced bile duct cancer.

No significant financial relationships to disclose.

Predictors of survival in patients with refractory metastatic colorectal cancer

583

Background: The survival of patients (pts) with metastatic colorectal cancer (mCRC) refractory to three active drugs including fluoropyrimidine, oxaliplatin and irinotecan is very limited but highly variable. Since estimating life expectancy is important for palliative intervention and advanced care planning, we aimed to suggest a model for improved prognostication of pts with mCRC.

Methods: We retrospectively reviewed 185 pts with mCRC who had been treated with fluoropyrimidine, oxaliplatin and irinotecan with no response to treatment since 2008.

Results: Of 185 pts, there were 104 (56.2%) males and 81 (43.8%) females. The median age was 58 years (range, 23-84 years). Additional cetuximab treatment was given in 43 (23.2%) pts. The median overall survival was 4.82 months. There were seven independent variables with a relationship to survival: performance status (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.31 to 2.42; p<0.001), resection of primary tumor (HR, 1.55; 95% CI, 1.04 to 2.31; p=0.033), histologic type (HR, 2.54; 95% CI, 1.59 to 4.06; p<0.001), neutrophil/lymphocyte ratio (HR, 1.62; 95% CI, 1.14 to 2.30; p=0.007), serum hemoglobin level (HR, 1.42; 95% CI, 1.02 to 1.96; p=0.035), serum albumin level (HR, 2.33; 95% CI, 1.38 to 3.92; p=0.001) and sum of metastasis site (HR, 2.00; 95% CI, 1.39 to 2.86; p<0.001). By combining these risk factors, pts with mCRC could be categorized into three different groups (Table). There was a significant difference in survival duration between the groups. (p<0.001).

Conclusions: Seven prognostic factors predicting survival were identified and used to categorize mCRC Pts who had been treated with fluoropyrimidine, oxaliplatin and irinotecan into three prognostic groups.

[Table: see text]

No significant financial relationships to disclose.

Trace organic contaminants and their sources in surface sediments of Santa Monica Bay, California, USA

Spatial distribution of selected contaminants in the surface sediments of Santa Monica Bay (SMB), California was investigated. Sediments were analyzed for DDTs (DDT and metabolites), polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), linear alkylbenzenes (LABs) and coprostanol. Effluent samples from the Hyperion Treatment Plant (HTP), which discharges treated municipal wastewater effluents into SMB, were also analyzed. The inter-correlation in the distribution trends of contaminants was examined. The concentrations of contaminants were interpolated in a geographic information system to visualize their spatial distribution in the Bay. Inventories of the contaminants were also estimated. The concentrations of coprostanol, LABs and PCBs are very high only in the vicinity of the sewage outfall whereas PAHs and DDTs occur widespread in the Bay. The poor correlation of DDTs with LABs, PAHs or coprostanol content confirms the historic origin of DDTs and their absence in the contemporary wastewaters. Moderate correlation of DDTs with PCBs implies historic deposits as a major origin of PCBs. There are hot spots of DDTs at water depths of 60 and 100m and the inventory of DDTs in Bay sediments is insignificant compared to that estimated in the Palos Verdes Shelf which extends from the southern edge of Redondo Canyon around Palos Verdes Peninsula. The concentration of toxic contaminants was examined according to published sediment quality guidelines. About 20 stations contain p, p'-DDE and/or total DDTs above ERM and, PCBs between ERL and ERM indicating potential for adverse biological effects.

Clinical significance of type 1 insulin-like growth factor receptor and insulin-like growth factor binding protein-3 expression in squamous cell carcinoma of head and neck

6036

Background: Type 1 insulin-like growth factor receptor (IGF-1R) plays an important role in the growth and apoptosis of cancer cell. The activities of IGF-1R are modulated by a family of high-affinity insulin-like growth factor binding proteins (IGFBPs), of which IGFBP-3 is the major serum carrier protein. The expression and significance of IGF-1R and IGFBP-3 in squamous cell carcinoma of the head and neck (SCCHN) is unknown. Methods: This study explored immunohistochemical expression of IGF-1R and IGFBP-3 in tumor samples from 131 patients with surgically resected SCCHN. Results: The positive expression of IGF-1R and IGFBP-3 was observed in 96 (73.3%) and 117 (89.3%) patients. There were no significant differences in baseline characteristics between the positive and negative expressed groups of IGF-1R and IGFBP-3. With the median follow up of 53.5 months, 3 year progression free (PFS) and overall (OS) survival rate was 64.0% and 72.9%, neither IGF-1R nor IGFBP-3 expression had prognostic values in the whole cohort. Thirty-seven (67.3%) of 55 stage IV patients demonstrated IGF-1R positivity. The subgroup analysis of in stage IV patients showed the poor PFS ( = 0.029) and OS (pp = 0.025) in IGF-1R positive groups. In a multivariate analysis using IGF-1R expression and other clinicopathological parameters, the IGF-1R expression was remained as an independent factor for PFS (p = 0.037, HR = 2.816, 95% C.I. 1.065 - 7.446) and OS (p = 0.034, HR = 3.169, 95% C.I. 1.089 - 9.225). Conclusions: Our work exhibited that IGF-1R expression is frequent in SCCHN patients and related with poor survival in advanced stage, this could support the attempts using the IGF-1R inhibitor for treatment of SCCHN.

No significant financial relationships to disclose.

-93G>A polymorphism of hMLH1 associated with prognosis for patients with colorectal cancer

4039

Background: Polymorphisms in the DNA repair genes may contribute to variation in DNA repair capacity, thereby affecting the risk of carcinogenesis and prognosis of colorectal cancer. Accordingly, the present study analyzed polymorphisms of DNA repair genes and their impact on the prognosis for patients with colorectal cancer. Methods: Three hundred and ninety- seven consecutive patients with curatively resected colorectal adenocarcinoma were enrolled in the present study. The genomic DNA was extracted from fresh colorectal tissue and 14 polymorphisms of DNA repair genes (XRCC1, hMLH1, ERCC2, ERCC4, VARS2[rs2074511, rs2249459], XPA, XPC, POLR2A, POLR2B, RFC1, RFC4, XAB2, DNMT3B) determined using a PCR-RFLP assay. Results: The median age of the patients was 63 years (range, 21–85), and 218 (54.9%) patients had colon cancer and 179 (45.1%) patients rectal cancer. Pathologic stages after surgery were as follows: stage 0/I (n=86, 21.7%), stage II (n=146, 36.8%), stage III (n=145, 36.5%), and stage IV (n=20, 5.0%). Multivariate survival analysis including stage, differentiation, age, and CEA level showed that the survival for the patients with the -93AA genotype of hMLH1 was worse than for the patients with the combined -93GG and GA genotype (overall survival: hazard ratio [HR]=2.953, 95% Confidential Interval [CI], 1.273–6.850, P=0.012; disease-free survival: HR=2.299, 95% CI, 1.417–3.730, P=0.001), whereas the other polymorphisms were not associated with survival. Conclusions: The -93G>A polymorphism of hMLH1 was found to be an independent prognostic marker for patients with colorectal cancer. Accordingly, in addition to the pathologic stage, the analysis of -93G>A polymorphism of hMLH1 can help identify patient subgroups at high risk of a poor disease outcome.

No significant financial relationships to disclose.

Fixed dose rate infusion of gemcitabine and UFT combination chemotherapy in patients with advanced biliary cancer

e15581

Background: Biliary cancer is diagnosed at advanced stage and recurrence is common after surgical resection. Gemcitabine and UFT combination chemotherapy showed promising results in advanced pancreatic cancer(APC) and fixed dose- rate(FDR) infusion(10mg/m2/min) of gemcitabine is more effective than 30min-infusion in APC patients. We conducted a prospective multicenter phase II study to evaluate the efficacy and toxicity of FDR gemcitabine and UFT combination chemotherapy in advanced biliary cancer(ABC) patients. We evaluated the quality of life(QOL) and relationship between treatment outcome and polymorphisms of DNA repair gene such as RecQ1, RAD54L, XRCC1 and ATM. Methods: We included the chemo-naive patients with measurable metastatic or recurrent biliary adenocarcinoma except gall bladder cancer. Patients received gemcitabine infusion of rate of 10mg/m2/min on day 1, 8, and 15 plus oral UFT (400mg/m2) on day 1 to 21. We used modified PCR-RFLP method to evaluate the polymorphism of DNA repair gene. The primary endpoint was response rate. Results: From October 2006 to March 2008, 47 patients were enrolled and 33 of them were included in this analysis. Median age was 58 years(range 33–73 years) and 18 patients were male. Partial response was 24.2% and disease control rate was 51.5%. The estimated median time to progression(TTP) was 87 days(95% CI 51–123). Median overall survival was 243 days(95% CI 114–372). Grade 3/4 neutropenia was observed in 12 of 33 patients(36.4%) and 17 times of 114 cycles of chemotherapy(14.9%). No febrile neutropenia was observed. Grade 3/4 thrombocytopenia occurred in 5 patients(15.2%). Non-hematologic toxicities were mild. Polymorphism of XRCC1 was related to TTP(TTP of wild, heterozygous variant and homozygous variant type was 162, 71 and 25 days, respectively. p=0.0039). QOL as a secondary endpoint was not analyzed at this time. Conclusions: FDR infusion of gemcitabine and UFT combination chemotherapy in chemo-naïve patients with ABC is a well-tolerated and effective regimen.

No significant financial relationships to disclose.

Prognostic impact of the NFKB1 insertion/deletion promoter polymorphism on survival in patients with surgically resected gastric cancer

e15638

Background: The present study analyzed the functional insertion/deletion polymorphism in the promoter region of NKFB1 gene and their impact on the prognosis for patients with gastric adenocarcinoma. Methods: Five hundred and three consecutive patients with surgically resected gastric adenocarcinoma were enrolled in the present study. The genomic DNA was extracted from paraffin-embedded tissue and the -94 insertion/deletion ATTG polymorphism of NFKB1 determined using a PCR- RFLP assay. Results: The NFKB1 promoter gene polymorphism was successfully amplified in 97.8% of the cases. There were no sexual differences in relation to the genotype and allele. No correlation was observed between the frequency of the genotype or allele and the T, N, or M stage. The multivariate survival analysis showed no association between the NFKB1 -94 insertion/deletion promoter polymorphism and the disease-free survival or overall survival of the patients with gastric cancer. Conclusions: The functional NFKB1 promoter polymorphism was not found to be a prognostic marker for Korean patients with surgically resected gastric adenocarcinoma.

No significant financial relationships to disclose.

Multicenter phase II study of docetaxel plus oxaliplatin combination chemotherapy in patients with advanced gastric cancer

15026

Background: The present study was conducted to evaluate the efficacy and safety of a combination regimen of docetaxel plus oxaliplatin in patients with advanced gastric cancer. Methods: Patients with previously untreated metastatic or recurrent, measurable gastric cancer received intravenous docetaxel 65 mg/m2 plus oxaliplatin (Oxalpla®, Yuhan.Co. Seoul, Korea) 120 mg/m2 on days 1 in a 3-week cycle. Treatment was continued until disease progression, patient refusal, or an unacceptable toxicity up to 9 cycles. Results: Forty-two patients were enrolled in the current study. Of these, 39 were assessable for efficacy and 41 assessable for toxicity. Seventeen partial responses were confirmed, giving an overall response rate of 40.5% (95% CI: 26.0% to 54.1%, intention-to-treat analysis). At a median follow-up of 160.5 days, the median time to progression was 6.1 months, whereas median overall survival was not reached yet. Grade 3/4 neutropenia occurred in 10 patients, plus febrile neutropenia was observed in 3 patients. Most common non-hamatologic toxicity was nausea (grade 1/2 56.9%). There were two treatment-related deaths. Conclusions: Docetaxel and oxaliplatin combination was found to be well-tolerated and effective in patients with advanced gastric cancer. Accordingly, this regimen can be regarded as an important first-line treatment option for advanced gastric cancer.

No significant financial relationships to disclose.

Use of absolute lymphocyte counts to predict response to chemotherapy and survival in diffuse large B-cell lymphoma

8082

Background: Absolute lymphocyte counts (ALCs) at diagnosis has been shown to be an independent prognostic factor in patients with follicular lymphoma (FL) although the precise mechanism was not fully elucidated. The current study evaluated the impact of Absolute lymphocyte counts (ALCs) at diagnosis in patients with diffuse large B-cell lymphoma (DLBCL) on the response to chemotherapy and survival. Methods: The treatment outcomes of the patients receiving CHOP (n=101) or R-CHOP chemotherapy (n=122) were compared according to ALCs at diagnosis (<1.0 vs. = 1.0×109/L). Results: Forty-two patients (19%) had a lower ALC count at diagnosis (CHOP, 23 [23%]; R-CHOP, 19 [16%]). The lower ALCs showed a good correlation with IPI (p<0.001), performance (p<0.001), LDH (p<0.001), stage (p=0.004), extranodal involvement (p=0.011), but not with age or sex. A significant difference of response rate was noted according to ALCs in favor of a higher ALCs (CR: 80% vs. 60%, p=0.005; ORR: 93% vs. 78%, p=0.003). In addition, event-free survival (EFS) was worse in a lower ALC group than higher ALC group: median duration of EFS, 1,773 days vs. 326 days (p<0.001). The OS was also in favor of a higher ALC group: median duration of OS, 3,000 days vs. 695 days (p<0.001). In multivariate analysis, ALC at diagnosis was an independent predictive factor for CR (HR 2.717, p=0.009) and prognostic factor for EFS (HR 2.148, p=0.004) or OS (HR 2.863, p=0.002). Conclusion: The ALCs at diagnosis appears to predict the survival of DLBCL patients. Our findings suggested that the ALCs at diagnosis may reflect host's immune status against DLBCL, implying that immune system of host will play a critical role on survival of DLBCL patients.

No significant financial relationships to disclose.

Clinical significance of ERCC1 expression in advanced squamous cell carcinoma of the head and neck treated with cisplatin- based concurrent chemoradiation

6061

Background: The cytotoxic effect of cisplatin is based on the DNA cross linking. Nucleotide excision repair is associated with resistant to platinum-based chemotherapy. The excision repair cross-complementation group 1 (ERCC1) enzyme plays a rate-limiting role in nucleotide excision repair pathway. We evaluated the expression of ERCC1 as a predictive factor for survival in patients of squamous cell carcinoma of the head and neck (SCCHN) treated with cisplatin-based concurrent chemoradiotherapy (CCRT). Methods: We reviewed the clinical records and pathologic specimens of locally advanced SCCHN patients who had been treated with cisplatin-based definitive CCRT between 1995 and 2005. ERCC1 expression of the biopsy specimen was assessed by immunohistochemical (IHC) staining and a semi- quantitative grading system (H-score) was used for the evaluation. The median value of the H-score was chosen as the cutoff point for positive ERCC1 expression. Results: A total of 44 specimens and clinical data of the patients were reviewed. The median age was 59 years (range; 27–75), and 81.8% were male; 94.2% had ECOG performance status 0–1. The positive ERCC1 expression rate was 54.5% of all specimens (N=24/44). Overall tumor response rate for CCRT was 90.9% (CR=65.9%; PR=25.0%). With a median follow-up of 45.9 months (range; 5.4–133.0), 5-year progression free survival (PFS) rate was 58.0% and 5-year overall survival (OS) rate was 57.2%. Patients in group of positive ERCC1 expression showed poor survival in terms of PFS and OS (p=0.04; p=0.05), compared with negative ERCC1 expression group. Conclusions: The positive ERCC1 expression might be a predictive factor for poor survival and early progression in patients with locally advanced SCCHN treated with cisplatin-based CCRT.

No significant financial relationships to disclose.

Resonant frequency-domain interferometry via third-harmonic generation

A method for measuring resonances using a combination of third-harmonic generation and frequency-domain interferometry is described and demonstrated in an index-matched dielectric material. The phase of the third-harmonic spectrum of a pulse generated from a resonant NdAlO(3) thin film and a temporally displaced sapphire substrate pulse was measured by analyzing the spectral interference pattern. The appropriate combination of substrate and film signals was obtained by translating the sample through the laser focus while observing the third-harmonic intensity.

Pilot remission induction therapy with idarubicin, plus intensified dose of Ara-C and priming with granulocyte colony-stimulating factor for acute myeloid leukemia

16516

Background: The sensitization of leukemic cells with hematopoietic growth factors can enhance the cytotoxicity of chemotherapy in acute myeloid leukemia (AML). Intensified remission induction (RI) therapy can also improve the treatment results for AML. Therefore, the current trial attempted to evaluate the efficacy and toxicity of granulocyte colony-stimulating factor (G-CSF) priming and a dose intensification of Ara-C in RI chemotherapy for AML. Methods: A total of 29 patients with newly diagnosed AML received G-CSF-priming RI chemotherapy consisting of idarubicin (12 mg/m2, D1–3), G-CSF (150 ug/m2, D3–8), and Ara-C (500 mg/m2, bid, D4–8), and the outcomes were compared with those for a historical group treated with a standard regimen consisting of idarubicin (12 mg/m2, D1–3) and Ara-C (100 mg/m2, D1–7). Results: There was no difference in the sex, age, subtype, and cytogenetic risk between the two groups. The complete remission (CR) rate and treatment-related mortality (TRM) were 72% and 17% for G-CSF-primed group and 71% and 10% for the historical group, respectively (p = 0.89 and p = 0.32). The time to neutrophil and platelet recovery did not differ significantly between the two groups (25 days vs. 24 days, p=0.17; 24 days vs. 23 days, p = 0.23, respectively). Similarly, the duration of fever was also not significantly different (5 days vs. 7 days, p = 0.58). Thirteen patients (45%) experienced fever and 5 patients (17%) manifested skin rashes during the G-CSF priming. After a median follow-up of 336 days, the 1-year overall survival (OS), disease-free survival (DFS), and event-free survival (EFS) rates were 72% vs. 63% (p = 0.83), 74% vs. 56% (p = 0.059), and 53% vs. 38% (p = 0.32), respectively. Conclusion: The G-CSF-priming RI regimen with an intensified dose of Ara-C did not show a superior efficacy when compared with a standard regimen, yet did produce a slightly longer DFS. Therefore, the sensitization of leukemic cells with growth factors and dose intensification would only seem to be a clinically applicable means to enhance the efficacy of RI chemotherapy in selected patients with AML, thereby warranting further studies focusing on specific subgroups of AML patients.

No significant financial relationships to disclose.

Multicenter study of intravenous busulfan, cyclophosphamide, and etoposide (IV Bu/Cy/VP-16) as conditioning regimen for autologous stem cell transplantation in patients with non-Hodgkin’s lymphoma

17544

Background: The current study aimed to evaluate the efficacy and toxicity of the combination of intravenous busulfan, cyclophosphamide, and etoposide (IV Bu/Cy/VP-16) as a preparative regimen prior to autologous hematopoietic stem cell transplantation (ASCT) in patients with non-Hodgkin’s lymphoma (NHL). Methods: Forty patients with relapsed (n = 24) or high-risk (n = 16) lymphoma were enrolled into the study. High-dose chemotherapy consisted of intravenous busulfan (0.8 mg/kg i.v. q 6 hr from day-7 to day-5), cyclophosphamide (50 mg/kg i.v. on day-3 and day-2), and etoposide (400 mg/m2 i.v. on day-5 and day-4). Results: The median age of patients was 34 years (range, 17–63 years), and 21 (52.5%) patients were male. Pathologic subtypes were as follows: diffuse large B cell (n = 20), peripheral T cell, unspecified (n = 8), extranodal NK/T cell (n = 4), angioimmunoblastic T cell (n = 3), anaplastic large cell (n = 4), nodal marginal zone B cell (n = 2), and lymphoblastic (n = 3). The median dose of infused CD34+ cells and MNC was 3.95 (range, 0.7–20.6) × 106 and 8.12 (range, 3.0–13.6) × 108, respectively. WBC and platelet were successfully engrafted after ASCT in all patients, and the median days of engraftment of WBC and platelet was 12 (range, 9–48) and 27 (range, 8–263) days, respectively. After the ASCT, 34 complete responses (CR; 85.0%) and 4 partial responses (PR; 10.0%) were confirmed. Thirty-three (82.5%) patients experienced a fever without documented infection, while 2 patient developed fungal infection. However, there was no treatment-related death. After median follow-up duration of 360 (range, 83–639) days, 33 patients are in continuous complete remission, 4 patients are alive in relapse, and 3 patients died of disease. The estimated event-free and overall survival rate at 1.5-year was 80.9 ± 10.0 % and 92.5 ± 5.7 %, respectively. Conclusions: IV Bu/Cy/VP-16 was found to be well-tolerated and effective as a conditioning regimen in patients with NHL. Accordingly, this regimen can be regarded as an alternative high-dose treatment option in the ASCT for NHL.

No significant financial relationships to disclose.

Phase II study of capecitabine and irinotecan combination chemotherapy in patients with advanced gastric cancer

14037

Background: Several studies have shown the efficacy of capecitabine and irinotecan combination chemotherapy for advanced colorectal cancer, while no results have yet been reported for advanced gastric cancer. Accordingly, the current study evaluated the efficacy and safety of a combination regimen of capecitabine plus irinotecan in patients with advanced gastric cancer. Methods: Patients with previously untreated metastatic or recurrent, measurable gastric cancer received oral capecitabine 1000 mg/m2 twice daily from day 1 to 14 and intravenous irinotecan 100 mg/m2 on days 1 and 8, based on a 3-week cycle. Results: Forty-one patients were enrolled in the current study, among whom 38 were assessable for efficacy and 40 assessable for toxicity. Three complete responses and 16 partial responses were confirmed, giving an overall response rate of 46.3%. At a median follow-up of 269 days, the median time to progression and overall survival were 5.1 months and 8.6 months, respectively. Grade 3/4 neutropenia occurred in 4 patients and grade 3 febrile neutropenia was observed in 2 patients. Grade 3 diarrhea and grade 2 hand-foot syndrome occurred in 6 patients and 8 patients, respectively. Conclusions: The combination of capecitabine and irinotecan was found to be well tolerated and effective in patients with advanced gastric cancer. Accordingly, this regimen can be regarded as an important first-line treatment option for advanced gastric cancer.

No significant financial relationships to disclose.

Palliative chemotherapy preferences and factors that influence patient choice in advanced cancer

16010

Background: We conducted this prospective study to determine the treatment preference of patients receiving chemotherapy in a palliative setting. We investigated the survival threshold for justifying toxicity, the factors influencing individual preference for chemotherapy, and the attitude of patients towards randomized trials. Methods: 138 patients (median age, 58 years; 73% male) with advanced cancer who had received at least one cycle of palliative chemotherapy were recruited. General demographic information, patient preferences for palliative chemotherapy, and randomized trials were determined using structured patient interviews. Results: The median age was 58 years (range, 25–77 years), and the majority of the study population were male (73%). 73 patients (60.1%) answered that they had some support by dependents. Fewer than half were given information about the impact of their chemotherapy on survival (n = 64, 48.1%), and just over one third of patients (n = 53, 40.5%) were presented with an alternative to anticancer therapy, such as supportive care (p < 0.001). While 75.7% of patients agreed to receive chemotherapy with mild toxicity, only 57.9% of patients agreed to chemotherapy with severe toxicity (p = 0.002). The median survival threshold was 12 months for mild toxicity, and 21 months for severe toxicity. Patients who experienced improvement of symptoms or quality of life were more likely to judge the treatment as acceptable. 105 patients (78.4%) refused a clinical trial with randomization between a conventional chemotherapy and supportive care. There were 85 patients (62.6%) that would refuse randomization between conventional chemotherapy and investigational chemotherapy. Finally, 58.6% of patients agreed to participate in trials with investigational agents. Conclusions: In the palliative setting, a discussion of prognosis and the merits of chemotherapy is a necessary part of the treatment decision-making processes, and choosing the proper treatment for cancer patients. Individual preferences assume greater importance in this setting. Randomized trials must be carefully designed with a priori equipoise.

No significant financial relationships to disclose.

Vascular endothelial growth factor (VEGF) polymorphism is associated with prognosis of patients with gastric cancer

4019

Background: Recent studies demonstrated that the expression of vascular endothelial growth factor (VEGF) family had a prognostic significance in patients with gastric cancer. The present study analyzed VEGF polymorphism and its impact on prognosis in patients with gastric cancer. Methods: Five hundred three consecutive patients with surgically resected gastric adenocarcinoma at a single institution between January 2000 and December 2001 were enrolled into the study. Genomic DNA was extracted from paraffin-embedded tumor tissue and four VEGF (-460T > C, +405C > G, 936C> T, and -1154G > A) genotypes were determined using a PCR-RFLP assay. Results: The median age of patients was 60.0 years (range, 25–83 years), and 337 (67.0%) patients were male. Pathologic stages after resection were as follows: stage 0 (n=6, 1.2%), stage I (n=277, 55.1%), stage II (n=105, 20.9%), stage III (n=74, 14.7%), and stage IV (n=41, 8.2%). The estimated 5-year disease-free survival (DFS) rates according to stage were significantly different (p < 0.0001). Three VEGF polymorphisms (+405C > G, 936C, and -1154G > A > T) were not associated with survival of patients, while -460T > C polymorphism had a prognostic significance. In patients with early stage gastric cancer (stage 0 or 1, n=283), the estimated 5-year DFS and carcinoma-specific survival (CSS) for patients with homozygous genotype (CC or TT) of -460T > C were superior to those for heterozygous genotype (CT) (98.1% versus 90.3%, p=0.0047; 98.1% versus 92.5%, p=0.0284). In Cox multivariate regression, stage and VEGF -460T > C genotype were an independent prognostic factors for both DFS (p=0.007; p=0.010) and CSS (p=0.013; p=0.038). Conclusions: VEGF -460T > C polymorphism was found to be an independent prognostic marker for patients with curatively resected early stage gastric adenocarcinoma. Accordingly, VEGF -460T > C polymorphism can help to identify patients with unfavorable clinical outcome and thereby may be useful to refine therapeutic decisions in early stage gastric cancer.

No significant financial relationships to disclose.

Normal human oral keratinocytes are more sensitive to N-methyl-N'-nitro-N-nitrosoguanidine-induced cytotoxicity and apoptosis than HPV-immortalized oral keratinocytes

Exposure of HPV-immortalized, but not normal human oral keratinocytes, to the carcinogen N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) renders the cells tumorigenic. The underlying mechanism of this differential response of normal and immortalized cells was investigated. Normal primary human oral keratinocytes and three HPV-immortalized human oral keratinocyte cell lines exposed to MNNG were evaluated for survival rate, single and double-strand DNA breaks, and the expression of p53 and bcl-2 proteins. MNNG exposure for 2 h induced both greater cytotoxicity and a more rapid kinetic of cell death in normal keratinocytes than in the immortalized cells. Further, normal keratinocytes were more sensitive to lower concentrations of MNNG that were subtoxic for the immortalized cells. Likewise, with lower concentration of MNNG (50 mu M), significant single-strand DNA breaks in normal keratinocytes were induced whereas no such effect was seen in the immortalized cells. Double-strand DNA fragmentation (apoptosis) was observed in normal keratinocytes exposed to 50 mu M MNNG but not in the immortalized cells. Higher concentrations of MNNG (100 mu M) were toxic to both normal and immortalized cells although the normal cells were still more sensitive and with faster kinetics of cell death. MNNG-induced apoptosis was not attributable to down regulation of the anti-apoptotic product bcl-2 in normal cells; however, exposure of normal keratinocytes to MNNG did result in induction of the apoptotic gene p53. No change in p53 level was seen in the immortalized cells. These findings suggest that the selective sensitivity of normal keratinocytes to MNNG-induced apoptosis is in part due to the induction of p53. The HPV-immortalized cells are resistant to MNNG-induced apoptosis and therefore are capable of undergoing mutations affecting cell proliferation and resulting in tumori-genicity.

Zinc deficiency and host response to helminth infection: Echinostoma caproni infections in CBA mice

The effect of zinc deficiency on the response of CBA mice to infection with the intestinal trematode Echinostoma caproni was examined. Young CBA mice were allocated to one of three dietary groups: a group fed a zinc deficient diet ad libitum, a control group pair fed a zinc sufficient diet and a control group fed a zinc sufficient diet ad libitum. The mice on the zinc deficient diet gained significantly less weight than the pair fed controls. In primary infections with six E. caproni metacercariae followed over a period of 128 days, zinc deficiency delayed worm expulsion. In addition, zinc deficiency resulted in a prolonged IgM response, a delayed IgG response and an increased IgA response towards the end of the experiment. Resistance to challenge infection day 21 following a primary infection with 25 E. caproni metacercariae was slightly, but not significantly, affected by zinc deficiency.

Malignant transformation of hpv-immortalized human oral keratinocytes by chemical carcinogens

We previously immortalized primary human oral keratinocytes by transfection with cloned human papillomavirus type 16 (HPV-16) DNA and established a cell line, human oral keratinocytes-16B (HOK-16B). This line contained intact HPV-16 DNA in an integrated form, expressed viral genes, and demonstrated an indefinite life span. However, the cells proliferated only in keratinocyte growth medium containing a low level of calcium and were not tumorigenic in nude mice. To develop an in vitro multistage model suitable for the study of human oral carcinogenesis and to investigate the molecular mechanisms of cell transformation, the HOK-16B cells were exposed to either benzo(a)pyrene [B(a)P] or 7,12-dimethylbenz(a)anthracene (DMBA). Two chemically transformed cell colonies, one from B(a)P exposure and the other from DMBA treatment, were isolated. These cell lines proliferated well in Dulbecco's minimum essential medium containing a physiological level of calcium, demonstrated anchorage-independent growth, and developed tumors in nude mice. They contained integrated HPV-16 sequences and expressed higher levels of epidermal growth factor receptor (EGFR) and c-myc transcripts compared to the parental cells. Similar to their immortalized parental cells, the chemically transformed cells also contained lower levels of p53 protein and transforming growth factor-beta (TGF-beta) transcripts than normal human oral keratinocytes. These results indicate that malignant transformation of oral keratinocytes can be caused by a sequential combined effect of high-risk HPV and chemical carcinogens. It also demonstrates that overexpression of viral E6/E7, EGFR and c-myc messages, together with the down-regulation of TGF-beta mRNA and the inactivation of p53 gene, may be associated with the malignant conversion of HPV-immortalized cells.

Effect of actinomycin-d on the cell-cycle progression and the expression of p53, waf1/cip1, gadd45, and mdm-2 genes in human oral keratinocytes - implication of human papillomavirus infection

Exposure of human oral keratinocytes immortalized by transfection with 'high risk' HPV DNA to chemical carcinogens converts the cells to malignant phenotype, but it does not transform normal cells. To investigate the underlying mechanism for different chemical carcinogen susceptibility of normal and the HPV-immortalized oral keratinocytes to genotoxic agent, we studied the progression of cell cycle and the expression of p53, WAF1/CIP1, gadd45 and mdm-2 genes in normal and in the HPV-immortalized oral keratinocytes after exposing cells to actinomycin D. Normal oral keratinocytes demonstrated transient G(1) arrest after the exposure, but the HPV-immortalized cells did not. Actinomycin D significantly increased the levels of intranuclear wild-type p53 and mdm-2 proteins and the transcripts of WAF1/CIP1, gadd45 and mdm-2 in normal cells, but it did not increase them in the HPV-immortalized cells. These data indicate that actinomycin D-induced transient cell cycle arrest may be associated with enhanced level of wild-type p53 protein and the transcripts of WAF1/CIP1 and gadd45 in normal human oral keratinocytes. This study also suggests that overexpressed mdm-2 may not be enough to abrogate the cell cycle arrest mediated by wild-type p53. Our data support the idea that conversion of the HPV-immortalized oral keratinocytes to tumorigenic cells may, in part, be due to the incapability of the cells to arrest the cell cycle when exposed to genotoxic agents, which would result in improper repair of damaged DNA and subsequent inheritance of genetic error.