Abstract P4-14-14: Clinicopathological features and endocrine therapy mode of ER low expression (1%-9%) breast cancer patients in China

Purpose: Since 2010, ASCO/CAP recommended that ER be considered positive if ≥1% tumor cells with positive nuclear staining by immunohistochemistry (IHC) in breast cancer. ASCO/CAP also recommended considering endocrine therapy (ET) in ER positive patients. However, most breast cancers are either ER negative or ER strongly positive (≥10%), and tumors with low ER (1-9%) expression are rare. Up to now, the effect of ET is controversial for these patients with ER 1-9% and unfortunately, we know little about the clinical information of this subgroup. In this study, we analyzed the clinicopathological characteristics and ET mode of patients with low ER expression. We sought to figure out whether the ASCO/CAP guidelines affect clinical ET decision in China and Which features are important considerations for doctors to choose ET. We also evaluated the efficacy of ET in these patients. Methods: Patients diagnosed stage I-III primary invasive breast cancer with ER low expression (1-9%) between January 2008 and December 2016 were retrospectively identified from six hospitals in China. Result: 457 patients (2.7%) had low expression of ER (1-9%) of 17216 patients. Mean age at diagnosis was 49 years. 288 patients (49.9%)were younger than 50 years old. 254 patients (55.6%) had stage II disease and 37 patients (8.1%) had lymphovascular invasion (LVI). 260 patients (56.9%) were HER2 positive; 408 patients had PR negative or low expression; 327 patients' (71.6%) Ki-67 status were > 20%. 388 patients (85%) received chemotherapy. Of those 388 patients, 90% patients received anthracycline combined with taxol chemotherapy regimens. 170 patients (37.2%)received ET. Before 2010, only 25.7% patients with low ER expression received ET. The proportion of ET increased after the 2010 ASCO/CAP guideline was published. In 2013, 50% patients received ET. The rate of ET was totally different in six hospitals. 55% patients received ET in the hospital with highest rate, while only 4% patients received ET in the hospital with lowest rate. Using the univariate logistic regression analysis of ET, ER expression, PR expression, Ki-67 status and LVI were associated with the rate of ET. But after adjustment for other covariates, only ER level was significantly associated with the rate of ET. Compared to patients with ER<5% tumors, patients with ER≥5% tumors had a significantly higher probability of ET rate (OR, 2.882; 95% CI: 1.928-4.308; P < 0.001). Median follow time was 30 months. The 5-year RFS rate was 85%. Younger age and positive lymph nodes were associated with worse RFS. Survival rate did not differ significantly between patients with or without ET (without ER vs with ET: OR, 0.870; 95% CI: 0.508-1.448; p=0.61). Conclusions: 2010 ACSO/CAP recommendation indeed result in an increase of ET rate for patients with 1%-9% ER positive. But these patients do not appear to benefit from ET. Prospective studies are needed for these patients and we need more accurate way to evaluate ER levels, which associate with endocrine response.

Citation Format: Fu P, Wang S, Yao M, Xiang A, Li J, Wang H, Geng C, Jin F, Yin Y, Huang X, Jiang Z. Clinicopathological features and endocrine therapy mode of ER low expression (1%-9%) breast cancer patients in China [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-14-14.

[Mean blood pressure among the adults in China 2010-2012: based on the results of mercury sphygmomanometer and converted electronic sphygmomanometer]

Objective: To analyze the average systolic blood pressure (SBP) and diastolic blood pressure (DBP) among adults aged 18 years old and above in China between 2010 and 2012; and to compare the difference in the results measured by mercury sphygmomanometer and converted electronic sphygmomanometer. Methods: The data was collected from Chinese Nutrition and Health Surveillance in 2010-2012. 120 428 adults aged 18 years old and above were selected from 150 survey counties (districts) of 31 provinces in China Mainland, by multi-stage stratified and probability proportion to size (PPS) cluster randomization sampling method. The average blood pressure value was calculated from three systolic and diastolic blood pressure readings measured by mercury sphygmomanometer. The value of Electronic Sphygmomanometer was converted by regression formula. Age-standardized results were calculated incorporating a complex sample weighting using the population data from the National Bureau of Statistics in 2009. Results: The overall adjusted mean of SBP based on the value of mercury sphygmomanometer among Chinese adults aged 18 years old and above was 122 mmHg (1 mmHg=0.133 kPa), 124 mmHg in men and 120 mmHg in women. The average SBP value was separately 115, 127, and 137 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average SBP was 122 mmHg in urban and 122 mmHg in rural areas. Mean DBP was 78 mmHg, 79 mmHg in men and 76 mmHg in women. The average DBP was separately 75, 81, and 81 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was 78 mmHg in urban and 77 mmHg in rural areas. The overall adjusted mean of SBP based on converted electronic device was 129 mmHg,130 mmHg in men and 127 mmHg in women, respectively. The mean of SBP was separately122, 134, and 143 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. Mean SBP was both 129 mmHg in urban and in rural areas. Mean DBP was 76 mmHg, 78 mmHg in men and 75 mmHg in women, respectively. The average DBP was separately 74, 79, and 79 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was both 76 mmHg in urban and rural areas. Conclusion: The average SBP and DBP was different between the mercury sphygmomanometer and converted electronic device. However, the results from both measures showed that the blood pressure was higher in men than in women, the blood pressure increased with the increase of age, and there was no difference between urban and rural areas.

Synthesis, crystal structures and optical properties of noncentrosymmetric oxysulfides AeGeS2O (Ae = Sr, Ba)

Two new noncentrosymmetric oxysulfides AeGeS₂O (Ae = Sr, Ba) were synthesized whose crystal structures feature unique 1∞[GeS₂O]²⁻ helical chains.

Abstract P3-03-04: Not presented

This abstract was not presented at the symposium.

[Surveillance of contamination level and antimicrobial resistance analysis of Salmonella on broiler carcasses after chilling in 4 poultry slaughterhouses of Henan Province]

Objective: Tests were carried out for obtaining contamination level and antimicrobial resistance of Salmonella on broiler carcasses after chilling in four poultry slaughterhouses in Henan. Methods: Totally, two hundred sixty nine broiler carcasses after chilling were collected in four slaughterhouses with the daily slaughter amount around 15 000 to 50 000. For qualitative analysis of Salmonella EFSA method was used and for quantitative analysis of Salmonella modified Rappaport-Vassiliadis most probable number (MSRV-MPN) method was used. All of the isolates were subjected to antimicrobial susceptibility testing of 8 antibiotics by minimum inhibitory concentration (MIC). Results: Overall, 48.7% (131/269) of the broiler carcasses after chilling were contaminated by Salmonella, and the average of contamination level is 1.32 most probable number MPN/g. Eight serotypes were detected. The dominant serotype is Salmonella enteritidis (93, 71.0%) followed by Salmonella Indiana (21, 16.0%). Only 2 (1.5%) Salmonella enteritidis strains were sensitive to all the tested antibiotics and the remaining 129 isolates were resistant to at least one kind of eight class antibiotics. Among them, resistant to NAL was the common (104, 79.4%) and 51 (38.9%) Salmonella isolates were multidrug-resistant. Conclusion: The contamination rate and multiple antimicrobial resistant of Salmonella on broiler carcasses after chilling from slaughterhouses was very serious, while the isolates contained various serotypes.

Complement regulatory proteins in kidneys of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis

The complement system activation is involved in the development of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). The study aimed to investigate the expression of complement regulatory proteins (CRPs) CD46, CD55 and CD59 in kidneys of 51 AVV patients. The expression of CD46, CD55 and CD59 in kidneys was detected by immunohistochemistry and double immunofluorescence staining. The immunohistochemical examination revealed that expression of the three CRPs could be detected in the glomeruli and tubules of both AAV patients and normal controls. The expression levels of the three CRPs in glomeruli of patients with AAV were significantly lower than those of normal controls. The scores of CD46 and CD55 expression in the tubules of AAV patients were significantly lower than those of normal controls, while there was no significant difference between the scores of CD59 expression in tubules of AAV patients and those of normal controls. Among AAV patients, the expression level of CD46 in glomeruli correlated inversely with the proportion of normal glomeruli, while it correlated with tubular atrophy in renal interstitium (r = -0·305, P = 0·026; r = 0·330, P = 0·023, respectively). The expression levels of CD55 and CD59 in glomeruli correlated with the proportion of total crescents (r = 0·384, P = 0·006; r = 0·351, P = 0·011, respectively). Double immunofluorescence staining indicated that all three CRPs were expressed on endothelial cells, podocytes and mesangial cells in glomeruli. The expression levels of the three CRPs were dysregulated in kidneys of patients with AAV. The expression levels of CD46, CD55 and CD59 were associated with the severity of renal injury of AAV patients.

Abstract OT2-01-10: Pilot study of carboplatin, nab-paclitaxel and pembrolizumab for metastatic triple-negative breast cancer (ongoing clinical trial)

BACKGROUND. Triple-negative breast cancer (TNBC) is associated with an aggressive phenotype and decreased survival. TNBC is characterized by tumor-infiltrating lymphocytes (TIL) which predict for a better prognosis and likely reflect immune recognition of tumor-associated antigens by TIL. However, potent immune suppressive signals exist in the tumor microenvironment such as those mediated by PD-1 with its ligand, PD-L1. Therefore, to test the validity of decreasing PD-1/PD-L1-mediated immune suppression, a Phase Ib study of single-agent pembrolizumab in 32 patients with advanced TNBC showed a partial response of 16.1% and stable disease of 9.7%, thereby attesting to the effectiveness of single-agent pembrolizumab in these patients. Other studies have demonstrated that cytotoxic chemotherapy favorably modulates immunity against cancer and there is therefore a strong rationale to combine chemotherapy with an immune modulator such as pembrolizumab for the treatment of mTNBC.

TRIAL DESIGN. This is an investigator-initiated, industry-sponsored (Merck) pilot study of carboplatin (C), nab-paclitaxel (N) and pembrolizumab (P) in 30 patients with metastatic (m) TNBC. Eligible patients will receive 3 cycles of CNP, with each cycle consisting of C (AUC 6 on days 1 of a 21-day cycle), N (100 mg/m2 IV on days 1, 8 and 15 of a 21-day cycle), and P (200 mg IV on day 15 of each cycle). After completion of 3 cycles CNP, patients with responding or stable disease by RECIST 1.1 criteria will be eligible for additional cycle(s) of CNP.

ELIGIBILITY CRITERIA. Patients must have radiologically measurable mTNBC, an ECOG performance status of 0-1, must not have received more than 2 prior therapies for this disease, and must be willing to undergo a preliminary biopsy of a metastatic focus for research purposes. A second post-treatment biopsy will be encouraged but will not be mandated.

SPECIFIC AIMS. The primary objective is to determine overall response rate (ORR) in patients treated with CNP. The secondary objectives are to determine progression-free survival (PFS) and safety/tolerability of CNP. Correlative objectives include the identification of pathologic and genomic correlates of response to CNP.

STATISTICAL METHODS. Clinical response will be scored using RECIST 1.1 criteria. Under the proposed treatment, the expected clinical response is about 35%. With the precision of the 2-sided 95% confidence interval for the response rate set to 0.17 (the distance to the expected response rate of 35%), the sample size required for the study is 30 patients. The true response rate of therapy will be estimated based on the number of responses using a binomial distribution and its confidence intervals will be estimated using Wilson's method. The Kaplan-Meier method will be used to estimate PFS. Factors including pathologic and genomic correlates that predict survival outcomes will be identified by Cox model or extensions of the Cox model.

TARGET ACCRUAL. We plan to enroll 30 patients over 2 years, with the first patient expected to be enrolled in September 2016.

CONTACT INFORMATION. Joseph Baar, MD, PhD. Seidman Cancer Center of University Hospitals Case Medical Center. E-mail: joseph.baar@uhhospitals.org.

Citation Format: Baar J, Abraham J, Silverman P, Budd GT, Vinayak S, Varadan V, Moore H, Montero A, Fu P. Pilot study of carboplatin, nab-paclitaxel and pembrolizumab for metastatic triple-negative breast cancer (ongoing clinical trial) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-10.

Nonlinear Transition from Mitigation to Suppression of the Edge Localized Mode with Resonant Magnetic Perturbations in the EAST Tokamak

Evidence of a nonlinear transition from mitigation to suppression of the edge localized mode (ELM) by using resonant magnetic perturbations (RMPs) in the EAST tokamak is presented. This is the first demonstration of ELM suppression with RMPs in slowly rotating plasmas with dominant radio-frequency wave heating. Changes of edge magnetic topology after the transition are indicated by a gradual phase shift in the plasma response field from a linear magneto hydro dynamics modeling result to a vacuum one and a sudden increase of three-dimensional particle flux to the divertor. The transition threshold depends on the spectrum of RMPs and plasma rotation as well as perturbation amplitude. This means that edge topological changes resulting from nonlinear plasma response plays a key role in the suppression of ELM with RMPs.

Clinical correlation of extensive-stage small-cell lung cancer genomics

BACKGROUND

Genomic studies in small-cell lung cancer (SCLC) lag far behind those carried out in nonsmall-cell lung cancer (NSCLC). To date, most SCLC studies have evaluated patients with surgically resectable disease. Here we sought to evaluate the genomic mutation spectrum of 'every-day' SCLC patient tumors with extensive stage disease (ES-SCLC) and to correlate mutations with the main clinical outcomes of response to chemotherapy, progression-free (PFS) and overall (OS) survival.

PATIENTS AND METHODS

A total of 50 SCLC patient tumors were examined in this study; targeted exome sequencing was obtained on 42 patients and whole-exome sequencing on 8 patients. Mutated genes were correlated with clinical outcomes using Kaplan-Meier methods (PFS, OS) and logistic regression (chemo-response). RB1 protein expression was detected by either western blotting of cultured cell lysates or immunohistochemistry of tumor specimens.

RESULTS

In all, 39 patients had ES-SCLC; 15 patients had either primary refractory/resistant disease and 21 patients had sensitive disease. The two most frequently mutated genes were TP53 (86%) and RB1 (58%); other frequently mutated genes (>10% patients) were involved in epigenetic regulation as well as the mTOR pathway. We identified a number of low-frequency, targetable mutations, including RICTOR, FGFR1, KIT, PTCH1 and RET. Using multivariate analysis, RB1 was the only significant factor (P = 0.038) in predicting response to first-line chemotherapy, with an odds ratio of 5.58 comparing mutant RB1 with wild-type. Patients with mutant RB1 had both better OS (11.7 versus 9.1 months P = 0.04) and PFS (11.2 versus 8.6 months, P = 0.06) compared with patients with wild-type RB1. Interestingly, ∼25% of SCLC cell lines and tumor specimens expressed RB1 protein, possibly representing the subgroup with wild-type RB1.

CONCLUSIONS

We found that SCLC tumors harboring no mutation in RB1 had a poor response to chemotherapy.

ID: 111: THE S1P TRANSPORTER, SPNS2, MEDIATES HGF-INDUCED LAMELLIPODIA FORMATION AND MIGRATION OF HUMAN LUNG ENDOTHELIAL CELLS

Rationale

We have demonstrated earlier that HGF-induced lamellipodia formation in human lung microvascular endothelial cells (HLMVECs) was through c-Met receptor tyrosine kinase and PI3 kinase/Akt signal transduction. Here, we show that HGF-mediated lamellipodia formation is dependent on intracellular S1P generation mediated by sphingosine kinase 1 (SphK1), the S1P transporter, Spns2 and S1P1 in HLMVECs.

Methods

HLMVECs were treated with HGF (20 ng/ml) for different time points. Lamellipodia were detected after HGF treatment by immunofluorescent staining of Spns2, cortactin and actin in lamellipodia, and lamellipodia were quantified by measuring cell periphery fluorescence intensity. Pearson's correlation coefficient was used to statistically quantify co-localization of proteins in lamellipodia. Endogenous SphK activity was blocked by SphK1 specific inhibitor PF-543, and expression of SphK1 in cells was down-regulated by siRNA. Cellular S1P levels were quantified by mass spectrometry.

Results

HGF stimulated phosphorylation of SphK1, and its localization to lamellipodia of HLMVECs. Down-regulation of SphK1, but not SphK2, with siRNA or inhibition of SphK1 with PF-543 (1–5 µM) attenuated HGF-induced lamellipodia formation in HLMVECs. The HGF-mediated phosphorylation of SphK1 and its localization in lamellipodia was dependent on PI3K/Akt and ERK1/2 signaling apthways. HGF increased S1P levels in HLMVECs, which was blocked by inhibition of SphK1 with PF-543. Further, HGF induced serine phosphorylation and translocation of Spns2, the S1P transporter, to lamellipodia, which was Akt dependent. The HGF-induced lamellipodia formation in HLMVECs was blocked by down-regulation of Spns2, suggesting extracellular action of S1P in lamellipodia formation. Down-regulation of S1P1, but not S1P2 or S1P3, with siRNA attenuated HGF-induced lamellipodia formation. Further, HGF stimulation enhanced association of Spns2 with S1P1 and blocking SphK1 activty with PF-543 attenuated the association between Spns2 and S1P1. Additionally, HGF-induced migration of HLMVECs was attenuated by down-regulation of Spns2.

Conclusion

These results suggest that HGF/c-Met mediated lamellipodia formation and motility is dependent on intracellular generation of S1P via activation and localization of SphK1 to cell periphery and Spns2 mediated transport of S1P to outside for signaling via S1P1 in HLMVECs. This work was supported by NIH/HLBI P01 HL98050 to VN.

ID: 120: REGULATION OF ENDOTHELIAL BARRIER PERMEABILITY BY PHOSPHOLIPASE D2

Pulmonary edema is a hallmark of several diseases including acute respiratory distress syndrome (ARDS) and is characterized by the disruption of the pulmonary endothelial barrier at its early stage. Maintaining the integrity of the adherens junctions (AJs) by stabilizing VE-Cadherin (VEC) at the cell membrane after injury could potentially be important to minimize endothelial barrier disruption. Since Phospholipase D (PLD) and its catalytic product, phosphatidic acid (PA), has been shown to be critical in membrane trafficking and in recycling of a number of cell surface receptors, we hypothesized that PLD/PA pathway accelerates the rate of VEC recycling to the lamellipodia to reassemble the AJs. We demonstrate, by measuring the trans endothelial resistance of human lung microvascular endothelial cells (HLMVECs), that inhibiting PLD2-dependent PA production increases the endothelium permeability in response to thrombin. Furthermore, immunostaining shows that the uniform redistribution of VEC to the AJs post thrombin insult is compromised when PLD-dependent PA production is inhibited, and resulted in the appearance of eminent intercellular gaps. Also, PLD2 inhibition prevented the HLMVECs from fully spreading after thrombin stimulation while the protrusive activity remained unaffected, suggesting that PLD2 is not required by HLMVECs to send protrusions, but is critical for the adherence of the protrusions. LPS-induced lung injury was more severe in PLD2 knockout mice compared to WT in an in vivo ARDS model. These observations suggest that PLD/PA signaling plays an important role in resealing of endothelial gaps post LPS-induced lung injury and could potentially be therapeutically utilized to enhance post-injury endothelium recovery.

Abstract OT1-01-02: Pilot trial of a type I polarized autologous dendritic cell vaccine incorporating tumor blood vessel antigen-derived peptides in patients with metastatic breast cancer

BACKGROUND. Cancer vaccines based on tumor-associated antigens are rarely curative in advanced cancer. This limitation relates to the heterogeneity of cancer due to defects in antigen presentation and altered immunophenotypes. Therefore, another method to promote anti-tumor immunity is to prime T cells against tumor-associated stromal cells. We have reported that IL-12 gene-therapy of established HLA-A2neg B16 melanomas in HLA-A2 transgenic (Tg) mice resulted in CD8+ T cell-mediated immunity against the host HLA-A2+ stromal cells within the tumor microenvironment (TME). We have also shown that vaccines based on a subset of tumor blood vessel antigen (TBVA)-derived peptides (DLK1310-318, EphA2883-891, HBB31-39, NRP1433-441, RGS55-13 and TEM1691-700) prevented HLA-A2neg MC38 tumor establishment and promoted the regression of melanomas in HLA-A2 Tg mice by CD8+ T cell targeting of HLA-A2+ pericytes and vascular endothelial cells in the TME.

TRIAL DESIGN. Based on this pre-clinical data, we are undertaking a Susan G. Komen-funded (IIR13261822; IND 15722) IRB-approved clinical trial of chemo-immunotherapy using the immunomodulatory drug gemcitabine (GEM) to suppress tumor infiltrating suppressor cells such as myeloid-derived suppressor cells (MDSC) and regulatory T cells (Tregs) with a dendritic cell (DC) vaccine pulsed with the above six HLA-A2-presented TBVA-derived peptides (DC-TBVA) in 30 HLA-A2+ patients with metastatic breast cancer (MBC). Eligible patients will first undergo leukapheresis for the generation of the DC-TBVA vaccine. Patients will then receive 3 cycles of GEM, 1000 mg/m2 IV on days 1 and 8 of a 21-day cycle for 3 cycles. Patients will then receive the DC-TBVA vaccine administered twice intradermally 7 days apart.

ELIGIBILITY CRITERIA. Patients must be HLA-A2+ and have radiologically measurable MBC, an ECOG performance status of 0-1 and not have any active immune disorders. Prior GEM therapy is acceptable as long as the last dose was ≥ 3 months from registration on this study. Patients may not be on steroids.

SPECIFIC AIMS. The 4 specific aims are to 1) assess the safety of GEM + αDC1-TBVA vaccination, 2) assess the clinical response of MBC to GEM + αDC1-TBVA vaccination, 3) determine the clinical efficacy of GEM + αDC1-TBVA vaccination in generating Tc1 immunity, and 4) correlate changes in MDSC and Tregs with the generation of anti-TBVA Tc1-cell immunity

STATISTICAL METHODS. Clinical response: if the response rate is less than 10%, then there is probability 0.05 or less of accepting the vaccine therapy; if the response rate is bigger than 32%, then the probability of rejecting the combination is less than 0.2. While the secondary goals of the study are exploratory, there is sufficient statistical power to identify moderate to large effects (i.e., there will be statistical power >.80 to detect changes from baseline in the different immune function parameters that are >0.6 standard deviations of the parameter.)

TARGET ACCRUAL. We will enroll 30 patients over 3 years, with the first patient expected to be enrolled in July 2015.

CONTACT INFORMATION. Joseph Baar, MD, PhD. Seidman Cancer Center. E-mail: joseph.baar@uhhospitals.org.

Citation Format: Baar J, Storkus W, Finke J, Butterfield L, Lazarus H, Reese J, Brufsky A, Downes K, Budd GT, Fu P. Pilot trial of a type I polarized autologous dendritic cell vaccine incorporating tumor blood vessel antigen-derived peptides in patients with metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT1-01-02.

Clinical efficacy of type-B ultrasound-guided intraperitoneal hyperthermic chemoperfusion combined with systemic chemotherapy in advanced gastric cancer patients with malignant ascites

OBJECTIVES

To evaluate the clinical efficacy of systemic chemotherapy combined with intraperitoneal hyperthermic perfusion in advanced gastric cancer patients with malignant ascites.

PATIENTS AND METHODS

Forty-eight gastric cancer patients with malignant ascites who were admitted to our hospital were selected and randomly divided into the hyperthermic perfusion and control groups. The control group only received systemic chemotherapy, and the hyperthermic perfusion group received systemic chemotherapy combined with intraperitoneal hyperthermic chemoperfusion. The therapeutic efficacy, the survival time and the associated toxicity were determined for the two groups.

RESULTS

The efficacy was significantly higher in the hyperthermic perfusion group (85.7%) than in the control group (30.0%) (P 0.05). The median progression-free survival (PFS) was significantly longer in the hyperthermic perfusion group (12 months) compared with the control group (6 months) (P < 0.05). The median overall survival (OS) was significantly longer in the hyperthermic perfusion group (21 months) compared with the control group (9 months) (P < 0.05). There was a significantly higher 1-year survival rate in the hyperthermic perfusion group (89.3%) than in the control group (36.4%) (P < 0.05); however, there was no significant difference in the 3-year survival rate (10.7% vs. 10.0%). The Karnofsky Performance Status (KPS) score in the hyperthermic perfusion group increased significantly from 62.8 ± 1.84 to 74.3 ± 5.0 after hyperthermic chemoperfusion (P < 0.05).

CONCLUSION

Systemic chemotherapy combined with intraperitoneal hyperthermic perfusion exhibited significant clinical efficacy in advanced gastric cancer patients with malignant ascites, helped control ascites, improved the quality of life and extended PFS and OS. This treatment regimen is worth promoting.

Wogonin increases doxorubicin sensitivity by down-regulation of IGF-1R/AKT signaling pathway in human breast cancer

Currently drug resistance has remained a major challenge in successful breast cancer therapy. Wogonin, one of the active components of scutellaria baicalensis, has shown anticarcinogenic, chemopreventive, and immunoregulatory functions. The present study aimed to explore whether wogonin exerted synergistic cytotoxicity with doxorubicin in breast cancer. Our data indicated that wogonin inhibited the proliferation of breast cancer cells in a dose- and time-dependent manner. Combined treatment with wogonin increased the doxorubicin sensitivity in breast cancer cells. Moreover, administration with wogonin alone or in combination with doxorubicin suppressed the expression of insulin like growth factor 1 receptor (IGF-1R) in Bcap-37 and MCF-7 cells. Incubation with insulin like growth factor (IGF) I or IGF-II promoted cell growth, which was reversed by wogonin co-administration. Mechanically, we found that down-regulation of IGF-1R diminished the chemosensitization role of wogonin in breast cancer. In addition, wogonin suppressed the phosphorylation levels of AKT and addition of AKT inhibitor abolished the synergistic cytotoxicity of wogonin and doxorubicin. Taken together, combined treatment with wogonin increased the doxorubicin sensitivity in breast cancer cells through regulation of IGF-1R/AKT signaling pathway. Therefore, these findings demonstrated that combination therapy with wogonin led to better therapeutic effects via regulating IGF-1R/AKT signaling pathway in doxorubicin-based chemotherapy for breast cancer.