Clinical outcome of patients with primary gliosarcoma treated with concomitant and adjuvant temozolomide: A single institutional analysis of 27 cases

CONTEXT AND AIM

The prognosis of primary gliosarcoma (PGS) remains dismal with current treatment modalities. We analyzed the outcome of PGS patients treated with concurrent and adjuvant temozolomide (TMZ).

SETTINGS AND DESIGN

Retrospective single institutional analysis.

MATERIALS AND METHODS

We retrospectively evaluated 27 patients of PGS treated with radiotherapy (RT) and TMZ during 2007-2012.

STATISTICAL ANALYSIS USED

Overall survival (OS) was estimated by the use of Kaplan Meier method and toxicities were evaluate using common terminology criteria for adverse events version 2.0 (National Cancer Institute, USA).

RESULTS

Median age at presentation and Karnofsky performance status was 45 years and 90 respectively and male: female ratio was 20:7. Patients received adjuvant RT to a total dose of 60 Gy at 2 Gy/fraction. All patients except 5 received adjuvant TMZ to a median number of 6 cycles. Grade 2 and 3 hematological toxicity was seen in 8% and 4% of patients respectively during concurrent RT. During adjuvant chemotherapy, 13.6% had Grade 3 thrombocytopenia and 9.5% had Grade 3 neutropenia. Median OS was 16.7 months (1 year and 2 year actuarial OS was 70.8% and 32.6% respectively). Adjuvant TMZ was associated with a better survival (median survival 21.21 vs. 11.93 months; P = 0.0046) on univariate analysis and also on multivariate analysis (hazard ratio 1.82, 95% confidence interval: 1.503-25.58; P = 0.012).

CONCLUSIONS

The results of our study, largest series of patients with PGS treated with concurrent and adjuvant TMZ shows an impressive survival with acceptable toxicity. We suggest TMZ be included in the "standard of care" for this tumor.

Simultaneous inhibition of key growth pathways in melanoma cells and tumor regression by a designed bidentate constrained helical peptide

Protein-protein interactions are part of a large number of signaling networks and potential targets for drug development. However, discovering molecules that can specifically inhibit such interactions is a major challenge. S100B, a calcium-regulated protein, plays a crucial role in the proliferation of melanoma cells through protein-protein interactions. In this article, we report the design and development of a bidentate conformationally constrained peptide against dimeric S100B based on a natural tight-binding peptide, TRTK-12. The helical conformation of the peptide was constrained by the substitution of α-amino isobutyric acid--an amino acid having high helical propensity--in positions which do not interact with S100B. A branched bidentate version of the peptide was bound to S100B tightly with a dissociation constant of 8 nM. When conjugated to a cell-penetrating peptide, it caused growth inhibition and rapid apoptosis in melanoma cells. The molecule exerts antiproliferative action through simultaneous inhibition of key growth pathways, including reactivation of wild-type p53 and inhibition of Akt and STAT3 phosphorylation. The apoptosis induced by the bidentate constrained helix is caused by direct migration of p53 to mitochondria. At moderate intravenous dose, the peptide completely inhibits melanoma growth in a mouse model without any significant observable toxicity. The specificity was shown by lack of ability of a double mutant peptide to cause tumor regression at the same dose level. The methodology described here for direct protein-protein interaction inhibition may be effective for rapid development of inhibitors against relatively weak protein-protein interactions for de novo drug development.

Paraneoplastic pemphigus as a first sign of metastatic retroperitoneal inflammatory myofibroblastic tumor: (18)F-FDG PET/CT findings

A 30-year-old female presented with a 3-month history of erosive stomatitis and bullous lesions, along with recurrent episodes of abdominal pain. She was found to have a retroperitoneal lump in left lumbar region. Skin biopsy revealed bullous disorder. CT guided biopsy of the retroperitoneal mass was suggestive of inflammatory myofibroblastic tumor (IMT). She was started on oral steroids and supportive care, and surgery was being planned when she developed respiratory failure. CT chest revealed vertebral metastases. PET/CT for whole body work up revealed a left para-aortic mass along with multiple skeletal metastases. The patient was kept on conservative management. After 3 months, the patient has shown clinical improvement, and an exploratory laparotomy is now being planned for the excision of the tumor, followed by chemotherapy. This case of retroperitoneal IMT is rare in terms of skeletal metastases with paraneoplastic pemphigus.

Abstract P1-11-12: Religion-related factors and breast cancer screening among American Muslims

Background: Cancer disparities research often overlooks the influence a shared religion may have across race and ethnicity, and thereby misses opportunities to leverage shared religious networks to promote screening. While American Muslims have low rates of mammography and their health behaviors are strongly influenced by religion, a description of such relationships is lacking in the literature. Our study fills this gap.

Methods: We conducted a mixed-methods exploration of how religion-related factors impact breast cancer screening practices. We sampled an ethnically and racially diverse group of Muslim women frequenting mosques and community sites. A survey incorporated measures of fatalism, religiosity, religious discrimination, and Islamic modesty, while subsequent focus groups elicited perspectives on how religious beliefs, values and identity impact breast cancer screening intentions. Survey analyses involved logistic regression models, while focus groups were analyzed using a team-based framework content analysis approach.

Results: Of 240 survey respondents, 72 were Arabs, 71 S. Asians and 59 African Americans. Seventy-five percent had insurance, while 85% had a PCP. 77% reported ever having a mammogram while only 37% a mammogram within the past 2 years. In multivariate models, positive religious coping (OR= 0.21;P <.05) and perceived religious discrimination in healthcare (OR=0.74;P <.05) were negatively associated with having a mammogram in the past two years, while having a primary care physician (OR=20;P<.01) was positively associated. Ever having a mammogram was positively associated with increasing age (OR=1.1;P<.05), years of US residency (10-20 yrs OR=11; 20 yrs OR=4.3;P<.05) and knowing someone with breast cancer (OR=3.5;P<.01). Importantly, ethnic/racial affiliation did not influence mammography rates.

Of 50 focus group participants there were nearly equal numbers of S. Asians, Arabs, and African Americans, 74% reported ever having a mammogram, with 56% having a mammogram within the past two years. Focus group data revealed that family support and encouragement strongly impacted screening intentions, and that obtaining screening in a way that accommodated notions of religious modesty was paramount and prior experiences with such accommodations influenced subsequent intentions. Focus group participants believed that the mosque is a critical community venue for setting religious mores but is underutilized for health education and for motivating theological responses to illness. Participants expressed the need for mosque administration and religious leaders to openly discuss breast health and mammography screening among the Muslim community.

Conclusions: Aspects of religion appear to influence cancer screening behaviors similarly across the socioeconomic, ethnic, and racial diversity of American Muslims. Promoting biennial mammography screening among American Muslims requires addressing ideas about religious coping as related to preventive cancer screening and empowering women to combat perceived religious discrimination. Mosques are underutilized in breast cancer screening interventions but are a ripe setting for religiously-tailored programming that can address barriers to screening and promote a culture of health in this community.

Citation Format: Aasim Padela, S Murrar, S Mallick, Z Hosseinain, C Liao, C Ajax, F Marfani, M Peek. Religion-related factors and breast cancer screening among American Muslims [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-12.