Reaction of plasma hepatocyte growth factor levels in non-small cell lung cancer patients treated with EGFR-TKIs

Hepatocyte growth factor induces resistance to epidermal growth factor receptor tyrosine kinase inhibitors. It has been hypothesized that epidermal growth factor receptor tyrosine kinase inhibitors administration may influence the levels of plasma hepatocyte growth factor. Patients with advanced non-small cell lung cancer and relapsed after chemotherapies were eligible. Plasma hepatocyte growth factor levels were analyzed on pretreatment and post-treatment day 15 and 30. We also investigated the correlation between plasma hepatocyte growth factor levels and sensitivity to epidermal growth factor receptor tyrosine kinase inhibitors, tissue immunoreactivity for hepatocyte growth factor and MET gene status. Thirty-one patients were enrolled. Plasma hepatocyte growth factor levels on post-treatment day 15 (630.1 ± 366.9 pg/ml) were significantly higher (p = 0.029) than the pretreatment plasma hepatocyte growth factor levels (485.9 ± 230.2 pg/ml). Plasma hepatocyte growth factor levels on the post-treatment day 30 (581.5 ± 298.1 pg/ml) tend to be higher than those before treatment (p = 0.057). Pretreatment plasma hepatocyte growth factor levels in patients with progressive disease (724.1 ± 216.4 pg/ml) were significantly higher than those in patients with stable disease (396.5 ± 148.3 pg/ml; p = 0.0008) and partial response (381.7 ± 179.0 pg/ml; p = 0.0039). The optimal pretreatment plasma hepatocyte growth factor cut-off value for diagnosis of responder was 553.5 pg/ml, and its sensitivity and specificity were 90% and 65%, respectively. Pretreatment plasma hepatocyte growth factor levels had no correlation with tissue immunoreactivities for hepatocyte growth factor, MET gene status and active EGFR mutations. Administration of epidermal growth factor receptor tyrosine kinase inhibitors significantly increased plasma hepatocyte growth factor levels. High levels of pretreatment plasma hepatocyte growth factor indicated intrinsic resistance to epidermal growth factor receptor tyrosine kinase inhibitors. Plasma hepatocyte growth factor can serve as a useful biomarker for the early diagnosis of tumor relapse treated with epidermal growth factor receptor tyrosine kinase inhibitors.

Plasma concentration of amrubicinol in gamma phase in patients treated for 3 days with amrubicin and hematological toxicities

e14606

Background: Amrubicinol (AMR-OH) is an active metabolite of amrubicin (AMR), a novel synthetic 9-amino-anthracycline derivative. The time-concentration profile of AMR-OH exhibits a continuous long plateau slope in terminal phase. To determine the relationships between the steady-state plasma concentration of AMR-OH and treatment effects and toxicities associated with AMR therapy, we performed a PK/PD study of AMR in patients with lung cancer treated with AMR alone or the combination of AMR + cisplatin (CDDP). Methods: AMR was given at a dose of 30 or 40 mg/m2 on days 1 to 3. Plasma samples were collected at pretreatment, 24 hours after the 1st injection (day 2), and 24 hours after the 3rd injection (day 4). Plasma concentrations of AMR, AMR-OH, and CDDP were determined by HPLC and AAS. Percent change in neutrophil count (dANC) and the plasma concentration of AMR-OH were evaluated using a sigmoid Emax model. Results: A total of 35 patients with a median age of 65 years (range 40–78), including 10 with small cell lung cancer (SCLC), 23 with non-small cell lung cancer (NSCLC), 1 with thymic cancer, and 1 with neuroblastoma were enrolled. A total of 107 plasma samples were available for study. Mean concentrations of AMR on day 2, AMR on day 4, AMR-OH on day 2, and AMR-OH on day 4 were 8.52ng/mL+4.63, 16.55ng/mL+11.92, 7.28 ng/mL+3.56 SD, and 13.35ng/mL+5.56 (mean ± SD), with significant increase from day 2 to day 4 for both AMR (p<0.0001) and AMR-OH (p<0.0001). Significant relationships were observed between AMR-OH on day 4 and the toxicity grades of leukopenia, neutropenia, and anemia (p=.018, p=.012, and p=.025). Thrombocytopenia grade exhibited a tendency toward relationship with AMR-OH on day 4 (p = .081). No relationships were observed between drug concentrations and responses. The plasma concentration of AMR-OH on day 4 was positively correlated with dANC in the group of all patients, as well as in patients treated with AMR alone and in patients with co-administration with CDDP using a sigmoid Emax model. Conclusions: The plasma concentration of AMR-OH on day 4 was correlated with hematological toxicities in patients treated with AMR. Assessment of plasma concentration of AMR-OH at one time point might enable prediction of hematological toxicities.

No significant financial relationships to disclose.

Monitoring of chemotherapy response in malignant pleural mesothelioma using fluorodeoxyglucose positron emission tomography

We report a 56-year-old man who underwent monitoring of the response to chemotherapy of malignant pleural mesothelioma (MPM). (8)F-fluoro-2-deoxy-(D)-glucose positron emission tomography (FDG-PET) and computed tomography (CT) were performed prior to chemotherapy and after the first and second courses of chemotherapy. The tumor lesion exhibited shrinkage on CT and a decrease in the standardized uptake value (SUV) max after the first course of chemotherapy, but exhibited size enlargement and an increase in SUV max after the second course of chemotherapy. These findings suggest that results of quantification of metabolic response by FDG-PET are related to the objective response as determined by CT in patients with MPM.

Barrier distributions derived from quasielastic backscattering of 48Ti, 54Cr, 56Fe, 64Ni, and 70Zn projectiles on a 208Pb target

In order to study the nucleus-nucleus interaction in Pb-based cold fusion, we have measured excitation functions for quasielastic scattering of 48Ti, 54Cr, 56Fe, 64Ni, and 70Zn projectiles on a 208Pb target at backward angles. The barrier distributions were derived from the first derivative of measured quasielastic scattering cross sections relative to the Rutherford scattering cross section. The centroids of the barrier distributions show a deviation from several predicted barrier heights toward the low energy side. The shape of the barrier distributions is well reproduced by the results of a coupled-channel calculation taking account of the coupling effects of two phonon excitations of the quadrupole vibration for the projectiles and of the octupole vibration for the 208Pb target.

Phase II study of docetaxel and carboplatin in elderly patients with advanced non-small cell lung cancer: Final results

18161

Background: Single-agent chemotherapy has been considered as standard treatment for elderly patients with non-small cell lung cancer (NSCLC). However recent subset analyses suggest that platinum-based combination chemotherapy may be safely administered to the elderly with good performance status (PS). We evaluated the efficacy and safety of carboplatin and docetaxel in a phase II study of elderly patients aged 70 years or older. Methods: Chemotherapy-naive patients aged =70 years with advanced NSCLC (IIIB-IV), ECOG performance status (PS) of 0–2, a measurable lesion, and adequate organ functions were enrolled. Patients received carboplatin (AUC 5) and docetaxel (60 mg/m2) administered on day 1 every 3 weeks. The primary endpoint was response rate (RR). This study, with a planned sample size of 25, had 80% power to support the hypothesis that the true RR was >30%, and 5% significance to deny the hypothesis that the true RR was <10%. Results: Between October 2003 and April 2006, 30 elderly patients with NSCLC were enrolled in the study and all patients were treated. Demographics: M/F 20/10; PS 0/1/2 2/23/5; median age 75 (range 70–84). Median number of treatment cycles was 3.5. Responses in the 30 evaluable patients included 1CR; 13PR; for an objective RR of 46.7% (95% CI 28.8–64.6%). By January 4, 2007, 21 (70.0%) of 30 patients had died. Median follow-up for survival was 8.4 months. The median time to tumor progression was 4.4 months, and the median survival was 9.9 months. The 1-year survival rate was 43.3%.Grade 3/4 hematologic toxicities included leukopenia (80.0%), neutropenia (86.7%), anemia (16.7%) and thrombocytopenia (3.3%). Non-hematologic toxicities were mild with no grade 4 toxicities; grade 3 nausea (10.0%), anorexia (30.0%), diarrhea (13.3%), fatigue (6.7%), allergic reaction (6.7%), pneumonitis (3.3%), febril neutropenia (16.7%) and infection (10.0%) were observed. Conclusions: The combination of carboplatin and docetaxel was safe and promising for the treatment of chemotherapy-naive elderly patients with advanced NSCLC. This regimen warrants further evaluation in a phase III trial.

No significant financial relationships to disclose.

Phase I study of TZT-1027, a novel synthetic dolastatin 10 derivative and inhibitor of tubulin polymerization, which was administered to patients with advanced solid tumors on days 1 and 8 in 3-week courses

PURPOSE

To determine the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), and pharmacokinetics of TZT-1027 (soblidotin), a dolastatin 10 analogue, in Japanese patients with advanced solid tumors when administered on days 1 and 8 in 3-week courses.

METHODS

Eligible patients had advanced solid tumors that failed to respond to standard therapy or for which no standard therapy was available, and also met the following criteria: prior chemotherapy < or = 2 regimens, Eastern Cooperative Oncology Group (ECOG) performance status < or = 1, and acceptable organ function. The MTD was defined as the highest dose at which no more than one of six patients experienced a DLT during course 1. Pharmacokinetic samples were collected in courses 1 and 2.

RESULTS

Eighteen patients were enrolled in the present study. Three doses (1.5, 1.65, and 1.8 mg/m(2)) were evaluated. Neutropenia was the principal DLT at doses of 1.65 and 1.8 mg/m(2). In addition, one patient also experienced grade 3 pneumonia with neutropenia, and another patient experienced grade 3 constipation, neuropathy, grade 4 neutropenia, and hyponatremia as DLTs at 1.65 mg/m(2). Phlebitis, the most frequent nonhematological toxicity, was improved by administration of additional saline after TZT-1027 administration. The MTD was 1.5 mg/m(2), at which DLT was not observed in a total of nine patients. The pharmacokinetic profile did not differ from that for the European population. One patient with metastatic esophageal cancer achieved partial response, and each of two patients with non-small cell lung cancer had a minor response.

CONCLUSIONS

When TZT-1027 was administered on days 1 and 8 in 3-week courses to Japanese patients, the MTD was 1.5 mg/m(2) and was lower than the value of 2.4 mg/m(2) in European patients. However, antitumor activity was observed at low doses. TZT-1027 was tolerated well at the MTD, without grade 3 nonhematological toxicities or neutropenia up to grade 2. TZT-1027 is a promising new tubulin polymerization inhibitor that requires further investigation in phase II studies.

Phase II study of docetaxel and carboplatin in elderly patients with advanced non-small cell lung cancer

17013

Background: Single-agent chemotherapy has been considered as standard treatment for elderly patients with non-small cell lung cancer (NSCLC). However recent subset analyses suggest that platinum-based combination chemotherapy may be safely administered to the elderly with good performance status (PS). We evaluated the efficacy and safety of carboplatin and docetaxel in a phase II study of elderly patients aged 70 years or older. Methods: Chemotherapy-naive patients aged ≥70 years with advanced NSCLC (IIIB-IV), ECOG performance status (PS) of 0 or 1, a measurable lesion, and adequate organ functions were enrolled. Patients received carboplatin (AUC 5) and docetaxel (60 mg/m2) administered on day 1 every 3 weeks. The primary endpoint was response rate (RR). This study, with a planned sample size of 25, had 80% power to support the hypothesis that the true RR was >30%, and 5% significance to deny the hypothesis that the true RR was <10%. Results: Between October 2003 and September 2005, 26 elderly patients with NSCLC were enrolled in the study and all patients were treated. Demographics: M/F 17/9; PS 0/1 2/24; median age 75 (range 70–84). Median number of treatment cycles was 4. Responses in the 26 evaluable patients included 1CR; 12PR; 7SD; for an objective RR of 50% (95% CI 31–69%) and a disease control rate of 77%. Median survival period and 1-year survival rate have not yet been reached. Grade 3/4 hematologic toxicities included leukopenia (82%), neutropenia (86%), thrombocytopenia (5%) and anemia (5%). Non-hematologic toxicities were mild with no grade 4 toxicities; grade 3 nausea (9%), anorexia (23%), diarrhea (14%), fatigue (9%), allergic reaction (9%) and infection (18%) were observed. Conclusions: The combination of carboplatin and docetaxel was safe and promising for the treatment of chemotherapy-naive elderly patients with advanced NSCLC. This regimen warrants further evaluation in a phase III trial.

No significant financial relationships to disclose.

A phase II trial of amrubicin (AMR) for recurrent or refractory small cell lung cancer (SCLC)

17053

Background: AMR, a totally synthetic 9-amino-anthracycline, demonstrated excellent single-agent activity for previously untreated extensive stage SCLC (Yana et al., Proc. ASCO, 1998, abstr.No.1734). The aim of this trial was to evaluate clinical activity of AMR in the treatment of patients with recurrent or refractory SCLC. Methods: Eligibility criteria were patients having histologically or cytologically proven measurable SCLC, had relapsed after one or two previous systemic chemotherapies, an Eastern Cooperative Oncology Group performance status (PS) of 0–2 and adequate organ function. AMR (40 mg/m2) was administered on days 1–3 every 3 weeks. This study, with a planned sample size of 25, had 80% power to support the hypothesis that the true response rate was >30%, and 5% significance to deny the hypothesis is the true RR was <10%. Results: Between July 2003 and October 2005, 19 patients were enrolled with the following characteristics: male/female, 15/4; median age, 66 years (range 47–78); PS 0/1/2, 0/16/3; sensitive relapse/refractory case, 7/12. Median number of treatment cycles was 3. A total of 59 courses were assessable for safety. The principle toxicity was myelosuppression. Grade 3/4hematologic toxicities were leukopenia (53/32%), neutropenia (32/53%), thrombocytopenia (32/0%) and anemia (42/0%). Non-hematologic toxicities weremild with no grade 4 toxicities; grade 3neutropenic fever (16%), infection (11%), diarrhea (5%), constipation (5%), and AST/ALT (11%) were observed.Responses included 7PR (3 sensitive cases and 4 refractory cases) and 8SD; for an objective RR of 37% (95% CI 16–59%). Conclusions: AMR is well tolerated and promising for treatment of recurrent or refractory SCLC. This regimen warrants further evaluation in a phase III trial.

No significant financial relationships to disclose.

Smoking history and prior surgical resection predict sensitivity to gefitinib in advanced non-small-cell lung cancer

BACKGROUND

Gefitinib is an inhibitor of epidermal growth factor receptor tyrosine kinase, and induces radiographic regression and symptomatic improvement in patients with non-small cell lung cancer (NSCLC). Phase II trials suggested female sex and adenocarcinoma were associated with response, never smoking history and adenocarcinoma were associated with survival. We attempted to identify additional clinical features associated with response and survival.

METHODS

We reviewed medical records and imaging studies of all 68 NSCLC patients treated by gefitinib monotherapy in our institution. We identified patients experiencing disease control and compared their clinical features with those of other patients. We considered partial response, stable disease or incomplete response and stable disease to be evidence of disease control. Univariate and multivariate analysis were performed to determine predictive and prognostic factors associated with disease control and survival.

RESULTS

Of 68 patients, 20 (29.4%) experienced disease control. Variables identified as significant for disease control with gefitinib included never smoking history (p=0.0128) and history of curative surgical resection (p=0.0007) on multivariate analysis. Variables identified as significant for overall survival included never smoking history (p=0.0128), history of curative surgical resection (p=0.0007), and performance status (PS) of 0 and 1 (p=0.0001) on multivariate analysis.

CONCLUSIONS

Our findings suggest that never smoking history and history of curative surgical resection are key factors for disease control and prognostic factors in patients with NSCLC treated with gefitinib.

EKB-569, a new irreversible epidermal growth factor receptor tyrosine kinase inhibitor, with clinical activity in patients with non-small cell lung cancer with acquired resistance to gefitinib

EKB-569 is a potent, low molecular weight, selective, and irreversible inhibitor of epidermal growth factor receptor (EGFR) that is being developed as an anticancer agent. A phase 1, dose-escalation study was conducted in Japanese patients. EKB-569 was administered orally, once daily, in 28-day cycles, to patients with advanced-stage malignancies known to overexpress EGFR. Two patients with advanced non-small cell lung cancer with EGFR mutations and acquired gefitinib resistance from the phase 1 study are described in detail. Case #1 is a 63-year-old man with smoking history. He received treatment from 4 March 2004. Because he had no severe adverse events, a total of 10 courses of therapy were completed through December 16. Grade 2 skin rash and ALT elevation, and grade 1 diarrhea and nail changes developed. A chest CT scan on 4 August 2003 revealed multiple pulmonary metastases that had decreased in size. Case #2 is a 49-year-old woman with no smoking history. She received therapy from 9 February 2004. She received a total of five courses of the therapy until 22 June 2004. Grade 3 nausea and vomiting and grade 1 diarrhea and dry skin developed. A chest CT scan on March 3 revealed multiple pulmonary metastases that had decreased in size. A brain MRI on March 4 showed that multiple brain metastases also had decreased in size. Based on RECIST criteria, they had stable disease but radiographic tumor regression was observed.

Evidence of complete fusion in the sub-barrier 16O+238U reaction

Evaporation residue cross sections in the 16O+238U reaction were measured for the energy range from above- to extreme sub-barrier. The cross sections are reproduced by a statistical model calculation, for which partial cross sections are calculated by a coupled-channel model taking into account the prolate deformation of 238U. Complete fusion was observed in the collision of the projectile with the tips of the 238U target, in the same way as the side collision.

A phase II study of continuous concurrent thoracic radiotherapy in combination with mitomycin, vindesine and cisplatin in unresectable stage III non-small cell lung cancer

The split-course concurrent thoracic radiation therapy (TRT) and full-dose chemotherapy for unresectable stage III non-small cell lung cancer (NSCLC) has produced promising results by comparison with the sequential approach. Instead of split-course radiation, we conducted a phase II study to investigate the feasibility of continuous concurrent TRT and chemotherapy. Twenty-two patients with unresectable NSCLC were enrolled onto a phase II study of continuous concurrent radiotherapy and chemotherapy. Treatment consisted of two courses of cisplatin (80 mg/m(2) on days 1 and 29), vindesine (3 mg/m(2) on days 1, 8, 29 and 36), and mitomycin (8 mg/m(2) on days 1 and 29). TRT began on day 2 at a dose of 60 Gy (2 Gy per fraction and 5 fractions per week for a total of 30 fractions). Of 22 patients assessable for response, none achieved a CR and 17 (77.3%) achieved a PR with an overall response rate of 77.3% (95% confidence interval, 54.6-92.2%). Grade 3 or 4 leukopenia was observed in 5/13 (81.8%) patients. Six patients (27.3%) experienced > or = grade 3 thrombocytopenia. Non-hematological toxicity was relatively mild. The overall median survival time was 19.0 months and the 1- and 2-year survival rates were 84.8 and 34.5%, respectively. It was possible to administer two courses of chemotherapy in 18 patients (81.8%) as planned. Nineteen (86.4%) of the 22 patients received the planned 60 Gy radiation. It seems to be difficult to administer the planned treatment without any interruption for the majority of patients. However, in the selected patients who completed the 60 Gy TRT, nearly half of the patients completed TRT without interruption. This combination regimen is considered to be feasible on condition that the stopping rule of the treatment is followed. We recommend administering radiotherapy continuously as far as possible.

A feasibility study of paclitaxel 225 mg/m(2) and carboplatin AUC = 6 in untreated advanced non-small cell lung cancer patients in Japan

BACKGROUND

The combination of paclitaxel (225 mg/m(2), 3 h infusion) and carboplatin [area under the curve (AUC) 6 mg/ml x min] is used widely for non-small cell lung cancer in the USA and is one of the standard regimens in the Southwest Oncology Group. In Japan, however, the upper limit of the approved dose for single-use paclitaxel is 210 mg/m(2) and the optimum dose of this agent in combination with carboplatin has not yet been established. This study was designated to determine whether the paclitaxel dose of 225 mg/m(2 ) plus carboplatin (AUC = 6) is tolerable for Japanese patients with untreated advanced non-small cell lung cancer.

METHODS

Ten patients were enrolled between October 1999 and June 2000 and all of these patients were evaluable for toxicity. Chemotherapy consisted of carboplatin (AUC = 6 mg/ml x min) and 225 mg/m(2 )of paclitaxel on day 1 every 3 weeks.

RESULTS

Neutropenia was the major toxicity and grade 4 neutropenia was observed in seven of the 10 patients (70%), but febrile neutropenia was not observed. Grade 4 anemia as a dose-limiting toxicity was observed in two patients. This was due to gastric ulcer bleeding in both patients. Only one patient experienced grade 3 peripheral neuropathy. No grade 3 or more myalgia or arthralgia was reported. Overall, 44 courses of chemotherapy were administered in 10 patients. Partial responses were observed in six of the 10 patients (60%). Median survival time was 7.7 months.

CONCLUSION

Paclitaxel at 225 mg/m(2) in a 3 h infusion and carboplatin AUC = 6 appears to be tolerable in Japanese patients with untreated advanced non-small cell lung cancer.

Retroperitoneal hematoma associated with femoral neuropathy: a complication under antiplatelets therapy

We report a case of retroperitoneal hematoma presenting as femoral nerve pulsy on antiplatelet therapy. The patient, a 78-year-old man who had undergone antiplatelet treatment using ticlopidine, was admitted to our hospital with complaints of sudden-onset low abdominal and back pain. Computed tomography showed an iso-density mass in the right retroperitoneum within the psoas muscle. We made a diagnosis of retroperitoneal hematoma compressing the femoral nerve and performed an operation to remove the hematoma in order to decompress the femoral neuropathy. Postoperatively, the patient rapidly recovered from the femoral neuropathy. In the particular case in which no antagonist against the ticlopidine is available, surgical decompression could produce a good outcome.

Changes in the regression slope correlating between urinary contents of alpha-1-microglobulin and ulinastatin and its relation to severity in mood disorders

With mood disorders, clinical portrayals alone do not always reflect the exact state and progress of the disease. The present study attempted to evaluate whether changes in regression slope correlating between urinary contents of alpha-1-microglobulin and ulinastatin provided objective information on the severity of mood disorders, based on our previous findings that the regression slope was more steeply inclined in patients with mood disorders than in age-matched healthy subjects. As a result, a close association between scores of the Hamilton Rating Scale for Depression and the regression slopes was found: the more inclined the slope, the greater the severity of symptoms of depression. These results suggest that changes in the slope of the regression plot correlating between urinary contents of alpha 1 M and UT may afford a useful objective index when monitoring the state of patients with mood disorders.

[Successful combination chemotherapy with low-dose methotrexate and steroids for dermatomyositis complicated by interstitial pneumonitis]

A 44-year-old woman visited our hospital in August 1997 with complaints of general fatigue and low-grade fever. Initial examination disclosed slightly elevated muscle enzymes and inflammatory reactions. A diagnosis of dermatomyositis was made on the basis of findings of skin symptoms consistent with Gottron's signs and a slight decrease in muscular strength. Reticular shadows were observed in both lower lung fields on chest X-ray films, and examination of transbronchial lung biopsy specimens revealed interstitial pneumonitis. After 1 course of steroid pulse therapy, the patient was placed on a regimen of prednisolone (PSL) at 60 mg/day and cyclosporin (CsA) at 200 mg/day. Although her skin symptoms and interstitial pneumonitis temporarily subsided, aggravated interstitial pneumonitis and elevated blood LDH levels were observed as the steroid dose (PSL) was being tapered. After a second course of steroid pulse therapy, the PSL dose was increased to 50 mg/day and CsA was replaced by methotrexate (MTX), at 7.5 mg/week. This brought the patient's interstitial pneumonitis under control. Although our patient had dermatomyositis complicated by interstitial pneumonitis which belongs to the group of poor prognosis, she responded favorably to combination chemotherapy with low-dose MTX.

Benign fibrous mesothelioma successfully treated by thoracoscope-assisted surgery: report of a case

We report herein the case of an 84-year-old man in whom a benign fibrous mesothelioma (BFM) was successfully treated by thoracoscope-assisted surgery. In September 1996, the patient underwent a sigmoidectomy for colon cancer, soon after which a followup examination disclosed a coin lesion on his chest X-ray film. The patient was readmitted to our hospital in November 1996 for further investigation of this tumor. A chest computed tomography scan revealed a 3.5 x 3.0 cm homogeneous tumor arising from the pleura. A needle biopsy was performed under ultrasonographic guidance, and the specimen was histopathologically diagnosed as a BFM. In view of his poor respiratory function, the tumor was excised by thoracoscope-assisted surgery. This case report serves to demonstrate the benefits of thoracoscope-assisted surgery for such patients.

[A case of retroperitoneal malignant lymphoma successfully treated by chemotherapy]

A 71-year-old woman was admitted to our hospital with the complaint of lower abdominal pain. CT scan revealed a huge retroperitoneal mass. On laparotomy the tumor was found to have extensively invaded the retroperitoneum, and an incisional biopsy was performed. Histopathological diagnosis of the biopsied specimen demonstrated diffuse malignant lymphoma of the pleomorphic type. Six cycles of CHOP chemotherapy were very effective for complete remission. Our review of 18 cases in the Japanese literature showed that chemotherapy and radiotherapy were effective for retroperitoneal malignant lymphoma, so due care must be taken in opting for surgery.

Carcinosarcoma of the colon: report of a case and review of the literature

We report a case of carcinosarcoma in the transverse colon in a 60-year-old woman. She was admitted to our hospital for further examination of occult blood in October, 1995. Colonoscopy disclosed an elevated lesion with ulceration in the transverse colon, and she underwent right hemicolectomy. Histopathological examination revealed the tumor to consist of both carcinomatous and sarcomatous elements, the latter being more predominant. Immunohistochemistry revealed vimentin immunoreactivity in most of the sarcomatous cells, and S-100 and myoglobin in a few carcinomatous cells. Distinct carcinomatous features were noted in one superficial portion of the tumor, and these carcinomatous cells showed immunoreactivity for epithelial membrane antigen. The patient is alive 14 months after surgery without evidence of recurrence. To our knowledge, this is the fourth reported case of carcinosarcoma of the colon. Our review of the literature disclosed poor prognosis in colonic carcinosarcoma.

Double cancers of the gallbladder and bile duct associated with anomalous choledochopancreatic duct junction

A rare case of double cancers of the gallbladder and bile duct associated with anomalous choledochopancreatic duct junction (ACPDJ) is reported. The patient was a 61-year-old Japanese woman who with presented right upper quadrant abdominal pain. Liver function tests results were normal. Computed tomography showed a polypoid lesion in the gallbladder, and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated ACPDJ and irregular wall of the inferior bile duct. A diagnosis of double cancers of the gallbladder and bile duct was made and a pancreaticoduodenectomy and liver bed resection was performed. His topathological examination showed papillary adenocarcinoma of the gallbladder and mucosal adenocarcinoma of the bile duct. The patient is in good health 15 months after the operation and shows no signs of recurrence. A review of the literature is presented.

Multivisceral transplantation in pigs: a clinicopathological analysis of tissue rejection

In this study, we established the surgical procedure and postoperative care of multivisceral transplantation (MVTX) in pigs, and examined the functional changes and rejection pattern of transplanted organs in MVTX. Twenty-two MVTXs were performed without immunosuppression, and nine cases (41%) that survived for 5 days or more after MVTX were used for evaluation. Rejection in grafts including the liver, pancreas, and gastrointestinal tract were assessed histopathologically. On day 5 after transplantation, the duodenum and small bowel already showed signs of mild rejection. On the other hand, in the liver, pancreas and stomach, rejection occurred later and was still mild on day 16. Hepatic rejection in MVTX appeared to occur later than in simple liver transplantation (LTX). These results showed that the susceptibility to rejection of individual visceral organs varies.

Regulation of albumin and alpha-fetoprotein gene expression by colloid osmotic pressure in human hepatoma cells

BACKGROUND

Colloid osmotic pressure has been thought to regulate albumin synthesis; however, the exact mechanism remains obscure. In the present study, the effect of colloid osmotic pressure on the albumin and alpha-fetoprotein gene expression in HuH-7 human hepatoma cells was analyzed.

METHODS

HuH-7 cells were treated with albumin or dextran (mean mol wt, 70,000), and changes in the levels of albumin and alpha-fetoprotein messenger RNA (mRNA) were analyzed by Northern blotting. Furthermore, in transient chloramphenicol acetyltransferase (CAT) plasmid transfection experiments, effects of colloid osmotic pressure on CAT activities were studied.

RESULTS

By Northern blot analysis, the levels of both albumin and alpha-fetoprotein mRNA were dose-dependently suppressed by the elevation of colloid osmotic pressure and returned to pretreatment levels 48 hours after the culture medium containing dextran was replaced with a dextran-free fresh medium. In transient CAT plasmid transfection experiments, the increased level of colloid osmotic pressure resulted in the repression of both albumin and alpha-fetoprotein promoter activities. In contrast, alpha-fetoprotein enhancer activity, which possibly regulates not only alpha-fetoprotein but also albumin gene expression, was not affected by changes in colloid osmotic pressure.

CONCLUSIONS

These results suggest that colloid osmotic pressure regulates both albumin and alpha-fetoprotein gene transcription through the modulation of their promoter activities.

A physiological role of epidermal growth factor in cell kinetics of gastric epithelium

Administration of epidermal growth factor (EGF) stimulates DNA synthesis in gut epithelial cells and inhibits gastric acid secretion. A physiological role of EGF in cell kinetics of gastric epithelium, however, has not been fully understood. In mature male mice, large amounts of EGF are produced in the submandibular glands, and sialoadenectomy (removal of the submandibular glands) causes a marked reduction of plasma EGF levels. For the evaluation of a biophysical function of EGF, sialoadenectomized mice and sham-operated mice were injected with 3H-thymidine to compare the proliferative activity and the cell-turnover of gastric epithelium between the two groups using the autoradiographic analysis. When mice were killed 90 min after a single injection of 3H-thymidine, the percentages of fundic gland mucosal cells radiolabeled in sialoadenectomized and sham-operated mice were 27.3 +/- 5.0% and 26.3 +/- 5.8% (mean +/- SD), respectively. The difference was not significant (p > 0.05). Similarly, the labeling indices of pyloric gland mucosal cells were not different between the two groups (26.7 +/- 4.3% vs 27.8 +/- 3.7%, p > 0.05). In contrast, when mice were given 17 repeated injections of 3H-thymidine at 6 hr intervals and killed 48 hr after the last injection, labeling indices in sialoadenectomized mice were significantly lower than those in sham-operated mice (35.3 +/- 4.3% vs 52.8 +/- 1.1% in the fundic gland area; 41.0 +/- 6.2% vs 55.1 +/- 5.9% in the pyloric gland area, p < 0.001, respectively). Treatment of sialoadenectomized mice with EGF (5 mg/mouse per day) completely restored the percentages of the radiolabeled cells to control levels. These findings suggest that endogenous EGF plays a major role in maintaining biological cell-turnover of the mouse gastric epithelium.

Interaction of interferon-alpha with interleukin-1 beta or tumor necrosis factor-alpha on hepatitis B virus enhancer activity

The interaction of IFN-alpha with IL-1 beta or TNF-alpha on hepatitis B surface antigen (HBsAg) expression was analysed in hepatitis B virus (HBV)-DNA integrated PLC/PRF/5 and non-integrated HuH-7 human hepatoma cells. Secretion of HBsAg in PLC/PRF/5 cells was reduced by IFN-alpha, IL-1 beta or TNF-alpha, and synergistically depressed when IFN-alpha was used in combination with IL-1 beta or TNF-alpha. By Northern blot analysis, the levels of HBsAg mRNA were suppressed by IFN-alpha in combination with IL-1 beta or TNF-alpha. In the chloramphenicol acetyltransferase plasmid transfection assay, IFN-alpha in combination with IL-1 beta or TNF-alpha caused a much greater suppression of HBV enhancer activity than IFN-alpha, IL-1 beta or TNF-alpha alone in both hepatoma cells. These findings suggest that the interaction of IFN-alpha with IL-1 beta or TNF-alpha synergistically represses HBV enhancer activity, resulting in depressed expression of HBsAg.

Inhibitory effect of prostaglandin Δ12-PGJ2 on cell proliferation and α-fetoprotein expression in HuH-7 human hepatoma cells

9-deoxy-delta 9,delta 12-13,14-dihydro-prostaglandin D2 (delta 12-PGJ2) is a potent inhibitor of proliferation of tumor cells. In the present study, the effect of delta 12-PGJ2 on the alpha-fetoprotein(AFP) and the albumin gene expression was analyzed in HuH-7 human hepatoma cells. delta 12-PGJ2 inhibited the cell growth and reduced the medium AFP concentrations dose-dependently. To determine whether this decline of AFP depends only on the relative decrease in cell numbers by delta 12-PGJ2, or is in part, due to the decrease in the cellular AFP synthesis by delta 12-PGJ2, Northern blot analysis was performed in this study. By Northern blotting, it was shown that delta 12-PGJ2 caused a marked reduction in the levels of the AFP mRNA and the albumin mRNA. In contrast, the level of the beta-actin mRNA was not changed by delta 12-PGJ2. In the transient chloramphnicol acetyltransferase plasmid transfection experiments, delta 12-PGJ2 did not suppress the AFP enhancer activity, which possibly regulates both the AFP and the albumin gene expression in HuH-7 hepatoma cells, but resulted in the selective repression of the AFP and the albumin promoter activity. These results suggest that delta 12-PGJ2 suppresses not only cell growth but also expression of the AFP gene and the albumin gene at the transcriptional level in human hepatoma cells.

Transforming growth factor beta 1 differentially regulates alpha-fetoprotein and albumin in HuH-7 human hepatoma cells

Transforming growth factor beta 1 (TGF-beta 1) is known to inhibit hepatocyte growth in vitro and in vivo. In this study, we analyzed the effect of TGF-beta 1 on alpha-fetoprotein (AFP) and albumin gene expression in HuH-7 human hepatoma cells. TGF-beta 1 inhibited cell growth in a dose dependent manner. The cellular secretion rate of AFP but not albumin was suppressed significantly by TGF-beta 1. TGF-beta 1 caused a significant reduction in the level of AFP mRNA. In contrast, the levels of albumin mRNA or beta-actin mRNA were not changed by TGF-beta 1. In transient transfection experiments, TGF-beta 1 resulted in selective repression of AFP promoter activity. These results suggest that TGF-beta 1 is one of the key factors involved in the differential regulation of the AFP gene and the albumin gene.

A case of hepatocellular carcinoma with the sign of Leser-Trelat: a possible role of a cutaneous marker for internal malignancy

A rare case of hepatocellular carcinoma who developed the complication of the sign of Leser-Trelat is reported. The patient, a 57-year-old male, visited our hospital with complaints of generalized malaise and anorexia. A diagnosis of hepatocellular carcinoma was made based on elevated alpha-fetoprotein measurement, ultrasonography, and hepatic arteriography findings. Chest x-ray film suggested pulmonary metastases of hepatocellular carcinoma. Thereafter, complications of the seborrheic keratosis developed in the trunk and the skin lesion was diagnosed as the sign of Leser-Trelat associated with hepatocellular carcinoma. The patient died of pneumonia 9 months after development of the sign of Leser-Trelat.

(NZW x BXSB)F1 mouse. A new animal model of idiopathic thrombocytopenic purpura

A decrease in thrombocyte count was observed in (NZW x BXSB)F1 (W/B F1) mice at the age of greater than 5 mo, whereas megakaryocyte counts were found to increase in such mice. FACS analyses revealed the presence of both platelet-associated antibodies (PAA) and circulating antiplatelet antibodies. There is a correlation between the presence of these antibodies and the degree of thrombocytopenia. The transplantation of normal bone marrow cells from BALB/c nu/nu mice to W/B F1 mice was found to have preventative and curative effects on thrombocytopenia; the mice showed normal platelet counts and no evidence of circulating antiplatelet antibodies. These results indicate that thrombocytopenia in W/B F1 mice is due to the presence of antibodies to platelets. We therefore think that W/B F1 mice serve as a useful animal model of idiopathic thrombocytopenic purpura (ITP) not only for elucidating the mechanism of the development of antiplatelet antibodies, but also for characterizing autoantibodies to platelets.

A mouse model for Niemann-Pick disease. Influence of genetic background on disease expression in spm/spm mice

Sphingomyelinosis (spm), an autosomal recessive mutation in mice originally occurred in the C57BL/KsJ inbred strain. Spm/spm mice of this genetic background show striking hepatosplenomegaly with a marked accumulation of sphingomyelin and cholesterol due to a deficiency of sphingomyelinase. However, in spm/spm mice of C57BL/6J and DBA/2J backgrounds, hepatosplenomegaly was not pronounced in spite of marked elevation of hepatic lipid concentrations. The lifespan of C57BL/6J-spm/spm and DBA/2J-spm/spm mice was shorter than that of C57BL/KsJ-spm/spm mice. This appeared to be associated with the comparatively rapid rise in hepatic lipid concentrations, which in turn might be related to the absence of hepatomegaly. Histological study revealed the formation of massive foam cell clusters in the livers and spleens of C57BL/KsJ-spm/spm mice, whereas in the case of C57BL/6J-spm/spm and DBA/2J-spm/spm mice, diffusely scattered foam cells were found. These findings suggest that the functions of reticuloendothelial system (RES) play a crucial role in the development of hepatosplenomegaly in response to lipid accumulation.

Time course of hepatic lipids accumulation in a strain of mice with an inherited deficiency of sphingomyelinase

Sphingomyelinosis (gene symbol, spm) is a recessive autosomal mutation in mice that causes a condition analogous to the human disease known as Niemann-Pick disease. The time course of hepatic lipids accumulation in this murine model was investigated. Hepatosplenomegaly in spm/ spm mice was noticeable as early as 4 weeks of age, and reached its maximum level at 6 weeks of age. Thereafter the weights of liver and spleen decreased in parallel with a decrease in body weight and an increase in severity of neurological symptoms. Hepatic concentrations of unesterified cholesterol and sphingomyelin were considerably elevated by 4 weeks of age, and further increased linearly to the terminal stages of the disorder. Sphingomyelinase activities in the livers of spm/ + and +/+ mice showed normal adult levels from as early as 4 weeks of age, whereas the activity in spm/ spm mice was consistently 30-40 percent of the normal level from 4 to 12 weeks of age.