Initial safety results of an expanded access program (EAP) of erlotinib in non-small cell lung cancer (NSCLC)

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Background: Erlotinib is an orally active and selective inhibitor of HER1/EGFR tyrosine kinase. In the BR.21 phase III trial, erlotinib significantly prolonged survival, delayed symptom progression, and improved quality of life in NSCLC patients (pts) (Shepherd et al, NEJM, 2005;353:123). The EAP is an open label, non-randomized, multicentre phase IV trial. Methods: Eligibility criteria included stage III/IV NSCLC pts who failed or were unsuitable for chemotherapy. Pts were given oral erlotinib, 150 mg/d, for as long as treatment provided clinical benefit without unacceptable toxicity. Pts were monitored monthly. Results: In Dec 05, data were available for 1,140 pts from 25 countries, median age 64 y (range 25–91). Key base-line characteristics (% pts) were: males 58%; Caucasian/Oriental 82/15; non-smoker/former or current-smoker 26/73. The % pts with ECOG PS 0/1/2/3 were 20/52/20/8. Most pts (55%) had adenocarcinoma. The % pts receiving erlotinib as 1st/2nd/3rd-line treatment were 12/47/40. As expected, rash was a common adverse event (AE: any grade [gr]: 65%; gr 3/4: 9%). Full safety data were available for 581 pts. Unexpected erlotinib-related AEs were only seen in <2% pts. Erlotinib-related AEs leading to treatment discontinuation were GI disorders in 21 pts (12 pts had gr 3/4 AEs) and skin disorders in 14 pts (6 pts had gr 3/4 rash). Only 10% of pts had dose reductions, mainly due to rash (66%; gr 3 in 8 pts) and diarrhea (17%; gr 3 in 2 pts). The median daily dose of erlotinib was 150mg. Serious erlotinib-related AEs were GI disorders (19 AEs; 11 gr 3/4), mainly diarrhea (8 AEs, 5 were gr 3). Pt accrual and analyses of response, survival data and assessment of various predictive biomarkers are ongoing. Response and survival data will be presented. Conclusions: These interim safety results of erlotinib in the real-life clinical setting in a large number of unselected pts with advanced NSCLC confirm the good tolerability observed in clinical trials. To date, the trial demonstrates that erlotinib is well tolerated, thus, allowing full dose administration to most pts.

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A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer

The neuropsychological performance of 85 women with early stage breast cancer scheduled for chemotherapy, 43 women scheduled for endocrine therapy and/or radiotherapy and 49 healthy control subjects was assessed at baseline (T1), postchemotherapy (or 6 months) (T2) and at 18 months (T3). Repeated measures analysis found no significant interactions or main effect of group after controlling for age and intelligence. Using a calculation to examine performance at an individual level, reliable decline on multiple tasks was seen in 20% of chemotherapy patients, 26% of nonchemotherapy patients and 18% of controls at T2 (18%, 14 and 11%, respectively, at T3). Patients who had experienced a treatment-induced menopause were more likely to show reliable decline on multiple measures at T2 (OR=2.6, 95% confidence interval (CI) 0.823–8.266 P=0.086). Psychological distress, quality of life measures and self-reported cognitive failures did not impact on objective tests of cognitive function, but were significantly associated with each other. The results show that a few women experienced objective measurable change in their concentration and memory following standard adjuvant therapy, but the majority were either unaffected or even improve over time.

ADAMTS-1 and -4 are up-regulated following transient middle cerebral artery occlusion in the rat and their expression is modulated by TNF in cultured astrocytes

ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) enzymes are a recently described group of metalloproteinases. The substrates degraded by ADAMTS-1, -4 and -5 suggest that they play a role in turnover of extracellular matrix in the central nervous system (CNS). ADAMTS-1 is also known to exhibit anti-angiogenic activity. Their main endogenous inhibitor is tissue inhibitor of metalloproteinases (TIMP)-3. The present study was designed to investigate ADAMTS-1, -4 and -5 and TIMP-3 expression after experimental cerebral ischaemia and to examine whether cytokines known to be up-regulated in stroke could alter their expression by astrocytes in vitro. Focal cerebral ischaemia was induced by transient middle cerebral artery occlusion in the rat using the filament method. Our results demonstrate a significant increase in expression of ADAMTS-1 and -4 in the occluded hemisphere but no significant change in TIMP-3. This was accompanied by an increase in mRNA levels for interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra) and tumour necrosis factor (TNF). ADAMTS-4 mRNA and protein were up-regulated by TNF in primary human astrocyte cultures. The increased ADAMTS-1 and -4 in experimental stroke, together with no change in TIMP-3, may promote ECM breakdown after stroke, enabling infiltration of inflammatory cells and contributing to brain injury. In vitro studies suggest that the in vivo modulation of ADAMTS-1 and -4 may be controlled in part by TNF.

Relationship of anhedonia and anxiety to social rank, defeat and entrapment

There is good evidence to suggest that depression is highly correlated with perceptions of low rank and subordinate status (i.e. feeling inferior, low-self esteem, feeling that others look down on the self, and submissive behaviour). However, it is possible for people to feel inferior and anxious, and behave submissively but not necessarily be depressed. More recently two other processes, defeat and entrapment, have attracted attention as possible processes linked specifically to depression and anhedonia. This research explored the relationship of these variables (social rank variables and defeat and entrapment) to two measures of hedonic tone (low positive affectivity and anhedonia) and anxiety in both a clinical and student population. All variables were strongly associated with lowered hedonic tone and anxiety. However, partial correlations, and a structural equation model fitted to the data from combined groups, suggests that perceptions of defeat play a specifically important role in anhedonia as measured by low positive affect. Framed within an evolutionary model the data suggest that the mechanisms which evolved to help animals accommodate and respond to defeats may have important regulatory effects over positive affect, reducing exploration of and engagement with the environment.

A comparison of behaviour in two differing psychiatric long-stay rehabilitation environments

This study compares aspects of behaviour in two long-stay resident groups with residual psychiatric difficulties. One group was residing on traditional psychiatric hospital wards and the other group was based in a newly built bungalow complex set within the hospital grounds. This study compares behavioural profiles between these two resident groups. Results indicate that bungalow residents showed significantly lower levels of psychiatric difficulty than their 'ward-based' counterparts. To explore this result further we conducted an examination of possible selection bias at the time of initial assessment. Historical data on both groups were obtained from case notes and analysed to seek possible explanations for this result. These results are discussed with respect to the provision of mental health care in smaller retained hospital facilities and nursing practice, which emphasizes the provision of effective philosophies of care accentuating choice, a sense of autonomy and involvement in care.

Significance of a prenatally diagnosed del(10)(q23)

Structural chromosome mosaicism is rare. We report a case of prenatal mosaicism for a deletion of chromosome 10(q23). To our knowledge, there are only three reports of prenatally diagnosed cases of del(10)(q23). Two of these cases were due to an inherited fragile site. In the present case amniocentesis revealed 46,XY,del(10)(q23)[9]/46,XY[45]. Follow-up chromosome analysis of peripheral blood and placental tissue from a phenotypically normal liveborn male revealed the del(10)(q23) in only 3/100 blood cells grown in low-folate medium. It appears that prenatally diagnosed deleted (10q) mosaicism represents culture artifact and is not clinically significant.

Myc activates telomerase

Telomere maintenance has been proposed as an essential prerequisite to human tumor development. The telomerase enzyme is itself a marker for tumor cells, but the genetic alterations that activate the enzyme during neoplastic transformation have remained a mystery. Here, we show that Myc induces telomerase in both normal human mammary epithelial cells (HMECs) and normal human diploid fibroblasts. Myc increases expression of hEST2 (hTRT/TP2), the limiting subunit of telomerase, and both Myc and hEST2 can extend the life span of HMECs. The ability of Myc to activate telomerase may contribute to its ability to promote tumor formation.

The role of defeat and entrapment (arrested flight) in depression: an exploration of an evolutionary view

BACKGROUND

The social rank theory of psychopathology suggests that with the evolution of social hierarchies various psychobiological mechanisms became attuned to the success or failure in conflict situations. Specifically, subordinates and those who have lost status are at greater risk of pathology than winners and those of higher status. In this theory concepts of defeat and entrapment are seen to be of special relevance to the study of depression. We outline the role of defeat and entrapment within the social rank theory of depression.

METHODS

New self-report measures of entrapment and defeat were developed and used to test predictions of the social rank theory of depression. Both a sample of students and depressed patients were assessed with these new scales and other social rank measures (e.g. social comparison and submissive behaviour).

RESULTS

The entrapment and defeat measures were found to have good psychometric properties and significantly correlated with depression. They were also strongly associated with other rank variables. Defeat maintained a strong association with depression even after controlling for hopelessness (r = 0.62), whereas the relationship between hopelessness and depression was substantially reduced when controlling for defeat. Entrapment and defeat added substantially to the explained variance of depression after controlling for the other social rank variables.

CONCLUSIONS

Defeat and entrapment appear to be promising variables for the study of depression. These variables may also help to develop linkages between human and animal models of psychopathology.

Submissive behaviour and psychopathology

OBJECTIVES

A variety of behaviours have been identified as submissive (Buss & Craik, 1986). These are believed to be associated with vulnerability to psychopathology. This paper explores the construct and measurement of submissive behaviours and their association with psychopathology.

DESIGN

Two self-report scales were designed to measure the frequencies of (a) typical submissive behaviours (SBS) and (b) passive/withdrawal and affiliative strategies focused on conflict de-escalation (CDS). The association of these scales with psychopathology was explored in a series of questionnaire studies.

METHODS

Study 1 assessed the SBS using a student sample (N = 332) and a mixed clinical group (N = 136). Of these, 177 students and 66 patients also completed the SCL-90-R. In Studies 2 and 3, the CDS and its association with depressive symptoms were assessed using a student sample (N = 154) and a depressed patient group (N = 60).

RESULTS

The SBS and CDS appeared reliable. There was a positive relationship between the SBS and the SCL-90-R, including interpersonal sensitivity and unexpressed hostility. The passive/withdrawal subscale of the CDS was associated with depressive symptoms. Evidence was obtained for sex differences with the affiliative subscale.

CONCLUSIONS

Some forms of submissive behaviour, especially those associated with passive/withdrawal and inhibition, are associated with a wide range of psychological problems.

A connection between pre-mRNA splicing and the cell cycle in fission yeast: cdc28+ is allelic with prp8+ and encodes an RNA-dependent ATPase/helicase

The fission-yeast gene cdc28+ was originally identified in a screen for temperature-sensitive mutants that exhibit a cell-division cycle arrest and was found to be required for mitosis. We undertook a study of this gene to understand more fully the general requirements for entry into mitosis. Cells carrying the conditional lethal cdc28-P8 mutation divide once and arrest in G2 after being shifted to the restrictive temperature. We cloned the cdc28+ gene by complementation of the temperature-sensitive growth arrest in cdc28-P8. DNA sequence analysis indicated that cdc28+ encodes a member of the DEAH-box family of putative RNA-dependent ATPases or helicases. The Cdc28 protein is most similar to the Prp2, Prp16, and Prp22 proteins from budding yeast, which are required for the splicing of mRNA precursors. Consistent with this similarity, the cdc28-P8 mutant accumulates unspliced precursors at the restrictive temperature. Independently, we isolated a temperature-sensitive pre-mRNA splicing mutant prp8-1 that exhibits a cell-cycle phenotype identical to that of cdc28-P8. We have shown that cdc28 and prp8 are allelic. These results suggest a connection between pre-mRNA splicing and progression through the cell cycle.

A short measure of social and separation anxiety

Separation and social anxiety have often been seen to relate to different social fears. This paper outlines a pilot study on a short separation and social anxiety scale in relationship to depression. Results suggest an acceptable factor structure and reliability. Both separation and social anxiety were found to be associated with depression and submissive behaviour. The association of social anxiety to depression was particularly strong in a depressed group.

Overconfidence and personal evaluations of social rank

Research on confidence judgements suggests that people are often overconfident. However, some studies have found that depressed mood reduces this positive bias. To date this has been explained as a mood phenomenon. In this study we explore an alternative theory which suggests that confidence is related to internal judgements of social rank and status. This theory suggests that the lower one perceives oneself to be in status and rank the less one can afford to be overconfident. Data from a student population suggests that confidence judgements are associated with internal judgements of status.

Involuntary subordination or dependency as key dimensions of depressive vulnerability?

Dependency associated with depression involves at least two forms of social behavior: (a) needs for nurturance/protection and close attachment, and an inability to function independently and (b) being (de)valued, fear of disapproval, and social status. In many studies, measures of dependency combine these two dimensions. This paper argues that this has led to confusion on the salient dimensions related to depression. It is suggested that behaviors currently regarded as dependent, and linked to depression, are better understood as forms of involuntary subordination that involve judgments of personal inferiority, and submissive-appeasement behavior. This paper presents preliminary evidence that social status, and its associated features of negative self-other comparisons and submissive behavior, may be particularly relevant to depression.

Assertiveness, submissive behaviour and social comparison

This paper explores the relationship between a new assertiveness measure (the Scale for Interpersonal Behaviour--SIB), social comparison and submissive behaviour. The paper investigates these measures in relation to the personality traits of neuroticism and introversion. Findings suggest: (a) that social comparison may be an important variable in assertiveness and submissive behaviour and shows a strong relationship to neuroticism and introversion; (b) that submissive behaviour is not the mirror opposite of assertive behaviour; and (c) submissive behaviour seems more strongly associated with introversion and neuroticism than assertive performance.

The phenomenology of shame and guilt: an empirical investigation

This paper explores the various literatures concerned with shame and guilt. Lewis' (1987) model of shame is outlined. The phenomena she suggested to be part of shame (feelings of helplessness, anger at others, anger at self, self-consciousness and feelings of inferiority) were investigated as to their relationship with shame. Strong support for these phenomena being related to shame, but not guilt, was found. Although located in separate literatures, shame and fear of negative evaluation have considerable overlap and this study set out to explore this relationship. The study further considered the role of submissive behaviour in shame and depression. Evidence was found to support the view that submissive behaviour is involved in both shame and depression.

Development and isotype diversity of antibodies to inhalant and dietary antigens in childhood atopic eczema

This study demonstrated that a major feature of childhood atopic eczema (AE) is the presence of serum IgG and IgE anti-house dust mite (anti-HDM) antibodies in almost all AE individuals. IgG anti-HDM antibodies, usually of the IgG1 isotype, became prevalent in AE children over the age of 4 years with the highest antibody levels in children in their early teens. In contrast, immunological sensitization to dietary antigens, notably milk and eggs, occurred in both AE children and age-matched non-atopic control children, and was often associated with IgG4 antibodies during early childhood. These became less prevalent with increasing age in control children but persisted in AE children, sometimes together with IgE antibodies. The later occurrence of anti-HDM antibodies in AE children could reflect immunological sensitization following inhalation of antigen, whereas sensitization to dietary antigens appears to be a natural event in early childhood.