Abstract P1-17-08: Efficacy of lapatinib and capecitabine combination therapy in brain metastases from HER-2 positive metastatic breast cancer: A systematic review and meta- analysis

Background:

Brain metastases contribute to significant morbidity and mortality in breast cancer. Approximately one fourth of breast tumors overexpress the human epidermal growth factor receptor 2 (HER2) protein and are twice as likely to develop brain metastases. There are currently no systemic therapies approved. We undertook a systematic review and pooled analysis of trials to determine the efficacy of lapatinib and capecitabine combination therapy in brain metastases from HER-2 positive metastatic breast cancer (MBC).

Methods:

We performed a comprehensive literature search using MEDLINE, EMBASE databases, and meeting abstracts through December 31, 2016. Trials that utilized lapatinib and capecitabine combination therapy in brain metastases from HER-2 positive MBC were incorporated in the analysis. The pooled estimated rates were calculated using random effects model. Heterogeneity was assessed using I2 statistic.

Results:

A total of 513 patients with brain metastases from HER-2 positive MBC from 6 trials and a subgroup of another 4 trials were included in our analysis. Lapatinib and capecitabine therapy was used as second-line treatment in 9 studies (n= 468) and as first-line treatment in the LANDSCAPE study (n= 45). Three studies were retrospective evaluations of randomized trials and the rest were phase 2 trials. CNS objective response rate (ORR) was 26% (95% CI: 19 – 33, I2: 65.9%). Complete response (CR) rate was 1% (95% CI: 0 - 2, I2: 0.0%) and partial response (PR) rate was noted at 24% (95% CI: 17- 31, I2: 66.1%). Stable disease (SD) occurred in 37% (95% CI: 29- 45, I2: 66.6%) and progressive disease (PD) in 19% (95% CI: 12- 25, I2: 66.5%). The first line LANDSCAPE study had the highest PR (49%) and ORR (53%) without a significant impact on CR rate; PD was 7%.

Conclusion:

Brain metastases in breast cancer is an area of urgent unmet need. Our meta-analysis showed that lapatinib/capecitabine therapy had some first line or second line activity in brain metastases from HER-2 positive MBC. Nevertheless, further randomized controlled trials are required in this patient population.

Citation Format: Thein KZ, Zaw MH, Yendala R, Igid HP, Chai-Adisaksopha C, Hardwicke F, Awasthi S, Radhi S. Efficacy of lapatinib and capecitabine combination therapy in brain metastases from HER-2 positive metastatic breast cancer: A systematic review and meta- analysis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-08.

Rapid analysis of pharmaceutical drugs using LIBS coupled with multivariate analysis

Type 2 diabetes drug tablets containing voglibose having dose strengths of 0.2 and 0.3 mg of various brands have been examined, using laser-induced breakdown spectroscopy (LIBS) technique. The statistical methods such as the principal component analysis (PCA) and the partial least square regression analysis (PLSR) have been employed on LIBS spectral data for classifying and developing the calibration models of drug samples. We have developed the ratio-based calibration model applying PLSR in which relative spectral intensity ratios H/C, H/N and O/N are used. Further, the developed model has been employed to predict the relative concentration of element in unknown drug samples. The experiment has been performed in air and argon atmosphere, respectively, and the obtained results have been compared. The present model provides rapid spectroscopic method for drug analysis with high statistical significance for online control and measurement process in a wide variety of pharmaceutical industrial applications.

Genome-wide association study of borderline personality disorder reveals genetic overlap with bipolar disorder, major depression and schizophrenia

Borderline personality disorder (BOR) is determined by environmental and genetic factors, and characterized by affective instability and impulsivity, diagnostic symptoms also observed in manic phases of bipolar disorder (BIP). Up to 20% of BIP patients show comorbidity with BOR. This report describes the first case-control genome-wide association study (GWAS) of BOR, performed in one of the largest BOR patient samples worldwide. The focus of our analysis was (i) to detect genes and gene sets involved in BOR and (ii) to investigate the genetic overlap with BIP. As there is considerable genetic overlap between BIP, major depression (MDD) and schizophrenia (SCZ) and a high comorbidity of BOR and MDD, we also analyzed the genetic overlap of BOR with SCZ and MDD. GWAS, gene-based tests and gene-set analyses were performed in 998 BOR patients and 1545 controls. Linkage disequilibrium score regression was used to detect the genetic overlap between BOR and these disorders. Single marker analysis revealed no significant association after correction for multiple testing. Gene-based analysis yielded two significant genes: DPYD (P=4.42 × 10-7) and PKP4 (P=8.67 × 10-7); and gene-set analysis yielded a significant finding for exocytosis (GO:0006887, PFDR=0.019; FDR, false discovery rate). Prior studies have implicated DPYD, PKP4 and exocytosis in BIP and SCZ. The most notable finding of the present study was the genetic overlap of BOR with BIP (rg=0.28 [P=2.99 × 10-3]), SCZ (rg=0.34 [P=4.37 × 10-5]) and MDD (rg=0.57 [P=1.04 × 10-3]). We believe our study is the first to demonstrate that BOR overlaps with BIP, MDD and SCZ on the genetic level. Whether this is confined to transdiagnostic clinical symptoms should be examined in future studies.

Fallopian tube papilloma--case report of a rare tumor

Fallopian tube neoplasms are rare. We report a rare case of fallopian tube papilloma discovered incidentally in a 45 year old female, operated for procidentia. Right tube was dilated at the infundibular region, with friable grey white tissue in the lumen. Microscopy showed delicate branching papillae lined by a single layer of epithelium resembling tubal lining. There were no features to suggest a reactive hyperplasia in response to inflammation or of aggressive behaviour.

A review of the clinicopathological and radiological features of unilateral nasal mass

Unilateral sinonasal pathology are common presentations but are regarded with caution as neoplastic conditions during their early stages may mimic an inflammatory pathology. The aim of the review was to analyse the varied presentations of patients with unilateral nasal mass and to identify features suggestive of neoplastic pathology. A retrospective review of all cases of unilateral nasal mass/polyp from Jan 09 to Jan 10 presenting at a tertiary care hospital were analysed. The patients were grouped as per their histopathological diagnosis as inflammatory and neoplastic. The demographic data, presenting symptoms, radiological and histopathological findings were compared between the two groups. Out of the 53 patients of unilateral nasal mass, 44 (83.1%) had inflammatory conditions and 9 (16.9%) had neoplastic conditions. Benign nasal polyp and inverted papilloma were the commonest inflammatory and neoplastic condition. Neoplastic conditions were significantly commoner in males (P = 0.0315) and in the age group above 50 years (P = 0.0046). Epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be significantly higher in neoplastic conditions. Neoplastic lesions of nose and paranasal sinus are one of the most challenging conditions that otolaryngologists have to diagnose and treat due to their hidden nature and late presentations. In our review neoplastic conditions were found to be higher in elderly male with epistaxis, extranasal symptoms and presence of extensive soft tissue involvement and bony destruction on CT scan. The clinician should have a high index of suspicion to rule out a neoplastic aetiology in all cases of unilateral nasal mass.

Regulation of tamoxifen sensitivity by a PAK1-EBP1 signalling pathway in breast cancer

Background:

EBP1, an ErbB3-binding protein, sensitises breast cancer cells to tamoxifen in part by decreasing ErbB2 protein levels. The p21-regulated serine/threonine kinase PAK1, implicated in tamoxifen resistance, phosphorylates EBP1 in vitro and in vivo at T261. Phosphorylation of EBP1 at this site induces tamoxifen resistance. We thus postulated that inhibition of PAK1 activity, by restoring EBP1 function, could ameliorate the hormone refractory phenotype of ErbB2-overexpressing breast cancer cells.

Methods:

Effects of EBP1 on ErbB2 levels were measured by western blotting. Effects of EBP1 and IPA-3 on tamoxifen sensitivity were measured using a tetrazolium based cell viability assay.

Results:

Transient transfection studies indicated that an EBP1 T261E mutant, which mimics EPB1 phosphorylated by PAK1, increased ErbB2 protein levels. An EBP1 T261A mutant, unable to be phosphorylated by PAK1, ameliorated PAK1-induced tamoxifen resistance, suggesting that phosphorylation of EBP1 by PAK1 contributes to tamoxifen resistance. We then tested if pharmacological inhibition of PAK1 activity might render hormone resistant cells, which endogenously overexpress PAK1, tamoxifen sensitive. IPA-3, a specific small MW PAK1 inhibitor, sensitised cells to tamoxifen only when EBP1 was ectopically expressed. IPA had no effect on tamoxifen resistance in T47D cells in which EBP1 protein had been ablated by shRNA. The IPA-induced increase in tamoxifen sensitivity was accompanied by a decrease in ErbB2 levels only in EBP1-overexpressing cells.

Conclusion:

These studies suggest that phosphorylation of EBP1 may be one mechanism of PAK1-induced hormone resistance and that PAK1 inhibitors may be useful in cells in which EBP1 is overexpressed.

Assessment of Health-Related Quality of Life in school-going adolescents: validation of PedsQL instrument and comparison with WHOQOL-BREF

BACKGROUND

Health-Related Quality of Life (HRQoL) studies are gaining importance. Yet there is a dearth of crossculturally validated generic HRQoL instruments for Indian adolescents. Two HRQoL instruments, namely World Health Organization Quality of Life-Brief (WHOQOL-BREF) and Pediatric Quality of Life inventory™ 4.0 (PedsQL), are widely used internationally, with both measuring four domains (physical, psychological/emotional, social relations and environment/school) but each having different questions with 26 in the former and 23 in the latter. This study was done among adolescents in the city of Lucknow to evaluate the psychometric properties of PedsQL and compare its performance with previously validated and culturally revised WHOQOL-BREF.

METHODS

This cross-sectional study was conducted in February 2010 after institutional ethical approval. Data were collected by a self-administered, redesigned questionnaire in which items of PedsQL and revised WHOQOL-BREF were intermingled. Reliability, content and construct validity were evaluated for PedsQL. Convergent validity of PedsQL with revised WHOQOL-BREF was calculated for domains with similar questions.

RESULTS

Parents of 76.5% adolescents (385/503) provided consent. Mean age of adolescents was 13.6 years (1.6 SD and 44.7% were girls). PedsQL showed substantial reliability (Cronbach alpha=0.82, p<0.00001) but poor to fair validity as compared to revised WHOQOL-BREF.

CONCLUSIONS

For Indian adolescents, PedsQL is a reliable and valid instrument. However, on comparison with revised WHOQOL-BREF, PedsQL has poor to fair validity. We conclude that revised WHOQOL-BREF is a better HRQoL instrument for Indian adolescents.

A cross-sectional pilot study to determine the prevalence of testosterone deficiency syndrome in working population of Indian men

Aim:

To determine the prevalence of testosterone deficiency syndrome (TDS) in healthy Indian men employed in a hospital aged above 40 years.

Materials and Methods:

A general medical health check-up camp was organized for all male employees above 40 years age working in surgical departments. After clinical history and systemic inquiry, subjects were requested to fill the St. Louis University's ADAM Questionnaire based on which the total and free-serum testosterone estimation was then done.

Results:

One hundred fifty seven healthy volunteers enrolled for the study (mean age 53.1 years; range 40–60). The androgen decline in the aging male (ADAM) Questionnaire detected 106 men (67.5%) to be symptomatic for TDS. Serum testosterone estimation in these subjects revealed 41/106 to have low free-serum testosterone levels and 32/106 to have low total-serum testosterone. In 11 and 6 cases, respectively, the serum free- and total-testosterone levels were found to be low although the subjects were asymptomatic for TDS.

Conclusions:

The prevalence of symptomatic biochemical hypogonadism was 26.1%. The higher prevalence of symptoms alone of TDS was unusual. It could be because of the nature of the questionnaire. Free-serum testosterone may be a better single test to diagnose symptomatic hypogonadism than total-serum testosterone.

Efficiency assessment of Common Effluent Treatment Plant (CETP) treating tannery effluents

The efficacy of Common Effluent Treatment Plant (CETP) based on activated sludge process employed for treatment of tannery effluent was analyzed for the efficiency to reduce chromium and other contaminants. Physico-chemical parameters of treated effluent were found within permissible levels of statutory limits. A significant reduction in COD and BOD levels were achieved during the course of treatment in CETP. A reduction of 98.46%, 87.5%, and 96.15% in bacterial counts especially in pathogens like Escherichia coli, Vibrio spp., and Pseudomonas spp. were observed after treatment. Pathogens were not detected in the dried sludge. Complete elimination of fecal streptococci was observed in treated effluent. Around 10.8% of microbial isolates from the effluent showed ability to reduce chromate >90%. In treated effluent chromium level was 5.48 mg/L, which exceeds the statutory limit of Indian standards. Cleaner production options to reduce chromium levels before discharging into water bodies is discussed.

Reduced vision and refractive errors, results from a school vision screening program in Kanchanpur District of far western Nepal

BACKGROUND

At present there is no data available on reduced vision and refractive errors in school children of far western Nepal. So, school screening records were used to obtain data useful for planning of refractive services.

METHODS

Data are provided from school screening conducted by Geta Eye Hospital during February/March 2008. The cases with complete data sets on visual acuity, refractive error and age were included and analyzed using computer software.

RESULTS

Of 1165 children (mean age 11.6 ± 2.5 years) examined, 98.8% (n = 1151) had uncorrected visual acuity of 6/9 and better in at least one eye whereas 1.2% (n = 14) had acuity 6/12 and worse in both eyes. Among them, either eye of 9 children improved to 6/9 and better with correction. However, visual acuity was 6/12 and worse in both eyes of 5 children even after correction. There were 24 children with refractive errors (myopia, 1.54%; n = 18 and hypermetropia, 0.51%; n = 6) in at least one eye. The spherical equivalent refraction was not significantly different with age and gender.

CONCLUSIONS

The incidence of reduced vision and refractive errors among school children of this semi rural district were low.

Refractive status among the students presenting to Geta Eye Hospital, Kailali, Nepal

A retrospective hospital based study was designed in order to evaluate the refractive status of students presenting to Geta Eye Hospital. All the hospital record of secondary level school students were collected from the record unit of the hospital. Children below 5 years of age and those with incomplete record were excluded from the study. All students who visited Geta Eye hospital during May 1 to July 30, 2007 AD were included in the study. Out of 328 students presenting to Geta Eye Hospital, presenting visual acuity was normal (6/6) in 67.4% students, while 32.6% had reduced presenting visual acuity. Altogether 7.0% students had presenting visual acuity worse than 6/18 in the better eye and 2.4% improved to better than 6/18 with correction. Significant refractive error (>0.50 D Spherical Equivalent) was found in total of 32.0% students. Myopia was present in 11.89% students, whereas Astigmatism and hypermetropia were present in 11.3% and 8.8% of the total students respectively. Out of total students, 95.4% students were found to have best corrected visual acuity of 6/6-6/18 in the better eye. There were 4.0% students in MVI category and 0.6% in SVI category after correction. Altogether 7.6% cases of amblyopia were found. Hyperopia was most commonly associated with amblyopia. Associated ocular morbidity in either eye was assessed and was found in 25.0% students. 6.4% cases had convergence insufficiency. About one third of the students presenting to hospital had significant refractive error. Thus, School can be our peripheral referral unit if we could train teachers to detect abnormal vision.

Clinical profile and prevalence of rotavirus infection in children presented with acute diarrhea at tertiary care referral hospital at northern part of India

A prospective analysis of 90 clinically diagnosed cases with acute diarrhea over a period of one year was carried out to determine the prevalence of rotavirus infection in children between 2 months to 2 years of age. Enzyme Linked Immunosorbent Assay (ELISA) and Polyacrylamide Gel Electrophoresis (PAGE) were used for detection of rotavirus from stool sample. Fourteen (15.6%) of them were found to be positive for group A rotavirus, 9 (23%) cases were between 6 months to 1 year of age. Rotavirus excretion was highest (50%) when all three symptoms (diarrhea, vomiting and fever) occurred in the same child. A planned study for surveillance of rotavirus serotypes is required from this area.

Prevalence and risk factors associated with worm infestation in pre-school children (6-23 months) in selected blocks of Uttar Pradesh and Jharkhand, India

BACKGROUND

Intestinal worm infestation is widely prevalent in developing countries and can result in impaired nutrition and development.

AIMS

To estimate prevalence of and risk factors for intestinal geohelminths and other intestinal parasites in children aged 6 to 23 months.

SETTINGS AND DESIGN

Cross sectional study in rural India.

MATERIALS AND METHODS

Proportionate population size sampling method was used to randomly select 15 villages per block. Thereafter, house-to-house survey was done to recruit eligible children and obtain fecal sample for microbiological examination.

STATISTICAL ANALYSIS

Univariate distribution of variables was assessed and comparison between categorical variables and continuous variables was done using a Chi-square test and student's t-test, respectively. Odds ratio was calculated to assess associations.

RESULTS

Overall 926 children were recruited and 909 fecal samples examined. Combined prevalence of infestation with intestinal geohelminths treatable by albendazole and other intestinal parasites non-treatable by albendazole was 50.3% (457/909) and 51.6% (469/909), respectively. Exclusive use of hand pump water (OR = 1.79, CI = 1.36-2.35, P CONCLUSION: Since almost half the children are infected with intestinal geohelminths treatable by albendazole, targeted deworming of population in this age group should be considered.

A rapid appraisal of functioning of Rogi Kalyan Samitis in Uttarakhand

OBJECTIVES

To study the structure and functioning of Rogi Kalyan Samitis (RKS) in community health centers of Uttarakhand state and observe the availability and utilization of funds by RKS.

METHODS

A cross-sectional study was conducted during September - December 2008 in two districts of the state. Eight community health centers (CHC), four from each district were selected by simple random sampling. In-depth interview of all member secretaries and members of RKS, 20% of in-patients and exit interview of 10% OPD patients of selected CHCs was done with interview schedules. In each CHC, two focus group discussions were conducted (one for males and one for females).

RESULTS

RKS was established in all selected CHCs, according to the guidelines issued under the NRHM. The main functions performed by the RKS included infrastructural strengthening of the CHCs, improvement in basic facilities, ensuring provision of emergency medical care, free medicines, basic laboratory and radiological investigation, transport facilities and hospital waste management. The flow of the central grant was found to be smooth. The expenditure however is below the mark in absence of predefined protocols. Only 53.30% of total funds available were utilized during the study period. Approximately three-fourth of the funds was utilized in civil work (32.70%), furniture and electrical works (28.28%) and in fuel (12.98%). More than 80% of all patients informed about availability of medicines, drinking water facilities, clean toilets and rooms in CHCs. However, most of the community members were not aware regarding the existence, objectives and the activities of RKS.