How accurate are predictive formulas calculating energy expenditure in adolescent patients with anorexia nervosa?

BACKGROUND & AIMS

To compare resting energy expenditure, measured by indirect calorimetry, to values estimated by different predictive formulas in adolescent patients with anorexia nervosa.

METHODS

We studied 22 female in-patients with a mean age of 14.7 years (SD 1.2). Resting energy expenditure was measured by indirect calorimetry (Deltatrac II MBM-200). We compared measured resting energy expenditure to values estimated by several predictive formulas [Fleisch, Harris-Benedict, FAO, Schofield-HW, Schebendach] using the intraclass correlation coefficient and the Bland-Altman method.

RESULTS

Body mass index increased significantly (P<0.001). Measured resting energy expenditure increased during hospitalization (P<0.05). All formulas overestimated resting energy expenditure with respect to indirect calorimetry except the Schebendach formula. The intraclass correlation between indirect calorimetry and the formulas were poor (0.09-0.20). We observed a poor clinical agreement (Bland-Altman).

CONCLUSIONS

Body mass index and resting energy expenditure increased during hospitalization. The majority of the predictive formulas overestimate resting energy expenditure in adolescent patients with anorexia nervosa. Therefore, indirect calorimetry may be a very useful tool for calculating caloric requirements in these patients.

Cerebral blood flow increase in cancer patients by applying cervical spinal cord stimulation

INTRODUCTION

Generally, high-grade gliomas and head and neck tumors have decreased loco-regional blood flow resulting in reduced delivery of chemotherapy and oxygen, as well as an increases in radiation resistance to radiotherapy. The aim of this study was to analyze the effect of cervical spinal cord electrical stimulation (cSCS) on cerebral blood flow in patients with those tumors.

PATIENTS AND METHODS

We have evaluated 27 cancer patients with 12 with high grade gliomas and 15 with advanced head and neck tumors, who had cSCS devices placed after tumor diagnoses and before the commencement initiating of radio-chemotherapy. They were 12 high grade gliomas and 15 advanced head and neck tumors. Before and after cSCS, cerebral blood flow was assessed bilaterally by transcranial Doppler.

RESULTS

During cSCS there was a significant (p<0.001) increase in systolic (mean > 22%) and diastolic (> 29%) blood-flow velocities in both, healthy and tumor middle cerebral arteries. The analyses by subgroup of tumors showed similarly significant outcomes findings.

CONCLUSIONS

The results suggest that neuro-stimulation spinal cord electrical stimulation can increase cerebral blood flow in cancer patients. The implication is that this technique could be useful in modifying locoregional ischemia in brain tumors thus improving the outcomes of after radio-chemotherapy. Further research is in progress to confirm the advantages of the technique.

Selective immediate hypersensitivity to cefepime

Cefepime is a fourth-generation cephalosporin with a broad antimicrobial spectrum and good activity against both gram-positive and gram-negative organisms. We present the case of a 61-year-old man who developed an immediate urticarial reaction after receiving a single dose of cefepime. Skin tests were positive to cefepime and negative to the other beta-lactam antibiotics. Controlled administration of amoxicillin-clavulanic acid and ceftazidime was well tolerated by the patient. To the best of our knowledge, this is the first report of selective hypersensitivity to cefepime demonstrated by skin and challenge tests. Complete allergological studies, including challenge tests with other beta-lactam antibiotics that produce a negative result in skin tests, should be considered in these patients.

Vascular endothelial cadherin regulates vascular permeability: Implications for ovarian hyperstimulation syndrome

CONTEXT

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of treatment with fertility drugs. It is characterized by increased vascular permeability and simultaneous overexpression of vascular endothelial growth factor (VEGF) in ovarian cells.

OBJECTIVE

We tested the hypothesis that the endothelium and endothelial cell-to-cell junctions are downstream targets of VEGF during OHSS pathogenesis. We investigated the potential involvement of vascular endothelial (VE)-cadherin, an interendothelial adhesion molecule, in the capillary hyperpermeability in OHSS.

DESIGN

Human endothelial cells from umbilical veins (HUVEC) were used as an in vitro model of OHSS.

INTERVENTION

Cell cultures were treated with varying doses of estradiol (E2), human chorionic gonadotropin (hCG), VEGF, and antihuman VEGF antibodies, either alone or in combination, and the effect on VE-cadherin release was evaluated at different time points. Permeability assays were performed using fluoresceinisothiocyanate-labeled albumin, and actin filaments rearrangement was evaluated by fluorescent microscopy.

RESULTS

Culturing of HUVEC with high doses of E2 produced no significant changes in VE-cadherin concentration, but hCG and VEGF produced a significant increase in VE-cadherin release. Time-course experiments showed that VE-cadherin was secreted 12 h after VEGF addition. Antihuman VEGF antibodies prevented these changes. Permeability assays demonstrated that, although E2 did not alter the arrangement of HUVEC in vitro, hCG and VEGF caused changes in the actin fibers indicative of increased capillary permeability. VEGF also induced an increase in paracellular permeability of HUVEC at the same doses used in the previous experiments.

CONCLUSIONS

Adhesion molecules like VE-cadherin may play a role in the development and progression of increased capillary permeability in severe OHSS.

Observation of Bs(0)-Bs(0) oscillations

We report the observation of Bs(0)-Bs(0) oscillations from a time-dependent measurement of the Bs(0)-Bs(0) oscillation frequency Deltams. Using a data sample of 1 fb(-1) of pp collisions at square root of s=1.96 TeV collected with the CDF II detector at the Fermilab Tevatron, we find signals of 5600 fully reconstructed hadronic Bs decays, 3100 partially reconstructed hadronic Bs decays, and 61,500 partially reconstructed semileptonic Bs decays. We measure the probability as a function of proper decay time that the Bs decays with the same, or opposite, flavor as the flavor at production, and we find a signal for Bs(0)-Bs(0) oscillations. The probability that random fluctuations could produce a comparable signal is 8 x 10(-8), which exceeds 5sigma significance. We measure Deltams=17.77 +/- 0.10(stat) +/- 0.07(syst) ps(-1) and extract /V(td)/V(ts)/=0.2060+/-0.0007(Deltams)(-0.0060)(+0.008)(Deltamd+theor).

Observation of B(s)0-->K+ K- and measurements of branching fractions of charmless two-body decays of B0 and B(s)0 mesons in pp collisions at square root of s = 1.96 TeV

We search for decays of the type B(s)0-->h+ h'- (where h,h' = K or pi) in 180 pb(-1) of pp collisions collected at the Tevatron by the upgraded Collider Detector at Fermilab. We report the first observation of the new mode B(s)0-->K+ K- with a yield of 236+/-32 events, corresponding to (fs/fd) x B(B(s)0-->K+ K-)/B(B0-->K+ pi-) = 0.46+/-0.08stat+/-0.07syst, where fs/fd is the ratio of production fractions of B(s)0 and B0. We find results in agreement with world averages for the B0 modes, and set the following new limits at 90% C.L.: B(B(s)0-->K- pi+) < 5.6 x 10(-6) and B(B(s)0-->pi+ pi-) < 1.7 x 10(-6).

Molecular analysis of estrogen receptor alpha gene AGATA haplotype and SNP12 in European populations: potential protective effect for cryptorchidism and lack of association with male infertility

BACKGROUND

A specific haplotype (AGATA) in the estrogen receptor alpha (ER1) gene was recently described as a new risk factor for cryptorchidism in the Japanese population. In this ethnic group, single-nucleotide polymorphism 12 (SNP12) was concluded to be the tag SNP for the AGATA haplotype.

MATERIALS AND METHODS

A large group of patients (total number=335) and controls (total number=567) of two Caucasian populations were analysed for the AGATA haplotype and SNP12 to verify whether this genetic variant and its tag SNP were associated with cryptorchidism or with severe spermatogenic failure.

RESULTS

We confirm that SNP12 is the tag SNP for the AGATA haplotype also in Caucasians. However, in contrast with the Japanese population we found a protective effect for ESR1 SNP12 on cryptorchidism in the Italian population. No association between SNP12 and severe spermatogenic disturbances was observed.

CONCLUSIONS

The observed associations (although with opposite effect) with cryptorchidism encourage future studies on independent cases and controls from different ethnic and geographic origins. On the other hand, in contrast with other ESR1 polymorphisms, SNP12 polymorphism is not associated with severe male factor infertility in two independent European population.

Search for excited and exotic muons in the mugamma decay channel in p-p collisions at sqrt s =1.96 TeV

We search for excited and exotic muon states mu* using an integrated luminosity of 371 pb(-1) of p[over]p collision data at sqrt[s]=1.96 TeV. We search for associated production of mumu* followed by the decay mu*-->mugamma. We compare the data to model predictions as a function of the mass of the excited muon M(mu*), the compositeness energy scale Lambda, and the gauge coupling factor f. No signal above the standard model expectation is observed. We exclude 107<M(mu*)<853 GeV/c(2) for Lambda=M(mu*) in the contact interaction model, and 100<M(mu*)<410 GeV/c(2) for f/Lambda=10(-2) GeV-1 in the gauge-mediated model, both at the 95% confidence level.

Search for large extra dimensions in the production of jets and missing transverse energy in pp collisions at square root of s = 1.96 TeV

We present the results of a search for new physics in the jets plus missing transverse energy data sample collected from 368 pb(-1) of pp collisions at square root of s = 1.96 TeV recorded by the Collider Detector at Fermilab. We compare the number of events observed in the data with a data-based estimate of the standard model backgrounds contributing to this signature. We observe no significant excess of events, and we interpret this null result in terms of lower limits on the fundamental Planck scale for a large extra dimensions scenario.

Measurement of the tt production cross section in pp collisions at square root of s = 1.96 TeV

We present a measurement of the top quark pair production cross section in pp collisions at square root of s = 1.96 TeV using 318 pb(-1) of data collected with the Collider Detector at Fermilab. We select tt[over ] decays into the final states enu+jets and mu nu+ jets, in which at least one b quark from the t-quark decays is identified using a secondary vertex-finding algorithm. Assuming a top quark mass of 178 GeV/c2, we measure a cross section of 8.7 +/- 0.9(stat)(-0.9)+1.1(syst) pb. We also report the first observation of tt[over ] with significance greater than 5sigma in the subsample in which both b quarks are identified, corresponding to a cross section of 10.1(-1.4)+1.6(stat)(-1.3)+2.0(syst) pb.

Search for a neutral Higgs boson decaying to a W boson pair in pp collisions at square root of s = 1.96 TeV

We present the results of a search for standard model Higgs boson production with decay to WW*, identified through the leptonic final states e+ e- nu nu,+/-mu -/+nu nu and mu+ mu- nu nu. This search uses 360 pb -1 of data collected from pp collisions at square root of s =1.96 TeV by the upgraded Collider Detector at Fermilab (CDF II). We observe no signal excess and set 95% confidence level upper limits on the production cross section times branching ratio for the Higgs boson to WW* or any new scalar particle with similar decay products. These upper limits range from 5.5 to 3.2 pb for Higgs boson masses between 120 and 200 GeV/c2.

Measurement of the Bs0-Bs0 oscillation frequency

We present the first precise measurement of the Bs0-Bs0 oscillation frequency Deltams. We use 1 fb-1 of data from pp collisions at sqrts=1.96 TeV collected with the CDF II detector at the Fermilab Tevatron. The sample contains signals of 3600 fully reconstructed hadronic Bs decays and 37,000 partially reconstructed semileptonic Bs decays. We measure the probability as a function of proper decay time that the Bs decays with the same, or opposite, flavor as the flavor at production, and we find a signal consistent with Bs0-Bs0 oscillations. The probability that random fluctuations could produce a comparable signal is 0.2%. Under the hypothesis that the signal is due to Bs0-Bs0 oscillations, we measure Deltams=17.31(-0.18)+0.33(stat)+/-0.07(syst) ps-1 and determine |Vtd/Vts|=0.208(-0.002)+0.001(expt)-0.006(+0.008)(theor).

Association of genetic markers within the KIT and KITLG genes with human male infertility

BACKGROUND

There is much evidence involving the KIT tyrosine kinase receptor and its ligand KITLG in the survival and proliferation of germ cells. Animal models and functional studies in humans suggest that this signalling pathway plays a role in male infertility.

METHODS

We studied three and two single-nucleotide polymorphisms (SNPs) (rs3819392, rs3134885, rs2237012, rs10506957 and rs995030) located within the genomic region of the KIT and KITLG genes, respectively. A total of 167 idiopathic infertile men (sperm counts <5 million spz/ml) and 465 unrelated healthy controls from the same geographical region were genotyped for these SNPs.

RESULTS

We found a statistically significant association of the rs3819392 polymorphism, which is located within the KIT gene, with idiopathic male infertility. In addition, a deviation from the Hardy-Weinberg equilibrium (HWE) law was observed for rs10506957 polymorphism within the KITLG gene only in the infertile group.

CONCLUSIONS

Our data indicate that the KIT/KITLG system may be involved in a low sperm count trait in humans.

Search for new physics in lepton+photon+X events with 305 pb(-1) of pp collisions at [square root of s] = 1.96 TeV

We present results of a search for anomalous production of events containing a charged lepton (l, either e or mu) and a photon (gamma), both with high transverse momentum, accompanied by additional signatures X, including missing transverse energy (ET) and additional leptons and photons. We use the same selection criteria as in a previous CDF search but with a substantially larger data set, 305 pb(-1), a pp collision energy of 1.96 TeV, and the CDF II detector. We find 42 lgammaET events versus an expectation of 37.3+/-5.4 events. We observe 31 llgamma+X events versus an expectation of 23.0+/-2.7 events. We find no events similar to the run I eegammagammaET event.

Measurement of the Bc+ meson lifetime using the decay mode Bc+ --> J/Psie+nue

We present a measurement of the Bc+ meson lifetime in the decay mode Bc+ --> J/Psie+nue using the Collider Detector at Fermilab II detector at the Fermilab Tevatron Collider. From a sample of about of 360 pb(-1) of pp collisions at square root of s = 1.96 TeV, we reconstruct J/Psie+ pairs with invariant mass in the kinematically allowed range 4< M(J/Psie) < 6 GeV/c2. A fit to the decay-length distribution of 238 signal events yields a measured Bc+ meson lifetime of 0.463(-0.065)(+0.073)(stat) +/- 0.036(syst) ps.

The «El Álamo» project (1990–1997): two consecutive hospital-based studies of breast cancer outcomes in Spain

BACKGROUND

The "Alamo" project is a retrospective analysis of 14,854 patients diagnosed of breast cancer between 1990 and 1997 in 50 Spanish hospitals.

METHODS

Alamo I (AI) consisted of 4,532 patients diagnosed with breast cancer between 1990 and 1993. Data were collected in 2000. Alamo II (AII) consisted of 10,322 patients diagnosed between 1994 and 1997. Data were collected in 2003.

RESULTS

At presentation, there were (AI vs. AII) 17.6% vs. 24.3% at stage I; 55.5% vs. 53.1% at stage II; 18.7% vs. 15% at stage III; 7.2% vs. 5.9 at stage IV. Median age was 57 (AI) vs. 58 years (AII) and 65.9% vs. 67.2% (AI vs. AII) were post-menopausal. Firstline treatment for disease stages I, II and III was surgery in 91% of patients in both studies. Breast conserving surgery rate increased from 20.2% (AI) to 32.7% (AII). Adjuvant systemic treatments were administered to 87.6% (AI) and 92.8% (AII) of patients. Recurrence rate diminished from 36.6% (AI) to 22.5% (AII) and the 9-year survival rate increased from 63.2% (95% CI: 61.5-64.9) to 70.1% (95% CI: 68.5-71.8).

CONCLUSION

Breast cancer outcomes in Spain have improved from 1990-1993 to 1994-1997, likely because of breast cancer screening program implementation and new therapies.

Electrical spinal cord stimulation during radiotherapy and temozolomide in high grade gliomas. A phase II report

11510

Background: Ischemia-hypoxia in high grade gliomas (HGG) turns tumor cells more aggressive and more resistant to radiotherapy (RT) and temozolomide (TMZ). Higher glucose metabolism pre-treatment has been correlated with better response to TMZ using 18-FDG-PET. In preliminary works, we have reported that electrical spinal cord stimulation (SCS) can modify loco-regional oxygenation, blood flow and metabolism in HGG. The aim of this study was to evaluate tumor response and toxicity in HGG using SCS during RT plus TMZ. Methods: 10 patients (males/females: 8/2; median age: 51 years (30–68)) were enrolled in this trial. Tumors were 6 glioblastomas and 4 relapsed anaplastic gliomas. Diagnosis was after complete resection (1), subtotal resection (6), biopsy (1) or MRI + PET (2 relapsed HGG). Tetrapolar electrode for SCS was percutaneously inserted on the posterior surface of the cervical spinal cord at C2-C4 level. RT was at 2 Gy/fraction, 5 fractions/week, total dose 60 Gy (40 Gy in previously irradiated tumors). TMZ was administered at 75 mg/m2 daily during RT, followed by at least 6 cycles of adjuvant TMZ at 200 mg/m2. Tumor response was evaluated by CT and PET. Results: After concurrent RT+TMZ, CT showed: 5 partial response (PR), 3 complete response (CR), 2 stable disease (SD). After 6 adjuvant cycles of TMZ, CT (median 10 months after surgery) showed: 4 PR, 3 CR, 3 progression disease (PD). PET showed post-surgical residual tumor in the 9 evaluated patients. After 6 cycles of TMZ, PET showed: 4 CR, 2 PR (they obtained delayed CR after 12 and 18 cycles of TMZ), PD n = 2, and two patients without PET assessment (1 with PR in CT, and 1 without tumor in CT). For the study group median overall survival (OS) was 22 months (95% CI = 14–30) and for glioblastomas 16 months (95% CI = 6–26). For relapsed anaplastic gliomas mean OS was 37 months (95% CI = 22–52). One patient did not finish scheduled adjuvant TMZ and only one patient experienced hematological toxicity with neutropenia G-I and thrombopenia G-III. Conclusions: Electrical SCS during RT+TMZ did not increase toxicity. Preliminary data about tumor response and OS seem to be encouraging and they support further research. Supported by Grants: FUNCIS 03/09 and ISCiii, RTICCC C03/10.

No significant financial relationships to disclose.

Clinical response at 4 months to neoadjuvant letrozole predicts distant disease free survival in postmenopausal women with stage II-III ER/PgR-positive breast cancer

10531

Background: Letrozole (L) is more active than tamoxifen in early stage ER[+] breast cancer both as adjuvant (BIG-98 trial) or neoadjuvant (LET-024) therapy. However, complete pathological remissions to neoadjuvant endocrine therapy are anecdotal (<5%), there are no new prognostic indicators with clinical implications. Methods: We have review our series of postmenopausal patients with stage II-III breast cancer ER/PgR[+] breast cancer treated in our institution with L as neoadjuvant therapy. All patients had completed 4 months of therapy (in the absence of PD), and had measurable clinical (or radiological) disease. An independent statistical analysis was conducted for disease free (DFS) and distant disease free survival (DDFS). Results: From IV/99 to XII/04, 107 patients fulfill the criteria. Median age 76 years (range 64 to 92); median tumour size 35 mm (range 25 to 100); cT2 75 (70%), cT3/4 32 (30%); cN[-] 83 (78%). The ORR (PR + CR) at 4 months was 63% (7 CR and 60 PR), 4 patients had PD as best response (4%) and 36 a SD (34%). Surgery was done in 63 patients (59%), including all non-responders. Only 2 patients received adjuvant CT. With a median follow-up of 32 month (range 8 to 66), 12 patients had relapsed (9 distant). The 3 years DFS and DDFS were 84% and 90% respectively. In univaried analysis: cN (p < 0.02), cT3/4 (p < 0.02), and clinical response at 4 months (CR) (p = 0.003) were related to DFS; and HER2 (p < 0.05), cN (p < 0.003), and CR (p = 0.007) with DDFS. Other factors like cT, HR-levels, or surgery were not significant. Multivariate analysis showed that only OR and cN remained independently predictive both for DFS and DDFS. Conclusions: Clinical response to neoadjuvant letrozole therapy is an independent predictor of distant disease free survival and could be of value to recommend or deny more aggressive therapies in addition to endocrine therapy.

[Table: see text]

No significant financial relationships to disclose.

A phase I trial of weekly combination KOS-862 (Epothilone D) and trastuzumab in HER-2 overexpressing malignancies

2028

Background: KOS-862 (Epothilone D) (K) has shown single agent activity against metastatic breast cancer (MBC) and NSCLC. Trastuzumab (H) is standard therapy for HER-2 overexpressing MBC. This phase IB trial determined the safety and PK profile of KOS-862 in a weekly schedule with H. Methods: Eligibility: pts with HER-2 overexpressing (IHC 3+ or FISH +) chemo-refractory tumors, ECOG ≤ 2, neuropathy ≤ gr 1, no CNS metastases, and no H ≤ 6 mo. prestudy. H given as a 4 mg/kg loading dose, then 2 mg/kg wkly. K given as a 90 min iv infusion wkly × 3 Q 4 wks after H. K dose escalation cohorts: 70, 85 & 100 mg/m2. H1 + H2 antagonists + corticosteroid prophylaxis given 30–60 min prior to K. DLT: gr 4 hematologic or gr 3 other toxicity, or toxicity requiring >4 wk treatment delay. Cycle 1 + 2 PK samples obtained for K + H. Results: 13 pts treated from 9/04 - 8/05. Median age 51 yrs (36–65). All pts had MBC. Prior H therapy n = 9, prior taxane n = 11. Enrollment: 70 mg/m2 (4), 85 mg/m2 (3), and 100 mg/m2 (6). Mean number cycles 3.9 (1–6). The 100 mg/m2 cohort was expanded to 6 pts per study design; no DLTs were noted. Toxicity: Principal neurotoxicities (gr 3 noted, if present): parasthesias (10 pts, 1 gr3), neuropathic pain (5 pts, 2 gr3), dizziness (4 pts), dysguesia (4 pts), ataxia (3 pts), transient confusion (3 pts), dysesthesias (2 pts), insomnia (2 pts). No gr 4 neurotoxicities reported. Non-neurologic toxicities were limited to gr 1/2 and included diarrhea, pyrexia, abdominal and back pain, arthralgias. PK (n = 13): KOS-862 CL 21 ± 10 L/hr, Vz 260 ± 110 L, T1/2 9.8 ± 3.9 hr. Seco-metabolite was 67% ± 35% of K. At 100 mg/m2 K dose (n = 6): Cmax 3.3 ± 1.1 μg/mL and AUCinf 11.0 ± 7.5 h*(g/mL). Neither K nor its seco-metabolite PK were affected by H. Responses: An 85 mg/m2 K pt (no prior H or taxane) had confirmed PR and a 100 mg/m2 K pt (prior taxane) had an unconfirmed PR. A 2nd 100 mg/m2 pt (no prior H or taxane, bone only disease) had > 90% CEA reduction. Conclusions: This phase I study demonstrates feasibility of full dose wkly KOS-862 coadministration with wkly H. Treatment-related toxicities were all gr 1 / 2, except for 3 cases gr 3 paresthesias and neuropathic pain. PK of K and its principal metabolite were not affected by H. Three clinical responses were observed; a phase II trial of this combination is ongoing in minimally-pretreated MBC.

[Table: see text]

Phase III study of gemcitabine plus vinorelbine (VG) versus vinorelbine (V) in patients (pts) with metastatic breast cancer (MBC) previously treated with anthracyclines (A) and taxanes (T). Final results of GEICAM 2000–04 study

575

Background: VG has shown to be efficacious and safe in MBC in pts previously treated with AT. This study compared treatment (TT) V with the combination of VG. Primary objective was progression free survival (PFS). Methods: pts previously treated with AT, aged ≥18, ECOG ≤ 2, were randomized to V: 30 mg/m2 day (d) 1, d8, or VG 30/1200 mg/m2 d1, d8, both every 21 days until disease progression. Stratification criteria were previous lines of TT for MBC (0 vs.1 vs.2) and visceral disease (yes vs. no). 126 pts per arm were needed to demonstrate a prolongation in PFS of 2 months (m) (from 3 to 5; HR = 1.67; α and β errors 0.05 and 10). Results: 252 pts (127 V and 125 VG) were recruited between 2001 and 2005. Arms were well balanced: median age was 57 years; median number of metastatic sites 2; visceral disease was present in 75% of pts; 17%, 53% and 29% of pts received study TT as first, second and third line respectively. Median number of cycles were 4 (1–21) in V and 6 (1–26) in VG. Median PFS was 6.3 m (95% CI, 5.3–7.3) for VG and 4.1 m (95% CI, 3.3–4.9) for V (p=0.0011). Objective response rate was 37% (CI 95% 29–46) for VG and 25% (CI 95%: 17–33) for V (p= 0.035). CTC grade 3–4 hematologic toxicity was significantly higher with VG vs. V (65% vs. 43% neutropenia, 33% vs. 17% leucopenia, and 11% vs. 2% thrombocytopenia); febrile neutropenia was present in 10.5% of pts on VG and 6% of pts in V (p=ns). Non-hematological toxicity was low and manageable in both arms. Conclusions: VG demonstrated significant efficacy advantages over V in pts with MBC previously treated with AT, with manageable toxicity. This favorable risk-benefit profile supports the use of this combination in this patient population.

[Table: see text]