Evaluation of the effect of screening on the detection of good and poor prognosis breast cancers

1525

Background: Since the advent of screening, breast cancer incidence has significantly increased in the United States as well as other countries. SEER data from the US shows that the increase is largely in localized disease without a concomitant or significant decrease in regionalized disease. In addition, the increase has occurred essentially in women over 50. We asked whether molecular characterization of tumors would shed light on the types of tumors detected in screening and in locally advanced breast cancers (LABC). Methods: We identified two groups of patients from European studies before and after the introduction of population based screened (in 1995) where the 70-gene prognosis test (MammaPrint) results were available. The first source is the European Validation Study (EVS) (Buyse et al, J Natl Cancer Inst. 2006). The second was a prospective implementation trial of MammaPrint in the Netherlands (RASTER study) (Bueno de Mesquita et al, Lancet Oncol. 2007). The source of LABC patients comes from the multicenter I-SPY TRIAL (CALGB 150007/150012) who underwent routine screening (prior mammogram within 2 years of diagnosis). Results: In women age 50–60, the fraction of cancers that were MammaPrint good prognosis were 40% and 60% prior to and after the introduction of screening, respectively. For women 50–60 who were actually undergoing screening, the fraction of tumors that were MammaPrint good prognosis was 67%. For patients aged 30–40 with stage I and II lymph node-negative disease, who did not undergo screening in either period, the fraction of MammaPrint good prognosis tumors did not change (29% and 31%, for EVS and Raster, respectively). For patients with LABC, from the I-SPY TRIAL, the fraction of tumors that are MammaPrint good prognosis is 7% and 29% for women aged 30–40 and 50–60, respectively. Of the LABC patients undergoing screening, 80% presented clinically during the interval between routine mammograms. Conclusions: Current screening programs are increasing the burden of low-risk cancers. Screening programs should consider including molecular profiles at the time of diagnosis to reduce overtreatment. The majority of LABCs have high-risk molecular profiles and do not present as screen detected cancers. New strategies are needed for early detection of LABC.

[Table: see text]

Protective role of silibinin on matrix metalloproteinase-2 and activator protein-1 on LoVo cells

e15136

Background: Silibinin, a flavonoid and the major active component of milk thistle, has been as a safe diet supplement for several decades. It has been proved with anti-hepatotoxic properties and pleiotropic anticancer capabilities. Current study aimed to investigate the role of silibinin as potential therapeutic target of colon cancer through antiangiogenesis and its related molecular mechanisms with matrix metalloproteinase- 2 (MMP-2) and activator protein-1 (AP-1). Colon cancer cell line, LoVo cells, treated with a major prognostic factor, interleukin-6 (IL-6), was studied. Methods and Results: By western blot analysis, silibinin suppressed MMP- 2 protein expression in time- and concentration-dependent manners. Furthermore, the inhibitors of JNK/AP-1 binding activity abolished the expression of MMP-2 in IL-6-stimulated LoVo cells, but not PI3K pathways. We also demonstrated that silibinin inhibited IL-6- stimulated LoVo cell migration and further tumor angiogenesis, which similar to the effects from addition with AP-1 inhibitor. By EMSA, the binding activity of AP-1 in LoVo cells was also decreased with silibinin treatment. In addition, the imaging of confocal microscopy revealed that AP-1 presentation was attenuated on IL-6-stimulated LoVo cells plus silibinin treatment. Conclusions: Taken together, these data indicated that silibinin inhibits angiogenesis through the suppression of MMP-2 expression and AP-1 binding activity in colon cancer cells. It suggests a novel anti-metastatic application of silibinin in colon cancer chemoprevention.

No significant financial relationships to disclose.

Induction chemotherapy followed by concurrent chemoradiotherapy with/without esophagectomy for locally advanced esophageal squamous cell carcinoma

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Background: To assess the feasibility of preoperative induction chemotherapy in addition to concurrent chemoradiotherapy (CCRT) followed by esophagectomy if possible for locally advanced esophageal squamous cell carcinoma (ESCC) with a special emphasis on M1a or nodal M1b disease. Methods: Patients who had histologic proof of T3N1M0, M1a, or nodal M1b ESCC first received up to 3 courses of induction chemotherapy (paclitaxel 70 mg/m2 or docetaxel 40 mg/m2 IV 1-hr D 1, 8; cisplatin 35 mg/m2 IV 2-hr D 1, 8; 5-fluorouracil 2000 and leucovorin 300 mg/m2 IV 24-hr D 1, 8; repeated every 28 days). This was followed by CCRT (paclitaxel 35 mg/m2 1-hr D 1, 4 /wk, cisplatin 15 mg/m2 1-hr D 2, 5/wk, and radiotherapy 2 Gy D 1–5 /wk) (Lin CC et al. Ann Oncol 18:93–8,2007). When the accumulated radiation dose reached 40 Gy, the feasibility of esophagectomy was evaluated in all patients. In patients for whom esophagectomy was not feasible, CCRT was continued to a dose of 60 Gy. Results: Fifty-six patients (M:F = 51:5, median age 58, range 41–78) with locally advanced (T3N1M0:M1a:M1b[nodal] = 30:7:19) ESCC (upper:mid:lower = 15:25:16) were enrolled from June 22, 2006 to December 17, 2008. By December 31, 2008, 10 patients are still under protocol treatment. Eighteen (T3N1:M1a:M1b[nodal] = 14:3:1) (40%) and 20 of 46 patients underwent surgery and continued CCRT up to 60 Gy, respectively. Nine (T3N1:M1a:M1b[nodal] = 7:2:0) (20%) and 5 patients had pathologic complete response and microscopic residual disease, respectively. With a median follow-up of 8.4 months (range 0.5–30.8), 17 (T3N1:M1a:M1b[nodal] = 9:2:6) patients had relapse. Four and 13 patients had local recurrence and distant metastasis, respectively. The median progression-free survival was 20.3 months. The median overall survival had not reached yet with 1- and 2-year overall survival being 76 and 57%, respectively. There was no difference in progression- free or overall survival among patients with T3N1M0, M1a, or nodal M1b disease. Conclusions: Three-step strategy of preoperative taxane-based induction chemotherapy then CCRT followed by esosphagectomy if possible appears quite active in locally advanced ESCC patients with 46% having M1a or nodal M1b disease.

No significant financial relationships to disclose.

Evaluation of estrogen receptor expression as a prognostic factor for very young women (below 35 years) with breast cancer in Taiwan

e22163

Background: In the past two decades, the incidence of very young (<35 years) breast cancer in Taiwanese has been rapidly increasing to quite close to that of Caucasian Americans. However, the clinicopathological features of this group of patients appear to be different from their Western counterpart. Here, we sought to determine the prognostic value of ER expression for this newly emerging population in Taiwan. Methods: We retrospectively collected information on all consecutive very young patients (age <35 years) with stage I-III breast cancer treated at National Taiwan University Hospital between 1997 and 2005. ER expression was evaluated by immunohistochemistry on formalin-fixed paraffin-embedded tissue sections. Tumor with more than 10% positive nuclei was considered ER positive. Results: A total of 178 patients with a median age of 32 (range: 21–35) years were included. The median follow-up time was 62.5 (95% confidence interval, 42.0–64.2) months. Univariate analysis showed that ER expression was significantly associated with favorable OS (HR=0.48, P=0.03), but not with DFS (hazard ratio [HR]=0.79, P=0.42). Multivariate analysis showed that stage and ER were independent prognostic factors. Conclusions: In contrast to the findings in Caucasians, ER expression was an independent prognostic factor for favorable overall survival in Taiwanese patients with very young breast cancer.

No significant financial relationships to disclose.

Helicobacter pylori-independent MALT lymphoma patients responsive to thalidomide—the molecular mechanism and the clinical application

e19512

Background: We have recently demonstrated that nuclear expression of BCL10 or NF-κB helps predict H. pylori-independent status; and inflammatory cytokines such as TNF-α may be related to BCL10 nuclear translocation (Blood 2005;106:1037–41;J Biol Chem 2006;281:167–75). Recent studies have been shown that the chimeric protein of t(11;18)(q21;q21) can lead to constitutive NF-κB activity and thereby mediate cell survival and anti-apoptotic signals. The present study was conducted to investigate the molecular mechanism and the clinical efficacy of thalidomide, an TNF-α or NF-κB inhibitor, in H. pylori-independent MALT lymphoma. Methods: Between October 2003 and June 2007, our study enrolled 11 H. pylori-independent MALT lymphoma patients ( 7 men and 4 women; age range, 43 to 79 years; 7 patients who had failed chemotherapy or rituximab) with nuclear expression of BCL10 or NF-κB in pretreatment lymphoma tissues treated at National Taiwan University Hospital with thalidomide 100mg to 200 mg oral given daily. The presence of t(11;18)(q21;q21) was identified by a multiplex reverse transcriptase polymerase chain reaction of the API2-MALT1 chimeric transcript. Results: Three (27.3%) of 11 patients achieved a complete response (CR), and 3 (27.3) of 11 patients achieved a partial response (PR), resulting in an overall response rate of 54.5% (95% CI, 19.5%-89.6%). The median time from thalidomide therapy to CR was 3.0 months (range, 2.7–4.9 months). At a median follow-up of 41.6 months (range, 17.7–63.8 months), the 3-year event-free survival and overall survival after thalidomide treatment was 80.8%, and 88.9%, respectively. The API2-MALT1 fusion transcript for t(11;18)(q21;q21) was detected in 1 (16.7%) of 6 patients with CR or PR, and 4 (80.0%) of 5 patients with stable or progressive disease (P = 0.08). Conclusions: Our results indicate that thalidomide can be an adjuvant treatment for H. pylori-independent MALT lymphoma patients. Additional investigation of the molecular mechanisms and biologic significance of the API2-MALT1 fusion transcript responsible for thalidomide resistance in this group of tumors is needed.

No significant financial relationships to disclose.

Phase II study of cetuximab plus weekly cisplatin and 24-hour infusion of high-dose 5-fluorouracil and leucovorin for the first-line treatment of advanced gastric cancer

4567

Background: Cisplatin-HDFL regimen, using weekly 24-hour infusions of cisplatin and high-dose 5-fluorouracil (5-FU) and leucovorin, is commonly used in Taiwan for patients with advanced gastric cancer (GC), showing an overall response rate of approximately 60% (95% CI: 45%-76%) [J Clin Oncol (Suppl) 2006; 24(18S): A14063 ]. We have demonstrated that cetuximab is cytotoxic to human GC cells, and has a chemosensitizing effect for cisplatin and 5-FU in GC cells [Proc AACR 2006; 47: A1233]. Methods: All patients had pathologically confirmed metastatic/ recurrent chemonaive GC, at least 1 measurable lesion, a fasting serum triglyceride level > 70 mg/dl, WHO PS 0/1/2, adequate hepatic, renal, and bone marrow functions. Cetuximab 400 mg/m2 was given as 2h infusion, initially (i.e., D1 of cycle 1); and followed by weekly 1h infusion of 250 mg/m2 (i.e., D8, D15, D22 of cycle 1, and D1, D8, D15, D22 of cycle 2). Cisplatin 35 mg/m2 was given as a 24h infusion, admixing with 5-FU 2,000 mg/m2 and leucovorin 300 mg/m2 (HDFL), D1, D8. A 24h infusion of HDFL was given on D15. Cycles were repeated every 28 days, and response evaluation was performed every 2 cycles & at the end of protocol treatment. The primary end-point was confirmed objective response rate (RR) by RECIST. Results: Between Dec. 2005 and Nov. 2008, 35 patients (M:19, F:16) with a median age of 56 (40–74) were enrolled and evaluable for response assessment. The overall RR was 68.6% (51–83%, 95% C.I.) with 1 CR and 23 PRs. Among a total of 269 cycles (median: 7, range: 2 to 22+ cycles) given, Gr3/4 neutropenia, infection, and hepatic toxicity developed in 6.0%, 4.8%, and 0.74% of 269 cycles, respectively. Two patients have developed acute hepatitis B flare-up among seven HBsAg (+) carriers, and were well controlled by lamivudine. Gr1, Gr2, and Gr3 acne- like rashes have developed in 57.1%, 31.4%, 5.7%; and Gr1, Gr2, Gr3 paronychia have developed in 40.0%, 8.6%, and 2.9% of 35 patients, respectively. Median PFS (range: 3 to 22+ months) and median OS (range: 3 to 35+ months) was11.0 and 14.5 months, respectively. Conclusions: Cetuximab plus infusional cisplatin-HDFL is a highly effective regimen with low toxicity and favourable survival in the first-line treatment of advanced GC.

No significant financial relationships to disclose.

MicroRNAs 15a and 16–1 regulates tumor proliferation in multiple myeloma

e14640

Background: MicroRNAs (miRNAs) are non-coding RNAs that act as negative regulators of gene expression. They have been described to play roles in solid tumors and hematologic malignancies. However the role of miRNAs in multiple myeloma (MM) has not been yet fully described. Methods: We performed miRNA-profiling of primary bone marrow-derived CD138+ MM cells, compared to their normal cellular counterparts and validated data by qRT-PCR. In vitro and in vivo functional studies were performed on miRNA-15a- and -16–1-precursors-transfected MM cells. Effect of miRNA-15a and -16–1 on signaling cascades have been evaluated by western blot and immunofluorescence. NF-kB activity has been studied using the Active Motif TransAM kit. In vivo MM cell growth has been evaluated by either using an in vivo imaging model or bioluminescence. Angiogenesis has been studied both in vitro and in vivo using the chorioallantoic membrane model. Results: We identified a MM-specific miRNA signature characterized by down-expression of miRNA-15a, -16–1 and over-expression of miRNA-222/-221/-382/-181a/-181b (P<0.01). Data were confirmed by qRT-PCR on matched samples. Predicted targets for the decreased miRNAs in MM patients included pro-angiogenic cytokines, oncogenes, cell cycle regulators, NFkB activators. Conversely, predicted targets for the increased miRNAs included cell cycle inhibitors, suppressors of cytokine signaling, and pro-apoptotic factors. We demonstrated that miRNA-15a and - 16–1 regulate proliferation and growth of MM cells. Indeed, transfected cells showed decreased DNA synthesis; decreased cyclinD1/cyclinD3/CDC25a/pRb protein expression; phase G1 cell cycle arrest. Moreover, transfected cells showed inhibition of NFkB pathway as shown by reduced p65-/p50-/p52-NFkB activities; downregulation of p-p65/p50/p52 nuclear protein level; upregulation of cttosolic phospho-IkB; and inhibited translocation of p-p65 from the cytolplasm to the nucleus. Similarly, inhibition of MM cell growth was confirmed in vivo; and anti-angiogenic properties of miRNA-15a and -16–1 were demonstrated both in vitro and in vivo. Conclusions: These data indicate that miRNAs play a pivotal role in the biology of MM; providing the basis for the development of new miRNA-based targeted therapies in this disease.

No significant financial relationships to disclose.

Cryopreservation of zebrafish (Danio rerio) blastomeres by controlled slow cooling

Cryopreservation is now a common practice in the fields of aquaculture, conservation and biomedicine. One approach for maintaining the genetic diversity of both nuclear genome and mitochondrial DNA is cryopreservation of the blastomere. This study sets out to determine an optimum cryopreservation protocol for blastomeres isolated from 50% epiboly zebrafish embryos. Freezing was performed in 0.25 ml straws in a programmable freezer. The optimum slow cooling protocol is identified as 5 degree C per min, from 22 to -6 degree C, holding for 15 min, 0.3 degree C per min from -6 to -40 degree C, 2 degree C per min from -40 to -80 degree C, cells were held for 10 min at -80 degree C before plunging into the liquid nitrogen. Thawing was performed in a water bath at 28 degrees C for 15 s followed by four step-wise removal of the cryoprotectant. Blastomeres had the highest survival level (70.2 +/- 3.2%) when a mixture of 1.5 M dimethyl sulfoxide (DMSO) and 0.1 M sucrose were used as cryoprotectants. This was higher than that achieved with either of the sugar alternatives, trehalose (60.6 +/- 3.1%) or glucose (43.1 +/- 4.9%). In the present study, cryopreservation of 50 percent epiboly zebrafish blastomeres was studied for the first time using controlled slow cooling method.

Housekeeping genes for cryopreservation studies on zebrafish embryos and blastomeres

Cryopreservation success is usually analysed in terms of cell survival, although there are other potential effects that do not necessarily result in cell death. These include DNA damage, which could result in altered gene expression. Real-time reverse transcriptase PCR allows quantitative analysis of gene expression but usually requires analysis of a 'housekeeping' gene as an internal reference. As the stability of housekeeping genes varies significantly among different groups of samples, it is recommended that those chosen are validated for each different type of sample group. This study aimed to validate housekeeping genes for use in cryopreservation studies of zebrafish embryos. Seven potential housekeeping genes were analysed across fresh and chilled intact embryos and across fresh and frozen isolated blastomeres using the GeNorm and NormFinder software packages. Results suggest that combined use of beta-actin and EF1alpha as housekeeping genes would be suitable for cryopreservation studies on zebrafish embryos and blastomeres.

Application of Radiofrequency Ablation of Renal VX2Tumors by Cooled-Tip Electrode in a Rabbit Model

Objective. This study has two purposes: (a) to compare the use of tumor cell suspensions and excised tumor tissue for generating renal tumors suitable for radiofrequency ablation (RFA) studies and (b) to assess the efficacy of RFA for ablation of renal VX2 tumors in a rabbit model. Procedures. VX2 tumor masses were used to inoculate 17 rabbits. The renal VX2 tumors of 13 rabbits were subsequently treated with a cooled-tip RF system at a power of 15-30 W for 3-6 minutes, and 4 rabbits served as control. After RFA, rabbits were observed by contrast-enhanced CT to ascertain the ablative range. Rabbits were divided into three groups and sacrificed at 3, 7, and 14 days post-treatment for histopathological studies. Results. Both tumor implant methods had a 100% success rate in generating tumors. The average lesion produced was 1.3x1.8x1.5 cm. Complete tumor ablation occurred in 76.9%, and local tumor growth in 23.1%. Depending on the position of the tumors, the complications after RFA treatment included infarction, perirenal hematoma, hydronephrosis, and abscess. The over-all complication rate was 38.5%. In histopathological studies, a central needle track, tumor coagulation, renal tissue coagulation, peripheral hemorrhage, and an inflammatory layer could be observed. Conclusion and clinical relevance. Application of RFA to destroy renal VX2 tumors in this rabbit model has a relatively high cure rate. It can be used to destroy small renal tumors in a precise and non-invasive manner. Impact on human medicine. We hope to apply this procedure in selected human renal tumors in the future.

Tissue Microarray Assessment of Selenoprotein P Expression in Gastric Adenocarcinoma

This study investigated selenoprotein P expression, using immunohistochemistry, in gastric adenocarcinoma tissue microarrays constructed from 30 gastric adenocarcinoma specimens and 30 normal gastric tissues (controls). Selenoprotein P expression scores were significantly lower in gastric adenocarcinoma (17/30, 56.7%) than in control tissues (25/30, 83.3%). Selenoprotein P was significantly more likely to be expressed in well-to-moderately differentiated cases (13/17, 76.5%) than in cases with low differentiation (4/13, 30.8%) and there was no significant difference in selenoprotein P expression between tumour node metastasis (TNM) stage I – II (11/19, 57.9%) and TNM stage III (6/11, 54.5%). In conclusion, selenoprotein P expression was low in gastric adenocarcinoma tissues compared with control tissues and was related to the degree of gastric adenocarcinoma differentiation but not to TNM stage.

Search for maximal flavor violating scalars in same-charge lepton pairs in pp collisions at sqrt[s]=1.96 TeV

Models of maximal flavor violation (MxFV) in elementary particle physics may contain at least one new scalar SU(2) doublet field Phi(FV)=(eta(0),eta(+)) that couples the first and third generation quarks (q_(1), q_(3)) via a Lagrangian term L(FV)=xi(13)Phi(FV)q(1)q(3). These models have a distinctive signature of same-charge top-quark pairs and evade flavor-changing limits from meson mixing measurements. Data corresponding to 2 fb(-1) collected by the Collider Dectector at Fermilab II detector in pp[over ] collisions at sqrt[s]=1.96 TeV are analyzed for evidence of the MxFV signature. For a neutral scalar eta(0) with m_(eta;(0))=200 GeV/c(2) and coupling xi(13)=1, approximately 11 signal events are expected over a background of 2.1+/-1.8 events. Three events are observed in the data, consistent with background expectations, and limits are set on the coupling xi(13) for m(eta(0)=180-300 GeV/c(2).

Increased detections of leptomeningeal presentations in men with hormone refractory prostate cancer: an effect of improved systemic therapy?

Metastases from prostate cancer occur largely in bone through a haematogenous route. Metastatic spread of prostate cancer to the leptomeninges was rarely seen in the past. However, there has been a recent increase in presentations of leptomeningeal spread from prostate cancer in our institutions. Between 2004 and 2006, four patients were diagnosed with metastatic prostate cancer with leptomeningeal metastases in our centres. All four patients had hormone refractory prostate cancer and had previously had chemotherapy. The median survival of these patients was approximately 15 months from the time of hormone refractoriness. The prognosis of leptomeningeal metastasis secondary to metastatic prostate cancer is poor, ranging from 2 to 7 months as seen in our series. New cases of leptomeningeal metastases seen in our series are hypothesized to be secondary to the use of effective modern systemic treatments. A parallel might be drawn with the increased rate of central nervous system metastases in breast cancer since the introduction of effective cytotoxic treatments and more recently targeted therapies. We suggest the clinicians to be aware of the potential change of natural history and pattern of progression in metastatic prostate cancer.

Search for doubly charged Higgs bosons with lepton-flavor-violating decays involving tau leptons

We search for pair production of doubly charged Higgs particles (H+/- +/-) followed by decays into electron-tau (etau) and muon-tau (mutau) pairs using data (350 pb(-1) collected from [over]pp collisions at sqrt[s]=1.96 TeV by the CDF II experiment. We search separately for cases where three or four final-state leptons are detected, and combine results for exclusive decays to left-handed etau (mutau) pairs. We set an H+/- +/- lower mass limit of 114(112) GeV/c(2) at the 95% confidence level.

Search for pair production of scalar top quarks decaying to a tau lepton and a b quark in pp over collisions at sqrt s=1.96 TeV

We search for pair production of supersymmetric top quarks (t over1), followed by R-parity violating decay t over1-->taub with a branching ratio beta, using 322 pb(-1) of pp over collisions at sqrt s=1.96 TeV collected by the upgraded Collider Detector at Fermilab. Two candidate events pass our final selection criteria, consistent with the standard model expectation. We set upper limits on the cross section sigma(t over1t over1) x beta2 as a function of the top-squark mass m(t over1). Assuming beta=1, we set a 95% confidence level limit m(t over1)>153 GeV/c2. The limits are also applicable to the case of a third-generation scalar leptoquark (LQ3) decaying LQ3-->taub.

Search for resonant tt[overline] production in pp[overline] collisions at sqrt[s]=1.96 TeV

We report on a search for narrow-width particles decaying to a top and antitop quark pair. The data set used in the analysis corresponds to an integrated luminosity of 680 pb(-1) collected with the Collider Detector at Fermilab in run II. We present 95% confidence level upper limits on the cross section times branching ratio. Assuming a specific top-color-assisted technicolor production model, the leptophobic Z' with width Gamma(Z')=0.012M(Z'), we exclude the mass range M(Z')<725 GeV/c(2) at the 95% confidence level.