Morphological changes induced by epidermal growth factor and estradiol on CG5 human breast cancer cell line: a scanning electron microscopy study

We studied the morphological changes induced by 17-b-estradiol (E2) and/or Epidermal Growth Factor (EGF) in an estrogen sensitive human breast cancer cell line (CG5) characterized by a high growth responsiveness to EGF and by a single class of high affinity I-125 EGF binding sites. EGF treated cultures showed conspicuous morphological changes consisting of retraction from the substrate, loss of cell-to-cell contacts and expression of surface crest-like and bled protrusions. E2-treated cells showed an increased number of microvilli with respect to control. In cells simultaneously treated with EGF and E2, despite the expression of microvilli, cell surface modifications were similar to those found in the presence of EGF alone, suggesting that EGF may negatively modulate the estrogen-induced morphological changes. In CG5 cells EGF induced a reduction of ER and PR levels and inhibited the estrogen-induced increase of PR. Our findings suggest that the activation of specific EGF-induced intracellular pathways could decrease or modulate those induced by E2.

Selective over-expression of mRNA coding for 90 KDa stress-protein in human ovarian cancer

The mRNA expression of the KDa stress-protein (SP) was assayed in normal and neoplastic human ovary. It was found that the expression level is low in normal ovary and in benign tumors and increases in the more advanced stages of ovarian cancer. A low level of mRNA coding for the 70 KDa SP--the most prominent among the inducible SPs-was constantly found in all specimens. No relationship was observed between SP 90 mRNA abundance and the receptor status of epidermal growth factor, estrogen and progesterone.

Serum levels of tumour associated glycoprotein (TAG 72) in patients with gynaecological malignancies

Serum levels of TAG 72 were measured in 726 serum samples from patients with benign and malignant gynaecological conditions in order to evaluate the clinical usefulness of TAG 72 alone or in combination with other tumour markers. Sixty-six per cent of patients with ovarian cancer showed abnormal concentrations of TAG 72 antigen. A good correlation was also found between serial TAG 72 values and the clinical course of disease during chemotherapy and follow-up. In cervical and endometrial cancer abnormal TAG 72 values occurred in 23% and 14% of cases, while none of the patients with breast cancer had abnormal TAG 72 levels. Among patients with benign disease only one out of 12 patients (8%) with benign ovarian tumours and one of 15 patients with uterine fibromyomatosis (7%) showed high TAG 72 serum levels. However, the determination of TAG 72 did not increase the sensitivity of CA 125 and squamous cell carcinoma antigen (SCC), in ovarian and cervical cancer, respectively. The systemic administration of recombinant interferon alpha-2b to 15 patients with ovarian cancer and different basal levels of TAG 72 did not increase serum levels of the antigen.

Steroid hormone receptors in carcinoma of the cervix: lack of response to an antiestrogen

Levels of estrogen (ER) and progesterone (PR) receptors were measured in 81 patients with primary cervical cancer. In 10 patients, receptor levels were evaluated before and after a short course of tamoxifen treatment. Fifty-six percent of cervical tumors contained ER, and 58%, PR. Receptor level and expression were not related to any clinical and histological characteristic. Moreover, both survival time and response to neoadjuvant chemotherapy did not correlate with the presence of ER and PR. Tamoxifen treatment did not influence ER and PR levels. Our results suggest that steroid hormone receptors are of little value in the management of cervical cancer, and that in this neoplasia, ER is probably not functional.

Recombinant alpha-2b-interferon enhances the circulating levels of a 90-kilodalton (K) tumor-associated antigen in patients with gynecologic and breast malignancies

The circulating levels of a 90-kilodalton (K) tumor-associated antigen were measured in the blood of 43 patients with gynecologic and breast malignancies who underwent a short course of recombinant alpha-2b-interferon (rIFN alpha-2b) (3 million U/m2/d intramuscularly [IM] for 3 days). Of the 43 patients, 23 showed abnormal 90-K levels (greater than 1.7 U/ml). A significant increase of antigen levels was already observed 24 hours after the first administration and persisted throughout the investigation period. Of 20 patients with 90-K levels below the normal limit, 12 went over the normal cutoff value after two rIFN alpha-2b injections. No significant modifications of 90-K levels were detected in nine women receiving rIFN alpha-2b for the treatment of genital condylomata. The serum levels of two other tumor-associated antigens, CA 125 and CA 15-3, were not modified by rIFN alpha-2b administration. The ability of rIFN alpha-2b to increase the circulating levels of 90-K might have important clinical implications for the serodetection of cancer.

Type II estrogen binding sites in human peripheral blood mononuclear cells: variations during the menstrual cycle

We have previously reported that human peripheral blood mononuclear cells (PBMC) contain type II estrogen binding sites (type II EBS). In this study, the fluctuations of type II EBS during the menstrual cycle were analyzed in 6 normally menstruating women. Approximately 3 times higher levels of type II EBS were found in the periovulatory period with respect to both follicular and luteal phases. In postmenopausal women the mean type II EBS levels were similar to those observed in the follicular phase of the cycle. However, in 3 postmenopausal patients a short course of estrogen or tamoxifen resulted in a marked increase of type II EBS levels. Tamoxifen was also found to compete with 17 beta-estradiol for type II EBS in PBMC, although to a lesser extent than diethylstilbestrol.

Doxorubicin and cyclophosphamide, alternated with bleomycin and mitomycin C as a second-line regimen in advanced ovarian carcinoma resistant to cisplatin-based chemotherapy

Fourteen patients with advanced ovarian carcinoma (FIGO stages III-IV) resistant to cisplatin were submitted to an alternating regimen with doxorubicin (A), cyclophosphamide (C), bleomycin (B) and mitomycin C (M). All patients had measurable disease on entry into the study. No responses were observed while 3 patients, previously showing no change in cisplatin, had disease stabilization lasting 3, 4 and 6 months, respectively. All but 1 patient died with a median survival from the start of ACBM therapy of 7 months (range 6-11). ACBM-induced toxicity was remarkable with 50% grade II-III myelotoxicity which required a dose reduction in 43%, treatment delays in 64% and treatment discontinuation in 14%. All patients suffered from mild to moderate nausea and vomiting while reversible alopecia was seen in 42.8%. The lack of response and the substantial toxicity observed suggest that the ACBM regimen in the doses and schedule employed is not beneficial in ovarian carcinoma resistant to cisplatin.

Rationale for very high-dose chemotherapy with peripheral blood stem cell support in advanced ovarian cancer

Although significant progress has been made in the management of advanced ovarian cancer, the majority of patients continue to die of this disease. Most advanced ovarian cancer patients present sub-optimal residual tumour after primary surgery and their prognosis is very poor since residual disease has been confirmed as the major factor predicting response to chemotherapy and survival. Therefore, it seems worth developing treatment modalities that can produce a longer remission period. In this short review, the authors summarize the clinical and experimental evidence supporting the usefulness of high-dose chemotherapy with autologous peripheral blood stem cell transplantation in advanced ovarian cancer.

Transvaginal ultrasound evaluation of myometrial invasion in endometrial carcinoma

In 20 cases of histologically proved endometrial cancer the depth of myometrial invasion was ascertained by means of transvaginal ultrasound, using a high-frequency endocavitary probe. The sonographic findings were confirmed by histologic examination in 18 of the 20 patients evaluated (90.0%). Transvaginal ultrasound provides a fuller preoperative clinical picture and supplies additional diagnostic information which is invaluable in the choice of therapeutic approach.

Predictive value of multiple tumor marker assays in second-look procedures for ovarian cancer

Sera from 51 ovarian cancer patients in clinical remission undergoing a second-look operation were studied. CA 125, CA 15-3, and 90K assays were performed in the week preceding surgery. Twenty-seven patients (53%) had no evidence of disease; 3 (6%) and 21 (41%) had microscopic and macroscopic disease. All patients but two with no evidence of disease had normal CA 125 serum levels, as did the three cases with microscopic disease and 6 patients with macroscopically detectable tumor. Of 17 patients with high CA 125 values, 15 (88%) were found to have persistent disease. Hence, the sensitivity and specificity of a CA 125 assay were 62 and 93%, respectively. CA 15-3 levels were low in all patients with no evidence of disease, in 2 cases with microscopic disease, and in 2 cases with residual tumor greater than 1 cm. All patients with high CA 15-3 titers had a positive second-look. The sensitivity and specificity of assay were 69 and 100%, respectively. With the 90K assay, 4 false-positive and 4 false-negative results were found and the sensitivity and specificity were 69 and 67%, respectively. However, 3 of 4 cases with a false-positive 90K assay had recurrence of disease with 7, 9, and 20 months later. Combination of the three markers increased sensitivity to 79%. These data suggest that more effective surveillance of disease status at second-look is obtained by using a combination of tumor marker assays.

Epidermal growth factor levels in human breast cyst fluid

Epidermal growth factor (EGF) seems to modulate the in vitro and in vivo growth of normal and neoplastic breast cells. We determined, by a radio-receptor assay, EGF levels in cyst fluid and in plasma of patients with gross cystic disease of the breast. The mean levels of EGF were lower in plasma than in breast cyst fluid (BCF) (p less than 0.001). In BCF of apocrine cysts we found higher EGF levels than in flattened cysts (p less than 0.001). The EGF content of apocrine BCF seems to be under sex steroid hormone control, being higher in reproductive age than in post menopause (p less than 0.05). Since it has been reported that patients with apocrine cysts are at a greater risk of developing breast cancer, we hypothesize that the high EGF concentration in apocrine BCF may play a role in the autocrine breast cyst epithelium growth control and neoplastic transformation.

Growth inhibitory effect of diheptyl diselenide on various human cancer cell lines

We tested the antiproliferative effects of Diheptyl Diselenide (DHDSe) on several different human cancer cell lines. Cells derived from human cancer (CG5), colon cancer (WIDR), laryngeal cancer (Hep-2), ovarian cancer (OV 166, OV 1225) and IM-9 lymphoblastoid cells were used. In all cell lines DHDSe inhibited cell growth in a dose dependent manner. At the highest concentration tested, an inhibition of cell proliferation ranging from 48% to 75% compared with control cells was observed. Our results show that DHDSe exerts a direct antiproliferative effect on human cancer cells in vitro and suggest that it may represent the parent compound of a new group of anticancer agents.

Randomized clinical trial comparing systemic interferon with diathermocoagulation in primary multiple and widespread anogenital condyloma

Two hundred three patients (median age 26 years; range 18-45) with untreated multiple and widespread anogenital condyloma were randomly assigned to one of four study arms in order to compare the efficacy, toxicity, and tolerability of recombinant interferon alpha-2b with those of diathermocoagulation. Of 200 evaluable patients, 51 were treated intramuscularly (IM) with 3 x 10(6) U (3 MU)/m2 daily for 3 weeks (total dose 63 MU/m2), 50 received subcutaneous thrice-weekly injections of 3 MU/m2 for 4 weeks (total dose 36 MU/m2), 51 underwent diathermocoagulation, and 48 were not treated and were used as a control group. Six months after the end of treatment, the overall response rate (complete and partial responses) was 70%: 57 and 82% for patients receiving interferon alpha-2b (IM and subcutaneously) and diathermocoagulation, respectively, and 8% for the control group. After 6 months from therapy, no significant differences in complete response were found among the different types of treatment: 20, 20, and 35% for the two interferon groups and the diathermocoagulation group, respectively. Fifteen and two complete responders in the cauterization and interferon groups, respectively, experienced disease recurrence (P less than .01). All patients given interferon therapy complained of flu-like symptoms, which declined progressively after the first week of treatment. Fatigue, lasting as long as patients received interferon, was the most prevalent chronic side effect. We conclude that systemic recombinant interferon alpha-2b is active in treating patients with primary condyloma lesions and does so as well as cauterization.(ABSTRACT TRUNCATED AT 250 WORDS)

Recombinant interleukin-2 continuous infusion in ovarian cancer patients with minimal residual disease at second-look

Recent reports suggest that recombinant interleukin-2 may be effective in the treatment of cancer patients with low tumor burden. Considering the poor long-term survival, 11 ovarian cancer patients with minimal residual disease at second-look have so far been selected for rIL-2 intravenous continuous infusion therapy: two induction courses (3 x 10(6) U/m2/day: 120 h + 108 h) followed by three maintenance courses (3 x 10(6) U/m2/day: 120 h) and third-look laparotomy. At present, three patients are still on treatment, three have completed it, and five have discontinued treatment. Sixty-seven per cent of the planned dose was administered in 49 cycles of which 42 (86%) required dose modifications due to hypotension (greater than or equal to grade III) and nephrotoxicity (greater than grade I). CNS and GI toxicity, allergies and fever, even though requiring dose modifications in a few cases, significantly affected patient compliance. The rebound lymphocytosis was clearly dose-related and a significant percentage increase after rIL-2 was detected only for IL-2 receptor positive cells. To date, four patients are evaluable for response after a median follow-up of 7 months, two progressed during the maintenance period, while one CR and one progression were detected in the two patients so far submitted to third-look laparotomy.

A primary amelanotic melanoma of the vagina diagnosed by immunocytochemistry

A case of primary malignant melanoma of the vagina is discussed. The lesion consisted of a nodule in the middle third of the vagina that was histologically suspected of being an unpigmented malignant melanoma. The melanocytic origin of the lesion was confirmed by the pattern of reactivity to a battery of human melanoma associated antigens and to class 1 and 2 histocompatibility antigens. No secondary lesions or alternative primary sites were found. The patient underwent radical hysterectomy with bilateral salpingooophorectomy, total vaginectomy and vulvectomy, radical inguinal, pelvic and paraaortic lymphadenectomy. The pathology report showed the presence of multiple neoplastic foci in the vagina. Although the removed lymph nodes were histologically free of metastases, microscopic foci of neoplastic cells were detected by immunohistochemistry in three lymph nodes. There is no evidence of recurrence at the twelfth postoperative month. Our results show that immunohistochemical techniques may usefully complement diagnostic histopathology in the diagnosis of female genital tract melanoma.

Circulating tumor markers in cervical cancer

Serum levels of CA 19-9, CA 125 and CA 15-3 were measured in 91 patients with cervical cancer (16 with intraepithelial neoplasia and 75 with invasive cancer). In 35 patients with locally advanced cervical cancer, serum marker levels were measured at monthly intervals during neo-adjuvant chemotherapy. CA 19-9 was found to be abnormally high only in advanced stages with an overall sensitivity of 7.3%. CA 125 and CA 15-3 were elevated in 31.9 and 23.1% of the patients, respectively, with a combined sensitivity of about 40%. The mean values of CA 125 and CA 15-3 were positively related to clinical stage and tumor differentiation. CA 125 and CA 15-3 values were correlated with response to chemotherapy in more than 80% of the cases. These findings suggest that CA 125 and CA 15-3 could be usefully employed in the management of cervical cancer.

Multiple serum markers in patients with endometrial cancer

Serum levels of carcinoembryonic antigen (CEA), CA 125 and CA 15-3 were measured in 47 patients with endometrial cancer and 20 with endometrial hyperplasia. Before treatment elevated serum levels of CEA, CA 125 and CA 15-3 were found in 14, 43 and 32% of cancer patients, respectively. In the 20 patients with endometrial hyperplasia, CEA and CA 15-3 values were normal, while elevated CA-125 titers were detected in 1 case. There was an increasing incidence of abnormal levels of all markers in relation to a higher tumor stage (stage I: 36%; II: 66%; III: 100%). The percentage of positive marker values increased in case of deep myometrial infiltration (greater than M1) and/or poorer tumor differentiation (greater than G1). However, only percent increase in CA 15-3 positivity was significantly higher in more infiltrating (greater than M1, 7 vs. 65%, p less than 0.01) and less differentiated (greater than G1, 0 vs. 47%, p = 0.01) tumors. These findings suggest that CA 15-3 is in some way associated with the prognostic factors of the disease. All patients except 2 with no evidence of disease after surgery had normal serum marker values. Moreover, CA 125 and CA 15-3 levels reflected the clinical course of the disease during chemotherapy and seemed to be useful for monitoring response to treatment.

Epidermal growth factor receptor expression in gynecological malignancies

Epidermal growth factor receptor (IEGF-R) levels were analyzed in 72 gynecological tumor specimens. Measurable EGR-R levels were found in a significant percentage of ovarian and uterine tumors. Moreover, all vulvar epidermoid carcinomas and uterine sarcomas analyzed were EGF-R positive. In all tumor types examined, scattered EGF-R levels were observed. Higher EGF-R levels were found in metastatic than in primary ovarian tumors. Moreover, EGF-R were found to be more expressed in less differentiated than in well-moderately differentiated endometrial tumors. Our results suggest a role of EGF or EGF-like substances in regulating the growth of gynecological malignancies, and indicate EGF-R expression as a possible prognostic factor.

Type II estrogen-binding sites and 17 beta-hydroxysteroid dehydrogenase activity in human peripheral blood mononuclear cells

Type II estrogen-binding sites (type II EBS) have been demonstrated in human peripheral blood mononuclear cells (PBMC) using a whole cell assay with [6,7-3H]estradiol [( 3H]E2) as tracer. During whole cell incubations for 60 min at 37 C for type II EBS quantification, we found that PBMC contain 17 beta-hydroxysteroid dehydrogenase (17 beta HSD) activity, which led to errors in estimating type II EBS concentrations by diminishing, by about 70%, the amount of available labeled E2. On the other hand, after 150 min at 4 C only 16% of the tracer was converted to estrone. Thus, we measured the maximal steady state binding in PBMC by incubating the cells with [3H]E2 at 4 C for 150 min. Equilibrium binding analysis of PBMC yielded sigmoid saturation curves with a saturation point at a ligand concentration of about 40 nmol/L. Scatchard analysis of binding data yielded a concave plot, which together with a Hill coefficient of 2.13, suggests that the type II EBS may have multiple binding sites which display positive cooperativity. The apparent equilibrium dissociation constant (Kd), determined from the [3H]E2 concentration required for half-saturation, was about 22 nmol/L. The type II EBS were estrogen specific, as demonstrated by competition experiments. Only those steroids with estrogenic activity inhibited binding of [3H]E2; nonestrogenic steroids did not. The type II EBS were found to be 3S macromolecules based on analysis of postlabeled fractions prepared by sucrose density gradient centrifugation. The number of type II EBS in PBMC from normal women was highest during the late follicular-early luteal phase of the menstrual cycle. We conclude that human PBMC specifically take up, retain, and metabolize E2.

Epidermal growth factor receptor in human breast cancer: correlation with steroid hormone receptors and axillary lymph node involvement

Epidermal growth factor (EGF-R) estrogen (ER) and progesterone (PR) receptors were evaluated in 89 primary breast cancers and 23 axillary lymph node metastases. About 57% of primary and 72.2% of metastatic tumors were EGF-R positive and median EGF-R levels were higher in metastatic deposits than in primary breast tumors (P less than 0.05). An inverse distribution of EGF-R and steroid hormone receptor positive tumors was found (chi 2 = 10.87; P less than 0.001 for PR and chi 2 = 5.01; P less than 0.05 for ER) and an interesting correlation between EGF-R expression in primary tumor and axillary lymph node involvement was demonstrated (chi 2 = 21.4; P less than 0.001). Immunohistochemical studies with a monoclonal antibody against EGF-R revealed the presence of EGF-R only in malignant cells. Our data suggest that EGF-R could identify a class of more aggressive breast tumors endowed with a higher metastatic potential and may therefore represent an unfavorable prognostic parameter in breast cancer.