Phase II study of capecitabine (X) in combination with vinorelbine (N) in patients (pts) with pretreated metastatic breast cancer (MBC)

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Background: X monotherapy is consistently effective and very well tolerated in pretreated MBC. N is also commonly used in this indication. In several studies, the combination of X + N led to response rates ranging from 43–67% in first-line MBC. As there are few data on the combination in pts with pretreated MBC, we evaluated the efficacy and safety of X + N in a multicenter phase II trial of pts previously treated with anthracycline- and taxane-containing regimens. Methods: Women >18 years of age with pretreated MBC, PS 0–2 and adequate organ function were enrolled to receive a 3-weekly regimen of XN: X 1000mg/m2 twice daily on days 1–14 and N 25mg/m2 on days 1&8, every 3 weeks up to a maximum of 6 cycles, disease progression or unacceptable toxicities. Results: A total of 32 pts were enrolled, median age 58 years (range 41–77), PS 0(74%), 1(19%), postmenopausal (61%). The most frequent sites of metastases were: liver (68%), nodes (36%), lung (36%). 58% of pts had ≥2 metastatic sites. 27 patients (87%) previously failed on anthracycline and taxane chemotherapy regimens. 152 cycles were administered with a median of 3 cycles/pt (range 1–10). Median relative dose intensity was 0.86 (0.51–1.01] for N and 0.85 (0.26–1.03] for X. All pts were evaluable for safety. The most common grade 3/4 clinical adverse events were vomiting (15%), asthenia (9%), and hand-foot syndrome (6%). Grade 3/4 hematological toxicities were: neutropenia (47%), leucopenia (9%), thrombocytopenia (3%). One pt died due to septic shock after the first cycle. 29 pts are evaluable for efficacy: the overall response rate was 52% (4 CR, 11 PR), with stable disease in 8 pts (28%). Median TTP was 7.5 months [95% CI, 5.7–9.8]. Conclusions: Our preliminary data indicate that the combination of X and N has promising clinical activity and good safety in pts with MBC who have failed prior taxane- and anthracycline-containing regimens.

No significant financial relationships to disclose.

Correlation between HER2/neu overexpression/amplification and clinicopathologic parameters in advanced gastric cancer (AGC) patients (pts): A prospective study

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Background: Trastuzumab is widely used in the treatment of HER2/neu overexpressing breast cancer pts and also exhibits activity in human gastric cancer cells that overexpress HER2/neu. We are conducting a phase II trial to assess the efficacy and tolerance of trastuzumab in combination with cisplatin as first line chemotherapy (CT) in HER2/neu positive AGC. Objectives: To determinate prospectively the frequency of HER2/neu expression and to evaluate the relationship with clinicopathologic characteristics in advanced gastric adenocarcinoma pts. Methods: Pts were screening for HER2/neu expression/amplification. Immunohistochemistry (IHQ) was performed using herceptest. A fluorescence in situ hybridization (FISH) assay was done when IHQ was = 2. HER2/neu expression was considered negative if IHQ = 0, 1 or IHQ = 2 and FISH negative; and positive if IHQ = 2 and FISH positive or IHQ = 3. Results: A hundred and twenty six pts were tested for HER2/neu status between 2/2004 and 12/2005. 96 (76%) males, median age 61 years (range 29–84). Histological characteristics: all were adenocarcinomas and 47% type intestinal, 33% diffuse, 20% unknown. Primary tumor localization was 101 (80%) gastric and 25 (20%) gastroesophageal junction (GEJ). 115 (91%) pts had metastases (47% liver; 45% lymph nodes; 27% peritoneum; 10% lung; 27% others) and 11 (9%) locoregional advanced disease. Prior therapies: 67 pts surgery, 18 adjuvant/neoadjuvant CT and 14 adjuvant irradiation. HER2/neu expression was negative in 109 (86.5%) cases. The positive cases were: type intestinal (15.5%); type diffuse (10%) (p = 0.54); 9% gastric localization and 29% GEJ tumors were HER2/neu positive too (p = 0.01). Conclusions: HER2/neu overexpression/amplification was found in 13.5% of AGC and is more common in gastroesophageal junction cancers. The study is ongoing.

[Table: see text]

Preliminary results of docetaxel (T) and trastuzumab (H) combination administered every 21 days in metastatic breast cancer (MBC) and HER-2 over-expression patients (P)

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Background: T combined with weekly H confers greater tumor response and survival compared to T monotherapy in P with Her-2 positive MBC. A recent report has demonstrated that H can be administered q3wks. The primary endpoint is to evaluate time to progression (TTP). Sencondary objectives are response rate, overall survival and safety profile. Methods: P cytologically or histologically confirmed of metastatic breast cancer, HER-2 positive (+++ by Herceptest, or FISH positive), age > 18, ECOG PS ≤ 2, and adequate organ function, were included. Prior chemotherapy for MBC or adjuvant anthracycline-based regimen in the previous 6 months was not allowed. Treatment: T 100 mg/m2 iv D1 q3wks for 6 cycles, H 8 mg/kg (cycle 1) and 6 mg/kg (consecutive cycles) iv D1, q3wks. P may receive H monotherapy until PD at the investigator criteria. Results: Over 41 analyzed P, median age was 57 years (29–75); ECOG PS 0–1 95% and ductal carcinoma 88%. Twenty five P received prior chemotherapy. Treatment: 217 cycles of TH (median 6) were administered. After that, 23 P received 189 cycles of H monotherapy (median 5, 1–32). During TH treatment median RDI was 97% for T and 96% for H, and it was 99% during H treatment. Over 33 P for efficacy analysis (2 consent withdrawal, 1 allergic reaction, 1 ongoing and 4 response not confirmed by RECIST criteria), 6 achieved CR and 12 PR, for an ORR of 54.6% (95% CI: 37.6–71.6). Median follow-up time was 11.8 m and median TTP was 8.8 m (95% CI, 1.9–15.6). All P were evaluable for safety. During TH treatment, grade III/IV neutropenia occurred in 16 cycles (7.4 %), 14 of them were febrile neutropenia episodes (6.5%). Other grade III/IV toxicities per cycle were: leucopenia (5.5%), hyperglycemia (2.3%), anorexia (2.3%) and skin (2.3%). During H monotherapy treatment, the only grade III-IV toxicities observed were, skin (1.6%), oedema (1.1%), nail disorders (0.5%) and malaise (4.3%). Six P (14.6%) dropped out due to cardiac toxicity: 5 had LVEF under 50% and one atrial fibrillation. Conclusions: Preliminary results suggest that TH q3wks followed by H as single agent, is an effective regimen for the treatment of P with Her2 positive MBC.

No significant financial relationships to disclose.

Importance of Early Adequate Exposure to Cyclosporine in Renal Transplant Outcome: Study of 1-Year Creatinine

INTRODUCTION

One-year serum creatinine (SCr) level has been used as a surrogate marker for graft survival in kidney transplantation. We evaluated the importance of different factors on this parameter, emphasizing the importance of adequate exposure to Cyclosporine (CyA).

METHODS

Ninety-six consecutive renal transplant recipients who underwent transplantation between 1996 and 2002 were treated with CyA, steroids, and azathioprine. Univariate and multivariate regression analyses were performed for 1-year SCr, acute rejection episodes (ARE), and duration of delayed graft function (DGF). We considered adequate CyA levels within 1 week to be >250 ng/mL trough levels (38%) or 3 hour postdose level (C3) >1100 ng/mL (62%).

RESULTS

Mean 1-year SCr was 1.52 +/- 0.5, ARE rate was 27%, and DGF rate was 31%. Overall, 53% of patients achieved adequate exposure to CyA at 1 week (68% on those monitored by C3). Univariate analysis identified female recipient gender, decreasing donor age, absence of ARE, and decreased DGF duration to yield lower 1-year SCr (P < .05). On multivariate analysis for donor age (lower), ARE rate, and duration of DGF (shorter) were the only factors considered to be significant for a lower 1-year SCr level. Multivariate analysis for ARE showed that adequate CyA exposure and lower HLA mismatch decreased ARE, whereas the ability to achieve adequate exposure to CyA and shorter cold ischemia time (CIT) correlated with a reduced incidence of DGF.

CONCLUSIONS

One-year SCr level is affected primarily by the incidence of ARE, by donor age, and by duration of DGF. Adequate CyA exposure is related to lower ARE; however, its relation to DGF may be influenced by the reluctance to increase exposure on patients with a nonfunctioning graft.

[Advances in ischaemic heart disease]

Atherothrombosis is a key concept in our new pathophysiologic understanding of cardiovascular disease. It has led to new preventive strategies, both pharmacologic and lifestyle-related, to more specific treatments and to emerging imaging modalities.

Epidermal growth factor receptor activating mutations in Spanish gefitinib-treated non-small-cell lung cancer patients

BACKGROUND

North American and Japanese non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) activation via tyrosine kinase (TK) mutations respond dramatically to gefitinib treatment. To date, however, the frequency and effect of EGFR TK mutations have not been examined in European patients.

PATIENTS AND METHODS

Eighty-three Spanish advanced NSCLC patients who had progressed after chemotherapy, were treated with compassionate use of gefitinib. Patients were selected on the basis of available tumor tissue. Tumor genomic DNA was retrieved from paraffin-embedded tissue obtained by laser capture microdissection. EGFR mutations in exons 19 and 21 were examined by direct sequencing.

RESULTS

EGFR mutations were found in 10 of 83 (12%) of patients. All mutations were found in adenocarcinomas, more frequently in females (P=0.007) and non-smokers (P=0.01). Response was observed in 60% of patients with mutations and 8.8% of patients with wild-type EGFR (P=0.001). Time to progression for patients with mutations was 12.3 months, compared with 3.6 months for patients with wild-type EGFR (P=0.002). Median survival was 13 months for patients with mutations and 4.9 months for those with wild-type EGFR (P=0.02).

CONCLUSIONS

EGFR TK mutational analysis is a novel predictive test for selecting lung adenocarcinoma patients for targeted therapy with EGFR TK inhibitors.

Sulfur formation by steady-state continuous cultures of a sulfoxidizing consortium and Thiobacillus thioparus ATCC 23645

The elemental sulfur formation by the partial oxidation of thiosulfate by both a sulfoxidizing consortium and by Thiobacillus thioparus ATCC 23645 was studied under aerobic conditions in chemostat. Steady state was attained with essentially total conversion to sulfate when the dissolved oxygen concentration was 5 mgO2 l(-1) and below a dilution rate (D) of 3.0 d(-1)for the consortium and 0.9 d(-1) for T thioparus. The consortium formed elemental sulfur in steady state under oxygen limitation. Fifty percent of the theoretical elemental sulfur yield was obtained with a dissolved oxygen concentration of 0.2 mgO2 l(-1). Growth of T thioparus was negatively affected with a concentration below 1.9 mgO2 l(-1). Consortium yield from batch cultures was 2.1 g(-1) (protein) mol(-1) (thiosulfate), which was comparable with the values obtained in the chemostat at dilution rates of 0.4 d(-1) and 1.2 d(-1). The consortium showed a maximum degradation rate of 0.105 g(thiosulfate) g(-1) (protein) min(-1) and a saturation rate for S2O3(2-) of 1.9 mM.

Growth hormone expression in ontogenic development in gilthead sea bream

The pattern of expression of the growth hormone (GH) gene was studied during the early development of gilthead sea bream ( Sparus aurata). The GH transcript was detected from the 2nd day of the larval stage onwards. In the next stages the expression level fluctuated, possibly due to different regulatory factors. The distribution of GH mRNA studied by in situ hybridization (ISH) was found to be pituitary specific. Hybridization signals for GH mRNA were detected for the first time in 4-day-old larvae. Throughout development the cells that express GH mRNA were mainly located in the proximal pars distalis. Mammosomatotroph cells coexpressing GH and PRL were not detected in juveniles or adults. Moreover, the possible involvement of GH in asynchronic growth in cultivation of gilthead sea bream was also examined by ISH. No differences in the distribution of GH cells were observed in the three sizes of juveniles of gilthead sea bream studied. These results suggest that the transcription of GH is involved in the early developmental stages of sea bream and the asynchronous growth-related changes are not due to distinct distribution of GH cells.

[Utility of beta-blockers in the treatment of chronic heart failure]

Heart failure has become a major public health problem. About 2-3% of people over 65 years suffer from Heart Failure. A huge amount of money is spent every year treating problems connected with this syndrome. In this paper we analyse randomised prospective trials which support the use of beta-blockers in these patients. We also analyse the benefits of this treatment and some special considerations concerning the use of these drugs.

Laparoscopic repair of a uteroperitoneal fistula

Repairs of pelvic fistulas using abdominal, vaginal, and laparoscopic approaches have been described. In the present case report, we describe our experience with the laparoscopic repair of a uteroperitoneal fistula.

Sodium and potassium clearance rhythmicity in diabetic rats with insulin treatment

The effect of insulin treatment on the daily distribution of the urinary volume and urinary sodium and potassium excreted, as well as their clearance rhythms in rats with streptozotocin (STZ)-induced diabetes was investigated. Normal(C), uncontrolled (D) and controlled insulin diabetic rats (DI), were studied during a light-dark (12 h:12 h) cycle and given food and water ad libitum. The DI rats showed a significant reduction in the urinary sodium and potassium excreted during 24 h with respect to the D rats, though these values were significantly higher than the C ones. A loss of the normal circadian rhythmicity of diuresis and both sodium and potassium clearance was observed in the D rats, together with higher values of M (MESOR) than in the C rats. These rhythms could be reestablished with continuous insulin infusion, their orthophases occurring near the C ones. However the M values of sodium and potassium clearance in DI rats are greater than C, showing higher values than this group during the rest phase. These results in DI rats may suggest that the constant rate infusion of insulin can be responsible for the high values of clearance of both ions at the rest phase and so for the incomplete renal rhythms restoration.

Determination of polychlorinated biphenyls in biota samples using simultaneous pressurized liquid extraction and purification

In order to reduce time and cost of analysis, a new pressurised liquid extraction method that automatically and rapidly achieves quantitative and selective (i.e., lipid-free) extraction of polychlorinated biphenyls (PCBs) in biota tissues was optimized. It consists of on-line clean-up by inclusion of sorbents in the extraction cell. The freeze-dried sample is dispersed with Florisil and loaded in the extraction cell containing an extra amount of Florisil. The extraction is performed under mild conditions using 55 ml of a dichloromethane-pentane (15:85) mixture, a temperature of 40 degrees C, a static extraction time of 10 min and two extraction cycles. The Florisil retains coextracted lipids from the matrix, and the extract, after pre-concentration, is clean enough for direct injection into GC-MS and GC-electron-capture detection (ECD). Quantitative recoveries (from 90 to 106%) are obtained for both native and spiked PCB congeners in samples with a high lipidic content (up to 42% dry mass, in spoonbill eggs). The reproducibility of replicate extractions was better than 11% relative standard deviation. Method detection limits were in the ranges of 0.001-0.004 and 0.002-0.07 ng g(-1) dry mass for GC-ECD and GC-MS-MS, respectively. The method was validated using the standard reference material SRM 2974 (a mussel tissue) from the US National Institute of Standards and Technology, compared to Soxhlet and matrix solid-phase dispersion extraction methods, and used to evaluate the contamination by PCBs in bivalves from South of Spain.

Sample treatment in chromatography-based speciation of organometallic pollutants

Speciation analysis is nowadays performed routinely in many laboratories to control the quality of the environment, food and health. Chemical speciation analyses generally include the study of different oxidation state of elements or individual organometallic compounds. The determination of the different chemical forms of elements is still an analytical challenge, since they are often unstable and concentrations in different matrices of interest are in the microg l(-1) or even in the ng l(-1) range (e.g., estuarine waters) or ng g(-1) in sediments and biological tissues. For this reason, sensitive and selective analytical atomic techniques are being used as available detectors for speciation, generally coupled with chromatography for the time-resolved introduction of analytes into the atomic spectrometer. The complexity of these instrumental couplings has a straightforward consequence on the duration of the analysis, but sample preparation to separate and transfer the chemical species present in the sample into a solution to be accepted readily by a chromatographic column is the more critical step of total analysis, and demands considerable operator skills and time cost. Traditionally, liquid-liquid extraction has been employed for sample treatment with serious disadvantages, such as consumption, disposal and long-term exposure to organic solvent. In addition, they are usually cumbersome and time-consuming. Therefore, the introduction of new reagents such as sodium tetraethylborate for the simultaneous derivatization of several elements has been proposed. Other possibilities are based in the implementation of techniques for efficient and accelerated isolation of species from the sample matrix. This is the case for microwave-assisted extraction, solid-phase extraction and microextraction, supercritical fluid extraction or pressurized liquid extraction, which offer new possibilities in species treatment, and the advantages of a drastic reduction of the extraction time and the embodiment into on-line flow analysis systems. This new generation of treatment techniques constitutes a good choice as fast extraction methods for feasible species-selective analysis of organometallic compounds under the picogram level, that can be used for national regulatory agencies, governmental and industrial quality control laboratories, and consequently, for manufacturers of analytical instrumentation.

Fecal occult blood test use by Kansas medicare beneficiaries

PURPOSE

The aim of this study was to examine utilization of and trends in fecal occult blood testing (FOBT) among beneficiaries since Medicare began FOBT coverage on January 1, 1998.

METHODS

We identified Kansas Medicare beneficiaries ages 65-79. Using Medicare claims, we determined which beneficiaries received FOBT during 1998-1999. We examined demographic variables associated with FOBT and rate changes over time. We linked beneficiaries to primary care practices (PCPs) and examined FOBT variations among 483 PCPs.

RESULTS

FOBT use remained unchanged during the study period. Of the 215,322 beneficiaries, 11% received at least one FOBT in 1998 and 11% in 1999; 18% had at least one test during the 2-year period, but only 4% had a test during both years. Caucasians and females had the highest FOBT rates. Although FOBT rates among PCPs ranged from 0 to 71%, only 19% of the practice rates exceeded 10%.

CONCLUSIONS

Few beneficiaries obtain annual FOBT and little change in rates has occurred since Medicare reimbursement began. Although FOBT rates vary widely between PCPs, most either do not provide FOBT or do not bill Medicare for FOBT. The FOBT claims rate is much lower than reported in patient surveys and may indicate that Medicare should reexamine its reimbursement policy.

Neuronal differentiation is triggered by oleic acid synthesized and released by astrocytes

Unlike in the adult brain, the newborn brain specifically takes up serum albumin during the postnatal period, coinciding with the stage of maximal brain development. Here we report that albumin stimulates oleic acid synthesis by astrocytes from the main metabolic substrates available during brain development. Oleic acid released by astrocytes is used by neurons for the synthesis of phospholipids and is specifically incorporated into growth cones. Oleic acid promotes axonal growth, neuronal clustering, and expression of the axonal growth-associated protein-43, GAP-43; all these observations indicating neuronal differentiation. The effect of oleic acid on GAP-43 synthesis is brought about by the activation of protein kinase C, since it was prevented by inhibitors of this kinase, such as H-7, polymyxin or sphingosine. The expression of GAP-43 was significantly increased in neurons co-cultured with astrocytes by the presence of albumin indicating that neuronal differentiation takes place in the presence of oleic acid synthesized and released by astrocytes in situ. In conclusion, during brain development the presence of albumin could play an important role by triggering the synthesis and release of oleic acid by astrocytes, which induces neuronal differentiation.

Temperature induces variations in the retinal cell proliferation rate in a cyprinid

We quantitatively evaluate the changes of the proliferative cell populations in the adult tench retinas maintained at 6 degrees C and 20 degrees C by both PCNA antigen detection and flow cytometry-based DNA measurements. Both the overall percentage of S-phase cells in the whole retinas and the number of PCNA-positive cells in each of the retinal layers were significantly lower in the tench kept at 6 degrees C, indicating that temperature affects the retinal germinal cell proliferation.