Clinical presentation, pathological features, and natural course of metastatic uveal melanoma (MUM) as an orphan and commonly fatal disease

e20005

Background: Uveal melanoma (UM) is a rare disease characterized by an unpredictable course and variable outcome ranging from cure by local treatment to the occurrence of untreatable metastasis. The current project analyzed patients with the metastatic phenotype. Methods: We performed data collection in 76 pts with MUM treated in Leuven between 1957–2008. Statistical analysis involved nonparametric tests, Kaplan Meyer and log rank test. Results: The med. age at diagnosis of UM was 58 yrs (range 30–94). Common initial treatments were surgery (71%), brachytherapy (20%) and external beam RT (7%). MUM was more common in women (F:M ratio 48:28) and independent from the side of the primary tumor (left vs. right eye). Synchronous metastasis was found in 9% of cases, all others had metachronous disease after a med. interval of 40 mos (range, 7–420). Statistical analysis failed to identify predisposing factors for MUM with the exception of a significant negative correlation between age at diagnosis of UM and time until metastatic disease (Spearman ρ = -0.4, p<0.001). Metastasis in >1 organ, usually liver plus another site, was seen in 47% of cases. The most frequent sites were liver (96%), lung (23%), subcutaneous (13%), bone (11%) and brain (3%).The med. OS from diagnosis of UM was 46 mos (range, 2–182), and 4,5 mos after diagnosis of metastasis (range, 1–128). 65% of MUM pts qualified for further treatment, including systemic therapy (60%), radiotherapy (7%) and surgery (7%). Systemic therapy (45 pts) included mainly chemo- (50%), chemo- plus hormones (12%), immuno- (3%) or hormonal therapy (3%). The most common drugs given were DTIC (43%), cisplatin (27%), tamoxifen (10%) or phase I agents (8%). Patient benefit (PR+SD) was seen in 16/45 pts (36%), including 2 PR. Conclusions: In this orphan disease with female predominance metastasis occurs late, is mainly found but not confined to the liver, and is associated with high morbidity, as >1/3 of pts do not qualify for further therapy. Advances in MUM can only be achieved by networking of sites interested in this tumor with systematic collection of data and tissue to improve our understanding of the molecular biology of the disease.

No significant financial relationships to disclose.

Spectrum of KIT and PDGFRA mutations in primary gastrointestinal stromal tumors: Polish Clinical GIST Registry experience

e21504

Background: KIT or PDGFRA gene mutations are found in 80–90% of gastrointestinal stromal tumors (GIST). The prognostic value of those mutations for the outcome in primary tumors is controversial. Objective: To assess the spectrum, frequency and prognostic significance of the KIT and PDGFRA gene mutations in Polish group of surgically treated primary GISTs. Methods: DNA isolated from paraffin blocks from 300 patients (pts) with histologically diagnosed primary GISTs included in clinical registry database, were analyzed using denaturing high performance liquid chromatography (DHPLC) and direct sequencing for KIT (exons 9, 11, 13, 17) and PDGFRA (exons 12, 14, 18) mutations. For primary GIST risk assessment the Miettinen stratification was used. Results: KIT/PDGFRA genes mutations were found in 82% tumors: KIT was mutated in 69% and PDGFRA in 13% of tumors. KIT exon 11 and 9 mutations were found in 61.5% and 7.5% respectively. Among KIT exon 11 mutants the most frequent were deletions (32.7%) followed by point mutations (15.3%), duplications (8.4%) and complex rearrangements (5.1%). KIT exon 11 mutations were found at the similar rates in tumors with gastric and non-gastric localization (53.9% vs. 46.1% respectively) while KIT exon 9 duplications were more often observed in non-gastric GISTs (86.4%, p=0.00036) and PDGFRA mutations were more frequently found in tumors originated from the stomach (86.8%; p=0.00017). In high risk tumors KIT exon 11 deletions were more frequently found than point mutations (p=0.017). On the other hand mutations in PDGFRA were more often observed in very low-/low- than high risk GISTs as compared to KIT exon 11 (p=0.0026). There was no statistically significant correlation between disease-free survival and the spectrum or frequency of mutations. Conclusions: Spectrum and frequency of KIT and PDGFRA mutations in Polish GIST population are similar to the previously described groups. No significance of mutations for disease outcome after surgery of primary tumors was found.

[Table: see text]

Development of cavitation while on bevacizumab (BV) therapy in patients (pts) with non-small cell lung cancer (NSCLC): Results from ARIES—A bevacizumab (BV) treatment observational cohort study (OCS)

e19045

Background: BV (Avastin), an anti-VEGF monoclonal antibody, prolongs progression-free and overall survival in advanced NSCLC pts. Severe (≥grade 3) pulmonary hemorrhage (sPH) is a rare but serious event that has been associated with BV-based therapy in phase 3 trials (rate of 2–4%). Potential risk factors include squamous histology, prior history of hemoptysis, and presence of tumor cavitation. Rates of baseline (BL) cavitation in NSCLC pts and development of cavitation on BV therapy are unknown. Pts in ARIES, an OCS of approximately 2,000 pts with NSCLC, had BL scans assessed for tumor cavitation. A substudy of approximately 250 pts also had follow-up scans to analyze the likelihood of developing cavitation on BV therapy. For the entire ARIES population, any pt developing sPH is assessed for tumor cavitation. Methods: Pts at specified ARIES sites submitted on-treatment CT scans to an independent review facility (IRF), in addition to BL scans. Evaluable pts had measurable disease at BL and at least one-post-BL scan. Correlations between cavitation (pre-existing or developing on-study) and clinical, tumor and treatment characteristics are evaluated using a chi-squared test or t-test. Incidence of sPH based on cavitation status will be assessed using Fisher's exact test. Results: As of 9/15/08, 210 pts had a post-BL CT scan reviewed by the IRF. Of these pts, 171 had measurable tumors at BL. For the 171 pt cohort: median F/U is 9.2 m; 99% have ≥1 quarterly update. Key BL characteristics for the substudy and overall cohorts, respectively, include: 44% vs 51% ≥65 yrs; 67% vs 67% adenocarcinoma; 6% vs 5% therapeutic AC. BL radiographic features: 41% vs 39% presence of central tumor; 13% vs 15% presence of cavitation. In substudy pts, there is 1 sPH to date in a pt without baseline cavitation. Conclusions: sPH is a rare, potentially serious event in pts with NSCLC receiving BV. Whether cavitation (BL or developing on-treatment) is associated with an increased risk of sPH has not been defined. The final analysis of an ARIES Lung substudy assessing on-study development of cavitation and association with sPH will be presented at the meeting.

[Table: see text]

Cediranib, a VEGF receptor 1, 2, and 3 inhibitor, and pemetrexed in patients (pts) with recurrent non-small cell lung cancer (NSCLC)

e19007

Background: There are only limited data regarding the use of anti-VEGF therapy in recurrent NSCLC and no data in NSCLC pts previously treated with bevacizumab. We are currently conducting a phase II trial evaluating cediranib, an oral inhibitor of VEGFR 1,2 and 3, and pemetrexed in recurrent NSCLC pts who may or may not have previously received bevacizumab. Methods: Pts with progressive and measurable NSCLC, 1 or 2 prior regimens, PS0–2, all histologic sub-types, BP ≤ 140/90, treated brain metastases are eligible. Pts on anti-coagulants are allowed. Pts with hemorrhage within 4 weeks are excluded. Pts start on cediranib 30mg daily followed 7 days later by pemetrexed at 500 mg/m2 every 21 days and cediranib daily. The study consists of two cohorts- cohort A (no prior bevacizumab) and cohort B (prior bevacizumab). Planned accrual is 37 pts each cohort. Consenting pts will undergo FLT PET scans and blood draw for circulating tumor cells before therapy, 1 week after cediranib, and after 1 cycle of the combination. Results: 33 pts have started therapy, (Cohort A- 20, Cohort B- 13), median age- 60, males- 56%, ever smokers- 88%, adenocarcinoma- 64%, squamous- 12%, brain mets- 27%, 1 prior regimen- 52%, PS0–1- 88%. Median cycles- 4 (range- 0–15). Grade 3/4 toxicities- neutropenia- 7pts, febrile neutropenia- 1pt, fatigue-7pts, diarrhea- 3pts, hypertension- 1pt, anorexia- 2pts, cardiac ischemia- 1pt, bronchopleural fistula- 1pt, esophagitis- 1pt. No major hemorrhage. Of the 17 pts who received cediranib for ≥ 4 cycles, 71% required dose reduction and of the 18 pts who received pemetrexed for ≥ 4 cycles, 22% required dose reduction. 31 pts (Cohort A- 19, Cohort B- 12) are response evaluable. Confirmed response rate is 16%(90% CI- 0.08–0.30) (Cohort A- 10%, Cohort B- 25%) and disease control rate (response+stable disease) is 71% (90% CI-0.56–0.82) (Cohort A- 74%, Cohort B- 67%). 8 of 9 pts who had FLT PET scans had a 20% or greater decline in standard uptake value after 1 week of cediranib alone. Conclusions: Cediranib and pemetrexed combination is tolerable. Efficacy has been observed with the combination in recurrent NSCLC pts, including those previously treated with bevacizumab. Accrual to this trial is ongoing.

[Table: see text]

Posttransplant Epstein-Barr virus-associated myogenic tumors: case report and review of the literature

Epstein-Barr virus (EBV) has been implicated in the pathogenesis of different types of malignancies. While nonmelanoma skin cancers, lymphomas and Kaposi sarcomas are the most frequently reported malignancies after solid organ transplantation, EBV-associated smooth muscle tumors (EBV-SMT) after transplantation are rare and thus far only 18 cases in kidney recipients have been reported. A case of a 51-year-old kidney transplant recipient diagnosed with EBV-SMT is reported together with a review of the literature.

The effect of whole-body cryostimulation on the prooxidant-antioxidant balance in blood of elite kayakers after training

The effect of whole-body cryostimulation prior to kayak training on the prooxidant-antioxidant balance was evaluated and compared to the effect of a single cryostimulation treatment in untrained men. The kayakers underwent a ten-day training cycle with pre-training daily whole-body cryostimulation for three min (temperature: -120 to -140 degrees C) and training without cryostimulation as a control. Blood samples were obtained before and after the sixth and the tenth day of training and from the untrained men before and 20 min after cryostimulation. In untrained men cryostimulation induced an increase in the activity of superoxide dismutase (SOD) by 36% (P<0.001) and glutathione peroxidase (GPx) by 68% (P<0.01) in the erythrocytes and an increase in the conjugated dienes (CD) in plasma by 36% (P<0.05) and in the erythrocytes by 71% (P<0.001). In the kayakers comparing both types of training after the sixth day, the level of CD in plasma was 46 (P<0.001) and 40% (P<0.01) lower in erythrocytes, and the concentration of thiobarbituric acid-reactive substances in plasma was 24% (P<0.05) lower with pre-training cryostimulation. After the sixth day of training with cryostimulation, SOD activity was also 47% (P<0.001) lower, while GPx activity after the tenth day was reduced by more than 50% (P<0.01) as compared to control training. Whole-body cryostimulation per se stimulates the generation of reactive oxygen species. Yet, the oxidative stress induced by kayak training was reduced by prior exposure to extremely low temperatures.

The outcomes of imatinib therapy of advanced gastrointestinal stromal tumors (GISTs) originating from the small bowel

10052

Background: The aim of the study was to assess the outcomes of imatinib (IM) therapy in subgroup of patients with advanced CD117(+) GIST originating from small intestine. Methods: In the group of 245 consecutive patients with inoperable and/or metastatic GIST CD117(+) treated with imatinib in the dose of 400–800mg daily and enrolled into prospectively collected Clinical GIST Registry between 09/2001 and 10/2006 we identified 123 patients (50.2%) with GIST originating from small bowel. There were 43 primary unresectable/metastatic tumors and 80 recurrent (after primary surgery) tumors. Median follow-up time was 31 months (range: 3–63). Results: The estimated 3-year progression-free survival (PFS; calculated form the date of the start of IM) and overall survival (OS) were 61% and 80%, respectively. The best responses observed during IM therapy according to RECIST criteria were as follows: complete responses (CRs) - 9 cases (7%), partial responses (PRs) - 66 cases (54%), stable disease SD - 29 cases (24%) and progressive disease (PD) - 19 (15%). In 42 analyzed specimens 29 GISTs (69%) had exon 11 KIT mutations, 9 (21%) - exon 9 KIT mutations and 4 (10%) other genetic abnormalities. We identified three factors negatively affecting PFS statistically significant (p<0.05) in multivariate analysis: baseline poor WHO performance status = 2, tumor genotype with other than exon 11 KIT mutant and primary tumor mitotic index >10/50HPF. Two more additional factors had negative impact on PFS in univariate analysis only: baseline high neutrophil count (p=0.04) and low baseline hemoglobin level (p=0.01). Conclusions: In analysis of the subset of patients with advanced GIST originating from the small bowel we confirmed long-term benefit from IM therapy. We identified three independent biological factors influencing the progression-free survival during imatinib therapy in this group of patients.

[Table: see text]

Natural course and clinical features of myxoid and round cell liposarcoma (MRCL) - a retrospective single center analysis

10066

Background and methods: MRCL, the 2nd most common type liposarcoma, represents ∼10 % of adult soft tissue sarcomas. In most pts the karyotypic hallmark is t(12;16)(q13;p11), leading to fusion of CHOP and FUS genes and generation of a hybrid protein. MRCL has unique sensitivity to antineoplastic agent ET-743 (Yondelis, Trabectidin), which induces specific morphological change and long-lasting response. We made a retrospective analysis of MRCL cases in our center. Results: 33 pts had histological diagnosis of MRCL with a mean (mn) follow-up of 45 mo (range, 2–214). By karyotyping or FISH analysis CHOP-FUS fusion was present in 12 and CHOP-EWS in 2 pts. The mn age at diagnosis was 45 yrs (range, 18–71), male:female ratio 1:0.8. Frequent primary sites: lower limb (25), abdomen (5), retroperitoneum (2), neck (2). Stage grouping at diagnosis: IA (2), IB (6), IIA (5), III (14), IV (2), not known (NK) (4). 2 had distant spread, 9 metachronous metastasis with a mn interval of 24 mo (range, 5–84). Main sites involved: abdomen (5), lung (3), bone (3). Surgery was performed with curative intent in 26/28 pts (5 NK), R0 resection in 23. 17/28 pts are alive without disease (16 previously R0-resected). 6/28 are alive with disease, 5 died due to MRCL. Relapse after R0 resection occurred after a mn of 24 mo (range, 5–84). Radiotherapy was used in 15/28 (5NK) with neoadjuvant (1), adjuvant (13) or palliative (3) intent (total doses 50–66 Gy). Chemotherapy (CT) was given in palliative (11) or neoadjuvant (1) fashion, after a mn of 1.3 surgical interventions (range, 0–3). 1st-line CT: doxorubicin- based combinations (7), single-agent doxorubicin (3), ET-743 (1). Best response: PR (5), NC (4), PD (1), NE (1). Mn duration of response was 6.3 mo (range, 1–15). 2nd-line CT: ET-743 (3), other agents (4). Best response: CR (1), PR (1), NC (3), PD (1), NE (1), with mn response duration of 7 mo (range, 1–13). 2 had further CT (PR 1, SD 1). Conclusions: MRCL is a chemosensitive sarcoma with variable clinical course. Local treatment can be curative, but systemic spread is frequent. Pts may respond to conventional CT or new agents such as ET-743. To evaluate the relative value of systemic treatment we need randomized trials in this unique clinical setting.

No significant financial relationships to disclose.

AZD2171 in combination with various anticancer regimens: Follow-up results of a phase I multi-cohort study

3544

Background: AZD2171 is an oral, highly potent and selective inhibitor of VEGF signaling. Recent trials have shown that combining a VEGF signaling inhibitor with certain chemotherapies provides clinical benefit in patients with breast, colorectal and non-small-cell lung cancers. AZD2171 was evaluated with various anticancer regimens in heavily pretreated patients with advanced solid tumors. Methods: Once-daily oral AZD2171 20 mg, 30 mg and 45 mg was given in combination with: (1) mFOLFOX6 every 2 weeks; (2) docetaxel 75 mg/m2 every 3 weeks; (3A) irinotecan 300 mg/m2 every 3 weeks; (3B) irinotecan as in 3A + cetuximab (400 mg/m2 loading dose, followed by 250 mg/m2 every week); or (4) pemetrexed 500 mg/m2 every 3 weeks. The novel study design allowed simultaneous evaluation of the safety and tolerability of these regimens with AZD2171. Secondary objectives include preliminary evaluation of potential pharmacokinetic (PK) interactions and efficacy (RECIST). Results: As of Nov 2006, 54 patients were evaluable for safety ( Table ). No unexpected toxicities were observed, and the safety profile of AZD2171 was similar to that observed in single-agent AZD2171 studies. Across all five treatment arms, common adverse events irrespective of causality included fatigue (n=46), diarrhea (n=45) and hypertension (n=21). Efficacy data were available for 39 patients, 24 of which were evaluable according to RECIST. A best overall objective tumor response of partial response (n=3) or stable disease (n=19) was observed ( Table ). AZD2171 did not appear to have a major effect on the PK profile of oxaliplatin, 5-FU, pemetrexed, irinotecan [SN38] and docetaxel. Steady-state PK parameter values of AZD2171 in this study are comparable with single-agent AZD2171 studies. Conclusion: In this group of heavily pretreated patients, combination treatment with AZD2171 and various anticancer regimens has been generally well tolerated, with no apparent PK interaction and encouraging preliminary evidence of antitumor activity.

[Table: see text]

No significant financial relationships to disclose.

Radiation pneumonitis (RP) in lung cancer patients treated with chemotherapy (CT) and thoracic radiation (TR): Retrospective analyses of patients treated at a comprehensive cancer center

19642

Background: Combined CT and TR is the current standard for locally advanced non-small cell lung cancer (NSCLC) and SCLC. Severe RP, an important adverse effect of TR, is reported in clinical trials to occur in 10% of patients receiving CT and TR. The rate in routine care may be higher as patients are not selected based on lung function. We conducted a retrospective study to assess the incidence of RP in lung cancer patients treated with CT and TR. Methods: Retrospective identification of patients who underwent combined modality therapy (concurrent or sequential CT and TR) for lung cancer (NSCLC & SCLC) at our cancer center between January 2001 and December 2004. Demographic features, RP incidence and grade (RTOG criteria), hospitalization rate and overall survival (OS) were assessed. Results: 51 patients who met the selection criteria were analyzed. The demographic features were - males 61%; Caucasians - 53%; African Americans - 39%; history of pulmonary disorder - 45%; NSCLC - 82%; CT - 62% received Cisplatin/Etoposide, while 24% received Carboplatin/Paclitaxel; 92% received concurrent CT and TR. The median dose of TR was 5940 cGy. 20 patients (39%) developed RP; 13 (25%) had grade = 3 RP. Median time to development of RP was 4.4 months. Rate of RP in females and males was 50% vs. 32% (p=0.25). Rate of RP in patients with pulmonary disorder at baseline was 52% vs. 29% in others (p=0.15). 1 year hospitalization rate was 75% and 42% in RP and non-RP patients (p=0.025). For all 51 patients, the median overall survival (OS) was 16.4 months (95% CI 11.8 - 23.3). Length of OS did not differ significantly (p = 0.36) between the 20 patients who had RP vs. the 31 who had no RP (median OS: 22.2 vs. 14.5 months, respectively). Conclusions: The RP rate in these 51 lung cancer patients treated off- protocol with CT and TR is higher than that reported in clinical trials. Despite higher morbidity in patients with RP (i.e., increased hospitalization), survival duration did not differ significantly based on RP status.

No significant financial relationships to disclose.

Tyrosine kinases as possible therapeutic targets in pulmonary artery intimal sarcoma

10055

Background: Pulmonary artery intimal sarcomas (PAIS) are very rare, highly malignant and clinically aggressive tumors, with yet elusive underlying pathogenic mechanisms and histogenesis. Our aim was to gain molecular insight in the oncogenic events leading to PAIS development, and to investigate the possibility of a pharmacological approach for the treatment of PAIS, specifically targeting the receptor tyrosine kinases (RTK) activated in these tumors. Methods: Fourteen cases of advanced high grade poorly differentiated PAIS were analyzed by immunohistochemistry and selectively by a variety of cytogenetic/molecular techniques, e.g. karyotyping, FISH, mRNA in situ hybridization, array-CGH, tyrosine kinases RT-PCR assay and Western blotting analysis. The study was supplemented by sequencing of PDGFRA, PDGFRB, KIT, VEGFR-1, VEGFR-2 and EGFR genes. Ex vivo functional assays were applied to test the sensitivity of PAIS primary tumor cells to different, clinically approved RTK inhibitors. Results: We demonstrate that (1) PAIS do not have mutations within the kinase domains of PDGFRs, KIT, VEGFRs or EGFR, (2) all cases show a similar cytogenetic molecular profile, characterized by amplification of PDGFRA/KIT/VEGFR2 and MDM2/CDK4 genes, while EGFR, PDGFRB and VEGFR1 are frequently polysomic but rarely highly amplified, (3) high level of expression of PDGFRA, VEGFR1/VEGFR2 and EGFR is uniformly present in the tested tumors, (4) PAIS demonstrate activation (phosphorylation) of PDGFRA and downstream PI3K-AKT and MAP-Kinase signaling pathways, (4) in ex vivo assays, a potent effect of BMS354825 on proliferation and survival of primary cells of PAIS is proven. Conclusions: PDGFRA is amplified and activated in PAIS, thus constituting one of many possible targets for the therapy. Tested inhibitors showed differential efficacy for inhibition of PAIS cells by ex vivo assays.

No significant financial relationships to disclose.

The effect of whole-body cryostimulation on lysosomal enzyme activity in kayakers during training

Effects of whole-body cryostimulation on lysosomal enzyme activity: acid phosphatase (AcP), arylsulphatase (ASA) and cathepsin D (CTS D), as well as on the creatine kinase (CK), and the cortisol concentration in the serum of kayakers during training were studied. Additionally, the effect of a single cryostimulation treatment in untrained men was evaluated. The kayakers were subjected to a ten-day training cycle, in which training sessions were preceded by whole-body cryostimulation at a temperature ranging from -120 to -140 degrees C, and to a control training without cryostimulation. Blood samples were taken from the kayakers before the training and after the sixth and tenth day of training and from untrained men before and after cryostimulation. The single cryostimulation caused a 30% (P < 0.05) decrease in the CK activity in untrained men. After the sixth day of training with cryostimulation, the activity of ASA was 46% (P < 0.001), AcP 32% (P < 0.05) and CK 34% lower (P < 0.05) than after the sixth day of training without cryostimulation. The results support that preceding training with whole-body cryostimulation alleviates exertion stress by a stabilisation of lysosomal membranes.

Expression of the carotenoid biosynthesis genes in Xanthophyllomyces dendrorhous

In the yeast Xanthophyllomyces dendrorhous the genes idi, crtE, crtYB, crtl and ast are involved in the biosynthesis of astaxanthin from isopentenyl pyrophosphate. The carotenoid production and the kinetics of mRNA expression of structural genes controlling the carotenogenesis in a wild-type ATCC 24230 and in carotenoid overproducer deregulated atxS2 strains were studied. The biosynthesis of carotenoid was induced at the late exponential growth phase in both strains. However, the cellular carotenoid concentration was four times higher in atxS2 than in the wild-type strain in the exponential growth phase, suggesting that carotenogenesis was deregulated in atxS2 at the beginning of growth. In addition, the maximum expression of the carotenogenesis genes at the mRNA level was observed during the induction period of carotenoid biosynthesis in the wild-type strain. The mRNA level of the crtYB, crtl, ast genes and to a lesser extent the idi gene, decayed at the end of the exponential growth phase. The mRNA levels of the crtE gene remained high along the whole growth curve of the yeast. In the atxS2 strain the mRNA levels of crtE gene were about two times higher than the wild-type strain in the early phase of the growth cycle.

Minimally-invasive treatment of intra-articular fractures of the calcaneum

We describe the results of 287 intra-articular fractures of the calcaneum in 247 patients treated by minimally-invasive reduction and K-wire fixation between 1994 and 2003. There were 210 men (85%) and 37 women (15%). The most common cause of injury was a fall from a height in 237 patients (96%). Fracture classification was based on the method described by Sanders and Essex-Lopresti. All patients were operated on within 21 days of injury and 89% (220) within 48 hours. The reduction was graded as nearly anatomical (less than 2 mm residual articular displacement and satisfactory overall alignment) in 212 (73.9%) fractures.

There were 20 cases (7%) of superficial pin-track infection and five (1.7%) of deep infection. All healed at a mean of 6 weeks (3 to 19). Loss of reduction was observed in 13 fractures (4.5%) and a musculocutaneous flap was needed in three (1%).

The results were evaluated in 176 patients (205 fractures) with a mean age of 44.3 years (13 to 67), available for follow-up at a mean of 43.4 months (25 to 87) using the Creighton-Nebraska Health Foundation Assessment score. The mean score was 83.9 points (63 to 100). There were 29 (16.5%) excellent, 98 (55.7%) good, 26 (14.8%) fair and 23 (13%) poor results. A total of 130 patients (73.9%) were able to return to their original occupation at a mean of 5.6 months (3.2 to 12.5) after the injury.

Semi-open reduction and percutaneous fixation is an effective treatment for displaced intra-articular fractures of the calcaneum.

Phase II trial of imatinib maintenance therapy after irinotecan and cisplatin in patients with c-kit positive extensive-stage small cell lung cancer (ES SCLC)

17089

Background: The prognosis for patients (pts) with ES SCLC is poor, with a median survival of 9 mo. This trial was designed to evaluate the efficacy and toxicity of cisplatin plus irinotecan followed by maintenance imatinib (Gleevec) in pts with c-kit positive ES SCLC. Methods: Immunohistochemistry for c-kit was performed on paraffin-embedded tissue prior to enrollment. Treatment consisted of irinotecan 65 mg/m2 IV on days 1 and 8 plus cisplatin 60 mg/m2 IV on day 1 repeated every 21 days for 4 cycles. If no evidence of disease progression was identified, Gleevec was given at 400 mg orally BID until disease progression or unacceptable toxicity. Results: 14 pts have been enrolled: median age 61 yrs (range 47–73); 9 men: 5 women; PS 0/1/2 = 3/10/1. 6 pts did not begin Gleevec due to disease progression (4), persistent grade 3 emesis (1), and referral for radiation therapy (1). 8 pts had a PR with cisplatin/irinotecan and received Gleevec. Median number of wks on Gleevec was 6.1 (range 4.6–25.1). Reasons for discontinuation of Gleevec were disease progression (7) and persistent neutropenia (1). Median progression-free survival was 4.7 mo. (range 0.7–16.3) for all pts and 5.5 mo. (range 4.7–16.3) for pts receiving Gleevec. There were no objective responses to Gleevec, but 3 pts (21%) had stable disease for 12, 15 and 25 wks. Median survival was 8.1 mo. (range 3.7–19.6) for all pts and 10.0 mo. (range 7.1–19.6) for those receiving Gleevec. Myelosuppression was mild (grade 1–2 ANC 13%, anemia 76%, platelets 13%) with one pt with grade 3 neutropenia. Non-heme toxicity included grade 1–2 nausea 76%, diarrhea 51% and peripheral edema 75%. Conclusions: Gleevec did not appear to maintain disease stability after response to chemotherapy in the majority of pts despite c-kit tumor positivity. Although disease stability with Gleevec was noted in 3 pts (12–25 wks) and therapy was well tolerated, this approach does not appear to warrant further clinical study. Supported by Novartis Pharmaceuticals.

No significant financial relationships to disclose.

Dual blockade of epidermal growth factor receptor (EGFR) and cyclooxygenase 2 (COX 2) may be dependent upon the EGFR mutational status in non-small cell lung cancer (NSCLC) cell lines

7170

Background: Recent data has shown that the benefit of EGFR TKIs (tyrosine kinase inhibitors) in NSCLC is in patients with tumors that have EGFR mutations and /or gene amplification. Even among these patients, the median survival with EGFR TKIs is only 22 months. Pre-clinical data has shown that dual blockade of EGFR and COX 2 pathways may be beneficial. A recent clinical trial conducted at our center suggested that this combination primarily impacted NSCLC tumors that have the EGFR biomarkers. We therefore hypothesized that the EGFR biomarker status determines the outcome of dual blockade of these pathways in NSCLC. Methods: Three different cell lines with varying biomarker status and sensitivities to EGFR TKIs were used- H3255 (L858R; gene amplified), H1650 (del E746-A750; gene amplified), H1781 (wild type). Cells were treated with erlotinib, EGFR TKI- 10nM-100nM or celecoxib, COX 2 inhibitor- 5 μM and with the combination of two drugs. Cell survival was determined by a standard MTT assay and apoptosis was measured by ELISA method. Western blot analysis was conducted to assess COX 2, EGFR and pAkt levels. Results: Celecoxib by itself had no effects on any of the cell lines. Erlotinib showed a concentration dependent growth inhibition of both H3255 (IC50–41.72nM; surviving fraction at 50nM was 52%) and H1650 (IC50 > 100nM; Surviving fraction at 50nM was 70%) but had no effect on H1781. Celecoxib added to erlotinib significantly enhanced the growth inhibition of H3255 (p = 0.001) and H1650 (p = 0.014) as well as apoptosis (H3255- p = 0.016; H1650- p = 0.011) at all concentrations of erlotinib but had no effect in H1781 cells. In western Blot analysis the combination significantly reduced levels of COX-2, EGFR and pAkt compared to baseline and either agent alone in H3255 cells. Conclusions: The addition of celecoxib to erlotinib has a differential effect in NSCLC cell lines based on their EGFR biomarker status. This beneficial effect of celecoxib addition may be through improved inhibition of each pathway.

[Table: see text]

Phase I evaluation of AZD2171, a highly potent and selective inhibitor of VEGFR signaling, in combination with selected chemotherapy regimens in patients with advanced solid tumors

3034

Background: AZD2171 is an oral, potent, selective inhibitor of vascular endothelial growth factor receptor (VEGFR). Trials have demonstrated that inhibition of the VEGF pathway, in combination with certain chemotherapy, provides benefit to patients with a broad range of solid tumors. Methods: This Phase I trial was conducted in heavily pretreated solid tumor patients. In a single protocol, escalating doses of AZD2171 were evaluated (20, 30 and 45 mg) in combination with four separate chemotherapy regimens: mFOLFOX6 (oxaliplatin 85 mg/m2; 5-FU 400 mg/m2; leucovorin 400 mg/m2 q2 weeks; Arm 1); irinotecan 300 mg/m2 q3 week (Arm 2); docetaxel 75 mg/m2 (Arm 3) and pemetrexed 500 mg/m2 (Arm 4). The primary objective was to evaluate safety and tolerability of the combinations and secondary objective to evaluate pharmacokinetic (PK) interaction and clinical efficacy. Maximum tolerated dose (MTD) toxicity was defined through two cycles. Results: 46 patients have been enrolled: 28/35 evaluable for efficacy/toxicity. The MTD has been reached in two arms: Arm 2 - 20 mg AZD2171 and Arm 4 - 30 mg AZD2171. Arm 3 enrollment continues at 45 mg AZD2171. Two dose-limiting toxicities (DLTs) were observed in eight patients at 30 mg AZD2171 in Arm 1. Enrollment of an additional cohort of less heavily pre-treated patients is ongoing to determine the tolerability of 30 mg AZD2171 with FOLFOX. DLTs have included grade 3 fatigue in Arms 1, 2 & 4; grade 3 diarrhea in Arm 1; grade 3 hand-foot syndrome & grade 4 neutropenic fever in Arm 2; and grade 3 hypertension in Arm 4. AZD2171 did not appear to have a major effect on the PK profile of any chemotherapy regimen tested. Steady-state values are comparable with AZD2171 monotherapy. There have been 13 responses (minor response, n=5; partial response, n=6; complete response, n=2; stable disease ≥ 4 cycles, n=6) in heavily pretreated patients, some having demonstrated resistance to identical chemotherapies. Duration of response has been impressive (4-22+ cycles). Conclusions: AZD2171 combinations have been well tolerated with expected toxicities and encouraging responses.

[Table: see text]

Scaffold Seeded With Cells Is Essential in Urothelium Regeneration and Tissue Remodeling In Vivo After Bladder Augmentation Using in Vitro Engineered Graft

OBJECTIVE

Tissue-engineering methods using synthetic biodegradable scaffolds seeded with cells have potential to induce regeneration to a functional bladder wall. The aim of the study was to induce in vivo urothelial growth on implanted scaffolds previously seeded with stromal cells as compared with matrices implanted without cells for rat cystoplasty augmentation.

MATERIALS AND METHODS

3T3 mouse fibroblasts were multiplied up to total of 10(8) cells. Cells were grown on Dulbecco's modified essential medium supplemented with 10% of fetal bovine serum and antibiotics in CO(2) chambers. Cells were seeded on biodegradable polyglycolic acid (PGA) scaffolds in eight rats: four bladders were augmented with cell-seeded grafts and the other four with acellular scaffolds. Rats were sacrificed after 4 months in preparation for hematoxylin and eosin staining.

RESULTS

One death in the acellular cystoplasty group was observed after 3 weeks. No epithelial layer was observed in the central part of the acellular graft. The cell-seeded grafts showed good visible multilayered epithelium with at least five layers of epithelial cells in the central part. The epithelium resembled rat native urothelium. The cell-seeded grafts showed a high degree of implanted 3T3 cells infiltration with good degradation of PGA fibers.

CONCLUSIONS

Our data indicated that urothelial proliferation on PGA grafts was intensified using a "feeder layer" of fibroblasts.

Activity of cathepsin D and alpha(1)-antitrypsin in the blood serum of patients with mammary carcinoma

THE AIM of this study was to determine the activity of cathepsin D and alpha(1)-antitrypsin in the blood serum of patients with mammary carcinoma.

PATIENTS AND METHODS

The study was conducted on 52 women operated for a unilateral breast tumor, divided into two groups, according to the number of metastases and tumor size. Cathepsin D activity was determined using the method of Anson, while alpha(1)-antitrypsin activity was determined according to the Eriksson method.

RESULTS

Both groups of patients with mammary carcinoma were found to have higher activity of cathepsin D before the treatment compared to healthy females. After the surgery the enzyme activity increased significantly, whereas 6 months after the surgery it generally decreased. The activity of alpha(1)-antitrypsin was significantly lower in patients before the treatment than in the controls, while after 6 months an increase in alpha(1)-antitrypsin activity was observed. The correlation between activity of cathepsin D and alpha(1)-antitrypsin was revealed. High enzyme activity and low alpha(1)-antitrypsin activity may result from the stage of neoplastic transformation.

CONCLUSION

The determination of cathepsin D activity together with alpha(1)-antitrypsin activity may serve as useful biochemical marker in monitoring of malignant changes in breast tumor.

Kidney Preserving Solutions Containing Lidocaine May Increase Urological Complication Rate After Renal Transplantation: An In Vitro Study

OBJECTIVE

The frequency of urological complications after renal transplantation is up to 12%. Some authors consider that lidocaine addition to preservation solutions produces a favorable influence on allograft function. However, lidocaine may influence urinary tract epithelial cells. The aim of this work was to establish the influence of lidocaine on cultured primary rabbit urothelial cells (PRUC) as a tool to understand mechanisms of urological complications after kidney transplantation.

DESIGN AND METHODS

A PRUC culture was established from an 8-month-old male rabbit bladder. The cells were cultured alone and then with in various concentrations of lidocaine for 24 hours or 1 hour. After an additional 24 hours, cell viability was assessed by the trypan blue exclusion test. Student's t test was used for statistical analysis, with significance set at P < .05.

RESULTS

The cytotoxic effects of lidocaine on PRUC were concentration dependent. One-hour exposure of PRUC culture to 0.5 or 1.0% lidocaine decreased cell viability. Both lidocaine concentrations decreased cell viability in PRUC culture after a 24-hour incubation; even 0.25% lidocaine caused changes in the PRUC culture morphology after a 1-hour incubation. Cells became rounded and detached from the growth surface. No cells were observed in the monolayer after 1-hour incubation with 1% of lidocaine.

CONCLUSIONS

The toxic effects of lidocaine on PRUC may forecast problems with supplementation of kidney preservation solutions, leading to impaired epithelial layer healing with an increased risk of urological complications.