Abstract 4769: Inhibition of ribosomal protein L9 expression suppresses colorectal carcinoma cell growth in vitro and in vivo

Background: Ribosomal protein L9 (RPL9), a component of the 60S subunit, is upregulated in human colorectal cancer (CRC). We thus hypothesized if targeting of RPL9 with small interfering (si) RNA could inhibit CRC progression. We also investigated molecular mechanism to mediate CRC cell death caused by RPL9 silencing. Methods: HCT116 and HT29 human CRC cells were transfected with RPL9 siRNA and tested for growth inhibition and apoptotic induction using MTS, FACS and microscopic analysis. To obtain insights into the molecular changes in response to RPL9 knockdown, global changes in gene expression were examined using RNA sequencing. Results: RPL9 silencing caused inhibition of CRC cell growth through induction of apoptotic cell death. RNA sequencing revealed that RPL9-specific knockdown led to dysregulation of 622 genes in HCT116 and 2882 genes in HT29 cells. Among those, 256 genes showed the same directional regulation (128 up- and 168 down-regulated genes), including up-regulation of tumor suppressors such as KLF6 and ATF3, and were considered as a common RPL9 knockdown signature. Western blotting proved that downregulation of RPL9 was accompanied with the decrease in the levels of PARP-1 and pro-caspase 3 delaying cell cycle progression and accelerating apoptotic signaling. Of importance, targeting RPL9 significantly inhibited CRC growth in a murine xenograft model. Conclusion: These results suggest that inhibition of RPL9 expression could be an attractive option for molecular targeted therapy of colorectal cancer.

Citation Format: In Hye Baik, Keon Uk Park, Ilseon Hwang, Hun-Mo Ryoo, Yun-Han Lee. Inhibition of ribosomal protein L9 expression suppresses colorectal carcinoma cell growth in vitro and in vivo. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4769.

Evaluation of Changes in New Calculated Panel Reactive Antibody Adopting HLA-Cw, DR51/52/53, and DQ Antigens in Koreans

BACKGROUND

Calculated panel reactive antibody (cPRA) (%) is percentage of donors that would be incompatible with the candidate, based on the candidate's unacceptable HLA antigens. cPRA based on antigen frequencies of HLA-A, B, and DR has been used in Korea. We developed new cPRA including HLA-Cw, DR51/52/53, and DQ. Changes in new-cPRA were evaluated.

METHODS

We analyzed the differences between cPRA based on HLA-A, -B, and -DR antigens (old-cPRA) from cPRA based on HLA-A, -B, -Cw, -DR, -DR51/52/53, and -DQ antigens (new-cPRA) on 125 waitlisted candidates for renal transplantation in Seoul National University Hospital. cPRA for unacceptable antigens was calculated according to 3 different cut-off values (MFI <1000, 3000, and 10000 for cPRAw, cPRAm, and cPRAs, respectively).

RESULTS

For HLA class I, cPRAw and cPRAm were significantly increased in new-cPRA compared to old-cPRA (median 78.3% vs 71.7%, P < .001; 34.0% vs 23.5%, P = .029, respectively). For HLA class II, cPRAw, cPRAm, and cPRAs were significantly increased in new-cPRA compared to old-cPRA (median 86.8% vs 42.6%; 58.0% vs 0.0%; 0.0% vs 0.0%, P < .001 for all).

CONCLUSIONS

cPRA (%) including HLA-Cw, -DR51/52/53, and -DQ showed remarkable increase, especially in HLA class II antigens. The meaning of this should be carefully interpreted through further studies considering clinical outcomes.

Comparison of the therapeutic effects of total laryngectomy and a larynx-preservation approach in patients with T4a laryngeal cancer and thyroid cartilage invasion: A multicenter retrospective review

BACKGROUND

In T4a laryngeal cancer with thyroid cartilage invasion, no optimal frontline treatment has yet been defined in controlled trials.

METHODS

We reviewed data from 89 patients with T4a laryngeal cancer featuring thyroid cartilage invasion who were treated initially with either total laryngectomy (n = 53) or a larynx-preservation strategy (n = 36).

RESULTS

The median progression-free survival (PFS) of the total laryngectomy group had not been attained at the time of analysis and was thus significantly longer than that of the larynx-preservation group (8.7 months). The median overall survival (OS) of patients who underwent total laryngectomy was 87.2 months, significantly longer than that of the larynx-preservation group (31.3 months). The survival benefit of primary surgery compared to a larynx-preservation strategy was more striking in patients of lower N classifications.

CONCLUSION

Total laryngectomy may be a better therapeutic option to treat T4a laryngeal cancer featuring thyroid cartilage invasion, especially in patients exhibiting limited nodal involvement (N0/N1). © 2016 Wiley Periodicals, Inc. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1271-1277, 2016.

Cytokine-release kinetics of platelet-rich plasma according to various activation protocols

Objectives

This study was conducted to evaluate the cytokine-release kinetics of platelet-rich plasma (PRP) according to different activation protocols.

Methods

Two manual preparation procedures (single-spin (SS) at 900 g for five minutes; double-spin (DS) at 900 g for five minutes and then 1500 g for 15 minutes) were performed for each of 14 healthy subjects. Both preparations were tested for platelet activation by one of three activation protocols: no activation, activation with calcium (Ca) only, or calcium with a low dose (50 IU per 1 ml PRP) of thrombin. Each preparation was divided into four aliquots and incubated for one hour, 24 hours, 72 hours, and seven days. The cytokine-release kinetics were evaluated by assessing PDGF, TGF, VEGF, FGF, IL-1, and MMP-9 concentrations with bead-based sandwich immunoassay.

Results

The concentration of cytokine released from PRP varied over time and was influenced by various activation protocols. Ca-only activation had a significant effect on the DS PRPs (where the VEGF, FGF, and IL-1 concentrations were sustained) while Ca/thrombin activation had effects on both SS and DS PRPs (where the PDGF and VEGF concentrations were sustained and the TGF and FGF concentrations were short). The IL-1 content showed a significant increase with Ca-only or Ca/thrombin activation while these activations did not increase the MMP-9 concentration.

Conclusion

The SS and DS methods differed in their effect on cytokine release, and this effect varied among the cytokines analysed. In addition, low dose of thrombin/calcium activation increased the overall cytokine release of the PRP preparations over seven days, relative to that with a calcium-only supplement or non-activation.

Cite this article: Professor J. H. Oh. Cytokine-release kinetics of platelet-rich plasma according to various activation protocols. Bone Joint Res 2016;5:37–45. DOI: 10.1302/2046-3758.52.2000540

Exome sequencing reveals recurrent REV3L mutations in cisplatin-resistant squamous cell carcinoma of head and neck

Dacomitinib, an irreversible pan-HER inhibitor, had shown modest clinical activity in squamous cell carcinoma of head and neck (SCCHN) patients. Therefore, validated predictive biomarkers are required to identify patients most likely to benefit from this therapeutic option. To characterize the genetic landscape of cisplatin-treated SCCHN genomes and identify potential predictive biomarkers for dacomitinib sensitivity, we performed whole exome sequencing on 18 cisplatin-resistant metastatic SCCHN tumors and their matched germline DNA. Platinum-based chemotherapy elevated the mutation rates of SCCHN compared to chemotherapy-naïve SCCHNs. Cisplatin-treated SCCHN genomes uniquely exhibited a novel mutational signature characterized by C:G to A:T transversions at CCR sequence contexts that may have arisen due to error-prone translesional synthesis. Somatic mutations in REV3L, the gene encoding the catalytic subunit of DNA polymerase ζ involved in translesional synthesis, are significantly enriched in a subset of patients who derived extended clinical benefit to dacomitinib (P = 0.04). Functional assays showed that loss-of-function of REV3L dramatically enhanced the sensitivity of SCCHN cells to dacomitinib by the loss of both translesion synthesis and homologous recombination pathways. Our data suggest that the ‘platinum’ mutational signature and inactivation of REV3L may inform treatment options in patients of recurrent SCCHN.

Ramosetron Versus Ondansetron in Combination With Aprepitant and Dexamethasone for the Prevention of Highly Emetogenic Chemotherapy-Induced Nausea and Vomiting: A Multicenter, Randomized Phase III Trial, KCSG PC10-21

BACKGROUND

A combination of serotonin receptor (5-hydroxytryptamine receptor type 3) antagonists, NK-1 receptor antagonist, and steroid improves the complete response (CR) of chemotherapy-induced nausea and vomiting (CINV) in cancer patients. Ramosetron's efficacy in this triple combination regimen has not been investigated. This prospective, multicenter, single-blind, randomized, phase III study compares a combination of ramosetron, aprepitant, and dexamethasone (RAD) with a combination of ondansetron, aprepitant, and dexamethasone (OAD) to prove the noninferiority of RAD in controlling highly emetogenic CINV.

METHODS

Aprepitant and dexamethasone were orally administered for both arms. Ramosetron and ondansetron were intravenously given to the RAD and OAD groups. The primary endpoint was no vomiting and retching and no need for rescue medication during the acute period (day 1); the noninferiority margin was -15%.

RESULTS

A total of 299 modified intention-to-treat cancer patients who received RAD (144 patients) and OAD (155 patients) were eligible for the efficacy analysis. The CR rates of RAD versus OAD were 97.2% versus 93.6% during the acute period, 77.8% versus 73.6% during the delayed period (day 2-5), and 77.1% versus 71.6% during the overall period. Furthermore, RAD was noninferior to OAD in subgroups stratified by age, cancer type, chemotherapeutic agents, and schedule. Repeated measures analysis showed that in male patients, RAD was superior to OAD. Profiles of adverse events were similar in both groups.

CONCLUSION

RAD is as effective and tolerable as OAD for CINV prevention in patients receiving highly emetogenic chemotherapy. Ramosetron could be considered one of the best partners for aprepitant.

Anti-angiotensin type 1 receptor antibodies associated with antibody-mediated rejection in patients without preformed HLA-donor-specific antibody

INTRODUCTION

Angiotensin II is a peptide hormone involved in the renin-angiotensin system (RAS). Anti-angiotensin receptor 1 (AT1R) antibodies are implicated in stimulating RAS and are suspected to have some adverse impacts on renal transplantation outcome.

METHODS

From November 2009 to February 2012, 37 remaining sera from renal transplantation recipients with biopsy-proven antibody-mediated rejection (AMR) (n = 6), acute cellular rejection (ACR) (n = 23), and AMR + ACR (n = 8) without preformed human leukocyte antigeon (HLA) antibodies were tested with anti-AT1R antibody assay. Forty-two control patients without rejection also were analyzed.

RESULTS

The frequency of elevated anti-AT1R antibodies was higher in patients with AMR (n = 14) compared to controls (28.6% vs 4.9%, P = .03, OR = 8.0). It was also higher in patients with AMR + ACR (n=8) (37.5% vs 4.9%, P = .03, OR = 12.0). There was no difference in frequencies of elevated anti-AT1R antibody in patients with ACR.

CONCLUSION

Anti-AT1R antibodies were suspected to be associated with occurrence of AMR without preformed HLA antibodies in renal transplantation. Further studies in a larger number of patients are needed.

A Muti-center, Randomized Phase II Study of Oxaliplatin and S-1 versus Capecitabine and Oxaliplatin in Patients with Metastatic Colorectal Cancer

Background: Capecitabine plus oxaliplatin (XELOX) is considered one of the primary chemotherapy regimens for patients with metastatic colorectal cancer (CRC). Oxaliplatin plus S-1 (OS) has also demonstrated significant efficacy in CRC. We performed this randomized phase II study to evaluate the efficacy and toxicity of XELOX versus OS as first-line chemotherapy in patients with metastatic CRC.

Methods: Patients were assigned randomly to receive either OS or XELOX chemotherapy. Oxaliplatin was administered intravenously to all patients at a dose of 130 mg/m² on day 1. Patients received either S-1 (40 mg/m²) or capecitabine (1,000 mg/m²), twice a day for 2 weeks, followed by a 1-week rest.

Results: Forty-two patients were assigned to the OS arm and 44 to the XELOX arm. The overall response rate was 33.3% (95% CI, 18.8-47.2) in the OS arm and 40.9% (95% CI, 25.5-54.4) in the XELOX arm (P = 0.230). The disease control rate was significantly higher in the OS arm than the XELOX arm [92.9% (95% CI, 83.7-100) versus 77.3% (95% CI, 64.5-89.4), P = 0.044]. With a median follow up of 17.9 months, the median progression-free survival was 6.1 months in the OS arm and 7.4 months in the XELOX arm, respectively (P = 0. 599). The median survival time was 18.7 months in the OS arm and 20.1 months in the XELOX arm (P = 0.340). The most common grade 3/4 hematologic toxicity was thrombocytopenia in both arms (19.0% for OS and 28.6% for XELOX). Grade 3/4 neutropenia was observed more frequently in the XELOX arm than the OS arm (16.7% vs. 2.4%, P = 0.026).

Conclusion: Both OS and XELOX were effective and well tolerated in patients with metastatic CRC. Our results indicate that the combination of oxaliplatin and S-1 is a possible additional therapeutic strategy for such patients.

Abstract 4189: Analgesic effect of quetiapine on the cancer induced bone pain animal model

Background: Cancer induced bone pain is one of the most common pain in patients with advanced cancer. Because of treatment associated side effects, it has been reported that more than half of cancer patients have inadequate and undermanaged pain control. Therefore, new mechanism-based therapies need to be developed to reduce cancer pain. Quetiapine is a commonly used atypical antipsychotic drug that has superior therapeutic effects in patients with schizophrenia and other neurological disorders like depression. We reported that a study of anti-inflammatory effect of quetiapine on collagen induced arthritis mouse model. Now we focused on the potential analgesic effects of quetiapine on the cancer induced bone pain (CIBP) animal model and the mechanism of bone pain evaluated by various nociceptors expression.

Methods: Fifteen male C3H/HeN mice were randomly divided into five groups: Control, CIBP, CIBP + quetiapine treatment, CIBP + opioid treatment and CIBP + melatonin treatment. Treatments were started when mouse showed positive signs of bone tumor until the day 28, according to the protocol, daily for 12 days. Pain thresholds of CIBP mouse model were measured by aesthesiometer for each group. At the end of the treatment period, tissue of mouse tibia were removed and quantitative and qualitative evaluation of TRPV1, TRPV4, ASIC1, ASIC2, and ASIC3 expression were done.

Results: The data showed that mouse behavior about pain thresholds was marked improved in CIBP + quetiapine treatment group compared with CIBP group. The expression of TRPV1, TRPV4, ASIC1, ASIC2, and ASIC3 in CIBP + quetiapine treatment group was significantly lower than those in CIBP groups.

Conclusions: These results suggest analgesic effect of quetiapine on CIBP animal model and provide the possibility that TRPV and ASICs could be a potential target of cancer pain management.

Citation Format: Keon Uk Park, Mi Hwa Heo, Jin Young Kim, Ilseon Hwang, Hun Mo Ryoo. Analgesic effect of quetiapine on the cancer induced bone pain animal model. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4189. doi:10.1158/1538-7445.AM2015-4189

Abstract 856: Correlation of prognosis and histologic patterns by the IASLC/ATS/ERS classification in invasive pulmonary adenocarcinoma: A meta-analysis

Background: Invasive pulmonary adenocarcinoma is composed of five histologic patterns including lepidic, papillary, acinar, solid, and micropapillary patterns by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society classification. Many researches for histologic pattern and survival rates were performed, but confirmative relationships of histologic pattern and patient's prognosis are unclear. Methods: We searched PubMed using the keywords “IASLC/ATS/ERS classification” and “International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society”. Review articles and case reports were excluded, and duplicated data, insufficient data, and overlapping articles are also excluded. The pooled analysis was performed with the Comprehensive Meta-analysis Software version 2.0. Results: Lepidic predominant pattern had significantly lower recurrence and expire than acinar, papillary, solid or micropapillary pattern. Acinar or papillary pattern had significantly lower recurrence and expire than solid or micropapillary pattern. Conclusions: Invasive adenocarcinoma with lepidic predominant pattern has better prognosis than that with the other predominant patterns. Acinar and papillary predominant patterns have better prognosis than solid and micropapillary predominant patterns in invasive pulmonary adenocarcinoma. There are no different prognoses between acinar and papillary predominant patterns, and solid and micropapillary predominant patterns of invasive pulmonary adenocarcinoma.

Citation Format: Keon Uk Park, Jin Young Kim, Hun Mo Ryoo, Ilseon Hwang. Correlation of prognosis and histologic patterns by the IASLC/ATS/ERS classification in invasive pulmonary adenocarcinoma: A meta-analysis. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 856. doi:10.1158/1538-7445.AM2015-856

Abstract 3949: Whole exome sequencing of platinum-refractory recurrent or metastatic squamous cell carcinoma of head and neck (R/M-SCCHN) reveals a novel cisplatin mutational signature and REV3L mutation as a molecular predictor for dacomitinib, a p

REV3L, a catalytic subunit of DNA polymerase zeta, is essential for tolerance of DNA damage via error-prone translesion synthesis. The goals of this study were to investigate the mutational landscape and predictive biomarkers of dacomitinib, Pan-ErbB inhibitor, in platinum-pretreated R/M-SCCHN.

Nineteen patients with R/M-SCCHN, who were refractory to platinum-based chemotherapy (18) or considered platinum-intolerant (1), were treated with dacomitinib 45mg/day. For fresh tumor samples taken immediately before treatment, whole exome-sequencing was performed. MuTect and SomaticIndelDetector were used to identify somatic SNVs and indels. For mutation signature analysis, we calculated the frequency of coding SNVs according to the 3 letter-based 96 trinucleotide classification system. Mutational profiles identified were compared with 306 treatment-naïve SCCHN samples from TCGA. MutSig algorithm was used to identify the recurrent mutations.

Tumor genomes were sequenced to a median coverage of 149X and matched normal blood genomes were sequenced as 150bp paired-ends to a coverage of 89X. Overall, we identified 10,289 somatic SNVs and Indels. Compared with 306 TCGA SCCHN, platinum-refractory SCCHN genomes showed higher mutations rates (median 13.2 vs. 5.3 mutations per Mb; P &lt;0.001) and lower Ti/Tv ratios (0.79 vs. 1.27), which were largely attributed to the overrepresentation of C&gt;A transversions. We extracted five distinct mutational signatures each of which represents unique mutational processes operative SCCHN genomes. In addition to the four signatures that have been previously reported in SCCHN (APOBEC, age, ultraviolets, smoking), we identified a novel mutational signature that has not been previously reported. This novel signature is characterized by the prominence of C&gt;A mutations mainly occurring on CpCpA and CpCpG trinucleotide contexts, which is closely associated with the action mechanism of cisplatin. Among 33 recurrent mutations, only REV3L mutation showed significant enrichment in responders (P = 0.0316). Of note, the frequency of REV3L mutations was higher in our data compared with that in TCGA data (21% vs. 3.9%; P = 0.0493), which was supported by the fact that REV3L mutations were not found in pre-cisplatin tumor samples in the same patients. In various in vitro assays, REV3L depletion synergized with dacomitinib to inhibit SCCHN cell growth by arresting cell cycle and inhibiting homologous recombinational repair.

In the whole exome sequencing of cisplatin-refractory SCCHN, we found a novel cisplatin mutational signature, which has not been found in treatment-naïve tumors and therefore may have therapeutic implications. REV3L mutation is a novel molecular predictor for the better efficacy of dacomitinib.

Citation Format: Byoung Chul Cho, Han Sang Kim, Myung-Ju Ahn, Keon Uk Park, Se-Hoon Lee, Hwan Jung Yun, Huang Kie Kyon, Tae-Min Kim, Patrick Tan. Whole exome sequencing of platinum-refractory recurrent or metastatic squamous cell carcinoma of head and neck (R/M-SCCHN) reveals a novel cisplatin mutational signature and REV3L mutation as a molecular predictor for dacomitinib, a p [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3949. doi:10.1158/1538-7445.AM2015-3949

Enhanced delivery of liposomes to lung tumor through targeting interleukin-4 receptor on both tumor cells and tumor endothelial cells

A growing body of evidence suggests that pathological lesions express tissue-specific molecular targets or biomarkers within the tissue. Interleukin-4 receptor (IL-4R) is overexpressed in many types of cancer cells, including lung cancer. Here we investigated the properties of IL-4R-binding peptide-1 (IL4RPep-1), a CRKRLDRNC peptide, and its ability to target the delivery of liposomes to lung tumor. IL4RPep-1 preferentially bound to H226 lung tumor cells which express higher levers of IL-4R compared to H460 lung tumor cells which express less IL-4R. Mutational analysis revealed that C1, R2, and R4 residues of IL4RPep-1 were the key binding determinants. IL4RPep-1-labeled liposomes containing doxorubicin were more efficiently internalized in H226 cells and effectively delivered doxorubicin into the cells compared to unlabeled liposomes. In vivo fluorescence imaging of nude mice subcutaneously xenotransplanted with H226 tumor cells indicated that IL4RPep-1-labeled liposomes accumulate more efficiently in the tumor and inhibit tumor growth more effectively compared to unlabeled liposomes. Interestingly, expression of IL-4R was high in vascular endothelial cells of tumor, while little was detected in vascular endothelial cells of control organs including the liver. IL-4R expression in cultured human vascular endothelial cells was also up-regulated when activated by a pro-inflammatory cytokine tumor necrosis factor-α. Moreover, the up-regulation of IL-4R expression was observed in primary human lung cancer tissues. These results indicate that IL-4R-targeting nanocarriers may be a useful strategy to enhance drug delivery through the recognition of IL-4R in both tumor cells and tumor endothelial cells.

Phase II clinical and exploratory biomarker study of dacomitinib in patients with recurrent and/or metastatic squamous cell carcinoma of head and neck

PURPOSE

The goals of this study were to investigate the clinical activity, safety, and biomarkers of dacomitinib, an irreversible tyrosine kinase inhibitor of EGFR, HER2, and HER4, in recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M-SCCHN).

EXPERIMENTAL DESIGN

Patients were eligible if the diseases were not amenable to curative treatment and had progressed on platinum-based chemotherapy, and were treated with dacomitinib 45 mg/day. The primary endpoint was objective response rate by RECISTv1.1. Exploratory analysis included the characterization of somatic mutation, gene copy number, gene expression, p16(INK4A) expression by IHC, and investigation of their relationship with clinical outcomes.

RESULTS

Forty-eight patients were evaluable for efficacy and toxicity. Ten patients (20.8%) had partial responses and 31 patients (65%) had stable diseases. The median progression-free survival (PFS) and overall survival (OS) were 3.9 months [95% confidence interval (CI), 2.9-5.0] and 6.6 months (95% CI, 5.4-10.3). Adverse events were mostly grade 1-2. Mutations in the PI3K pathway (PIK3CA, PTEN) and high expression of inflammatory cytokines (IL6, IL8, IL1A, IL1B, IL4, and TNF) were significantly associated with shorter PFS (2.9 vs. 4.9 months without mutations, P = 0.013; 2.8 vs. 9.9 months with low expression, P = 0.004). Those harboring PI3K pathway mutations or high inflammatory cytokine expression had shorter median OS (6.1 vs. 12.5 months lacking PI3K pathway mutations and with low inflammatory cytokine expression, P = 0.005).

CONCLUSIONS

Dacomitinib demonstrated clinical efficacy with manageable toxicity in platinum-failed R/M-SCCHN patients. Screening of PI3K pathway mutation and inflammatory cytokine expression may help identify which R/M-SCCHN patients are likely to gain benefit from dacomitinib.

A multicenter phase II study of everolimus in patients with progressive unresectable adenoid cystic carcinoma

Background

The aim of this study was to examine the efficacy and safety of everolimus in patients with progressive unresectable adenoid cystic carcinoma (ACC).

Methods

Histologically confirmed ACC patients with documented disease progression within 12 months prior to the study entry were eligible. Everolimus was given at a dose of 10 mg daily until progression or occurrence of unacceptable toxicities. The primary endpoint was a 4-month progression-free survival (PFS).

Results

A total of 34 patients were enrolled. The 4-month PFS probability was 65.5% (95% one-sided confidence interval [CI], 47.7 to infinity). Median PFS duration was 11.2 months (95% CI, 3.6 to 15.8). Complete or partial response was not achieved. Twenty-seven (79.4%, 95% CI, 63.2 to 89.6) patients showed stable disease (SD). Tumor shrinkage within SD criteria was observed in 15 patients (44.1%) and SD lasting 6 months was observed in 13 patients (38.2%). Four patients had disease progression. Among the 18 patients with both pre- and post-treatment (at 8 weeks) FDG-PET scans available, 8 patients (44.4%) showed a partial metabolic response, defined as a ≥25% reduction in maximum standardized uptake values (SUVmax). The most common adverse events were stomatitis, anemia, asthenia, and leukopenia. No unexpected everolimus related toxicities were reported.

Conclusions

Everolimus showed promising efficacy and good tolerability in progressive unresectable ACC.

Trial registration

ClinicalTrials.gov identifier, NCT01152840

Outbreak among healthy newborns due to a new variant of USA300-related meticillin-resistant Staphylococcus aureus

BACKGROUND

The prevalence of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) is increasing throughout the world and is an important cause of skin and soft tissue infection (SSTI) in children and neonates.

AIM

To describe the successful control of an outbreak caused by a new strain of CA-MRSA in a newborn nursery.

METHODS

The investigation of the outbreak in July 2012 is reported with the control measures taken. Molecular typing of the MRSA isolates was performed.

FINDINGS

An outbreak of SSTI caused by CA-MRSA occurred in a newborn nursery. Six neonates were infected in a one-month period [infection rate: 8.5% (6/71)]. A new variant of CA-MRSA was responsible, which was characterized as USA300-related, Panton-Valentine Leucocidin (PVL) positive, arginine catabolic mobile element (ACME) negative, sequence type 8 (ST8), staphylococcal cassette chromosome mec (SCCmec) type IVa, agr type I and spa type t008. The outbreak among term neonates followed a rapid transmission pattern and was successfully controlled by implementing various outbreak control measures, including universal chlorhexidine bathing.

CONCLUSION

This is the first report of a hospital outbreak caused by a USA300-related CA-MRSA clone in Korea. Early recognition and reinforcement of infection control measures are important in decreasing transmission of CA-MRSA in a hospital setting.

Clinical features and treatment outcomes in patients with mantle cell lymphoma in Korea: Study by the Consortium for Improving Survival of Lymphoma

Background

We investigated the clinical features and treatment outcomes of patients with mantle cell lymphoma (MCL) in Korea.

Methods

We retrospectively analyzed the clinical characteristics and prognosis of 131 patients diagnosed with MCL between January 2004 and December 2009 at 15 medical centers in Korea; all patients received at least 1 chemotherapeutic regimen for MCL.

Results

The median age for the patients was 63 years (range, 26-78 years), and 77.9% were men. A total of 105 patients (80.1%) had stage III or IV MCL at diagnosis. Fifty-two patients (39.7%) were categorized with high- or high-intermediate risk MCL according to the International Prognostic Index (IPI). Eighteen patients (13.7%) were in the high-risk group according to the simplified MCL-IPI (MIPI). The overall incidence of extranodal involvement was 69.5%. The overall incidence of bone marrow and gastrointestinal involvements at diagnosis was 41.2% and 35.1%, respectively. Cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab were used frequently as the first-line treatment (41.2%). With a median follow-up duration of 20.0 months (range, 0.2-77.0 months), the overall survival (OS) at 2 years was 64.7%, while the event-free survival (EFS) was 39.7%. Multivariate analysis showed that the simplified MIPI was significantly associated with OS. However, the use of a rituximab-containing regimen was not associated with OS and EFS.

Conclusion

Similar to results from Western countries, the current study found that simplified MIPI was an important prognostic factor in Korean patients with MCL.

Modified Histologic Classification as a Prognostic Factor in Pulmonary Adenocarcinoma

Background. The histologic pattern of pulmonary adenocarcinoma is highly heterogeneous and considered to be an important prognostic factor. The predominant histologic pattern is emphasized in the 2011 International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society classification, but few studies present a detailed investigation of the histologic changes and prognosis pulmonary adenocarcinoma using resected specimens. Methods. We examined 125 cases of surgically resected pulmonary adenocarcinoma and carefully observed histologic patterns. Invasive adenocarcinoma was divided into 3 groups according to a modified histologic classification system: group 1 had a lepidic or papillary predominant pattern with ≤10% solid or micropapillary pattern; group 2 had an acinar predominant pattern with ≤10% of the solid or micropapillary pattern; and group 3 had a solid or micropapillary predominant pattern, or any predominant pattern with >10% solid or micropapillary pattern. Results. Proportions of predominant lepidic, papillary, acinar, solid, and micropapillary patterns were 11 (9.3%), 8 (6.8%), 54 (45.8%), 38 (32.2%), and 7 (5.9%), respectively. Vague areas between 2 different patterns were frequently observed, which were considered as transitional areas for one pattern to the other pattern (gradual dedifferentiation). Modified histologic classification was significantly associated with disease-free and overall survival rate ( P = .026 and .010, respectively) using the Kaplan–Meier survival test, and an independent prognostic factor ( P = .016) in overall survival using the Cox regression test. Conclusion. Pulmonary adenocarcinoma demonstrates heterogeneous histologic patterns with gradual dedifferentiation, and this modified histologic classification is an important prognostic factor for patients with pulmonary adenocarcinoma.