FRI0392 ADVERSE EVENTS IN PATIENTS WITH OSTEOARTHRITIS TREATED WITH SUBCUTANEOUS TANEZUMAB: A POOLED ANALYSIS OF THE OVERALL POPULATION AND SELECTED SUBGROUPS FROM 3 RANDOMISED PLACEBO-CONTROLLED TRIALS

Background:

Tanezumab, a monoclonal antibody against nerve growth factor (NGF), is in development for the treatment of osteoarthritis (OA).

Objectives:

To assess the effects of gender, age and body mass index (BMI) on the incidence of adverse events (AEs) in patients (pts) treated with subcutaneous (SC) tanezumab in pooled data from three phase 3 OA studies. Anti-NGF therapy has been associated with joint safety events1. Here we focus on treatment emergent AEs, including abnormalities of peripheral sensation (APS).

Methods:

All three randomised, double-blind, placebo-controlled studies enrolled pts with radiographically-confirmed OA of the hip or knee, who had inadequate response or could not tolerate standard of care analgesics. In the 16-week (wk) Study 1 (NCT01089725), pts received placebo, tanezumab 2.5 mg, 5 mg or 10 mg at baseline and wk 82. Due to a clinical hold on NGF antibodies, <10% of pts received the 2nddose at wk 8. Pts in the 16-wk Study 2 (NCT02697773), received placebo or tanezumab 2.5 mg at baseline and wk 8 or tanezumab 2.5mg at baseline and 5mg at wk 81. Pts in the 24-wk Study 3 (NCT02709486), received placebo, tanezumab 2.5 mg or 5 mg at baseline, wks 8 and 16. All treatments were given SC. AE data from the treatment period of each study were pooled for placebo, tanezumab 2.5 mg and 5 mg groups and examined by subgroups of gender, age and BMI. Data from the 10 mg group of Study 1 were not included due to the low sample size.

Results:

The incidence of any AE was numerically higher in females across treatment groups and in pts with a BMI ≥30 kg/m2in the tanezumab 5mg, but not 2.5 mg group, vs the overall population (Table 1). SAEs were infrequent but numerically higher across all tanezumab 5 mg subgroups vs placebo (Table 2). Paraesthesia and hypoaesthesia were the most common AEs of APS and were increased in all tanezumab groups in the overall population vs placebo. In any of the subgroups, the incidence of paraesthesia or hypoaesthesia was ≤7.8% and ≤3.9%, respectively. The difference within a patient subgroup for paraesthesia or hypoaesthesia was typically comparable with that of the overall population across treatments.

Table 1.

Incidence of AEs during the treatment period

% of pts with an AE in each subgroupPlacebon=586Tanezumab2.5 mgn=602Tanezumab2.5 mg/5 mg n=219Tanezumab5 mgn=347Overall population51.752.347.054.8Gender Male51.149.741.346.6 Female52.053.650.459.0Age (years) <6555.054.044.054.5 ≥6547.250.052.654.9BMI (kg/m2) <2558.146.651.945.5 25–<3051.455.943.750.0 30–<3549.251.543.258.9 ≥3552.752.355.360.9

BMI, body mass index; kg/m2, kilogram per square metre

Table 2.

Incidence of SAEs during the treatment period

% of pts with a SAE in each subgroupPlacebon=586Tanezumab2.5 mgn=602Tanezumab2.5 mg/5 mg n=219Tanezumab5 mgn=347Overall population1.52.21.42.6Gender Male1.63.01.32.5 Female1.51.71.42.6Age (years) <651.22.61.41.9 ≥652.01.61.33.1BMI (kg/m2) <251.61.102.3 25–<301.62.702.7 30–<351.62.01.43.1 ≥351.32.34.31.6

BMI, body mass index; kg/m2, kilogram per square metre

Conclusion:

This pooled analysis showed that the safety profile of tanezumab in the subgroups studied is broadly similar to that of the overall study population.

References:

[1]Schnitzer, T. J.et al. JAMA(2019)

[2]Birbara, C.et al. J Pain Res(2018)

Disclosure of Interests:

Francis Berenbaum Grant/research support from: TRB Chemedica (through institution), MSD (through institution), Pfizer (through institution), Consultant of: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Bone Therapeutics, Regulaxis, Peptinov, 4P Pharma, Paid instructor for: Sandoz, Speakers bureau: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Sandoz, Alan Kivitz Shareholder of: AbbVie, Amgen, Gilead, GSK, Pfizer Inc, Sanofi, Consultant of: AbbVie, Boehringer Ingelheim,,Flexion, Genzyme, Gilead, Janssen, Novartis, Pfizer Inc, Regeneron, Sanofi, SUN Pharma Advanced Research, UCB, Paid instructor for: Celgene, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, Sanofi, Speakers bureau: AbbVie, Celgene, Flexion, Genzyme, Horizon, Merck, Novartis, Pfizer Inc, Regeneron, Sanofi, Thomas Schnitzer Consultant of: Pfizer, Lilly, AstraZeneca, GSK, Mark Brown Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Sean Donevan Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., Anne Hickman Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Lars Viktrup Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Christine West Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Takaharu Yamabe Shareholder of: Pfizer, Employee of: Pfizer

SAT0361 HEALTHY HUMAN SPINAL PROCESSES PERI-ENTHESEAL T-CELLS EXHIBIT A TR1 RATHER THAN A FOXP3 REGULATORY PHENOTYPE

Background:

We have previously reported that the normal spinal enthesis has populations of conventional T-cells including CD4+ & CD8+ T-cells that could be induced to produce IL-17A and TNF following anti-CD3/CD28 stimulation. The biology of such cells in health including their normal function and antigen reactivity is completely unknown. The purpose of this work was to define the phenotype, functionality and TCR reactivity of such T-cells in health.

Objectives:

To investigate whether the T-cells at the normal enthesis were regulatory in nature and to determine the type of regulatory T-cell as Tr1 or FOXP3 regulatory T-cell and to determine T-cell reactivity.

Methods:

Healthy interspinous ligament and spinous process with matched peripheral blood were harvested from patients undergoing elective spinal surgery (n=20). Entheseal soft tissue (EST) & peri-entheseal bone (PEB) was enzymatically digested and then sorted. Tr1 and Treg phenotypes were investigated using flow cytometry. Analysis of cytokines, growth factors and chemokines was performed by qRT-PCR, ELISA and flow cytometry. TCR sequencing was performed and a search for putative T-cell reactivity was done using TCR3 database.

Results:

Pro-inflammatory cytokine transcripts including IL-17A, IL-17F, IL-22, IL-23 (p19) & TNF were very low or undetectable in the Enthesis T-cells (Fig 1). Flow cytometry confirmed entheseal T-cells had a Tr1 phenotype (CD4+ LAG3+ CD49b+). Intracellular flow cytometry showed enthesis T-cells had very low FOXP3 expression, when compared to their blood counterparts. Intracellular flow cytometry and gene expression showed high basal expression of growth factors and regulatory proteins such as IL-10 & TGFβ, when compared to blood T-cells. RNA-Seq data, showed 13 potential TCR clonal sequences the most common of which are predicted to be reactive viral infection was CMV present in 8 sequences and Influenza A virus present in 2 sequences.

Conclusion:

The healthy human enthesis has regulatory T-cells of a Tr1 phenotype rather than a FOXP3 Treg phenotype. Many clones have antigen specificity indicating reactivity to prior infection. These findings suggest that conventional entheseal T-cells have a role in enthesis immune homeostasis.

Disclosure of Interests:

Hannah Rowe Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Abdulla Watad: None declared, Tobias Russell Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Kassem Sharif: None declared, Darren Newton: None declared, Miriam Wittmann: None declared, Qiao Zhou Grant/research support from: Funded by the PARTNER fellowship program, Almas Khan: None declared, Peter Loughenbury: None declared, Robert Dunsmuir: None declared, Abhay S Rao: None declared, Peter Millner: None declared, Tony Kenna: None declared, Matthew Brown: None declared, Charlie Bridgewood: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC

Abstract DL-1: Essential Genes and Cistromes in Breast Cancer

Steroid hormones mediate critical lineage-specific developmental and physiologic responses. While estrogen is required for normal breast development, the genes regulated by estrogen and the genomic targets of the estrogen receptor (ER) are altered in ER+ breast cancers. The requirement of most breast cancers for estrogen has led to the development of endocrine therapies that block ER action. While initial endocrine interventions are successful, in the advanced disease setting resistance to ER-targeted therapy almost invariably arises. As with other targeted therapies, gain of function mutations play a significant role in the development of therapeutic resistance to ER directed treatments in breast cancer. In addition, pathways downstream of ER are activated in cases in which ER itself is not genetically altered suggesting that these pathways remain essential. Activation of these pathways may depend on mutations in other transcription factors involved in steroid receptor networks or chromatin modifying enzymes involved in transcriptional regulation mediated by ER. These mutations may be present in the protein coding regions of the genes or in the cis-regulatory elements regulating expression of key genes in the pathways. Renewed success in targeting ER and promising advances in inhibiting the activity of the chromatin modifying enzymes provides new opportunities for the treatment of patients with breast cancer. Using genome-wide CRISPR-Cas9 knockout screens we have identified the genes essential for hormone-dependent breast cancer growth including key genes in the receptor-centered transcriptional networks.

Although large sets transcription factor binding sites or cistromes have been identified across the human genome, defining which of these sites is functional in a given condition remains challenging. Using CRISPR-Cas9 knockout screens and gene essentiality or fitness as the readout, we systematically investigated the essentiality of more than 10,000 FOXA1 and CTCF binding sites in breast cancer cells. We found that essential FOXA1 binding sites act as enhancers to orchestrate the expression of nearby essential genes through the binding of lineage-specific transcription factors. In contrast, CRISPR screens of the CTCF cistrome revealed two classes of essential binding sites. The first class of essential CTCF binding sites act like FOXA1 sites as enhancers to regulate the expression of nearby essential genes, while a second class of essential CTCF binding sites was identified at TAD boundaries and display distinct characteristics. Using regression methods trained on the screening data and public epigenetic profiles, we developed a model to predict essential cis-elements with high accuracy. The model for FOXA1 essentiality correctly predicts non-coding variants associated with cancer risk and progression. Taken together, CRISPR screens of cis-regulatory elements can define the essential cistrome of a given transcription factor and can inform the development of predictive models of cistrome function. In addition, defining the essential cistrome may shed light on the noncoding regions of the genome most likely to harbor oncogenic driver mutations.

Citation Format: M Brown. Essential Genes and Cistromes in Breast Cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr DL-1.

Plastic pollution in paradise: Daily accumulation rates of marine litter on Cousine Island, Seychelles

The daily accumulation rates, composition, sizes and potential sources of marine litter collected on a remote island within the Western Indian Ocean were investigated. In total, 9119 items of marine litter were collected during 40 surveys, which equated to 0.0082 items·m^-1·d^-1. Between 2003 and 2019 there was a significant increase in the amount of litter deposited, with the highest daily accumulation rate recorded in 2019 (0.0255 items·m^-1·year^-1). All specific litter types increased over time and also differed significantly in their accumulation rates, with polystyrene fragments/pieces (0.00249 items·m^-1·d^-1), plastic items (0.00135 items·m^-1·d^-1) and plastic bottles (0.0011 items·m^-1·d^-1) being the most commonly encountered during this study. The majority of the litter found was ≤5 cm in size. Nearly all (>80%) litter collected was made of or contained some form of plastic. Recommendations for improved management of litter and the importance of establishing regular beach clean-ups within the Seychelles are briefly discussed.

"There is a Place": impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness

BACKGROUND

The twin problems of severe alcohol dependence and homelessness are associated with precarious living and multiple acute, social and chronic harms. While much attention has been focused on harm reduction services for illicit drug use, there has been less attention to harm reduction for this group. Managed alcohol programs (MAPs) are harm reduction interventions that aim to reduce the harms of severe alcohol use, poverty and homelessness. MAPs typically provide accommodation, health and social supports alongside regularly administered sources of beverage alcohol to stabilize drinking patterns and replace use of non-beverage alcohol (NBA).

METHODS

We examined impacts of MAPs in reducing harms and risks associated with substance use and homelessness. Using case study methodology, data were collected from five MAPs in five Canadian cities with each program constituting a case. In total, 53 program participants, 4 past participants and 50 program staff were interviewed. We used situational analysis to produce a series of "messy", "ordered" and "social arenas" maps that provide insight into the social worlds of participants and the impact of MAPs.

RESULTS

Prior to entering a MAP, participants were often in a revolving world of cycling through multiple arenas (health, justice, housing and shelters) where abstinence from alcohol is often required in order to receive assistance. Residents described living in a street-based survival world characterized by criminalization, unmet health needs, stigma and unsafe spaces for drinking and a world punctuated by multiple losses and disconnections. MAPs disrupt these patterns by providing a harm reduction world in which obtaining accommodation and supports are not contingent on sobriety. MAPs represent a new arena that focuses on reducing harms through provision of safer spaces and supply of alcohol, with opportunities for reconnection with family and friends and for Indigenous participants, Indigenous traditions and cultures. Thus, MAPs are safer spaces but also potentially spaces for healing.

CONCLUSIONS

In a landscape of limited alcohol harm reduction options, MAPs create a new arena for people experiencing severe alcohol dependence and homelessness. While MAPs reduce precarity for participants, programs themselves remain precarious due to ongoing challenges related to lack of understanding of alcohol harm reduction and insecure program funding.

Testing an active intervention to deter researchers' use of questionable research practices

INTRODUCTION

In this study, we tested a simple, active "ethical consistency" intervention aimed at reducing researchers' endorsement of questionable research practices (QRPs).

METHODS

We developed a simple, active ethical consistency intervention and tested it against a control using an established QRP survey instrument. Before responding to a survey that asked about attitudes towards each of fifteen QRPs, participants were randomly assigned to either a consistency or control 3-5-min writing task. A total of 201 participants completed the survey: 121 participants were recruited from a database of currently funded NSF/NIH scientists, and 80 participants were recruited from a pool of active researchers at a large university medical center in the southeastern US. Narrative responses to the writing prompts were coded and analyzed to assist post hoc interpretation of the quantitative data.

RESULTS

We hypothesized that participants in the consistency condition would find ethically ambiguous QRPs less defensible and would indicate less willingness to engage in them than participants in the control condition. The results showed that the consistency intervention had no significant effect on respondents' reactions regarding the defensibility of the QRPs or their willingness to engage in them. Exploratory analyses considering the narrative themes of participants' responses indicated that participants in the control condition expressed lower perceptions of QRP defensibility and willingness.

CONCLUSION

The results did not support the main hypothesis, and the consistency intervention may have had the unwanted effect of inducing increased rationalization. These results may partially explain why RCR courses often seem to have little positive effect.

Evaluation of the VIDAS Staph Enterotoxin II (SET 2) Immunoassay Method for the Detection of Staphylococcal Enterotoxins in Selected Foods: Collaborative Study

A multilaboratory study was conducted to determine the limit of detection (LOD) of Staphylococcal enterotoxins (SET) in 5 foods. Cooked chicken, ham, potato salad, pasteurized liquid whole milk, and canned mushrooms were each spiked with a different enterotoxin (A, B, C1, D, or E), and tested at 0.25 and 0.5 ng/g SET levels to determine the LOD of the assay for those foods in a collaborative study. Unspiked controls were also included. A total of 19 laboratories representing government and industry participated. In this study, 1674 test portions were analyzed, of which 1638 were used in the statistical analysis. Of the 1638 test portions used in the statistical analysis, 1104 were spiked test portions, of which 1073 were positive by the VIDAS Staph enterotoxin II (SET 2) method. The detection rates at the 0.25 ng/mL level were cooked chicken, 98.2; ham, 99.0; potato salad, 99.1; liquid whole milk, 85.2; and canned mushrooms, 100. The detection rates at the 0.5 ng/mL level were cooked chicken, 97.4; ham, 98.1; potato salad, 100; liquid whole milk, 99.0; and canned mushrooms, 100. The data indicate that the SET 2 method is capable of detecting SET at 0.25 ng/g in cooked chicken, ham, potato salad, and canned mushrooms and at 0.5 ng/g in pasteurized liquid whole milk.

P2277Utility of cardiovascular implantable electronic device (CIED)-derived patient activity, a novel digital biomarker, to predict inappropriate therapy

Background

The role of cardiovascular implantable electronic device (CIED)-derived activity to predict inappropriate implantable cardioverter-defibrillator (ICD) therapy is not known. The Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy (MADIT-RIT) enrolled 1500 patients with contemporary indication for an ICD or a CRT-D. We aimed to identify whether activity, as a digital biomarker, predicted inappropriate therapy.

Methods

In 1500 patients enrolled in MADIT-RIT, CIED-derived patient activity was acquired daily. CIED-derived activity was averaged for the first 30 days following randomization and utilized in this study to predict inappropriate therapy post- 30-day. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models were used to evaluate first inappropriate therapy by 30-day CIED-derived patient activity quintiles, and by 30-day device derived patient activity as a continuous measurement.

Results

There were a total of 1463 patients with activity data available (90%), 135 patients received at least one inappropriate therapy during the post-30 day follow-up period. Patients in the highest quintile (Q5) of CIED-derived activity (more active) were younger, more often males and more likely to have had a prior ablation of an atrial arrhythmia. Patients in the highest quintile of 30-day CIED-derived median activity had the highest risk of receiving inappropriate therapy, 21% at 2 years as compared 7–11% in the other four quintiles (Figure, p<0.001 for the overall duration). Patients with the highest level of 30-day median patient activity (Q5) had 1.75 times higher risk of any inappropriate therapy as compared with lower levels of activity, Q1-Q4 (HR=1.75, 95% CI: 1.23–2.50, p<0.002). Each 10% increase in CIED-derived 30-day median patient activity was associated with a significant, 73% increase in risk of receiving inappropriate therapy (HR=1.73, 95% CI: 1.17–2.54, p=0.005). Patients in the highest quintile for activity had a 68% increase in the risk of SVT excluding atrial fibrillation, atrial flutter or atrial tachycardia (HR=1.69, 95% CI: 1.26–2.25, p=0.004), despite 96% receiving beta-blocker medications.

Inappropriate ICD Therapies by Activity

Conclusions

CIED-derived 30-day median patient activity predicted subsequent inappropriate therapy in ICD and CRT-D patients enrolled in MADIT-RIT. Patients with high levels of 30-day CIED-derived median patient activity were at a significantly higher risk of receiving inappropriate therapy. Activity, as a digital biomarker, may have utility in predicting and managing the risk of inappropriate therapy in this population.

Acknowledgement/Funding

Boston Scientific

2179Clinical significance of device-derived activity in ICD and CRT-D patients - Data from MADIT-RIT

Background

The Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy (MADIT-RIT) enrolled 1500 patients and showed that novel ICD programming reduced inappropriate therapy and improved survival. However, the role of device-derived patient activity to predict mortality is not known.

Methods

In 1500 patients enrolled in MADIT-RIT, device-derived patient activity was captured daily. Device-derived activity was averaged for the first 30 days following randomization, and utilized in this study to predict mortality post-30 days. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models were used to evaluate all-cause mortality by 30-day device derived patient activity quintiles, and as a 3-level function of 30-day device derived patient activity (Q1, Q2–3, Q4–5).

Results

There were a total of 1463 patients with data available (98%), 66 of them died during the follow-up post-30 days. Patients in the lowest quintile (Q1: 4%∼1 hour daily activity) of device-derived activity were older, they were more often female, and they more often had diabetes and NYHA class III HF symptoms. Patients in the lowest quintile of 30-day device derived median activity (1 hour daily activity) had the highest risk of mortality, 15% in 2 years as compared to Q2–3 (1–2 hours daily activity, 8–7% 2-year mortality), and Q4–5 (>2 hours daily activity, 2–3% 2-year mortality) (Figure, p<0.001 for the overall duration). Each quintile decrease in device-derived 30-day median patient activity was associated with a significant, 41% increase in mortality (HR=1.41, 95% CI: 1.15–1.71, p=0.001). Patients with the lowest level of 30-day median patient activity (Q1) had 4.13-times higher risk of mortality as compared to the highest level of activity patients, Q4–5 (HR=4.13, 95% CI: 1.89–9.03, p<0.001). Patients with intermediate levels of activity (Q2–3) still had a 2.8-fold increase in death as compared to the highest activity level cohort of patients (HR=2.79, 95% CI: 1.31–5.91, p=0.008).

Figure 1

Conclusions

Device-derived 30-day median patient activity predicted subsequent all-cause mortality in ICD and CRT-D patients enrolled in MADIT-RIT. Patients with low and moderate levels of 30-day device-derived median patient activity (less than 2 hours daily activity) were at a significantly higher risk of death, and these cohorts warrant further investigation and management to improve outcomes.

Acknowledgement/Funding

MADIT-RIT was funded by an unrestricted research grant from Boston Scientific to the University of Rochester.

The necessity of education and hepatitis B vaccination for young people: A study of high risk behaviour for blood borne viruses in the United Kingdom

Blood borne virus (BBV) infection in adults involved in high risk behaviour is well recognized. There are limited reported data on young people involved in high risk behaviour. A descriptive questionnaire was used to ascertain risk behaviour at the Young People's Substance Misuse Service (Birmingham). Data collection included risk behaviour and serological tests for hepatitis B, C and HIV. Sixty-five of one-hundred three (63%) young people participated; 37/65 male; age range 13.9-18.9 (median 17.4 years). Risk behaviour included 6 intravenous drug, 58 cannabis, and 61 had sexual partners, of whom 52 (85%) engaged in unprotected sex. Sixty-five participants were negative for BBV infection: 9 were HBV immune. HB vaccination was not available at the centre (for <18 year), and all refused referral to their general practitioner for vaccination due to fear of disclosure. The main risk for BBV acquisition was unprotected sex with multiple sexual partners and illicit drug use. Most were unaware of the risks related to high risk behaviour. Effective education programmes of relevant risk factors with HBV vaccination should be implemented during preadolescence. We recommend an integrated service via specialized centres, to work together to improve awareness and increase efforts to vaccinate adolescents at risk for HBV infection.

An evaluation of the safety of continuing trastuzumab despite overt left ventricular dysfunction

Background

The major limitation in the use of trastuzumab therapy is cardiotoxicity. We evaluated the safety of a strategy of continuing trastuzumab in patients with breast cancer despite mild, asymptomatic left ventricular impairment.

Methods

Charts of consecutive patients referred to a cardio-oncology clinic from January 2015 to March 2017 for decline in left ventricular ejection fraction (lvef), defined as a fall of 10 percentage points or more, or a value of less than 50% during trastuzumab therapy, were reviewed. The primary outcome of interest was change in lvef, measured before and during trastuzumab exposure and up to 3 times after initiation of cardiac medications during a median of 9 months.

Results

All 18 patients referred for decline in lvef chose to remain on trastuzumab and were included. All patients were treated with angiotensin converting-enzyme inhibitors or beta-blockers, or both. After initiation of cardiac medications, lvef increased over time by 4.6 percentage points (95% confidence interval: 1.9 percentage points to 7.4 percentage points), approaching baseline values. Of the 18 patients, 17 (94%) were asymptomatic at all future visits. No deaths occurred in the group.

Conclusions

Many patients with mildly reduced lvef and minimal heart failure symptoms might be able to continue trastuzumab without further decline in lvef, adverse cardiac events, or death when treated under the supervision of a cardiologist with close follow-up.

High Performance Bi-2212 Round Wires Made with Recent Powders

Multifilamentary Bi₂Sr₂CaCu₂O_x (Bi-2212) wire made by the powder-in-tube technique is the only high temperature superconductor made in the round shape preferred by magnet builders. The critical current density (J _C ) of Bi-2212 round wire was improved significantly by the development of overpressure heat treatment in the past few years. Bi-2212 wire is commercially available in multiple architectures and kilometer-long pieces and a very promising conductor for very high field NMR and accelerator magnets. We studied the effects of precursor powder and heat treatment conditions on the superconducting properties and microstructure of recent Bi-2212 wires. Short samples of recent wire with optimized overpressure processing showed J _C (4.2 K, 15 T) = 6640 A/mm² and J _C (4.2 K, 30 T) = 4670 A/mm², which correspond to engineering critical current densities J _E (4.2 K, 15 T) = 1320 A/mm² and J _E (4.2 K, 30 T) = 930 A/mm².