Long-term follow-up of patients undergoing auto-SCT for advanced germ cell tumour: a multicentre cohort study

Failure of cisplatin-based chemotherapy in advanced germ cell tumour (GCT) is associated with a poor outcome. High-dose chemotherapy and auto-SCT is one therapeutic option, although the long-term outcome after this procedure is unclear. We conducted a multicentre cohort study of consecutive patients undergoing a single auto-SCT for GCT between January 1986 and December 2004. Of 71 subjects, median follow-up is 10.1 years. OS at 5 years is 44.7% (95% confidence interval (CI) 32.9-56.5%) and EFS is 43.5% (95% CI 31.4-55.1%). There were seven (10%) treatment-related deaths within 100 days of auto-SCT. Three (4.2%) patients developed secondary malignancies. Of 33 relapses, 31 occurred within 2 years of auto-SCT. Two very late relapses were noted 13 and 11 years after auto-SCT. In multivariate analysis, favourable outcome was associated with IGCCC (International Germ Cell Consensus Classification) good prognosis disease at diagnosis, primary gonadal disease and response to salvage chemotherapy. We conclude that auto-SCT results in successful outcome for a relatively large subgroup of patients with high-risk GCT. Late relapses may occur, a finding not previously reported.

Neptune's Story

It is conjectured that Triton was captured from a heliocentric orbit as the result of a collision with what was then one of Neptune's regular satellites. The immediate post-capture orbit was highly eccentric with a semimajor axis a approximately 10(3)R(N) and a periapse distance rp that oscillated periodically above a minimum value of about 5R(N). Dissipation due to tides raised by Neptune in Triton caused Triton's orbit to evolve to its present state in less, similar10(9) years. For much of this time Triton was almost entirely molten. While its orbit was evolving, Triton cannibalized most of the regular satellites of Neptune and also perturbed Nereid, thus accounting for that satellite's highly eccentric and inclined orbit. The only regular satellites of Neptune that survived were those that formed well within 5R(N) and they move on inclined orbits as the result of chaotic perturbations forced by Triton. Neptune's arcs are confined around the corotation resonances of one of these inner satellites. The widths and lengths of the arcs imply that the satellite's radius is at least 30/(sin i)(2/3) kilometers for i less, similar 1, where i is the angle of inclination.

Project ASPIRE: an Interactive, Multimedia Smoking Prevention and Cessation curriculum for culturally diverse high school students

A Smoking Prevention Interactive Experience (ASPIRE) is an innovative, computer-based smoking prevention and cessation intervention delivered to a culturally diverse population of high school students. Founded in the Transtheoretical Model of Change, five main and two "booster" sessions comprise the interactive intervention. Here we describe the intervention and the baseline characteristics from our study sample of 1,574 10th graders from 16 high schools in Houston, Texas. Environmental and behavioral smoking risk factors were assessed, and the two intervention groups were comparable with respect to most measured variables. The intervention program holds considerable promise in its ability to reduce smoking among teens.

A phase IB study of ABT-751 in combination with docetaxel in patients with advanced castration-resistant prostate cancer

BACKGROUND

This study investigated the safety, pharmacokinetics (PK) and clinical antitumor activity of ABT-751, a novel sulfonamide antimitotic and vascular disrupting agent, in combination with docetaxel (Taxotere) in patients with castration-resistant prostate cancer (CRPC).

PATIENTS AND METHODS

Patients received docetaxel (60-75 mg/m(2)) i.v. on day 1 and ABT-751 (100-200 mg) orally daily for 14 days, repeated every 3 weeks for up to 10 times on four escalating dose levels (DLs).

RESULTS

Thirty-two patients received a median of 8.5 treatment cycles (range 1-10). One of six patients on DL 3 (D 60 mg/m(2) + A 200 mg) and 4 (D 75 mg/m(2) + A 200 mg) experienced dose-limiting toxicity, and both DLs were expanded. Overall, severe adverse events occurred more commonly on DL 4 than 3 (47% versus 18% of patients). PK data for docetaxel and ABT-751 were similar to reported literature. Best post-treatment prostate-specific antigen decline of > or =50% occurred in 60% and objective responses occurred in 45% of patients. Median overall survival was 24 months (95% confidence interval 8.3-37.7 months).

CONCLUSIONS

The combination of ABT-751 and docetaxel is safe and active in CRPC. Based on the cumulative safety analysis, the recommended phase II dose of ABT-751 is 200 mg daily with docetaxel 60 mg/m(2) for this patient population.

Transcriptome-wide mutation discovery in patients in a phase II clinical trial of first-line erlotinib for clinically selected patients with advanced non-small cell lung cancer

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Background: The purpose of this study was to clinically select a population of patients (pts) likely to benefit from erlotinib and to perform extensive genetic profiling of fresh tissue tumour to identify predictive biomarkers. Methods: Treatment was erlotinib 150 mg p.o. daily until disease progression. Eligibility criteria included: stage IIIB/IV NSCLC; no prior chemo; ECOG ≤2; at least 2 of the following 4 criteria: women, never-smokers, Southeast Asian origin, adenocarcinoma and/or BAC. All pts had baseline serum samples and a fresh frozen tumour biopsy. EGFR and KRAS were sequenced using traditional methods to identify known mutations of erlotinib. Transcribed coding regions of all other expressed genes were sequenced to uncover novel mutations and other genetic features. Results: From Sept-06 to Oct-08, 65 pts have been enrolled. Of these 60 have completed at least 8 wks of erlotinib (or progressed before 8 wks). 49F and 11M; 45 never smokers. PS 0/1/2: 10/39/11. 18 Caucasian and 42 Asian. Pathology: 44 ACA; 3 BAC;1 squamous carcinoma; 13 NSCLC NOS. Responses: PR - 21 (35%); SD - 24 (DCR 75%); PD - 10; NE - 5. 85% did not progress at 8 weeks. 19 of 51 (37%) pre-treatment samples had an EGFR mutation. 10 of the 28 pts with response data (24pts still on drug) had a PR and 7 of these had either an LREA deletion or L858R point mutation. 1 of 3 post-treatment samples developed a T790M mutation on erlotinib. 3 of 51 pts have KRAS mutations. Analysis of over 21 Giga basepairs of aligned transcriptome sequencing data from 20 tumour samples has uncovered 1089 putative non-conservative gene mutations of which 15 are seen in multiple tumours: TUBA1C, EPS8L1, ARID4B, RPL22, C20orf52, CCT8, HLA-DRB5, TRIP6, and PLP2 in 4 tumours, C20orf52 and CTSL1 in 5 tumours, and SERF2, TMEM173, and an uncharacterized gene in 6 tumours. Conclusions: Clinical selection of pts enriches the EGFR mutation positive and KRAS mutation negative population and leads to high rates of non-progression. Full tumour RNA analysis identified several recurrent mutations that may describe mechanisms of erlotinib response and resistance. The discovery of novel mutations in multiple pts suggests patterns that may shed light on lung cancer specific behaviour.

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Expert opinion on the use of anthracyclines in patients with advanced breast cancer at cardiac risk

Anthracyclines are considered to be among the most active agents for the treatment of breast cancer. However, their use is limited by cumulative, dose-related cardiotoxicity. Such cardiotoxicity results in a permanent loss of cardiac myocytes and a progressive reduction in cardiac function following each subsequent dose of anthracycline. Initially, damage to the heart is subclinical; however, increasingly impaired cardiac function can result in cardiovascular symptoms, with serious cardiac injury resulting in chronic heart failure. Since the early detection and treatment of cardiotoxicity can reduce its clinical effects, it is important that oncologists are aware of these adverse effects and manage them appropriately. This review examines the risk factors for anthracycline-associated cardiotoxicity and offers recommendations on strategies to reduce the cardiotoxicity of anthracyclines in the management of patients with advanced breast cancer.

Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high-school students

Few studies have examined the long-term efficacy of computer-based smoking prevention and cessation programs. We analyzed the long-term impact of A Smoking Prevention Interactive Experience (ASPIRE), a theoretically sound computer-based smoking prevention and cessation curriculum for high school students. Sixteen predominantly minority, inner-city high schools were randomly assigned to receive the ASPIRE curriculum or standard care (receipt of the National Cancer Institute's Clearing the Air self-help booklet). A total of 1160 students, 1098 of whom were nonsmokers and 62 smokers at baseline, were included. At 18-month follow-up, among baseline nonsmokers, smoking initiation rates were significantly lower in the ASPIRE condition (1.9% vs. 5.8%, p < .05). Students receiving ASPIRE also demonstrated significantly higher decisional balance against smoking and decreased temptations to smoke. Differences between groups in self-efficacy and resistance skills were not significant. There was a nonsignificant trend toward improved smoking cessation with ASPIRE, but low recruitment of smokers precluded conclusions with respect to cessation. ASPIRE demonstrated the potential for an interactive multimedia program to promote smoking prevention. Further studies are required to determine ASPIRE's effects on cessation.

The role of the epidermal growth factor receptor tyrosine kinase inhibitors as therapy for advanced, metastatic, and recurrent non-small-cell lung cancer: a Canadian national consensus statement

PURPOSE

To provide consensus recommendations on the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIS) in patients with advanced or meta-static non-small-cell lung cancer (NSCLC).

METHODS

Using a systematic literature search, phase II trials, randomized phase III trials, and meta-analyses were identified for inclusion.

RESULTS

A total of forty-six trials were included. Clear evidence is available that EGFR-TKIS should not be administered concurrently with platinum-based chemotherapy as first-line therapy in advanced or metastatic nsclc. Evidence is currently insufficient to recommend single-agent EGFR-TKIS as first-line therapy either in unselected populations or in populations selected on the basis of molecular or clinical characteristics. Following failure of platinum-based chemotherapy, the evidence suggests that second-line EGFR-TKIS or second-line chemotherapy result in similar survival. Quality of life and symptom improvement for patients treated with an EGFR-TKI appear better than they do for patients treated with second-line docetaxel. Sequence of therapy may not appear to be important, but if survival is the outcome of interest, the goal should be to optimize the number of patients receiving three lines of therapy. Based on available data, molecular markers and clinical characteristics do not appear to be predictive of a differential survival benefit from an EGFR-TKI and therefore those factors should not be used to select patients for EGFR-TKI therapy.

CONCLUSIONS

The EGFR-TKIS represent an additional therapy in the treatment of advanced or metastatic NSCLC. The results of ongoing clinical trials may define the optimal role for these agents and the effectiveness of combinations of these agents with other targeted agents.