Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes

BACKGROUND AND PURPOSE

Stent-assisted coiling and balloon-assisted coiling are 2 well-established techniques for treatment of wide-neck intracranial aneurysms. A direct comparative analysis of angiographic outcomes with the 2 techniques has not been available. We compare the angiographic outcomes of wide-neck aneurysms treated with stent-assisted coiling versus balloon-assisted coiling.

MATERIALS AND METHODS

A retrospective review was conducted on 101 consecutive patients treated at our institution, 69 with stent-assisted coiling and 32 with balloon-assisted coiling. Two multivariate logistic regression analyses were performed to determine predictors of aneurysm obliteration and predictors of progressive aneurysm thrombosis at follow-up.

RESULTS

The 2 groups were comparable with respect to all baseline characteristics with the exception of a higher proportion of ruptured aneurysms in the balloon-assisted coiling group (65.6%) than in the stent-assisted coiling group (11.5%, P < .001). Procedural complications did not differ between the stent-assisted coiling group (6%) and the balloon-assisted coiling group (9%, P = .5). The rates of complete aneurysm occlusion (Raymond score 1) at the most recent follow-up were significantly higher for the stent-assisted coiling group (75.4%) compared with the balloon-assisted coiling group (50%, P = .01). Progressive occlusion of incompletely coiled aneurysms was noted in 76.6% of aneurysms in the stent-assisted coiling group versus 42.8% in the balloon-assisted coiling group (P = .02). Retreatment rates were significantly lower with stent-assisted coiling (4.3%) versus balloon-assisted coiling (15.6%, P = .05). In multivariate analysis, stented aneurysms independently predicted both complete aneurysm obliteration and progression of occlusion.

CONCLUSIONS

Stent-assisted coiling may yield lower rates of retreatment and higher rates of aneurysm obliteration and progression of occlusion at follow-up than balloon-assisted coiling with a similar morbidity rate.

Using macrophage activation to augment immunotherapy of established tumours

Background:

Successful immunotherapy will require alteration of the tumour microenvironment and/or decreased immune suppression. Tumour-associated macrophages (TAMs) are one major factor affecting tumour microenvironment. We hypothesised that altering TAM phenotype would augment the efficacy of immunotherapy.

Methods:

We and others have reported that 5,6-Dimethylxanthenone-4-acetic-acid (DMXAA, Vadimezan) has the ability to change TAM phenotypes, inducing a tumour microenvironment conducive to antitumour immune responses. We therefore combined DMXAA with active immunotherapies, and evaluated anti-tumour efficacy, immune cell phenotypes (flow cytometry), and tumour microenvironment (RT–PCR).

Results:

In several different murine models of immunotherapy for lung cancer, DMXAA-induced macrophage activation significantly augmented the therapeutic effects of immunotherapy. By increasing influx of neutrophils and anti-tumour (M1) macrophages to the tumour, DMXAA altered myeloid cell phenotypes, thus changing the intratumoural M2/non-M2 TAM immunoinhibitory ratio. It also altered the tumour microenvironment to be more pro-inflammatory. Modulating macrophages during immunotherapy resulted in increased numbers, activity, and antigen-specificity of intratumoural CD8⁺ T cells. Macrophage depletion reduced the effect of combining immunotherapy with macrophage activation, supporting the importance of TAMs in the combined effect.

Conclusion:

Modulating intratumoural macrophages dramatically augmented the effect of immunotherapy. Our observations suggest that addition of agents that activate TAMs to immunotherapy should be considered in future trials.

Abstract P6-07-22: Association between SPARC mRNA expression, prognosis and response to neoadjuvant chemotherapy in early breast cancer (BC): a pooled in-silico analysis

Background: SPARC (Secreted Protein Acidic and Rich in Cysteine) is known to regulate cell growth and to inhibit cell-cycle progression. It has high affinity in binding albumin and hence has been suggested to predict benefit of albumin-bound cytotoxic agents. We conducted a pooled analysis to elucidate SPARC expression according to BC molecular subtypes and its association with clinical outcome in early BC.

Methods: We used publically available datasets and normalized microarray data as published by the original studies. Eligible patients were those who received no adjuvant systemic therapy (untreated series), were treated with tamoxifen (tam-treated series) or were treated with neoadjuvant anthracyclines ± paclitaxel or docetaxel (neoadjuvant series). We computed 2 SPARC modules, SPARC7 and SPARC8 that were composed of genes with an absolute correlation above 0.7 and 0.8 with SPARC, respectively. In the untreated series, we examined the expression of SPARC according to BC subtype defined by PAM50. We investigated the correlation with other gene modules representing diverse biological processes; proliferation (AURKA, GGI), immune (STAT1, IRM), and stroma (DCN, PLAU). We investigated the association with relapse-free survival (RFS) in univariate and multivariate models, both in the untreated and tam-treated series. This was performed in all patients and according to BC subtype. In the neoadjuvant series, we investigated the association with pathological complete response (pCR) in all patients and according to BC subtype. All multivariate models were adjusted for tumor size, nodal status, age and histological grade.

Results: 1008, 393 and 996 patients were included in the untreated, tam-treated and neoadjuvant series, respectively. SPARC expression was highest in luminal-A, small (&lt; 2 cm) and low histological grade tumors (all p &lt; 0.0001). We found high positive correlation between SPARC, SPARC modules and stroma-related modules (r = 0.90) but a negative correlation with proliferation (r = −0.66). No correlation was observed with immune-related modules. In the untreated series, SPARC was not associated with prognosis in the univariate model. However, restricting the analysis to the HER2 molecular subtype, high SPARC expression was associated with short RFS in both univariate and multivariate models (HR: 3; 95% CI [1.5–6.3], p = 0.002). In the tam-treated series, SPARC expression was not associated with clinical outcome neither in luminal-A nor luminal-B. In the neoadjuvant series, SPARC expression was not associated with pCR (p = 0.37) except in the HER2 subtype in which high expression was independently associated with low pCR rates in the multivariate model (OR: 0.32; 95% CI [0.1–0.9], p = 0.043). Similar associations were observed with SPARC7 and SPARC8 modules.

Conclusion: Two main conclusions could be drawn from our analysis 1) SPARC is highly expressed in low proliferative ER+ tumors; 2) High SPARC expression is associated with short RFS and poor response to neoadjuvant therapy in patients with HER2+ BC. These results could be relevant in the clinical development of albumin-bound compounds, in which SPARC expression is believed to identify patients who could benefit from these agents.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-22.

Abstract P3-05-03: Characterization of PIK3CA mutations in lobular breast cancer

Background: Invasive lobular carcinoma (ILC) is the second most common breast cancer (BC) histotype, after invasive ductal carcinoma (IDC), representing ∼10-15% of the global BC population. The vast majority of ILC are estrogen receptor (ER)-positive. PIK3CA has been reported to be the most frequently mutated gene in ER-positive BC. However, until now PIK3CA mutations have mainly been described in IDC. In this study, we sought to characterize the type, prevalence, intra-patient (pt) mutational heterogeneity, and the association with transcriptomic phenotype and clinical outcome of PIK3CA mutations in ILC.

Methods: Gene expression data (HG-U133 Plus2.0) was generated from frozen samples of 116 ILC (primary tumors). For the same series, PIK3CA mutation profiling (Sequenom) was performed on at least 2 formalin-fixed paraffin embedded (FFPE) tissue blocks of the primary tumor for 102 cases, and on the only available block for the remaining 14 cases. Matched local recurrence (LR) and multiple metastatic (M) samples were also characterized for 3 and 8 pts respectively. For the transcriptomic and survival analyses, we evaluated the association between PIK3CA mutation status and gene signatures recapitulating important biological processes, and invasive disease-free & overall survival, respectively.

Results: PIK3CA mutations were detected in the primary tumor of 40/116 (35%) ILC pts: 14 (35%) mutations in the helical domain and 25 (62.5%) in the kinase domain. PIK3CA analysis in different blocks from the same primary tumors revealed a mutational heterogeneity in 7/102 (7%) cases. There was a discordance between primary and LR samples in 1/3 patients with LR, with a mutation reported in the primary but in not the LR. In 3/8 pts for which M samples were available, we observed intra-pt heterogeneity. In the first pt, a mutation in the kinase domain was reported only in 1/2 investigated blocks from the primary tumor, and in only 1/2 liver Ms. In the second pt, a mutation in the helical domain was found in the primary tumor and in the LR but not in the pleura M. In the third pt, although no mutation was observed in the primary tumor, a mutation in the helical domain was found in the M of the epiploon, but not in the Ms from the diaphragm or the ovary. Transcriptomic analyses revealed that primary tumors with a PIK3CA mutation in the helical domain were associated with increased levels of 2 stroma signatures (Bonferroni p-val: PLAU sign -Desmedt 2008–0.042 and DCN sign- Farmer 2009 – 0.048) compared to tumors without mutation. The survival analyses did not reveal any significant difference in survival between pts with and without a PIK3CA mutation.

Conclusions: This study represents the largest series described so far which investigated PIK3CA mutations in ILC. The incidence of PIK3CA mutations reported here is similar to the one reported for IDC. The investigation of multiple tumor samples per pt revealed intra-tumor as well as primary/recurrence heterogeneity. To get a definitive answer on the prognostic role of PIK3CA mutation in ILC, we are currently performing a PIK3CA mutation profiling study (Sequenom) on a series of ∼1000 consecutive ILC with long-term follow up (Iorfida et al. 2012); results will be available by SABCS2012.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-05-03.

Short-term outcome of psychogenic non-epileptic seizures after communication of the diagnosis

We previously described a communication strategy for the delivery of the diagnosis of psychogenic non-epileptic seizures (PNES) that was acceptable and effective at communicating the psychological cause of PNES. This prospective multicenter study describes the short-term seizure and psychosocial outcomes after the communication of the diagnosis and with no additional treatment. Participants completed self-report measures at baseline, two and six months after the diagnosis (seizure frequency, HRQoL, health care utilization, activity levels, symptom attributions and levels of functioning). Thirty-six participants completed the self-report questionnaires. A further eight provided seizure frequency data. After six months, the median seizure frequency had dropped from 10 to 7.5 per month (p=0.9), 7/44 participants (16%) were seizure-free, and an additional 10/44 (23%) showed greater than 50% improvement in seizure frequency. Baseline questionnaire measures demonstrated high levels of impairment, which had not improved at follow-up. The lack of change in self-report measures illustrates the need for further interventions in this patient group.

Expression and characterization of constitutive heat shock protein 70.1 (HSPA-1A) gene in in vitro produced and in vivo-derived buffalo (Bubalus bubalis) embryos

Cells are blessed with a group of stress protector molecules known as heat shock proteins (HSPs), amongst them HSP70, encoded by HSPA-1A gene, is most abundant and highly conserved protein. Variety of stresses hampers the developmental competence of embryos under in vivo and in vitro conditions. Present work was designed to study the quantitative expression of HSPA-1A mRNA in immature oocytes (IMO), matured oocytes (MO), in vitro produced (IVP) and in vivo-derived (IVD) buffalo embryos to assess the level of stress to which embryos are exposed under in vivo and in vitro culture conditions. Further, HSPA-1A gene sequence was analysed to determine its homology with other mammalian sequences. The mRNA expression analysis was carried out on 72 oocytes (40 IMO; 32 MO), 76 IVP and 55 IVD buffalo embryos. Expression of HSPA-1A was found in oocytes and throughout the developmental stages of embryos examined irrespective of the embryo source; however, higher (p < 0.05) expression was observed in 8-16 cell, morula and blastocyst stages of IVP embryos as compared to IVD embryos. Phylogenetic analysis of bubaline HSPA-1A revealed that it shares 91-98% identity with other mammalian sequences. It can be concluded that higher level of HSPA-1A mRNA in IVP embryos in comparison with in vivo-derived embryos is an indicator of cellular stress in IVP system. This study suggests need for further optimization of in vitro culture system in which HSPA-1A gene could be used as a stress biomarker during pre-implantation development.

A case-control study of bidi smoking and bronchogenic carcinoma

OBJECTIVE:

To evaluate the risks imposed by tobacco smoking, in particular, bidi smoking, in the development of lung cancer.

METHODS:

Two hundred eighty-four histologically confirmed patients of bronchogenic carcinoma and 852 controls matched for age, sex, and socioeconomic status were interviewed according to a predesigned questionnaire. Effects of individual variables defining the various aspects of tobacco smoking, in particular, bidi smoking, were assessed using logistic regression models.

RESULTS:

81.3% cases of bronchogenic carcinoma were ever smokers as compared with 42.2% among controls. The odd ratios for ever smoking, bidi smoking, and cigarette smoking were 5.9 (confidence interval [CI] 4.3, 8.4), 6.1 (CI 4.3, 8.7), and 5.3 (CI 2.7, 10.4), respectively.

CONCLUSION:

Bidi smoking poses a very high risk for lung cancer even more than that of cigarette smoking.

Stem cells and lung diseases

This paper is designed to review our current understanding of the role of stem and progenitor cells in lung repair after injury and to review the current status of cell therapy approaches for lung diseases. It was found that circulating EPCs (endothelial progenitor cells) play roles in both acute lung injury and in fibrotic lung diseases. Circulating fibrocytes can contribute to the pathophysiology of fibrotic lung diseases and thus may be a potential therapeutic target. MSCs (mesenchymal cells) suppress lung injury and inflammation in several mouse models of inflammatory and immune-mediated lung diseases. In addition, novel areas of investigation have developed that include increasing exploration of three-dimensional culture systems and bioengineering approaches to generate functional lung tissue ex vivo and in vivo.