Neuroprotection of ulinastatin on transient cerebral ischemia via antioxidative mechanisms

Ulinastatin [also called urinary trypsin inhibitor (UTI)] has beneficial effects on cerebral ischemic injury evoked by cardiac arrest (CA). However, the underlying mechanisms are unknown. The purpose of this report was to determine the involvement of antioxidative signal pathway of the hippocampus in effects of UTI in the process of neurological functions after transient cerebral ischemia. CA was induced by asphyxia followed by cardiopulmonary resuscitation in rats. Western blot analysis and ELISA were used to examine expression of Nrf2-antioxidant response element (ARE) and superoxide dismutases (SOD), and the levels of products of oxidative stress. In addition, the modified neurological severity score (mNSS) and spatial working memory performance were employed to assess neurological deficiencies in CA rats. Our results show that CA impaired Nrf2-ARE and SOD in the hippocampus CA1 region and amplified products of oxidative stress, namely 8-isoprostaglandin F2α (8-iso PGF2α) and 8-hydroxy-2’-deoxyguanosine (8-OHdG). Systemic administration of UTI largely restored Nrf2-ARE and SOD, and this also attenuated amplification of 8-iso PGF2α and 8-OHdG induced by cerebral ischemia and thereby alleviated neurological deficits with increasing survival of CA rats. Our data suggest that UTI improves Nrf2-ARE signals and inhibits products of oxidative stress in the hippocampus, which is linked to improvement of neurological deficiencies in transient cerebral ischemia. UTI plays a beneficial role in modulating cerebral ischemic injury via antioxidative mechanisms.

Abstract PD5-11: Not presented

This abstract was not presented at the symposium.

Abstract P2-09-16: Tumor infiltrating lymphocytes (TILs) as a biomarker for resistance to palbociclib (Pal) in the NeoPalAna trial

Background: Cyclin-dependent kinase (CDK) 4/6 inhibitors improve disease free survival for patients (pts) with advanced hormone receptor positive (HR+) and HER2 negative (HER2-) breast cancer (BC). However, there are no established biomarkers that identify sensitive versus resistant tumors. We have recently reported results from the phase II neoadjuvant NeoPalAna trial (NCT01723774 ) which demonstrated that Pal enhanced the anti-proliferative activity when added to anastrozole (Ana) monotherapy in HR+HER2- BC. Interestingly, a small group of pts (15%) were resistant to Pal, exhibiting persistent tumor cell proliferation (Ki67 >2.7%) on Ana plus Pal. Several studies have evaluated the prognostic and predictive importance of TILs in BC, particularly in triple negative and HER2+ subtypes. Studies evaluating TILs in HR+ BC is limited. Here we evaluated the utility of TILs in identifying Pal-resistant tumors.

Methods: Serial biopsies were collected from pts at 4 time points: baseline (BL), cycle 1 day 1 (C1D1) following 28 days of Ana monotherapy, cycle 1 day 15 (C1D15) at 2 weeks post the addition of Pal, and at surgery (Surg). TILs were evaluated using published recommendations by the TILs international working group. Agilent 4X44 whole genome gene expression arrays performed on fresh frozen biopsies at BL, C1D1, and C1D15 were analyzed for pathways and gene signatures that differentiate Pal-resistant (Pal-r) (C1D15 Ki67 >2.7%) from Ana-sensitive (Ana-s) (C1D1 Ki67 ≤2.7%) or Pal- sensitive (Pal-s) (C1D1 Ki67 >2.7% but C1D15 Ki67 ≤2.7%) tumors defined by Ki67 response. TILs at each time point were pairwise compared between response groups using Wilcoxon rank sum test and Benjamini-Hochberg adjusted two-sided p-values were reported. Change between 2 time points within a response group was evaluated by Wilcoxon signed rank test.

Results: The TILs were significantly different between Ana-s and Pal-s groups [BL p=0.03, C1D1 p=0.01, C1D15 p=.02], as well as between Ana-s and Pal-r groups [BL p=0.03, C1D1 p=0.04, C1D15 p=0.02]. Overall Pal-r samples showed the highest TILs at all time points, while Ana-s samples showed the lowest TILs. There was no significant change between time points.

Elevated TILs in Pal-r group was further supported by microarray gene expression analysis which demonstrated a large group of genes associated MHC Class-I (15+ HLA and proteasome genes) as well as Immune–inflammation pathways (18+ T cell & lymphocyte markers, signaling genes) being up regulated at BL in the Pal-r group (n=5). Pal-r samples showed a similar trend in subsequent time points although the numbers of samples were small. Many genes within this immune-inflammatory group of genes were correlated with Ki67 change at C1D15 from BL, suggestive of a potential relationship with resistance.

Conclusions: Our data shows Pal resistance was consistently associated with higher TILs at BL and post treatment, which correlated with increased expression of inflammation-immune group genes. TILs may have utility to be used as a biomarker to identify Pal resistant BC. Our data is hypothesis generating and raises the possibility of immune therapy to overcome Pal resistance in BC.

Citation Format: Sanati S, Barve R, Luo J, Hoog J, Head R, Ellis M, Ma C. Tumor infiltrating lymphocytes (TILs) as a biomarker for resistance to palbociclib (Pal) in the NeoPalAna trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-16.

Abstract P1-07-04: Physical activity, weight and outcomes in patients receiving first-line chemotherapy for metastatic breast cancer: Results from CALGB 40502 (Alliance)

Background: Obesity and inactivity are associated with an increased risk of cancer-related and overall mortality in women with early-stage breast cancer, but there are few data in advanced breast cancer.

Methods: C40502 was a Phase III trial of first-line chemotherapy for patients with metastatic breast cancer (MBC). Participants were randomized to weekly paclitaxel, nab-paclitaxel or ixabepilone. Height and weight at the time of study enrollment were abstracted from medical records. After study activation, the protocol was amended to collect physical activity (PA) data. Participants completed the Nurses' Health Study Exercise Questionnaire, indicating the frequency, type and duration of recreational PA in which they engaged at study enrollment. Metabolic equivalent (MET)-hours of weekly PA (MET-hrs/wk) were calculated using the Ainsworth Compendium. PA was dichotomized to 0-9 or 9+ MET-hrs/wk based on data in early stage breast cancer suggesting that women who engaged in > 9 MET-hrs of PA/wk had lower cancer-specific mortality. Association with clinical endpoints was evaluated using multivariate Cox proportional hazard models adjusting for treatment assignment, age, tumor hormone-receptor status, prior taxane use, disease-free interval and visceral metastases.

Results: 799 patients enrolled in C40502 between 2008 and 2011. Baseline body mass index (BMI) was available for 792 patients and PA data for 500 participants. Median follow up was 60 months. Median age was 56.7 years; 72% of patients had hormone receptor (HR)-positive cancers. Median BMI was 28.6 kg/m2 (IQR: 24.7-33.1 kg/m2). Patients engaged in a median of 3.3 MET-hrs/wk of PA (about 1 hour of moderate-intensity PA/wk) (IQR: 0.7-12.7 MET-hrs/wk). Neither BMI nor PA was significantly associated with progression-free (PFS) or overall survival (OS).

BMI and OutcomesBMI (kg/m2)N (%)PFS (months)Adj HRP valueOS (months)Adj HRP value18.5-24.9209 (26.4)10.0 (9.1-11.2)ref0.4826.1 (23.3-33.2)ref0.5425-29.9248 (31.3)9.0 (7.6-10.3)1.00 (0.83-1.22) 22.0 (20.0-25.4)1.05 (0.85-1.30) ≥30335 (42.3)8.7 (7.7-9.7)0.97 (0.81-1.17) 25.5 (23.1-29.5)0.95 (0.78-1.16) 

PA and OutcomesPA (MET-hrs/wk)N (%)PFS (months)Adj HRP valueOS (months)Adj HRP value0-9344 (68.8)7.9 (7.4-9.2)ref0.1323.6 (20.1-26.8)ref0.21>9156 (31.2)9.8 (8.9-12.0)0.86 (0.71-1.05) 27.4 (22.3-35.6)0.87 (0.70-1.08) 

There was a trend toward longer PFS and OS in patients who reported PA > 9 MET-hrs/wk vs 0-9 MET-hrs/wk, especially in individuals with HR+ cancers (median PFS 11.7 vs 9.2 months [adj HR = 0.84 (0.66-1.05)] and OS 34.0 vs 26.5 months [adj HR = 0.83 (0.66-1.05)] with PA >9 vs 0- 9 MET-hrs/wk).

Conclusions: In some of the first data looking at the relationship between lifestyle factors and outcomes in MBC, there was no relationship between BMI and PFS or OS in patients receiving first-line chemotherapy for advanced disease. A trend toward improved PFS and OS was seen in multivariate analysis in patients who reported higher levels of PA, but results were not statistically significant and could have been influenced by other patient factors. More information is needed regarding the relationship between PA and cancer outcomes, especially in patients with HR+ cancers.

Citation Format: Ligibel JA, Huebner LJ, Rugo HS, Burstein H, Toppmeyer DL, Anders CK, Ma C, Hudis CA, Winer EP, Barry WT. Physical activity, weight and outcomes in patients receiving first-line chemotherapy for metastatic breast cancer: Results from CALGB 40502 (Alliance) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-04.

Abstract PD8-03: ESR1 gene fusions drive endocrine therapy resistance and metastasis in breast cancer

Background. Dysregulation of the estrogen receptor gene (ESR1) is an established mechanism of inducing endocrine therapy resistance. We previously discovered a chromosomal translocation event generating an estrogen receptor gene fused in-frame to C-terminal sequences of YAP1 (ESR1-YAP1) that contributed to endocrine therapy resistance in estrogen receptor positive (ER+) breast cancer models. This study compares functional, transcriptional, and pharmacological properties of additional ESR1 gene fusion events of both early stage (ESR1-NOP2) late stage (ESR1-YAP1 and ESR1-PCDH11x) breast cancers to gain a better understanding of therapeutic resistance and metastasis. Understanding the role of ESR1 fusions in inducing metastasis is critical, since the primary cause of death in breast cancer patients is through metastasis to distant sites.

Methods. RNA-seq screens identified ESR1 fusions from early and late stage, endocrine therapy resistant breast tumor samples. Functional experiments were conducted using ER+ breast cancer cell lines, xenograft, and PDX models to test the ability of ESR1 fusions to induce therapeutic resistance and metastasis. ChIP-seq and RNA-seq were performed to examine transcriptional properties and differential gene expression induced by the fusions which directed subsequent pharmacological experiments with a CDK4/6 inhibitor.

Results. ESR1-YAP1 and ESR1-PCDH11x promoted estrogen-independent and fulvestrant-resistant growth in vitro and induced greater tumor growth and increased metastatic capacity to the lungs of xenografted mice. In contrast, the ESR1-NOP2 fusion was sensitive to low estrogen conditions in vitro, and did not promote tumor growth. RNA-seq profiling revealed E2F targets pathway as the most highly enriched pathway induced by the ESR1 fusions. IHC revealed higher levels of pRb in ESR1-YAP1 and ESR1-PCDH11x xenograft tumors and subsequent CDK4/6 inhibition completely blocked tumor growth in an ESR1-YAP1 PDX model. Integrating RNA-seq with ChIP-seq data, we discovered a set of EMT and metastasis genes bound by all ESR1 fusions and WT-ER, but whose expression was strongly and uniquely up-regulated only by the ESR1-YAP1 and ESR1-PCDH11x fusions. These studies also revealed gained sites bound only by the ESR1-YAP1 and ESR1-PCDH11x fusions, not bound by WT-ER nor ESR1-NOP2. Genes mapping to these sites have a role in metastatic biology and were highly up-regulated by the YAP1 and PCDH11x fusions, potentially mediated by long range transcriptional activation.

Conclusion. ESR1-YAP1 and ESR1-PCDH11x are driver fusions that occur in drug-resistant, advanced stage breast cancer and are a new class of recurrent somatic mutation that can cause acquired endocrine therapy resistance, yet can be treated with CDK4/6 inhibition. These driver fusions also confer increased metastatic ability through their ability to drive expression of genes that contribute to EMT and metastasis. In contrast, ESR1-NOP2 did not produce functional protein and appears to be a passenger event. These studies may provide pre-clinical rationale for targeting ESR1 translocated breast tumors, since the presence of an ESR1 driver fusion places a patient in a therapeutic category where none of the currently available endocrine therapies are likely to be effective.

Citation Format: Lei JT, Shao J, Zhang J, Iglesia M, Chan DW, Cao J, Anurag M, Singh P, Haricharan S, Kavuri SM, Matsunuma R, Schmidt C, Kosaka Y, Crowder R, Hoog J, Phommaly C, Goncalves R, Ramalho S, Rodrigues-Peres RM, Lai W-C, Hampton O, Rogers A, Tobias E, Parikh P, Davies S, Ma C, Suman V, Hunt K, Watson M, Hoadley KA, Thompson A, Perou CM, Creighton CJ, Maher C, Ellis MJ. ESR1 gene fusions drive endocrine therapy resistance and metastasis in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD8-03.

Abstract P2-02-14: Circulating tumor DNA predicts clinical outcome in early stage triple negative breast cancer

Background- Triple negative breast cancer (TNBC) is the most aggressive subtype of breast cancer as these patients have the highest risk of recurrence and death. Only 35% of TNBC patients achieve a pathologic complete response (pCR) following neoadjuvant chemotherapy. Patients who do not achieve pCR have a 27% risk of distant recurrence and ultimate death at 3 years compared to 9% for pCR. Unidentified micrometastases are responsible for ultimate overt progression and death. Developing strategies to identify patients with minimal residual disease following curative treatment is an unmet need. Circulating tumor DNA (ctDNA) can characterize and monitor advanced cancers. In this study, we sought to assess if ctDNA can predict clinical outcome in TNBC.

Methods-Biospecimens were obtained from patients with stages II and III TNBC enrolled on a neoadjuvant trial (NCT02124902). Patients have a research biopsy and plasma for ctDNA collected at baseline, cycle 1 day 3, definitive surgery for those with residual disease, and at recurrence for those who relapse. Plasma for ctDNA is also collected every 6 months for 5 years after treatment. Patients receive docetaxel and carboplatin every 3 weeks X 6 cycles. Surgery is 3-5 weeks after chemotherapy. Six patients' serial tumor samples and germline DNA were studied by whole exome sequencing. The median sequencing depth was 90.13x. Sequencing was performed on samples with high cellularity (≥50%). All 6 patients also had serial ctDNA analyzed using Swift Biosciences Accel-Amplicon™ 56G Oncology Panel v2. After identifying somatic mutations in each breast tumor series, we determined the subset of mutations that intersected with the regions targeted by the Swift 56 gene panel. We then evaluated whether corresponding mutations could be detected in ctDNA, and if ctDNA predicted clinical outcome.

Results-Four of the 6 patients were non-pCR with residual disease following chemotherapy. We identified 627 somatic variants by exome analysis that were called by at least two somatic variant callers and passed additional quality filtering steps. Of these, 10 variants overlapped with the Swift panel. TP53 variants were identified in all 6 patients' tumor tissue samples. At least one TP53 variant was identified in 4 patients' baseline pre-chemotherapy ctDNA samples. Both pCR patients had either no detectable ctDNA TP53 mutations (NTN007-ref. in baseline tumor tissue was 19.58% variant allele frequency [VAF]); or clearance of ctDNA following chemotherapy from 4.45% VAF at baseline to 0.06% following chemotherapy (NTN004-ref. in baseline tumor tissue 37.34% VAF). Three non-PCR patients had persistent TP53 mutations in ctDNA during the treatment course. One non-pCR patient did not have detectable mutations in ctDNA. The only patient with recurrent disease whose ctDNA TP53 mutation persisted during the treatment course (baseline VAF-1.65%, cycle 1 day 3-0.78%, definitive surgery-0.09%), was found to have a higher ctDNA VAF at recurrence (29.55%).

Conclusion-In this pilot study, mutation tracking by ctDNA is sensitive and distinguishes pCR from non-pCR in TNBC patients receiving neoadjuvant chemotherapy. ctDNA also identifies recurrence following curative therapy. Evaluating ctDNA as a biomarker of outcome in TNBC is warranted.

Citation Format: Ademuyiwa F, Feng Y-Y, Skidmore Z, Kunisaki J, Walker J, Fulton R, Krysiak K, Skinner T, Weilbaecher K, Ma C, Griffith O, Griffith M. Circulating tumor DNA predicts clinical outcome in early stage triple negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-02-14.

Abstract P2-01-01: Trajectory patterns of circulating tumor cells (CTC) in chemotherapy-treated metastatic breast cancer (MBC) patients predict poor clinical outcomes: CALGB 40502 (Alliance)/NCCTG N063H study

Little is known about the dynamics of CTCs during treatment and its clinical significance. We examined the predictive utility of serial CTC analysis in ER+HER2- MBC patients (pts) treated with chemotherapy in the CALGB 40502/NCCTG N063H study, a randomized phase III trial of weekly paclitaxel compared to weekly nanoparticle albumin bound nab-paclitaxel or ixabepilone +/- bevacizumab as first-line therapy (ClinicalTrials.gov Identifier: NCT00785291, Support: U10CA180821, U10CA180882).

Methods: Of the 783 pts treated, 469 had ≥3 serial blood samples (including baseline) successfully analyzed for CTCs by CellSearch® and were included in this analysis (n=2,202). Samples with ≥5 CTCs per 7.5 mLs of blood were considered CTC+. The prognostic and predictive performance of baseline CTCs (bCTC) and CTC status from baseline to cycle 2 (b2CTC) were compared to a novel latent mixture model classification based on trajectory of CTCs (tCTC). Akaike Information Criterion (AIC) was used to select the model (bCTC vs b2CTC vs tCTC) that best predicts overall survival (OS), progression-free survival (PFS), and time-to-treatment failure (TTF).

Results: 53% of the pts were CTC+ at baseline. b2CTC status changed in 36% of the pts, most of whom were CTC+CTC- (35%), and very few CTC-CTC+ (1%); the rest of the pts did not experience a change in b2CTC status (46% CTC-CTC- and 19% CTC+CTC+). Mixture model analysis revealed 4 groups of pts that show distinct tCTC patterns over the course of treatment: consitently very low/undectectable CTCs (tCTCneg, 56%), low (tCTClo, 24%), intermediate (tCTCmid, 15%), or high (tCTChi, 5%). bCTC, b2CTC, and tCTC were significantly correlated with tumor subtype (all p <0.0022) and presence of bone metastasis (all p <0.0001). Multivariate analysis showed that pts who were CTC+ at baseline, and those whose b2CTC status remained positive (CTC+CTC+) had significantly reduced OS, PFS and TTF.

 OSPFSTTFModelsHR (95% CI)p-valueHR (95% CI)p-valueHR (95% CI)p-valuebCTC (vs CTC-)      → CTC+2.5(1.8-3.3)<0.00011.6(1.3-2.0)<0.00011.3(1.1-1.6)0.0046b2CTC (vs CTC+CTC-)      → CTC-CTC+1.6(0.5-5.4)0.41491.6(0.6-4.5)0.39051.6(0.6-4.3)0.3961→ CTC+CTC+2.7(1.9-3.8)<0.00011.8(1.4-2.5)<0.00011.8(1.3-2.4)<0.0001→ CTC-CTC-0.5(0.4-0.8)0.00020.8(0.6-0.9)0.01600.9(0.7-1.1)0.2771tCTC (vs tCTCneg)      → tCTClo2.6(1.9-3.7)<0.00011.9(1.4-2.4)<0.00010.9(0.7-1.1)0.0033→ tCTCmid5.3(3.6-8.0)<0.00012.5(1.8-3.4)<0.00011.8(1.4-2.5)0.0001→ tCTChi10.8(6.1-19)<0.00013.0(1.8-5.0)<0.00012.3(1.4-3.7)0.0009CTC- (<5 CTCs per 7.5 mLs); CTC+ (≥5 CTCs per 7.5 mLs)

Pts with tCTClo, tCTCmid and tCTChi had significantly shorter OS, PFS and TTF compared to those with tCTCneg. After adjustment for potential confounders, AIC analysis revealed that the tCTC model best predicts OS and PFS, while b2CTC best predicts TTF.

 AIC Score*ModelsOSPFSTTFbCTC243240514199b2CTC240540384186tCTC237940264188*The lowest AIC score indicates the best model.

Conclusions: Analysis of CTC trajectory patterns identified pts with poor outcome who could potentially benefit from more effective treatment. Validation in independent cohorts is warranted to confirm the findings in this study.

Citation Format: Magbanua MJ, Hendrix L, Hyslop T, Barry WT, Winer EP, Hudis C, Toppmeyer D, Burnstein H, Qadir M, Ma C, Scott JH, Park JW, Rugo HS. Trajectory patterns of circulating tumor cells (CTC) in chemotherapy-treated metastatic breast cancer (MBC) patients predict poor clinical outcomes: CALGB 40502 (Alliance)/NCCTG N063H study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-01-01.

Enhanced energy transfer in heterogeneous nanocrystals for near infrared upconversion photocurrent generation

The key to produce inorganic heterogeneous nanostructures, and to integrate multiple functionalities, is to enhance or at least retain the functionalities of different components of materials. However, this ideal scenario is often deteriorated at the interface of the heterogeneous nanostructures due to lattice mismatches, resulting in downgraded performance in most hybrid nanomaterials. Here, we report that there is a narrow window in controlling temperature in a Lewis acid-base reaction process to facilitate epitaxial alignment during the synthesis of hybrid nanomaterials. We demonstrate a perfectly fused NaYF₄:Yb,Tm@ZnO heterogeneous nanostructure, in which the semiconductor ZnO shell can be epitaxially grown onto lanthanide-doped upconversion nanoparticles. By achieving a matched crystal lattice, the interface defects and crystalline grain boundaries are minimized to enable more efficient energy transfer from the upconversion nanoparticles to the semiconductor, resulting in both enhanced upconversion luminescence intensity and superior photoelectrochemical properties. This strategy provides an outstanding approach to endow lanthanide-doped upconversion nanoparticles with versatile properties.

Environmental controls on sap flow in black locust forest in Loess Plateau, China

Black locust accounts for over 90% of artificial forests in China's Loess Plateau region. However, water use of black locust is an uphill challenge for this semi-arid region. To accurately quantify tree water use and to explain the related hydrological processes, it is important to collect reliable data for application in the estimation of sap flow and its response to environmental factors. This study measured sap flow in black locust in the 2015 and 2016 growth seasons using the thermal dissipation probes technique and laboratory-calibrated Granier's equation. The study showed that the laboratory calibrated coefficient α was much larger than the original value presented by Granier, while the coefficient β was similar to the original one. The average daily transpiration was 2.1 mm day-1 for 2015 and 1.6 mm day-1 for 2016. Net solar radiation (Rn) was the key meteorological factor controlling sap flow, followed by vapor pressure deficit (VPD) and then temperature (T). VPD had a threshold control on sap flow at threshold values of 1.9 kPa for 2015 and 1.6 kPa for 2016. The effects of diurnal hysteresis of Rn, VPD and T on sap flow were evident, indicating that black locust water use was conservative.

Effect of Mg/Ca molar ratios on characteristics of anaerobic-anoxic denitrifying dephosphatation

In this study, the effect of three Mg/Ca molar ratios (5.0, 3.8 and 1.7) on denitrifying phosphate removal performance, biomass morphology, and Extracellular Polymeric Substances (EPS) were examined. Results showed that when the influent Mg/Ca molar ratio was 3.8, the anaerobic-anoxic EBPR performed complete phosphate removal. The microbial bacterial population was a mixed culture comprised of 81±3% DPAO and 13±2% denitrifying glycogen accumulating organisms (DGAO). A higher influent Mg/Ca molar ratio (5.0) had a distinct impact on phosphate removal, biomass morphology, and EPS. This probably induced the deterioration of the anaerobic-anoxic Enhanced Biological Phosphorus Removal (EBPR). The results of this study may inform the proper operation of an anaerobic-anoxic EBPR, and contribute to its application in the real world.

Increased expression of programmed cell death protein 1 on NK cells inhibits NK-cell-mediated anti-tumor function and indicates poor prognosis in digestive cancers

Abnormal expression of activating/inhibitory receptors leads to natural killer (NK) cells dysfunction in tumor. Here we show that programmed cell death protein 1 (PD-1), a well-known immune checkpoint of T cells, is highly expressed on peripheral and tumor-infiltrating NK cells from patients with digestive cancers including esophageal, liver, colorectal, gastric and biliary cancer. The increased PD-1 expression on NK cells indicates poorer survival in esophageal and liver cancers. Blocking PD-1/PD-L1 signaling markedly enhances cytokines production and degranulation and suppresses apoptosis of NK cells in vitro. PD-1/PD-L1 exerts inhibitory effect through repressing the activation of PI3K/AKT signaling in NK cells. More importantly, a PD-1 blocking antibody was found to significantly suppress the growth of xenografts in nude mice, and this inhibition of tumor growth was completely abrogated by NK depletion. These findings strongly suggested that PD-1 is an inhibitory regulator of NK cells in digestive cancers. PD-1 blockade might be an efficient strategy in NK cell-based tumor immunotherapy.

Screening for Atrial Fibrillation

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

Characterization of retroviral infectivity and superinfection resistance during retrovirus-mediated transduction of mammalian cells

Retroviral vectors including lentiviral vectors are commonly used tools to stably express transgenes or RNA molecules in mammalian cells. Their utilities are roughly divided into two categories, stable overexpression of transgenes and RNA molecules, which requires maximal transduction efficiency, or functional selection with retrovirus (RV)-based libraries, which takes advantage of retroviral superinfection resistance. However, the dynamic features of RV-mediated transduction are not well characterized. Here, we engineered two murine stem cell virus-based retroviral vectors expressing dual fluorescence proteins and antibiotic markers, and analyzed virion production efficiency and virion stability, dynamic infectivity and superinfection resistance in different cell types, and strategies to improve transduction efficiency. We found that the highest virion production occurred between 60 and 72 h after transfection. The stability of the collected virion supernatant decreased by >60% after 3 days in storage. We found that RV infectivity varied drastically in the tested human cancer lines, while low transduction efficiency was partially overcome with increased virus titer, prolonged infection duration and/or repeated infections. Furthermore, we demonstrated that RV receptors PIT1 and PIT2 were lowly expressed in the analyzed cells, and that PIT1 and/or PIT2 overexpression significantly improved transduction efficiency in certain cell lines. Thus, our findings provide resourceful information for the optimal conditions of retroviral-mediated gene delivery.

Clinical, endoscopic and radiographic outcomes with ustekinumab in medically-refractory Crohn's disease: real world experience from a multicentre cohort

BACKGROUND

Ustekinumab is a monoclonal antibody targeting interleukins-12 and -23, with efficacy in Crohn's disease (CD) demonstrated in clinical trials.

AIM

To assess the real-world clinical, endoscopic and radiographic response and remission outcomes achieved with ustekinumab in medically-refractory CD.

METHODS

A retrospective multicentre cohort study was performed on CD patients receiving ustekinumab between 2011 and 2016. The primary outcome was achievement of clinical and objective steroid-free response and remission at 3, 6 and 12 months. Clinical response and remission were defined by reduction in Harvey Bradshaw Index (HBI) of ≥3 points and an HBI ≤4 points respectively. Objective response was defined by improvement in endoscopic or radiographic CD, as assessed by ileocolonoscopy, contrast-enhanced ultrasound or CT/MR enterography. Objective remission was defined by endoscopic mucosal healing or complete resolution of inflammatory parameters on radiographic assessment.

RESULTS

A total of 167 CD patients were treated with ustekinumab. 95.2% (159/167) previously failed anti-TNF therapy. Median follow-up was 45.6 weeks (IQR: 24.4-88.9). At 3 months, clinical response was achieved in 38.9% (65/167) and remission in 15.0% (25/167) of patients. At 6 months, clinical response was achieved in 60.3% (91/151) and remission in 25.2% (38/151) of patients. At 12 months, clinical response was achieved in 59.5% (66/111) and remission in 27.9% (31/111) of patients. Endoscopic or radiographic response was demonstrated in 54.5% (67/123) at 6 months and 55.8% (48/86) of patients at 12 months.

CONCLUSIONS

Ustekinumab is an effective therapeutic option for inducing and maintaining clinical, endoscopic and radiographic response in patients with Crohn's disease failing anti-TNF therapy.

Short- and medium-term effects of light to moderate alcohol intake on glycaemic control in diabetes mellitus: a systematic review and meta-analysis of randomized trials

BACKGROUND

People with diabetes are told that drinking alcohol may increase their risk of hypoglycaemia.

AIMS

To report the effects of alcohol consumption on glycaemic control in people with diabetes mellitus.

METHODS

Medline, EMBASE and the Cochrane Library databases were searched in 2015 to identify randomized trials that compared alcohol consumption with no alcohol use, reporting glycaemic control in people with diabetes. Data on blood glucose, HbA_1c and numbers of hypoglycaemic episodes were pooled using random effects meta-analysis.

RESULTS

Pooled data from nine short-term studies showed no difference in blood glucose concentrations between those who drank alcohol in doses of 16-80 g (median 20 g, 2.5 units) compared with those who did not drink alcohol at 0.5, 2, 4 and 24 h after alcohol consumption. Pooled data from five medium-term studies showed that there was no difference in blood glucose or HbA_1c concentrations at the end of the study between those who drank 11-18 g alcohol/day (median 13 g/day, 1.5 units/day) for 4-104 weeks and those who did not. We found no evidence of a difference in number of hypoglycaemic episodes or in withdrawal rates between randomized groups.

CONCLUSIONS

Studies to date have not provided evidence that drinking light to moderate amounts of alcohol, with or without a meal, affects any measure of glycaemic control in people with Type 2 diabetes. These results suggest that current advice that people with diabetes do not need to refrain from drinking moderate quantities of alcohol does not need to be changed; risks to those with Type 1 diabetes remain uncertain.

Promoter polymorphisms of the TIM-4 gene are correlated with disease activity in patients with systemic lupus erythematosus

Although the TIM gene family plays important roles in immune responses, little is known about TIM regulation in the development of systemic lupus erythematosus (SLE). This study aimed to investigate the association of two TIM-4 single nucleotide polymorphisms (SNPs) rs6874202 (-1419G>A) and rs62382402 (-1609G>A) with SLE susceptibility in a Chinese Han population. The results showed no significant differences between patients with SLE and control group for rs6874202 and rs62382402 (p = .72, .53 respectively). However, the anti-dsDNA levels in serum from SLE patients with GG genotype of TIM-4 gene at -1419 site were significantly higher than those with GA and AA genotype (p = .0335), and C3 levels of SLE patients with GG and GA genotype were much lower than those with AA genotypes (p = .0187). Moreover, the apoptotic cell levels of SLE patients with AA and GG genotypes were significantly higher than those with GA genotypes in patients with SLE (p = .0393). In addition, the C3 concentration of SLE patients with the GG genotype of TIM-4 gene at -1609 site was found to be significantly higher than those with the GA genotype (p = .0129). The results imply that GG genotype of the TIM-4 gene at -1419 site might be associated with the disease activity of SLE.

Long non-codingRNA (lncRNA) TUG1 and the prognosis of cancer: a meta-analysis

Some studies assessed the association between lncRNA taurine-upregulated gene 1 (TUG1) and the survival in cancer. However, the results were inconclusive.  Therefore, we performed a meta-analysis to determine this association. We used the following electronic databases to search for eligible literature: PubMed, Embase, Chinese National Knowledge Infrastructure (CNKI) and Wanfang. We used ORs and 95% CIs to measure the association between TUG1 and the survival of cancer. There was no significant association between TUG1 and OS of cancer (HR=1.26, 95% CI=0.97-1.64). In the subgroup analysis by cancer type, significant association could be find in osteosarcoma (HR=1.72, 95% CI=1.27-2.32) and digestive system's tumors (HR=1.66, 95% CI=1.04-2.66). In conclusion, this meta-analysis study indicated that TUG1 might associate with the OS of osteosarcoma and digestive system's tumors.

Thyrotropin Alters T Cell Development in the Thymus in Subclinical Hypothyroidism Mouse Model

Subclinical hypothyroidism (SCH) is highly prevalent in the general population and is associated with potential deleterious effects. Although developing T cells express thyroid-stimulating hormone receptor (TSH-R), the changes of T cell development in thymus in SCH have not been fully clarified. SCH mouse model, which is characterized by elevated serum TSH but similar thyroid hormone levels, was used to study the role of TSH in T cell development. Thymus weight of SCH mice increased 18% compared with controls. Importantly, the frequencies of CD4⁺ and CD8⁺ single-positive (SP) thymocytes increased 38% and 44%, respectively. We demonstrated that TSH protected thymocytes from apoptosis as evidenced by a significant decrease of Annexin V-positive thymocytes in SCH mice. Further analysis showed that extracellular-regulated kinases (ERK) 1/2 in thymus were activated in SCH mice. With analysis of T cell receptor excision circles (TREC), we found that TSH increased recent thymic emigrants (RTE) in spleen tissue in SCH mice. Thus, these results suggest that TSH promoted T cell development and enhanced the thymic recent output in SCH mice, possibly by suppression of apoptosis of thymocytes, indicating that modification of the ERK signalling pathways.

Abstract P4-22-04: A randomized, double-blind, phase 2 study of ruxolitinib (RUX) or placebo (PBO) in combination with capecitabine (CAPE) in patients (pts) with advanced HER2-negative breast cancer (ABC) and elevated C-reactive protein (CRP), a marker of systemic inflammation

Background: Systemic inflammation is associated with poor prognosis in pts with ABC. The JAK/STAT pathway is a key regulator of inflammatory signaling, associated with tumorigenesis, cell survival, and progression. We evaluated the efficacy and safety of RUX, a JAK1/JAK2 inhibitor, plus CAPE in pts with HER2-negative ABC and high systemic inflammation defined by the modified Glasgow Prognostic Score (mGPS). Methods: In this double-blind phase 2 trial, pts were randomized 1:1 to 21 day cycles of RUX+CAPE or PBO+CAPE: RUX 15 mg or PBO PO BID for 21 d; CAPE 1000 mg/m2 PO BID for 14 d. Key inclusion criteria were systemic inflammation by mGPS of 1 or 2 (ie, CRP >10 mg/L), ECOG performance status ≤2, ≤2 prior chemotherapy regimens, and no prior CAPE. The primary endpoint was overall survival (OS); key secondary endpoints were progression-free survival (PFS), objective response rate (ORR; complete [CR] + partial response [PR]) per RECIST v1.1, clinical benefit rate (CBR; CR + PR + stable disease for ≥6 mo), duration of response, and safety. Treatment differences in OS and PFS were analyzed by the log-rank test; HRs and CIs were analyzed by the Cox proportional hazards model. Results: Baseline characteristics were similar between pts randomized to RUX+CAPE (n=76) vs PBO+CAPE (n=73): mGPS status (1, 82.9% vs 83.6%), hormone receptor (HR) status (positive, 67.1% vs 63.0%), and number of prior chemotherapy regimens for ABC (0, 50.0% vs 50.7%; 1, 38.2% vs 34.2%; 2, 9.2% vs 13.7%). Median treatment durations were 85 d with RUX in the RUX+CAPE group and 65 d with PBO in the PBO+CAPE group. Median OS was 11.2 mo with RUX+CAPE vs 10.9 mo with PBO+CAPE (HR, 0.932; 95% CI, 0.59–1.46; P=0.762). Median OS was 6.1 mo with RUX+CAPE vs 5.5 mo with PBO+CAPE in HR-negative pts and 11.7 mo and 12.2 mo in HR-positive pts. Median PFS was 4.5 mo with RUX+CAPE and 2.5 mo with PBO+CAPE (HR, 0.737; 95% CI, 0.49–1.12; P=0.151). Median PFS was 2.1 mo with RUX+CAPE vs 2.2 mo with PBO+CAPE in HR-negative pts and 6.1 mo and 4.1 mo in HR-positive pts. ORRs were 28.9% and 13.7% (P=0.024) in the RUX+CAPE and PBO+CAPE arms, respectively. The CBRs were 13.2% and 6.8%, respectively (P=0.278). Worsening of hematologic toxicity was higher and rates of grade 3/4 palmar-plantar erythrodysethesia (PPE) were lower (1.4% vs 12.7%, respectively) with RUX+CAPE (Table).

Safety RUX+CAPE (n=71)PBO+CAPE (n=71)%All-GradeGrade 3/4All-GradeGrade 3/4Nonhematologic Adverse Event*Fatigue56.35.643.74.2Nausea54.98.549.35.6Diarrhea47.98.526.82.8PPE46.51.438.012.7Vomiting38.05.629.64.2Hypokalemia15.58.57.02.8Worsening of Hematologic Toxicity†Anemia80.323.956.37.0Lymphopenia40.815.545.112.7Neutropenia39.411.322.52.8Thrombocytopenia39.411.315.51.4*Most common all-grade (≥35%) or grade 3/4 (≥5%) events in the RUX+CAPE arm (safety group). †Laboratory abnormalities.

Conclusion: These data support the prognostic capabilities of the mGPS. The addition of RUX to CAPE for pts with ABC and high systemic inflammation was associated with an improved ORR compared with PBO+CAPE, but did not improve OS or PFS.

Citation Format: O'Shaughnessy J, DeMichele A, Ma C, Richards P, Yardley DA, Wright G, Kalinsky K, Steis R, Diab S, Kennealey G, Geschwindt R, Jiang W, Rugo H. A randomized, double-blind, phase 2 study of ruxolitinib (RUX) or placebo (PBO) in combination with capecitabine (CAPE) in patients (pts) with advanced HER2-negative breast cancer (ABC) and elevated C-reactive protein (CRP), a marker of systemic inflammation [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-04.

Abstract PD2-03: Recurrent functionally diverse in-frame ESR1 gene fusions drive endocrine resistance in breast cancer

Background. We previously reported an alternative ESR1 somatic gain-of-function chromosomal translocation event in a patient presenting with aggressive, endocrine therapy resistant estrogen receptor (ER) positive disease, producing an in-frame fusion gene consisting of N-terminal ESR1 and the C-terminus of the Hippo pathway coactivator YAP1 (ESR1-YAP1). We recently identified another ESR1 fusion through RNA sequencing (RNA-seq) in advanced stage ER+ disease from a chest wall recurrence in a male patient that was refractory to multiple lines of treatment. Two examples of fusions discovered in primary breast cancer samples include ESR1 fused in-frame to C-terminal sequences from NOP2 (ESR1-NOP2), identified in a resistant cohort from a RNA-seq screen focused on 81 primary breast cancers from aromatase inhibitor clinical trials, and a second ESR1 fusion, fused in-frame to the entire coding sequence of POLH (ESR1-POLH), that was identified from RNA-seq analysis of 728 Cancer Genome Atlas breast samples. This current study extends our previous characterization of ESR1-YAP1 by comparing functional and pharmacological properties of these three additional ESR1 gene fusion events of both early stage and advanced breast cancers.

Methods. In vitro and in vivo experiments were conducted to test ESR1 fusions to induce therapeutic resistance, and metastasis. The transcriptional and binding properties of each fusion was also examined. Pharmacological inhibition with Palbociclib, a cyclin-dependent kinase 4/6 inhibitor, was utilized to assess drug sensitivity in ESR1 fusion containing breast cancer cells and in a patient derived xenograft (PDX) model expressing ESR1-YAP1 (WHIM18).

Results. The YAP1 and PCDH11x fusions conferred estrogen-independent and fulvestrant-resistant growth. Immunohistochemistry revealed significantly higher numbers of ER+ cells in lungs of mice xenografted with T47D cells expressing the YAP1 and PCDH11x fusions compared to YFP control, NOP2 and POLH fusions. Results from ChIP-seq and microarray studies suggest that these two fusions promote proliferation and metastasis through genomic action by binding estrogen response elements (ERE) and subsequent gene activation. We thereby define these fusions as “canonical” fusions compared to “non-canonical” NOP2 and POLH fusions, which demonstrated dramatically decreased genomic binding ability. The non-canonical fusions induced genes associated with basal-like breast cancer and promoted HER2, EGFR, and MAPK gene expression signatures in contrast to genes associated with cell cycle/proliferation induced by canonical fusions. The proliferative ability of canonical fusion-containing ER+ cells was inhibited by Palbociclib in a dose-dependent manner. In vivo WHIM18 tumors in mice fed with Palbociclib-containing chow demonstrated significantly reduced tumor volume, growth rate, and weight compared to tumors in mice on control chow.

Conclusions. In-frame ERE activating canonical fusions occur in end-stage drug resistant advanced breast cancer and can be added to ESR1 point mutations as a class of recurrent somatic mutation that may cause acquired resistance. Growth induced by these fusions can be antagonized by Palbociclib and is potentially clinically helpful.

Citation Format: Lei JT, Shao J, Zhang J, Iglesia M, Cao J, Chan DW, He X, Kosaka Y, Schmidt C, Matsunuma R, Haricharan S, Crowder R, Hoog J, Phommaly C, Goncalves R, Ramalho S, Lai W-C, Hampton O, Rogers A, Tobias E, Parikh P, Davies S, Ma C, Suman V, Hunt K, Watson M, Hoadley KA, Thompson A, Chen X, Perou CM, Creighton CJ, Maher C, Ellis MJ. Recurrent functionally diverse in-frame ESR1 gene fusions drive endocrine resistance in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD2-03.

Abstract P5-04-02: Serum thymidine kinase 1 activity as a pharmacodynamics marker of cyclin-dependent kinase 4/6 inhibition in patients with early stage breast cancer receiving neoadjuvant palbociclib

Background: Thymidine kinase 1 (TK1) is a fundamental enzyme in DNA synthesis. TK1 expression is E2F-dependent and peaks in the S-phase of the cell cycle. In preclinical studies, inhibition of cyclin-dependent kinase (CDK) 4/6 led to dose dependent reduction of TK1 activity in cultured media. We hypothesized that serum TK1 could serve as a non-invasive surrogate marker of cell proliferation in patients (pts) receiving CDK4/6 inhibitors. In this study, we examined serum TK1 activity from breast cancer (BC) pts enrolled on a neoadjuvant study of palbociclib (Palbo) plus anastrozole (A), for changes induced by Palbo, and correlated with changes in tumor Ki67.

Methods: In this phase II neoadjuvant study, 50 pts with clinical stage II or III estrogen receptor positive (ER+) HER2- BC, received A (in combination with goserelin if premenopausal) alone for 28 days in cycle 0 (C0), followed by the addition of Palbo (125 mg daily on days 1-21) on cycle 1 day 1 (C1D1) for 4 28-day cycles (C1 to C4) unless C1D15 tumor Ki67>10%, in which case pts went off study. Following completion of cycle 4, A was continued for another 3-5 weeks to allow Palbo washout prior to surgery, except in 8 pts who received an additional 10-12 days of Palbo immediately prior. Blood and tumor biopsies were collected at 4 time points: baseline, C1D1, C1D15, and surgery. Serum TK1 activity was measured using the highly sensitive Divitum™ assay according to the Divitum™ Instructions for use (Biovica, Sweden). Tumor Ki67 IHC was performed at the Washington University AMP laboratory using the CONFIRM anti-Ki67 rabbit monoclonal antibody (clone 30-9), and pathologist guided image analysis.

Results: There was no statistically significant difference in TK activity between baseline and C1D1 serum samples (Table 1). However, serum TK activity decreased significantly from C1D1 to C1D15 following the addition of Palbo and increased significantly from C1D15 to surgery following Palbo washout (Table 1), indicating a significant effect of Palbo on TK activity. At C1D15, TK activity was below the detection limit of 20 Du/L in 44 of 48 pts, and was at low levels (24, 26, 26, and 58 Du/L) in the remaining 4 pts, indicating a profound effect by Palbo. Interestingly, the TK activities of the 4 pts with tumor Ki67 >10% at C1D15 were all below 20 Du/L, suggesting the possibility of tumor cell proliferation independent of CDK4/6 inhibition.

The sensitivity and specificity of change (increase/decrease) in serum TK activity to predict tumor Ki67 (increase/decrease) induced by Palbo were 83% (19/23, 95%CI: 66-99%) and 93% (26/28, 95%CI: 83%-100%), respectively. The Kappa statistic was 0.761 (P<0.001), indicating substantial agreement between the two tests.

Conclusions: Serum TK1 activity may serve as a pharmacodynamics marker of CDK4/6 inhibition and further investigation is warranted.

Table 1. Serum TK1 and tumor Ki67 Serum TKKi67 Median (IQR) (Du/L)NMedian (IQR) (%)NBaseline46 (25-73)4824.34% (11.92%-35.43%)45Cycle 1 day 143 (27.5-98)495.37% (2.49%-13.59%)*45Cycle 1 day 1520 (20-20)*480.78% (0.23%-1.05%)*45Day of surgery136.0 (37.5-259)*378.33% (2.25%-23.03%)*34*P<0.001 compared to the preceding time point.

Citation Format: Liu N, Thomas S, Luo R, Hoog J, Suh EM, Bergqvist M, Neumüller M, Guo Z, Vij K, Sanati S, Ellis M, Ma C. Serum thymidine kinase 1 activity as a pharmacodynamics marker of cyclin-dependent kinase 4/6 inhibition in patients with early stage breast cancer receiving neoadjuvant palbociclib [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-04-02.

Abstract OT3-04-01: BRE12-158: A phase II randomized controlled trial of genomically directed therapy after preoperative chemotherapy in patients with triple negative breast cancer (TNBC)

Background: About 1/3 of patients with TNBC who receive preoperative therapy will experience a pathological complete response (pCR). Patients with residual disease have a markedly inferior overall survival (OS) compared to those who experience pCR. Recently, the CREATE-X trial demonstrated an improvement in disease free survival (DFS) and OS for post-neoadjuvant capecitebine; although the addition of capecitebine to standard therapy has not previously improved outcome across other non-selected adjuvant or neo-adjuvant trials. Prior data have also demonstrated that the residual tumors are genomically diverse and that these genetic changes are reflected at time of relapse.

Trial Design: This trial is a randomized phase II trial to determine whether a genomically guided therapy in the setting of incomplete response to standard neoadjuvant therapy will improve outcomes compared to standard of care. DNA from archived tumor samples collected at the time of surgery will be extracted and sequenced. The sequencing data will be interrogated for known genomic drivers of sensitivity or resistance to existing FDA approved agents. A cancer genomic tumor board (CGTB) will consider the genomic data along with the patient's prior treatment history, toxicities, and comorbidities and select the optimal therapy. Participants with a CGTB recommendation will be randomized to Experimental Arm A (genomically directed monotherapy) or Control Arm B (standard of care). Participants may have no CGTB recommendation either because sequencing did not identify a matched drug or because the drug was contraindicated and will be assigned to Control Arm B.

Eligibility criteria: Patients must have histologically confirmed TNBC with completion of all definitive local therapy and no evidence of metastatic disease. There must be significant residual disease characterized by >2cm primary tumor, or lymph node positivity or RCB classification II or III. An FFPE tumor block with tumor cellularity >20% is required. All patients must have completed preoperative chemotherapy including a taxane or anthracycline or both.

Specific aims: The Primary Aim is to compare 2-year DFS with a genomically directed therapy vs. standard of care. Secondary Aims include 1-year DFS, 5-year OS, collection of archival specimens for correlative studies, and to describe toxicities. Exploratory Aims are to describe the evolution of genomically directed therapies during the course of the study and to evaluate the drug specific effect on efficacy and toxicity.

Statistical methods: In order to detect an improvement in the fraction of patients free from disease at 2-year from 40% in the control Arm B to 63.2% in the genomically directed Experimental Arm A (corresponding to an HR=0.5), 136 participants will have 80% power to detect a difference in DFS using a two-side log-rank test with 0.05 level of significance.

Present accrual/target accrual: 38 accrued of 136 to be randomized.

Citation Format: Schneider B, Miller KD, Badve S, O'Neil B, Helft P, Chitambar C, Falkson C, Nanda R, McCormick M, Danso M, Blaya M, Langdon R, Lippman M, Paplomata E, Walling R, Thompson M, Robin E, Aggarwal L, Shalaby I, Canfield V, Adesunloye B, Lee T, Daily K, Ma C, Erban J, Radhakrishnan N, Bruetman D, Graham M, Reddy NA, Lynce FC, Radovich M. BRE12-158: A phase II randomized controlled trial of genomically directed therapy after preoperative chemotherapy in patients with triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-04-01.

Abstract P4-21-40: In vitro and in vivo activity of HER2-targeted antibody-liposomal doxorubicin conjugate MM-302 in HER2-intermediate tumors

This abstract was withdrawn by the authors.

Abstract OT3-02-06: Femara plus ribociclib or placebo as neo-adjuvant endocrine therapy for women with ER+, HER2-negative early breast cancer - The Feline trial

Background:

In early ER+ breast cancer, neo-adjuvant (NA) endocrine therapy (ET) may identify a subset of patients with endocrine sensitive disease with excellent outcomes without chemotherapy. In patients receiving a NA aromatase inhibitor, on- therapy, short term (day 14) Ki-67 of <10% and post NA pre-operative endocrine prognostic index (PEPI) 0 at surgery are associated with low relapse rates without chemotherapy. Ribociclib, a novel CDK4/6 inhibitor is active in ER+ metastatic breast cancer. We hypothesize that ribociclib+letrozole as NA ET for stage II-III breast cancer will increase the number of women with a PEPI 0 at surgery.

Trial Design:

Randomized, placebo-controlled, multi-center, phase II, investigator initiated trial of NA letrozole +/- ribociclib in postmenopausal women with ER+, HER2-, breast cancer. Subjects will be randomized 1:1:1 to letrozole 2.5 mg daily + placebo, letrozole 2.5mg daily + ribociclib 600mg daily on D1-21 of a 28 day cycle (intermittent dosing), or letrozole 2.5mg daily + ribociclib 400mg daily (continuous dosing). Treatment will be continued for 6 months followed by surgery. Research core biopsies and blood will be collected at baseline, at day 14, and at surgery. A Ki67 >10% at day 14 will result in discontinuation of the subject from the protocol as this may be an early indicator of resistance to endocrine therapy. An MRI will be done after 2 months of therapy to assess response/progression. Primary endpoint is a PEPI score of 0 at surgery.

Key Eligibility Criteria:

Postmenopausal (natural or surgical) women with stage II/III ER+, HER2- breast cancer. Must have a palpable breast mass of at least 2 cm. Multicentric/contralateral invasive disease not allowed. Ipsilateral/contralateral DCIS is allowed. Inflammatory breast cancer is excluded.

Specific Aims:

Primary objective: To determine if ribociclib+letrozole as a 24 week NA ET increases rate of PEPI score of 0 at surgery compared to letrozole. Secondary objectives: To determine if ribociclib+letrozole as a 24 week NA ET increases the proportion of tumors with complete cell cycle arrest compared to letrozole; to determine if ribociclib in combination with letrozole for 24 weeks results in improved 5 year RFS compared to letrozole; to examine differences in response rates between the two ribociclib containing arms vs letrozole.

Statistical Methods:

The two ribocilib containing arms (n=80) will be combined for analysis against placebo + letrozole (n=40). Assuming that addition of ribociclib will increase the rate of PEPI 0 by 20%, and setting Type I error rate at 10% and Type II error rates at 20% in the final analysis, a sample size of 80 women in the treatment arms (40 in each arm) and 40 women in the control arm are needed to show significance.

Patient accrual and target accrual:

Participating sites include The Univ of Kansas Med Ctr, City of Hope National Med Ctr, Massachusetts General Hospital, University of Miami Sylvester Comprehensive Cancer Ctr, University of Arkansas for Medical Sciences, and University of Wisconsin. The trial has accrued 16 patients with a target accrual of 120 patients. Accrual should be complete in 2/2017.

Contact information: Qamar Khan, MD (qkhan@kumc.edu).

Citation Format: Khan QJ, Prochaska LH, Mohammad J, Yuan Y, O'Dea A, Bardia A, Wisinski K, Hard M, Baccaray S, Makhoul I, Wagner J, Laura S, Ma C, Sharma P. Femara plus ribociclib or placebo as neo-adjuvant endocrine therapy for women with ER+, HER2-negative early breast cancer - The Feline trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-02-06.

[Epidemic profile of mumps in China during 2004-2013]

OBJECTIVE

To analyze the epidemiological characteristics of mumps in China from 2004 to 2013.

METHODS

Data of mump cases occurring between 2004 and 2013 were gathered from the national notifiable disease reporting system in China (excluding Hong Kong, Macao, and Taiwan); only cases classified as "final card" , laboratory confirmed, or clinical diagnosis were included. Descriptive epidemiology techniques were used to analyze features of sex, age, trends over time, and geography.

RESULTS

Average incidence of mumps between 2004 to 2013 was 24.20/100 000. Peaks were in 2011 and 2012, with incidence 33.9/100 000 (454 385/1.340 million) and 35.6/100 000 (479 518/1.347 million). Two seasonal peaks occurred regularly in years, one from April to July in the first year, and the other from November to January in the next year. During the study period, provinces with the highest incidence were Ningxia, Tibet, Xinjiang, and Guangxi; incidences were 72.1/100 000 (4 425/6.13 million), 48.5/100 000 (1 396/3 million), 51.7/100 000 (10 887/21.04 million), and 40.8/100 000 (19 179/46.99 million), respectively. Guangdong (28 078), Sichuan (21 924), Guangxi (21 616), and Zhejiang (20 000) provinces reported the highest number of mumps cases. Beijing, Tianjin, and Shanghai showed a consistently low incidence. Mumps cases occurred primarily among children aged 5-9 years, with incidence ranging from 118.2/100 000 to 281.4/100 000. In 2004-2008, the peak age was 6-8 years (174.1/100 000) and in 2009-2013, peak age was 5-7 years (234.5/100 000).

CONCLUSION

The highest incidences of mumps in China were reported in 2011 and 2012, with children of school age constituting the majority of cases.

Pre-harvest foliar application of ethephon strengthens gibberellins-induced fruit expansion in Pyrus pyrifolia

To identify the roles of ethylene in fruit development in Japanese pear Pyrus pyrifolia 'Niitaka', one of the non-climacteric genotypes, source-sink strength and fruit development during fruit expansion were investigated when ethephon was applied after a conventional gibberellic acid (GA) lanolin paste treatment on the pedicel. The results demonstrate that the conventional GA treatment during the early stage of fruit expansion resulted in larger fruit size and advanced fruit maturation, but pre-harvest foliar application of ethephon only advanced fruit maturation. However, pre-harvest foliar application of ethephon with a preceding conventional GA treatment during the early stage of fruit expansion dramatically improved fruit size and advanced fruit maturation over GA or ethephon alone. Moreover, the early foliar application of ethephon showed a better efficacy in increasing fruit size than the late spraying. A further study revealed that when ethephon was applied after the conventional GA treatment, it improved source-sink strength associated with leaf photosynthesis and the specific rate of [¹³C] accumulation in fruit, and also strengthened cell expansion more than did GA or ethephon alone.

Association between alpha-adducin gene rs4963 polymorphism and hypertension risk in Asian population: a meta-analysis

Some studies investigated the association between ADD1 rs4963 polymorphism and hypertension risk. However, the results remained inconclusive. Thus, we performed a meta-analysis. Published reports were searched in PubMed and Google Scholar. The strength of association was assessed by calculating odds ratios (OR) and 95% confidence interval (CI). Twelve studies with 5097 cases and 5937 controls were conducted in this study. Individuals with ADD1 rs4963 polymorphism showed an increased hypertension risk (OR = 1.21; 95%CI, 1.11-1.33; P < 0.0001). Subgroup analyses were performed according to country and age. The results showed that Chinese with ADD1 rs4963 polymorphism showed an increased hypertension risk (OR = 1.28; 95%CI, 1.09-1.51; P = 0.003). However, subjects in Japan and India did not have increased hypertension risk. In the subgroup analysis by age, older subjects, but not younger subjects, with ADD1 rs4963 polymorphism showed an increased hypertension risk (OR = 1.19; 95%CI, 1.07-1.32; P = 0.001). In conclusion, this meta-analysis suggested that ADD1 rs4963 polymorphism might be associated with increased hypertension risk.