The treatment of uterine leiomyosarcoma: clinical outcomes of 18 cases and the effectiveness of chemotherapy

PURPOSE

To investigate clinical outcomes with respect to the effectiveness of chemotherapy in the treatment of uterine leiomyosarcoma.

METHODS

Study subjects were 18 patients with uterine leiomyosarcoma treated surgically at our hospital between February 1986 and December 2007. A chemotherapy regimen that combined ifosfamide, epirubicine, and cisplatin (IEP) was used as the main first-line chemotherapy.

RESULTS

FIGO disease stages were as follows: Stage I (n = 11), Stage II (n = 1), Stage III (n = 3), Stage IV (n = 3). Five-year overall survival of patients with Stage I-III disease was 65.3% (95% CI: 46.1-92.4%). None of patients with Stage IV disease survived for more than two years. Of seven patients who suffered advanced or recurrent disease, six received IEP; the response rate was 50%, one complete response and two partial responses.

CONCLUSIONS

The combination of surgery and chemotherapy seems to be an acceptable treatment for uterine leiomyosarcoma. IEP may be an active regimen for this aggressive disease.

Abstract P1-12-03: The STAGE Study: A Phase III Comparison of Anastrozole Plus Goserelin with Tamoxifen Plus Goserelin as Pre-Operative Treatments in Premenopausal Breast Cancer Patients

Background: Although superior antitumor activity of anastrozole over tamoxifen has been well established in postmenopausal breast cancer patients, it still remains to be examined whether or not anastrozole is superior to tamoxifen in premenopausal breast cancer patients whose ovarian function is suppressed by goserelin to postmenopausal levels. The aim of this study was to compare anastrozole plus goserelin versus tamoxifen plus goserelin as pre-operative treatment for premenopausal Japanese women with breast cancer.

Methods: Phase III, randomized, double-blind, parallel-group, multi-center study (D539BC00001). Premenopausal patients (pts) with ER-positive and HER2-negative breast cancer and with operable and measurable lesions (T [2-5 cm], N0, M0) were randomized 1:1 to receive a goserelin 3.6 mg depot injection once monthly plus either anastrozole 1 mg (A+G) or tamoxifen 20 mg (T+G) p.o. once daily. Treatment continued for 24 weeks prior to surgery or until any other criterion for discontinuation was met. Concomitant chemotherapy was not permitted during the pre-operative period. The primary objective was to assess the best overall tumor response (either a complete response [CR] or a partial response [PR]), according to modified RECIST criteria. Tumor size was measured by caliper and ultrasound every 4 weeks and by magnetic resonance imaging/computed tomography (MRI/CT) every 12 weeks. Tolerability (adverse events [AEs], laboratory tests, vital signs, WHO performance status) was assessed as a secondary objective. AEs were evaluated according to CTCAE v3.0.

Results: In total, 197 pts were randomized (A+G: 98, T+G: 99) and 185 pts completed the 24-week pre-operative treatment period and went on to receive breast surgery. The remaining 12 pts discontinued study treatment due to disease progression (A+G: 1; T+G: 5), voluntary discontinuation (A+G: 2; T+G: 3) and AE (T+G: 1). Pt demographics were generally well balanced. Median duration of exposure was similar for A+G (171 days) and T+G (170 days); treatment compliance was 99% for both. A+G led to a statistically significantly higher overall response rate compared with T+G, by caliper as well as by ultrasound and MRI/CT.

The safety profiles were consistent with the known safety profile of anastrozole, tamoxifen and goserelin. The incidence of AEs was similar

for A+G (88.8%) vs T+G (85.7%); most AEs were mild or moderate (CTC grade 1 or 2). The most common AEs were hot flash (A+G: 52.0%; T+G: 53.1%) and arthralgia (A+G: 35.7%; T+G: 20.4%). Conclusion: This study has demonstrated that the A+G combination has a superior benefit-risk profile compared with T+G as pre-operative treatment in Japanese premenopausal women with ER-positive breast cancer.

Abstract P3-13-05: Estrogen Receptor-Positive Breast Cancer in Japanese Women: Trends in Incidence, Characteristics and Prognosis

Background: The incidence of breast cancer in Japanese women has doubled in all age groups over the past two decades. Patients and Methods: We examined the characteristics of patients and tumors treated in three time periods between 1982 and 2010. Estrogen receptor (ER), progesterone receptor (PgR), and HER2 status were assessed by immunohistochemistry. Correlation of hormone receptor levels with clinicopathological factors and prognosis was analyzed in ER-positive, HER2-negative breast cancer in two age groups (≥50 years vs. >50 years).

Results: A total of 1903 women with breast cancer, who were treated at Nagoya City University Hospital, were included in this study. The frequency of ER-positive breast cancer in women aged 50 years or younger increased greatly over the interval studied (1982-1991: 52.5%, 1992-2001: 72.6%, 2002-2010: 87.1%, P < 0.0001). The frequency of ER-positive tumors was also significantly increased in women over 50 years of age (1982-1991: 69.4%, 1992-2001: 73.3%, 2002-2010: 78.6%, P = 0.029). In ER-positive, HER2-negative breast cancer, tumor grade was negatively correlated with expression levels of ER (P = 0.0029) and PgR (P < 0.0001). Interestingly, PgR levels were significantly higher in women aged 50 years or younger than in women over 50 years old (P < 0.0001). In both age groups, the prognosis for patients with ER-positive, HER2- negative breast cancer significantly improved over time, due to advances in adjuvant therapies. ER and PgR expression levels were not associated with disease-free survival. Lymph node status and tumor size were strong prognostic factors regardless of the biological characteristics of the tumors in ER-positive, HER2-negative breast cancer in both age groups. Conclusions: It is necessary to establish risk factors, both genetic and environmental, capable of predicting the risk of ER-positive breast cancer and thus enable the efficient selection of candidates for hormone receptor-targeted chemoprevention. Furthermore, new approach should be considered to improve survival for node-positive, ER-positive breast cancer.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-13-05.

Estrogen receptor-positive breast cancer in Japanese women: trends in incidence, characteristics, and prognosis

BACKGROUND

The incidence of breast cancer in Japanese women has doubled in all age groups over the past two decades.

PATIENTS AND METHODS

We examined the characteristics of the tumors treated in three time periods between 1982 and 2010. Estrogen receptor (ER), progesterone receptor (PgR) and HER2 status were assessed by immunohistochemistry. Correlation of hormone receptor levels with clinicopathological factors and prognosis was analyzed in ER-positive, HER2-negative breast cancer in two age groups (≤50 years versus >50 years).

RESULTS

The frequency of ER-positive breast cancer in women aged 50 years or younger increased greatly over the interval studied (1982-1991: 52.5%, 1992-2001: 72.6%, 2002-2010: 87.1%, P < 0.0001). The frequency of ER-positive tumors also significantly increased in women over 50 years of age (1982-1991: 69.4%, 1992-2001: 73.3%, 2002-2010: 78.6%, P = 0.029). In ER-positive, HER2-negative breast cancer, tumor grade was negatively correlated with expression levels of ER and PgR. Prognosis for patients with ER-positive, HER2-negative disease significantly improved over time, due to advances in adjuvant therapies.

CONCLUSION

It is necessary to establish risk factors, both genetic and environmental, capable of predicting the risk of ER-positive breast cancer and thus enable the efficient selection of candidates for hormone receptor-targeted chemoprevention.

Three dose regimens of fulvestrant in postmenopausal Japanese women with advanced breast cancer: results from a double-blind, phase II comparative study (FINDER1)

BACKGROUND

FINDER1 compared efficacy, tolerability and pharmacokinetics (PK) of three fulvestrant dose regimens in postmenopausal Japanese women with estrogen receptor (ER)-positive locally advanced/metastatic breast cancer recurring or progressing after prior endocrine therapy.

PATIENTS AND METHODS

The primary end point of this randomised, multicentre, phase II study was objective response rate (ORR) and the secondary end points included time to progression (TTP), clinical benefit rate (CBR), PK profiles and tolerability. Postmenopausal women with ER-positive advanced breast cancer were randomised to 28-day cycles of fulvestrant approved dose (AD), loading dose (LD) or high dose (HD) until disease progression.

RESULTS

Hundred and forty-three patients (median age 61 years) received fulvestrant AD (n = 45), LD (n = 51) or HD (n = 47). ORR was similar across dose regimens: 11.1%, 17.6% and 10.6% for AD, LD and HD, respectively, with overlapping confidence intervals. TTP and CBR were also similar between groups (median TTP: 6.0, 7.5 and 6.0 months, respectively; CBR: 42.2%, 54.9% and 46.8% for AD, LD and HD, respectively). C(max) and area under the plasma concentration-time curve were dose proportional and PK steady state was reached earlier with LD and HD than with AD. All three doses were well tolerated, with a similar adverse-event profile and no emerging safety concerns.

CONCLUSION

Fulvestrant AD, LD and HD had similar efficacy and tolerability profiles in postmenopausal Japanese women with ER-positive advanced breast cancer.

Predictors of Response to Exemestane as Primary Endocrine Therapy in Estrogen Receptor-Positive Breast Cancer

Endocrine therapy is the most important treatment of choice for estrogen receptor-positive breast cancer. Potential mechanisms for resistance to endocrine therapy involve estrogen receptor (ER)-coregulatory proteins and cross-talk between ER and other growth factor-signaling networks. However, the factors and pathways responsible for endocrine therapy resistance, particularly resistance to aromatase inhibitors, have not been clearly established. Sixteen postmenopausal patients with ERΑ-positive primary breast cancer were treated daily with 25 mg of exemestane (an aromatase inhibitor) for 6 months. Expressions of ERΑ, ERΒ, progesterone receptor (PgR), androgen receptor (AR), AIB1, aromatase, EGFR, HER2, Ki67, cyclin D1, p53, Bcl2, Stat5 and IGFBP5, and phosphorylations of ERΑ serine (Ser) 118, ERΑ Ser167, Akt Ser473 and p44/42 MAPK threonine (Thr) 202/ tyrosine (Tyr) 204 were examined by immunohistochemistry on pretreatment tumor biopsies and posttreatment surgical specimens. Analyses were made to test for correlations with response to exemestane. Of the 16 patients, 7 responded and 9 retained stable disease. High-level expression of AIB1 and phosphorylation of Akt Ser473 were significantly associated with a better response to exemestane, suggesting that these factors could be considered as predictors of exemestane response. Expressions of ERΑ, ERΒ, PgR, aromatase, Ki67, cyclin D1 and p53, and phosphorylations of ERΑ Ser118, ERΑ Ser167 and p44/42 MAPK Thr202/Tyr204 were decreased, whereas expressions of Stat5 and IGFBP5 were increased in posttreatment specimens compared to the values in pretreatment biopsies. Thus, the analysis of factors involved in the estrogen-dependent growth-signaling pathways may be useful in identifying patients responsive to exemestane.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2041.

Measurement and calculation of radioactivities of spallation products by high-energy heavy ions

Irradiation experiments were performed at the HIMAC (Heavy Ion Medical Accelerator in Chiba) facility, National Institute of Radiological Sciences, Japan. The radioactivity distributions of spallation products in a thick Cu target were obtained by irradiating 230 and 100MeV/nucleon Ne, C, He, p and 230MeV/nucleon Ar ions. The gamma-ray spectra from thin irradiated samples of C, Al and Cu inserted into a Cu target were measured with a HPGe detector. From the gamma-ray spectra, we obtained the spatial distribution of radioactive yields of spallation products of about 40 nuclides in Cu sample in the Cu target. Our results agree with other experimental data. We also calculated the spatial distribution of residual radioactivities in the Cu target by the PHITS (Particle and Heavy-Ion Transport code System) code and compared with measured results. The PHITS code provides good results on residual activity calculations.

Aspherical refractive lenses for small-angle neutron scattering

Aspherical neutron lenses are discussed in detail as focusing elements for existing small-angle neutron scattering (SANS) diffractometers. The conceptual design can be obtained by analytical equations, while computer simulations provide the intensity distribution of the primary beam, which is strongly correlated with the instrumental resolution and the minimal momentum transferQ. For large illuminated sample/lens areas of 50 mm diameter the aspherical lens design is essential, while spherical lenses are limited toca20 mm diameter with a 60% spherical aberration for standard SANS experiments. Scattering experiments on different samples proved the applicability and revealed the resolution limits of the two lens types. From theoretical considerations it is proposed that lens cooling can be used to reduce the thermal diffuse scattering.

Clinicopathologic and prognostic features of triple-negative breast cancer analyzed in registration data of the Japanese Breast Cancer Society, 11705 cases

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Background: Triple-negative (TN) breast cancers which are negative for ER, PgR, and HER2 by immunohistochemistry are associated with a poor prognosis. To clarify the characteristics of TN tumors, the data of the registration committee of the Japanese Breast Cancer Society were analyzed with respect to clinicopathologic factors, response to neoadjuvant chemotherapy (NAC) and prognosis. Methods: Of 14,748 cases that were registered in 2004, 11,705 cases (79.4%) were examined for ER, PgR, and HER2 status, which was based on local institute. In the 2,331 cases of all registered cases, the prognosis and details of the treatment were analyzed with 47.8 months as median follow-up period. In 184 cases (7.9%), NAC was mainly performed using anthracycline and taxane based chemotherapy. Results: Luminal A type with positive for ER and/or PgR and negative for HER2 was most prevalent (53.8%), followed by TN type (15.5%). TN cancers were diagnosed at a slightly advanced stage and more of the cases had lymph node metastases compared to other types. Mucinous or tubular carcinoma was frequently seen in the Luminal A type. Squamous cell, spindle cell carcinoma, or metaplastic carcinoma with bone/cartilage metaplasia was found in only TN type. The HER2 type and TN type had statistically worse outcome compared to Luminal type in DFS and OS (P<.0001 and P<.0001, respectively). Pathological response rate of NAC, including grade 2 and 3, was higher in TN tumor as 51.5 % (22/53) than in Luminal A tumor as 16.7% (12/72). Responders in TN tumors have a better prognosis than non-responder (P=.0016), but this tendency was not recognized in non-TN tumors (P=.15). Conclusions: The ratio of the TN tumors in Japan was 15–6%. Central reviews of immunohistochemistry, such as ER, PgR, HER2, CK5/6, EGFR etc, will be confirmed in this cohort, for TN tumors are similar to basal-like tumors discriminated by gene- profiling.

[Table: see text]

Concurrent chemoradiotherapy for locally advanced cervical esophageal carcinoma: A phase II study of oral fluoropyrimidine agents (UFT, S-1) plus cisplatin with radiotherapy

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Background: Carcinoma of the cervical esophagus is a highly virulent disease. Although surgery is the standard therapy, the results of surgery alone are poor. Oral fluoropyrimidines (UFT, S-1) are useful to treat head and neck cancer and enhance the effectiveness of radiotherapy. We evaluated concurrent chemoradiotherapy using an oral fluoropyrimidine (UFT, S-1) and cisplatin in patients with locally advanced cervical esophageal carcinoma. Methods: Chemoradiotherapy with UFT and cisplatin (R-U-P) consisted of 60Gy of radiotherapy during 6 weeks, with daily UFT (200 mg/m2/day) and a 24-h infusion of cisplatin (70 mg/m2) on Days 8 and 36. Chemoradiotherapy with S-1 and cisplatin (R-S-P) consisted of two courses. One included 30 Gy of radiotherapy over 3 weeks, with daily S-1 (80 mg/m2/day) for 2 weeks and a 24-h infusion of cisplatin (70 mg/m2) on Day 8. The other included chemoradiotherapy after 2 weeks. Responders received at least 2 four-week courses of the chemotherapy. Results: Twenty patients were enrolled: 8 were treated with R-U-P and 12 with R-S-P. Four patients had stage II tumors and 16 had stage III tumors. All patients completed the chemoradiotherapy. The most prominent toxicity was myelosuppression. Grades 3 and 4 leukocytopenia occurred in 5 (25%) and 2 (10%) patients, respectively. Nonhematologic toxicity was moderate: grade 2 nausea/vomiting, pain, oral mucositis, and renal dysfunction occurred in 25%, 25%, 20% and 10% of the patients, respectively. Complete response (CR) was attained in all 4 patients with stage II tumors. In stage III cases, CR, partial response (PR), and response rates were 81%, 13%, and 94%, respectively these reached 75%, 17%, and 92% in the R-U-P group, and 90%, 10%, and 100% in the R-S-P group, respectively. All stage II patients survived. In stage III cases, the one-year survival rate was 75% and the three-year survival rate was 50%. Conclusions: Chemoradiotherapy with an oral fluoropyrimidine (UFT, S-1) plus cisplatin is convenient, tolerable, and effective, and it is a promising nonsurgical management option for patients with locally advanced cervical esophageal carcinoma.

No significant financial relationships to disclose.

Calculation of energy-deposition distributions and microdosimetric estimation of the biological effect of a 9C beam

Among the alternative beams being recently considered for external cancer radiotherapy, (9)C has received some attention because it is expected that its biological effectiveness could be boosted by the beta-delayed emission of two alpha particles and a proton that takes place at the ion-stopping site. Experiments have been performed to characterise this exotic beam physically and models have been developed to estimate quantitatively its biological effect. Here, the particle and heavy-ion transport code system ( PHITS ) is used to calculate energy-deposition and linear energy transfer distributions for a (9)C beam in water and the results are compared with published data. Although PHITS fails to reproduce some of the features of the distributions, it suggests that the decay of (9)C contributes negligibly to the energy-deposition distributions, thus contradicting the previous interpretation of the measured data. We have also performed a microdosimetric calculation to estimate the biological effect of the decay, which was found to be negligible; previous microdosimetric Monte-Carlo calculations were found to be incorrect. An analytical argument, of geometrical nature, confirms this conclusion and gives a theoretical upper bound on the additional biological effectiveness of the decay. However, no explanation can be offered at present for the observed difference in the biological effectiveness between (9)C and (12)C; the reproducibility of this surprising result will be verified in coming experiments.

Bacterium organizes hierarchical amorphous structure in microbial cellulose

A pellicle, a gel film of microbial cellulose, is a supermolecular system containing 99% of water by weight, which is closely related to an amorphous structure in it. Using ultra-small-angle neutron scattering, in order to cover over a wide range of length scales from nm to 10 microm, we examined the hierarchical amorphous structure in the microbial cellulose, which is synthesized by a bacterium (Acetobacter xylinum). The microbial cellulose swollen by water shows small-angle scattering that obeys a power law q -behavior according to q -alpha as a function of the magnitude of the scattering vector q . The power law, determined by scattering, is attributed to a mass fractal due to the distribution of the center of mass for the crystallite (microfibril) in amorphous cellulose swollen by water. As q increases, alpha takes the values of 2.5, 1, and 2.35, corresponding, respectively, to a gel network composed of bundles, a bundle composed of cellulose ribbons, and concentration fluctuations in a bundle. From the mass fractal q -behavior and its length scale limits, we evaluated a volume fraction of crystallite in microbial cellulose. It was found that 90% of the cellulose bundle is occupied by amorphous cellulose containing water.