P2-08-05: Use of Dynamic Contrast-Enhanced MR Imaging To Predict Pathological Response in Primary Breast Cancer

Purpose: To investigate the effect of bevacizumab infusion on vascular parameters assessed by dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging and to test their association with pathological response in primary breast cancer.

Materials and Methods: 73 patients (median age, 47 ys; age range, 29–70 ys) with biopsy-proven, previously untreated, primary breast cancer were recruited from October 2009 to November 2010 in this phase II, multicenter and non-randomized clinical trial. Patients (pts) received single infusion of bevacizumab (15 mg/kg) (C1) 3 weeks prior to the beginning of neoadjuvant chemotherapy consisting in 4 cycles of docetaxel (60 mg/mq), doxorubicin (50 mg/mq) and bevacizumab (15 mg/kg) every 21 days (C2-C5) following by surgery. All pts underwent DCE-MR imaging before and 14–21 days after C1. Quantitative and semiquantitative kinetic parameters were calculated at baseline and after C1, including the volume transfer constant (K(trans)), which primarily reflects the wash-in of the contrast agent, the backflow rate contrant (K(ep)), extracellular volume fraction (V(e)) and the initial area under the gadolinium concentration-time curve over 60 seconds (IAUGC(60)). Changes in the DCE-MRI kinetic parameters K(trans), K(ep), V(e) and IAUGC(60) were calculated and Wilcoxon test was used to assess significant effects induced by bevacizumab on kinetic parameters. Pathological response on surgical specimens after C5 was assessed according to Miller and Payne classification. Pts with tumor reduction >30% were considered as responders (G3-G4-G5) whether tumor reduction <30% were considered as no responders (G1-G2). DCE-MR imaging parameters and clinical-pathological characteristics were correlated with pathological response using Mann-Whitney test in univariate and logistic regression in multivariate analyses. Receiver operating curves (ROC) was used to define the best cut-off of the parameter found associated with pathological response.

Results: DCE-MRI was performed before (n=72) and after (n=71) C1. K(trans), K(ep), V(e) and IAUCG(60) values were significantly different at the baseline and after C1 (p<0.01). Median changes were, respectively, −51, −101, −52.5 and −4.8. Fifty-two (74%) pts achieved response (G3-G4-G5) after C5 whether 18 (24%) were considered as no responder (G1-G2); for 3 (4%) patients Miller/Payne tumor evaluation was not available. At univariate analysis, negative estrogen receptor (ER) status and higher post-C1 K(ep) (p=.057) showed a trend toward an association with response. At multivariate analysis, only ER status remains a significant predictor of response (p= .04). Area under ROC curve for K(ep) was 0.65 (IC95% 0.05−0.8, p=.057)

Conclusion: Bevacizumab affects tumor vasculature, perfusion and permeability as showed by the significantly reduction in all kinetic vasculature parameters obtained in DCE-MR imaging after C1. However, in our population these changes were not associated with pathological response. On the other hand, backflow rate constant, K(ep), a perfusion-related parameter derived from DCE-MRI yielded after C1 major than 80, may be associated with higher pathological response with a specificity of 88% and sensitivity of 90%. Future studies are warranted to confirm these findings.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-05.

P5-13-04: Changes in Phosphorylation Status at VEGFR2 and Basal Tumor Hypoxic Volume Assessed by Misonidazol (MISO) Positron Emission Tomography (PET/CT) as Potential Biomarkers for Predicting Response to Bevacizumab in Breast Cancer

Background: To evaluate the expression of novel putative biomarkers as predictors of benefit from bevacizumab in stage II-III, previously untreated breast cancers (BC) patients (pts) in the context of a phase II, single-arm, multicenter and prospective clinical trial. To address this aim, we examined baseline and induced changes after a single bevacizumab administration as potential early predictors of response. Methods: Pts received a single infusion of bevacizumab (15 mg/kg) (C1) 3 weeks prior to the beginning of neoadjuvant chemotherapy consisting in 4 cycles of docetaxel (60 mg/mq), doxorubicin (50 mg/mq) and bevacizumab (15 mg/kg) every 21 days (C2-C5) following by surgery. Early assessment of tumor changes was performed by paired tumor-biopsies and MISO PET/CT before and 14–21 days after bevacizumab administration (C1). Biomarker expression was assessed by immunohistochemistry (IHC) (Ki67, CD31, CD31/Ki67, VEGFR2, pVEGFR2 [Y951]) on formalin-fixed, paraffin-embedded tissue before and after bevacizumab infusion (C1). MISO SUV and tumor volume depicted by PET were calculated. Pathological response on surgical specimens was assessed according to Miller/Payne classification. Pts with tumor reduction >90% were considered as best responders (G4-G5) whether tumor reduction <90% were considered as no responders. Association between pathological response, IHC and MISO biomarkers was analyzed using Mann-Whitney test. ROC curve was performed to test sensibility and specificity of the biomarker found significantly associated with response and its value as independent predictor was tested in the multivariate analysis using logistic regression.

Results: This analysis was performed on the training set including 73 patients (49 yr, range 29–70). Twenty (27%) patients obtained best response (G4-G5) whether 50 (68%) were considered as no responder (G1-G2-G3). Response was associated with negative estrogen receptors expression (p=0.02) and high Ki67 basal and after C1 expression (p=0.009 and p=0.01). Six (54%) of triple negative tumors were responders (p=0.05). Interestingly, change in pVEGFR2 [Y951] staining induced by bevacizumab administration and basaline MISO tumor volume was found significantly associated with response (p=0.03 and 0.057). Decrease in the phosphorilation status of VEGFR2 (Y951) >70% yielded a receiver operating characteristic (ROC) curve area of 0.681 (95% CI: 0.536 — 0.825) with 84% sensitivity and 95% specificity. The positive and negative predictive values for this marker were 60% and 64%, respectively. The change in phosphorilation status of VEGFR2p remains a significant predictor biomarker of response in multivariate analysis (OR=0.9, IC%95 0.96−0.99, p=0.04) after adjusting for clinical-pathological characteristics.

Conclusion: These findings underline the potential value of early decrease in phosphorilation status of VEGFR2 after bevacizumab infusion as predictive biomarker of response to anti-angiogenic therapy in breast cancer. Moreover, tumor hypoxic volume obtained by MISO might be associated with response. A validation set is warranted to confirm these findings.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-13-04.

Exemestane versus anastrozole as front-line endocrine therapy in postmenopausal patients with hormone receptor-positive, advanced breast cancer: final results from the Spanish Breast Cancer Group 2001-03 phase 2 randomized trial

BACKGROUND

Several aromatase inhibitor studies have reported variations in the inhibitory potency of these agents that could lead to differences in clinical outcomes. In the current study, the authors formally evaluated the activity of anastrozole and exemestane in postmenopausal women with hormone-responsive, advanced breast cancer.

METHODS

Postmenopausal women who had measurable disease according to Response Evaluation Criteria in Solid Tumors and had not received previous endocrine therapy for advanced breast cancer were randomized to receive either oral exemestane 25 mg daily or oral anastrozole 1 mg daily until they had disease progression. The primary endpoint was the objective response rate (ORR), and secondary endpoints included the clinical benefit rate (CBR), time to progression (TTP), overall survival, and safety. Crossover to the other aromatase inhibitor was permitted at the time of disease progression; ORR, CBR, and TTP after second-line treatment also were explored.

RESULTS

In total, 103 patients were enrolled. The median patient age was 71.6 years, 52.4% of patients had visceral disease, and 75.8% of patients had ≥ 2 disease sites. Half of the patients had received previous tamoxifen, and 60% had received previous chemotherapy. The efficacy observed in the exemestane and anastrozole groups was an ORR of 36.2% and 46%, respectively; a CBR of 59.6% and 68%, respectively, and a TTP of 6.1 months and 12.1 months, respectively. At progression, 28 patients crossed over to the other aromatase inhibitor, including 16 patients who switched to exemestane (CBR, 43.7%; TTP, 4.4 months) and 12 patients who switched to anastrozole (CBR, 8.3%; TTP, 2 months). Both drugs were generally well tolerated, and no study drug-related serious adverse events were reported.

CONCLUSIONS

In this phase 2 randomized trial, no significant differences in clinical activity were observed in favor of exemestane to justify a superiority phase 3 trial design in the first-line setting.

The peptide-binding motif of HLA-DR8 shares important structural features with other type 1 diabetes-associated alleles

The objective of this study was to characterize the peptide-binding motif of the major histocompatibility complex (MHC) class II HLA-DR8 molecule included in the type 1 diabetes-associated haplotype DRB1(*)0801-DQA1(*)0401/DQB1(*)0402 (DR8-DQ4), and compare it with that of other diabetes-associated MHC class II alleles; DR8-bound peptides were eluted from an HLA-DR homozygous lymphoblastoid cell line. The repertoire was characterized by peptide sequencing using a LTQ ion trap mass spectrometer coupled to a multidimensional liquid chromatography system. After validation of the spectra identification, the definition of the HLA-DR8 peptide-binding motif was achieved from the analysis of 486 natural ligands, based on serial alignments of all possible HLA-DR-binding cores. The DR8 motif showed a strong similarity with the peptide-binding motifs of other MHC class II diabetes-associated alleles, HLA-DQ8 and H-2 I-A(g7). Similar to HLA-DQ8 and H-2 I-A(g7), HLA-DR8 preferentially binds peptides with an acidic residue at position P9 of the binding core, indicating that DR8 is the susceptibility component of the DR8-DQ4 haplotype. Indeed, some DR8 peptides were identical to peptides previously identified as DQ8- or I-A(g7) ligands, and several diabetes-specific peptides associated with DQ8 or I-A(g7) could theoretically bind to HLA-DR8. These data further strengthen the association of HLA-DR8 with type I diabetes.

Changes in phenolic compounds of Aragon red wines during alcoholic fermentation

Changes in the principal phenolic compounds during the maceration-fermentation process of Garnacha, Merlot and Syrah grapes cultivated in Aragón region (northeast of Spain) have been investigated. While Garnacha is a traditional grape variety cultivated in this region, Merlot and Syrah have been introduced recently. During fermentation, Syrah showed the highest concentration in anthocyanins, flavan-3-ols and flavonols (802.7 ± 0.5 mg/L, 74.7 ± 2.4 mg/L and 37.1 ± 1.5 mg/L at the end of fermentation, respectively). Unexpectedly, Garnacha, a variety with lower phenolic content, showed the highest amount of hydroxycinnamic acids (83.1 ± 5.6 mg/L at the end of fermentation). The overall results also indicated that the evolution during maceration-fermentation process of the different phenolic compounds and their concentrations were influenced by the varietal factor.

Partnerships for Knowledge Building: An Emerging Model

Knowledge Building is approached in this study from an organizational perspective, with a focus on the nature of school-university-government partnerships to support research-based educational innovation. The paper starts with an overview of what is known about effective partnerships and elaborates a conceptual framework for Knowledge Building partnerships based on a review of literature and two case studies of school-university-government partnerships. In one case, a Ministry of Education wanted to bring more vitality into schools of small remote villages, and in the other case another Ministry of Education wanted to renew its school-based international cooperation profile. Emerging from this work is a three-component model for going to scale with Knowledge Building partnerships: Knowledge Building as a shared vision; symmetric knowledge advancement; and multi-level, research-based innovation. Characteristics of, and conditions for, effective partnerships for Knowledge Building are elaborated, and an emerging model is developed to help communities establish effective partnerships and contribute to this evolving model.

Computer-aided diagnosis of Alzheimer's disease using support vector machines and classification trees

This paper presents a computer-aided diagnosis technique for improving the accuracy of early diagnosis of Alzheimer-type dementia. The proposed methodology is based on the selection of voxels which present Welch's t-test between both classes, normal and Alzheimer images, greater than a given threshold. The mean and standard deviation of intensity values are calculated for selected voxels. They are chosen as feature vectors for two different classifiers: support vector machines with linear kernel and classification trees. The proposed methodology reaches greater than 95% accuracy in the classification task.

Multiple paternal origins of domestic cattle revealed by Y-specific interspersed multilocus microsatellites

In this study, we show how Y-specific interspersed multilocus microsatellites, which are loci that yield several amplified bands differing in size from the same male individual and PCR reaction, are a powerful source of information for tracing the history of cattle. Our results confirm the existence of three main groups of sires, which are separated by evolutionary time and clearly predate domestication. These three groups are consistent with the haplogroups previously identified by Götherström et al. (2005) using five Y-specific segregating sites: Y1 and Y2 in taurine (Bos taurus) cattle and Y3 in zebu (Bos indicus) cattle. The zebu cattle cluster clearly originates from a domestication process that was geographically and temporally separated from that of taurine clusters. Our analyses further suggest that: (i) introgression of wild sire genetic material into domesticated herds may have a significant role in the formation of modern cattle, including the formation of the Y1 haplogroup; (ii) a putative domestication event in Africa probably included local Y2-like wild sires; (iii) the West African zebu cattle Y-chromosome may have partially originated from an ancient introgression of humped cattle into Africa; and (iv) the high genetic similarity among Asian zebu sires is consistent with a single domestication process.

Classification of functional brain images using a GMM-based multi-variate approach

This paper presents a novel method for automatic selection of regions of interest (ROIs) of functional brain images based on Gaussian mixture models (GMM), which relieves the so-called small size sample problem in the classification of functional brain images for the diagnosis of Alzheimer's disease (AD). In a first step, brain images are preprocessed in order to find an average image including differences between controls and AD patients. Then, ROIs are extracted using a GMM which is adjusted by using the expectation maximization (EM) algorithm. This reduced set of features provides the activation map of each patient and allows us to train statistical classifiers based on support vector machines (SVMs). The leave-one-out cross-validation technique is used to validate the results obtained by the supervised learning-based computer aided diagnosis (CAD) system over databases of SPECT and PET images yielding an accuracy rate up to 96.67%.

Brain death epidemiology in Uruguay and utilization of the Glasgow coma score in acute brain injured patients as a predictor of brain death

OBJECTIVE

The knowledge of brain death (BD) epidemiology and the acute brain injury (ABI) progression profile are relevant to improve public health programs, organ procurement strategies, as well as intensive care unit (ICU) protocols aiming to increase the detection of potential donors. The aim of this study was to analyze the BD epidemiology and the ABI progression profile among subjects admitted to ICUs with a Glasgow Coma Score (GCS) < or = 8.

MATERIALS AND METHODS

This was a prospective, observational study of BD reported to the National Institute of Donation and Transplantation from 2000-2006. The patients with ABI and GCS < or = 8 who were admitted to 5 ICUs with In-hospital Transplant Coordination were analyzed over the period of 2005-2007.

RESULTS

The BD detection increased from 28.7 in 2000 to 58.5 BD pmp in 2006. The real donor global rate increased from 10 to 24.6 pmp from 2000 to 2006. The ABI patients with GCS < or = 8 had a global mortality rate of 56%, including 23.4% who evolved to BD.

CONCLUSIONS

This study showed a 200% increment of detected BD and 150% of real donors, although these results are still below the international figures. GCS follow-up appeared to be a good tool to predict the BD outcome. The follow-up of patients with ABI allowed us to improve our BD detection strategy.

Effect of pulsed electric field processing of red grapes on wine chromatic and phenolic characteristics during aging in oak barrels

The influence of a pulsed electric field (PEF) treatment of grape berries at pilot-plant scale on the evolution of the chromatic and phenolic characteristics of Cabernet Sauvignon red wines during aging in American oak barrels and subsequent storage in bottle has been studied. Results obtained in this investigation confirm that the better chromatic characteristics and higher phenolic content obtained due to the PEF treatment after the fermentation process remain or even increase during aging in oxidative conditions in American oak barrels and their subsequent storage in bottle. No sensory differences in color and bouquet were detected after 8 months of aging in bottle by triangle tests. According to the results, PEF is a promising enological technology to obtain wines with the high phenolic content necessary for the production of high quality oak aged red wines.

Review of the Uruguayan Kidney Allocation System: the solution to a complex problem, preliminary data

The National Kidney Transplant Program with cadaveric donors is based on centralized and unique waitlist, serum bank, and allocation criteria, approved by Instituto Nacional de Donación y Trasplante (INDT) in agreement with clinical teams. The median donor rates over last 3 years is 20 per million population and the median number of waitlist candidates is 450. The increased number of waiting list patients and the rapid aging of our populations demanded strategies for donor acceptance, candidate assignment, and analysis of more efficient and equitable allocation models. The objectives of the new national allocation system were to improve posttransplant patient and graft survivals, allow equal access to transplantation, and reduce waitlist times. The objective of this study was to analyze variables in our current allocation system and to create a mathematical/simulation model to evaluate a new allocation system. We compared candidates and transplanted patients for gender, age, ABO blood group, human leukocyte agents (HLA), percentage of reactive antibodies (PRA), and waiting list and dialysis times. Only 2 factors showed differences: highly sensitized and patients >65 years old (Bernoulli test). An agreement between INDT and Engineering Faculty yielded a major field of study. During 2008 the data analysis and model building began. The waiting list data of the last decade of donors and transplants were processed to develop a virtual model. We used inputs of candidates and donors, with outputs and structure of the simulation system to evaluate the proposed changes. Currently, the INDT and the Mathematics and Statistics Institute are working to develop a simulation model, that is able to analyze our new national allocation system.

Quality management indicators for tissue banks: an operative model from the period of 2002-2007

AIM

The purpose of this study was to determine a specific indicator model to evaluate the Quality Management System (QMS) in Tissue Banks (TB) for deceased and/or live donors.

METHODS

Quantitative Indicators for Quality Management are considered for deceased donors as the origin of therapeutic tissues. A glossary of definitions was established (also applicable for tissues from live donors): Deceased Therapeutic Real Donors (DTRD), donors that were processed and at least 1 tissue was harvested for a therapeutic purpose; Deceased Effective Donors (DED), DTRD in which 1 or more tissues were validated, stored, and/or grafted; Processed Tissues (PT), number of tissues harvested from a DTRD, which were processed and counted as final product units; Validated Tissues (VT), number of tissues as final product units, which fulfilled quality criteria to be grafted; Grafted Tissues (GT), number of transplanted tissues for therapeutic purposes; and Grafted Patients (GP), number of patients who were grafted with validated tissues. MANAGEMENT QUANTITATIVE INDICATORS: Deceased donors were considered from 2002 to 2007. The total number of tissues was 15,363: Productivity Index (PI), PI = DED/DTRD; Processing Quality Rate (PQR), PQR = VT/PT%; Productivity Efficiency per Donor (PED), PED = VT/DED; Grafted Tissues Coefficient (GTC), GTC = GT/VT; and Grafted Patients Index per Donor (GID), GID = GP/DED.

RESULTS

Results were as follows: PI = 0.80; PQR = 76%; PED = 30.99; GTC = 0.93; and GID = 4. In our study, 80% of DTRD produced VT (PI = 0.80), which represented 76% of PT (average, 31 final products per donor). Also, 93% of the VT were grafted with 5 patients grafted per donor.

CONCLUSIONS

Defined variables resulted in useful tools to evaluate QMS in a TB.

Uruguayan experience with cryopreserved arterial homografts

INTRODUCTION

We analyzed the Uruguayan experience with cryopreserved arterial homografts. We studied 55 medical records in the period from June 9, 2000 to April 7, 2007, including 41 from males and 14 from females, ranging from 36-78 years of age. The clinical indications were as follows: Group 1, revascularization of infrainguinal atherosclerotic occlusive disease by bypass due to the lack of availability of a suitable vein (n = 35); Group 2, substitution of an infected prosthetic grafts (n = 15); and Group 3, arteriovenous fistula (AVF) after failure of previous prosthetic loops by repeated thrombosis and/or infection in the absence of a vein (n = 5).

RESULTS

Among Group 1, primary and secondary patency rates were 61% and 71%, respectively at 1 year with 15 complications, 3 infections, 8 thromboses, 2 aneurysms, 1 homograft degradation, and 1 death related to surgery. Among Group 2, the primary and secondary patency rates were 71% and 79%, respectively, at 1 year with 6 patients experiencing complications. Group 3 did not have complications with a primary patency rate of 67% at 1 year.

CONCLUSIONS

The use of cryopreserved arterial homografts is a valid, accessible, and safe alternative in complicated vascular situations. In our country, it is a technology to consider for patients with critical limb ischemia, when the risk of a major amputation is high and it is not possible to have a suitable vein or prosthetic bypass. It can be an excellent alternative for the substitution of infected synthetic bypasses, especially to substitute in situ for an infected aortic graft.

SVM-based CAD system for early detection of the Alzheimer's disease using kernel PCA and LDA

Single-photon emission tomography (SPECT) imaging has been widely used to guide clinicians in the early Alzheimer's disease (AD) diagnosis challenge. However, AD detection still relies on subjective steps carried out by clinicians, which entail in some way subjectivity to the final diagnosis. In this work, kernel principal component analysis (PCA) and linear discriminant analysis (LDA) are applied on functional images as dimension reduction and feature extraction techniques, which are subsequently used to train a supervised support vector machine (SVM) classifier. The complete methodology provides a kernel-based computer-aided diagnosis (CAD) system capable to distinguish AD from normal subjects with 92.31% accuracy rate for a SPECT database consisting of 91 patients. The proposed methodology outperforms voxels-as-features (VAF) that was considered as baseline approach, which yields 80.22% for the same SPECT database.

SVM-based computer-aided diagnosis of the Alzheimer's disease using t-test NMSE feature selection with feature correlation weighting

This letter shows a computer-aided diagnosis (CAD) technique for the early detection of the Alzheimer's disease (AD) based on single photon emission computed tomography (SPECT) image feature selection and a statistical learning theory classifier. The challenge of the curse of dimensionality is addressed by reducing the large dimensionality of the input data and defining normalized mean squared error features over regions of interest (ROI) that are selected by a t-test feature selection with feature correlation weighting. Thus, normalized mean square error (NMSE) features of cubic blocks located in the temporo-parietal brain region yields peak accuracy values of 98.3% for almost linear kernel support vector machine (SVM) defined over the 20 most discriminative features extracted. This new method outperformed recent developed methods for early AD diagnosis.