Abstract P3-07-42: Predicting outcome and benefit to first-line bevacizumab in advanced/metastatic hormone receptor (HR)+/HER2-negative breast cancer (BC) treated with endocrine therapy: A correlative science study from the LEA phase III clinical trial (GEICAM/2006-11_GBG 051)

Introduction: The role of bevacizumab in combination with chemotherapy in metastatic BC is controversial, and no biomarker exists as of today that predicts benefit to this agent. In the LEA clinical trial, a numerical, statistically non-significant benefit from the addition of bevacizumab to endocrine therapy (ET) was observed in the first-line metastatic setting (18.4 vs. 13.8 months of Progression-Free Survival (PFS), p=0.14). Here, we explored various gene expression-based predictors of outcome and benefit to bevacizumab.

Methods and materials: LEA trial randomized 380 patients with HR+/HER2- advanced disease to bevacizumab in combination with ET (ET+B) vs. ET alone. Primary endpoint was PFS. Expression of BC selected genes was evaluated in formalin-fixed paraffin-embedded (FFPE) primary tumors using the nCounter platform from patients randomized in Spain that consent for biomarker analyses. The following variables were evaluated: 1) research-based PAM50 intrinsic subtypes (categorical variable; Luminal A, Luminal B, HER2-enriched, Basal-like and Normal-like); 2) research-based PAM50 signatures (continuous variable; scores showing the distant of the gene expression values of an individual sample compared to the centroid gene values for each PAM50 intrinsic subtype); 3) risk of recurrence (ROR) groups (low, medium and high); 4) the 13-gene hypoxia/VEGF signature (continuous); and 5) Ki67 by immunohistochemistry (continuous). Uni- and multivariable Cox models for PFS were used to test the prognostic significance of each variable. To determine whether each variable is predictive of bevacizumab benefit, we tested the interaction term of each variable by treatment arm in a Cox model.

Results: Tumor samples from 103 patients were analyzed: 55 (53%) in ET+B arm and 49 (47%) in ET arm. Subtype distribution was as follows: 57 (55.3%) Luminal A, 32 (31.1%) Luminal B, 5 (4.9%) HER2-enriched, 1 (1.0%) Basal-like, and 8 (7.8%) normal-like. In a univariate analysis, Luminal B tumors had a poorer outcome using Luminal A as reference (13.8 vs. 21.3 months, respectively; (hazard ratio, HR=1.80, 95% CI 1.10-2.95, p=0.019). Concordant with this finding, Luminal A signature was associated with a better outcome. Similarly, ROR-P high group showed a poorer outcome than ROR-P low group (8.5 vs. 19.4 months; HR=2.88, 95% CI 1.30-6.35, p=0.009). Neither VEGF-13 signature nor Ki67 were found to be associated with PFS. Similar findings were obtained after adjustment for treatment, age, previous ET, ECOG, visceral disease and number of metastatic sites. In terms of treatment benefit, the HER2-enriched signature was the only variable found predictive of bevacizumab PFS benefit in univariate (p=0.010) and multivariate (p=0.015) analyses.

Conclusions: In advanced HR+/HER2- disease, intrinsic subtype (i.e. Luminal A vs. B) independently predicts PFS following first-line ET. In addition, HR+/HER2-negative tumors with high expression of the HER2-enriched signature, a biomarker of estrogen-independence, benefit the most from bevacizumab. Further validation of these prognostic and predictive biomarkers is warranted.

Citation Format: Prat A, de la Haba-Rodriguez J, Guerrero Á, García-Sáenz JA, Morales S, Antón A, Muñoz M, Ramos M, Martínez-Jáñez N, Margelí M, Servitja S, Rojo F, Galván P, González S, Cruz J, Sánchez-Rovira P, Perelló A, Rodríguez-Martin C, Casas M, Carrasco E, Caballero R, Martín M. Predicting outcome and benefit to first-line bevacizumab in advanced/metastatic hormone receptor (HR)+/HER2-negative breast cancer (BC) treated with endocrine therapy: A correlative science study from the LEA phase III clinical trial (GEICAM/2006-11_GBG 051). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-42.

First Report of Xanthomonas campestris pv. raphani Causing Leaf Spot Disease of Brassica oleracea in Portugal

Representing over 25% of the vegetable production, Brassicaceae crops are very important for Portuguese agriculture. Xanthomonas campestris pv. raphani (Xcr) was first described as the causative agent of a leaf spot disease affecting radish and turnip (4). Despite its ability to infect Solanaceae hosts upon inoculation, this pathogen affects mostly Brassicaceae plants. Typical symptoms include circular dark spots that become lighter and are occasionally surrounded by a chlorotic halo. In severely affected leaves, spots were not limited by the veins and coalesced into irregular shapes that perforated the leaves, rendering the plants unsuitable for marketing. In the early 2000s, several isolates causing leaf spots on Brassica oleracea varieties (cauliflower, white cabbage, savoy cabbage, and tronchuda cabbage) were collected in Sintra, near Lisbon. The isolates, identified as putative X. campestris (Xc), formed typical yellow mucoid and convex colonies when grown on YDC medium. Biochemical characterization (2) showed their ability to produce levan and hydrolyze starch and esculin. Isolates were also able to use celobiose, trehalose, glucose, mannose, raffinose, and sucrose. Furthermore, the isolates were oxidase negative and were unable to hydrolyze arginine and to use rhamnose, indol, inositol, and sorbitol, confirming them as Xc. The expected 619-bp amplicon was obtained for all isolates, after PCR using primers DLH120/DLH125 (1). Koch's postulates were fulfilled through pathogenicity tests on B. oleracea cv. Wirosa and Raphanus sativus, hosts susceptible to Xcr as well as to X. campestris pv. campestris (Xcc). Inoculations on B. carinata (Assession No. PI199947) and Solanum lycopersicum, hosts susceptible only to Xcr, were performed to confirm pathovar identification (2). Four plants of each host were inoculated with each isolate by spraying bacterial water suspensions (OD₆₀₀ = 0.1) onto leaf surfaces. Positive and negative controls were performed using Xcc type strain (CFBP 5241) and sterile distilled water, respectively. Plants were kept 15 days with 16-h light and 8-h dark photoperiods at 24 and 18°C, respectively, at RH >80% and checked daily for symptom development. Leaf spots typical of Xcr were observed for all isolates on all hosts 5 days after inoculation. All isolates were recovered after re-isolation from inoculated plants, retaining their initial features. Negative control plants showed no symptoms, while CFBP 5241 caused V-shaped lesions, typical of Xcc, on B. oleracea cv. Wirosa and R. sativus. Further confirmation of the identification was attained by partial sequencing of the gyrB gene, using primers X.gyr.fsp.s1/X.gyr.rsp3 (3). Sequences from four isolates (CPBF 143, Genbank KM094906; CPBF 207, GenBank KM094907; CPBF 209, GenBank GU596416; and CPBF 1171, GenBank GU596419) were compared by nucleotide blast at NCBI and displayed higher levels of DNA similarity (>98%) to NCPPB 1946, the type strain for Xcr, than to NCPPB 528, the type strain for Xcc. The polyphasic approach combining phenotypic and genomic data confirmed the presence of X. campestris pv. raphani in Portugal for the first time. References: (1) T. Berg et al. Plant Pathol. 54: 416, 2005. (2) R. Lelliot and D. Stead. Methods for the Diagnosis of Bacterial Diseases of Plants. Blackwell Scientific Publications, Oxford, England, 1987. (3) N. Parkinson et al. Int. J. Syst. Evol. Microbiol. 57:2881, 2007. (4) H. White. Phytopathology 20:653, 1930.

A Web platform for the interactive visualization and analysis of the 3D fractal dimension of MRI data

This study presents a Web platform (http://3dfd.ujaen.es) for computing and analyzing the 3D fractal dimension (3DFD) from volumetric data in an efficient, visual and interactive way. The Web platform is specially designed for working with magnetic resonance images (MRIs) of the brain. The program estimates the 3DFD by calculating the 3D box-counting of the entire volume of the brain, and also of its 3D skeleton. All of this is done in a graphical, fast and optimized way by using novel technologies like CUDA and WebGL. The usefulness of the Web platform presented is demonstrated by its application in a case study where an analysis and characterization of groups of 3D MR images is performed for three neurodegenerative diseases: Multiple Sclerosis, Intrauterine Growth Restriction and Alzheimer's disease. To the best of our knowledge, this is the first Web platform that allows the users to calculate, visualize, analyze and compare the 3DFD from MRI images in the cloud.

A spatially explicit approach for estimating space use and density of common genets

Many species that occur at low densities are not accurately estimated using capture–recapture methods as such techniques assume that populations are well–defined in space. To solve this bias, spatially explicit capture–recapture (SECR) models have recently been developed. These models incorporate movement and can identify areas where it is more likely for individuals to concentrate their activity. In this study, we used data from camera–trap surveys of common genets (Genetta genetta) in Serra da Malcata (Portugal), designed to compare abundance estimates produced by SECR models with traditional closed–capture models. Using the SECR models, we observed spatial heterogeneity in genet distribution and density estimates were approximately two times lower than those obtained from the closed population models. The non–spatial model estimates were constrained to sampling grid size and likely underestimated movements, thereby overestimating density. Future research should consider the incorporation of cost–weighed models that can include explicit hypothesis on how environmental variables influence the distance metric.

Preoperative levosimendan. A new way for organoprotection

Preoperative use of levosimendan in cardiac surgery patients is one of the most attractive therapeutic alternatives in subjects with left or right ventricular dysfunction. Our review explores the pharmacological bases and clinical evidence for the use of levosimendan, with the intention of making a series of recommendations regarding its use in preoperative optimization prior to cardiac surgery. We carried out a survey of 102 Spanish anesthesiologists in order to shed light on the grey areas regarding the use of this drug prior to surgery. Our findings suggest that levosimendan is recommended for patients with severe left or right ventricular dysfunction, moderate left ventricular dysfunction in which Intra-aortic Balloon Counterpulsation (IABC) is necessary and severe pulmonary hypertension. Administration of levosimendan prior to surgical cardiac intervention without an initial bolus reduces the likelihood of complications.

Home telemonitoring effectiveness in COPD: a systematic review

OBJECTIVES

To provide a systematic review of the effectiveness of home telemonitoring to reduce healthcare utilisation and improve health-related outcomes of patients with chronic obstructive pulmonary disease (COPD).

METHODS

An electronic literature search in Medline, Embase, B-on and Web of Science was conducted from June to August 2012 and updated until July 2013, using the following keywords: [tele(-)monitoring or tele(-)health or tele(-)homecare or tele(-)care or tele-home health or home monitoring] and [Chronic Obstructive Pulmonary Disease or COPD]. Randomised and non-randomised controlled trials evaluating home telemonitoring interventions in COPD were included. A meta-analysis using risk ratio (RR) and standardised mean difference (SMD) was conducted for healthcare utilisation (hospitalisations, length of stay, emergency department visits) and associated costs, and health-related outcomes [mortality, exacerbations and health-related quality of life (HRQOL)].

RESULTS

Nine articles were included. Significant differences were found for hospitalisation rates (RR = 0.72; 95% CI = 0.53-0.98; p = 0.034); however, no differences in the other healthcare utilisation outcomes were observed. There was a trend to reduced healthcare costs in the telemonitoring group. In two studies, this intervention was associated with a reduced number of exacerbations (p < 0.05) and a significant increase in HRQOL (SMD = -0.53; 95% CI = -0.97- -0.09; p = 0.019).

DISCUSSION AND CONCLUSIONS

Home telemonitoring appears to have a positive effect in reducing respiratory exacerbations and hospitalisations and improving quality of life. However, the evidence of its benefits is still limited and further research is needed to assess the effectiveness of home telemonitoring in COPD management, as there are still few studies in this area.

A new approach to determine the homogeneity in hyperspectral imaging considering the particle size

Determining homogeneity of a mixture using hyperspectral-imaging (HSI) techniques is at this moment an interesting research subject in pharmaceutical industry. A new methodology based in the macropixel analysis technique for the homogeneity assessment in powder blend mixtures has been developed. The appropriate selection of the macropixel size for evaluation of the homogeneity is a topic under discussion. We propose that the macropixel size selection would be based in a statistical criterion called "representative sample size" criterion. Moreover, it has been demonstrated that the macropixel size should be a function of the particle size and, thus, the particle size has been included in the formula to calculate the macropixel size. The proposed equations allow to accurately calculate the homogeneity index (H% Poole). By means of using simulated chemical images, a relationship between the H% Poole index and the controlled homogeneity was established. The method has been applied to determine the homogeneity of binary and ternary powder blends mixtures of different pharmaceuticals discriminating between homogeneous and non-homogeneous samples.