Chromogranin A is a reliable biomarker for gastroenteropancreatic neuroendocrine tumors in an Asian population of patients

PURPOSE

To evaluate the significance of plasma chromogranin A (CgA) levels in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET) in terms of disease status and treatment responses.

MATERIALS AND METHODS

Forty-four GEP-NET patients comprising 15 disease-free patients and 29 patients with active disease, as well as 26 healthy participants were enrolled in this study between April 2010 and April 2011. Clinicopathological factors were collected and serial plasma CgA levels were measured.

RESULTS

Plasma CgA levels were significantly higher in GEP-NET patients with active disease than in disease-free patients (p = 0.011) or healthy participants (p = 0.001). No difference in CgA levels was observed in terms of primary tumor location, tumor grade, and functional status in patients with active disease. CgA values at 94 U/l distinguished healthy individuals or disease-free patients from patients with active disease. Sensitivity and specificity rates were 86 and 88%, respectively. CgA levels at 110 U/l differentiated patients without recurrence from those with recurrence, with a sensitivity rate of 100% and a specificity rate of 80%. Patients (5/5, 100%) with stable disease and who showed partial response after treatment had a more than 20% decrease in CgA levels compared with the baseline values. Patients (6/6, 100%) with progressive disease showed a less than 20% decrease or increase in CgA levels.

CONCLUSION

The plasma CgA level is a reliable biomarker for GEP-NET. We conclude that changes in CgA levels are associated with disease status and treatment responses.

Biochemotherapy with carmustine, cisplatin, dacarbazine, tamoxifen and low-dose interleukin-2 for patients with metastatic malignant melanoma

BACKGROUND

The toxicity and efficacy of biochemotherapy with low-dose interleukin-2 for patients with metastatic malignant melanoma (MM) were studied.

METHOD

Metastatic chemo-naive MM patients were given biochemotherapy (BCDT regimen) with carmustine (BCNU), cisplatin (CDDP), dacarbazine (DTIC), and tamoxifen and interleukin-2 (IL-2) 18 Million International Units in divided doses by subcutaneous injection three times a week for four weeks. BCDT consisted of BCNU (150 mg/m2, day l every 8 weeks), CDDP (25 mg/m2, days l-3 every 4 weeks), DTIC (220 mg/m2, days 1-3 every 4 weeks) and tamoxifen 10 mg twice a day. Treatment was repeated for a total of 6 cycles, or until disease progression or unbearable toxicity.

RESULTS

From Nov 2001 to July 2005, 40 patients (20 men; 20 women) were enrolled. Their median age was 54 years (range 22-79 years). Subtypes of melanoma included 23 (57.5%) acral lentiginous, 11 (27.5%) nodular, 1 (2.5%) mucosal, and 5 (12.5%) others. Grade 3-4 toxicities included neutropenia (27.5%), anemia (45%), and thrombocytopenia (40%). Constitutional IL-2 toxicities included indurate injection site (57.5%), fever (60%), chills (55%), itchy skin (42.5%), bone pain (32.5%) and myalgia (45%). Grade 1-2 hypotension was noted in 12.5% of patients. Eosinophilia (range 5% to 71%) was evident in 72.5% of patients. The response rate was 32.5% including 5% with a complete response, 27.5% with a partial response, and 17.5% with stable disease. The median progression-free survival was 6.2 months (95% CI: 2.9~9.6 months). The median overall survival was 11.3 months (95% CI: 7.0~15.6 months). Five patients (12.5%) who presented with oligo-metastasis achieved five-year survivals.

CONCLUSIONS

Our data demonstrated that low-dose IL-2 plus BCDT is tolerable. A durable response and long-term survival can be achieved in a small subgroup of patients.

Neutralization of interleukin (IL)-10 released by monocytes/macrophages enhances the up-regulatory effect of monocyte/macrophage-derived IL-6 on expressions of IL-6 and MUC1, and migration in HT-29 colon cancer cells

The interactions between monocyte-derived IL-6 and IL-10 in colon cancer are unknown. We continued previous work that showed monocyte/macrophage-derived IL-6 induces IL-6 and MUC1 expression in HT-29 cancer cells, and evaluated if IL-10 present in monocyte/macrophage is involved in this IL-6-mediated effect. We treated HT-29 cells with monocyte/macrophage supernatant following neutralization of monocyte/macrophage-released IL-10. Neutralization markedly enhanced monocyte/macrophage-derived IL-6 effects on HT-29 cells including IL-6 and MUC1 production and cell migration. Double blocking of IL-6 and IL-10 in monocyte/macrophage supernatants abolished this enhancement. Western blot analysis of STAT3 phosphorylation showed that this augmented response in HT-29 cells following IL-10 neutralization is probably mediated through enhanced IL-6-induced phosphorylation (Tyr(705)) of STAT3 proteins. Therefore, monocytes/macrophages have the capacity to release the functionally associated cytokines IL-6 and IL-10 whose interactions can account for the pathogenesis and progression of colon cancer.

Tumor growth inhibition of metastatic nasopharyngeal carcinoma cell lines by low dose of arsenic trioxide via alteration of cell cycle progression and induction of apoptosis

BACKGROUND

Although arsenic trioxide (ATO) has displayed anticancer activity against primary nasopharyngeal carcinoma (NPC), its efficacy in metastatic NPC deserved further investigation because the biological/therapeutic difference in cancer cells probably exists between primary and distant sites.

METHODS

Two human metastatic NPC cell lines (NPC-BM1 and NPC-BM2) were investigated. We measured cellular proliferation, cell cycle, and apoptotic extent of BM1 and BM2 cells treated with ATO in vitro. Furthermore, we evaluated the tumor growth after ATO treatment in vivo.

RESULTS

Low-dose ATO treatment is sufficient to induce an antiproliferative effect, alter the cell cycle, and increase apoptosis in BM1 and BM2 cells. BM1 tumor growth in a xenograft model with low-dose and short-schedule (1 mg/kg/day, intraperitoneal injection for 5 consecutive days) of ATO treatment significantly slowed in vivo.

CONCLUSION

ATO at low dose seems to be an encouraging schedule for palliative treatment of metastatic NPC.

Long-term survivors of adult rhabdomyosarcoma of maxillary sinus following multimodal therapy: case reports and literature reviews

Rhabdomyosarcoma of the maxillary sinus is uncommon in adults. The clinical course and appropriate treatment strategy for the disease remains to be elucidated. This article describes two adult patients with rhabdomyosarcoma of the maxillary sinus who achieved long-term survival after undergoing multimodal therapy. We also reviewed the literature regarding 23 patients who were 15 years of age or older and had rhabdomyosarcoma of the maxillary sinus and were treated between 1950 and 2000. Results of our analysis suggest that multimodal therapy may become the mainstay treatment for adult rhabdomyosarcoma of the maxillary sinus. We believe that adequate surgical procedures, planned radiotherapy, aggressive chemotherapeutic agents and the best supportive care for complications may improve the prognosis of patients with this disease.

Characterization of the response of dendritic cells and regulatory T cells to tumor antigens in patients with renal cell carcinoma

BACKGROUND

This study characterized dendritic cells (DCs), regulatory T cells (Tregs) and the immune responses to tumor antigens in renal cell carcinoma (RCC) patients.

METHODS

Thirty patients with RCC and five healthy donors were studied. DCs were generated from the adherent cells among peripheral blood mononuclear cells (PBMCs), then cultured in medium containing granulocyte-macrophage colony-stimulating factor (GM-CSF) and IL-4 for 7 days. The phenotypes of the DCs and Tregs were analyzed by flow cytometry. A mixed lymphocyte reaction (MLR) was performed to assess the functioning of the DCs and Tregs. A cytotoxic assay was performed to measure the antigen presentation ability of the DCs from the RCC patients (RCC-DCs). These DCs were pretreated with TNF-alpha (TNF-DCs) or tumor lysate (TuLy-DCs) on the 3rd day of DC culture.

RESULTS

The RCC-DCs expressed significantly less CD40 (p = 0.03) and CD80 (p = 0.007) upon TNF-alpha cultivation than the DCs from healthy donors. Theperipheral Tregs during stage I disease were significantly less (p = 0.032) than during stages II-IV. The RCC-DCs were as efficient as DCs from healthy donors (p = 0.83) when stimulating the proliferation of allogeneic T cells; however, these RCC-DCs were less efficient when stimulating autologous T cells than allogeneic T cells (p = 0.023). Tregs inhibited autologous T cell proliferation rather than allogeneic T cell proliferation in response to TuLy-DCs stimulation. Prostaglandin E(2) did not increase the ability of immature DCs to stimulate T cell proliferation.

CONCLUSIONS

Patients with RCC have less potent anti-tumor immune responses.

The -174 G/C polymorphism in interleukin-6 (IL-6) promoter region is associated with serum IL-6 and carcinoembryonic antigen levels in patients with colorectal cancers in Taiwan

INTRODUCTION

We investigated the associations between -174 G/C polymorphism of interleukin-6 (IL-6) gene promoter and serum IL-6 and carcinoembryonic antigen (CEA) levels in Taiwanese patients with colorectal cancer (CRC).

RESULTS AND DISCUSSION

The frequency of the G allele was only 0.043, which is significantly lower compared to Western analogs. On grouping genotypes as G-positive (GG and CG) and G-negative (GG), the average IL-6 level and CEA levels were significantly lower in G-positive patients than in G-negative analogs (IL-6, 3.56 +/- 4.38 vs. 15.38 +/- 9.52 pg/ml, P = 0.021; CEA, 27.7 +/- 25.7 vs. 157.7 +/- 59.6 ng/ml, P = 0.012). The patients without the G allele had higher incidences of synchronous cancers of other origins (P = 0.003).

CONCLUSION

In conclusion, ethnicity affects the status of -174 G/C IL-6 polymorphism. This polymorphism status consequently influences the expressions of serum IL-6 and CEA and incidences of synchronous cancers of other origins.

De novo dedifferentiated chordoma of the sacrum: a case report and review of the literature

Dedifferentiated chordoma is a rare primary malignant bone cancer. Most cases of dedifferentiated chordoma (DC) are transformed from recurrent chordoma after surgical resection or radiation. The prognosis of DC is extremely poor because of the aggressive nature of the tumor and the potential distant metastases. We report a case of de novo DC of the sacrum in a patient without prior surgical procedure or radiation treatment. A complete review of reported cases sourced from reports published in English literature is discussed and expanded upon and conclusions on the treatment of DC are presented.

Macrophage-derived interleukin-6 up-regulates MUC1, but down-regulates MUC2 expression in the human colon cancer HT-29 cell line

Little is known regarding the effects of IL-6 released by tumor-infiltrating macrophages on the mucin expression of colon cancer cells. We isolated macrophages from healthy donors and harvested the supernatant after 48-h cultures. Using flow cytometry and intracellular staining methods, we found that macrophage supernatant effectively induced MUC1 up-regulation and MUC2 down-regulation of colon cancer cells in vitro. Western blotting analysis using monoclonal antibody against IL-6 or gp 130 verified that this IL-6-driven activity was through the activation of tyrosine phosphorylation (Tyr(705)) of STAT3 in cancer cells. We analyzed the surgical specimens of 29 patients with colon cancer by an immunohistochemical staining method and demonstrated the co-localization of macrophages, and the expression of IL-6, CD68, and MUC1 in colon cancer patients. Therefore, macrophage-derived IL-6 modulates the mucin expression of colorectal cancer cells that might in turn produce a permissive milieu favorable to cancer spread.

Zoledronic acid is unable to induce apoptosis, but slows tumor growth and prolongs survival for non-small-cell lung cancers

BACKGROUND

Although zoledronic acid (ZOL), a third-generation nitrogen-containing bisphosphonate, has been identified as an attractive therapeutic agent against breast cancer, prostate cancer, multiple myeloma as well as small-cell lung cancer (SCLC), as best as we are aware, the anti-tumor effect of ZOL upon non-small-cell lung cancer (NSCLC) remains to be effectively investigated. This study examined the effects of ZOL upon the line-1 tumor cell, using a murine lung adenocarcinoma cell line similar to the behavior of human lung adenocarcinoma.

METHODS

We investigated the anti-tumor effects of ZOL (3-100 microM) on line-1 tumor cells in vitro, including cellular proliferation, by means of an MTT assay, cell-cycle analysis by flow cytometry and by assessing the level of apoptosis by annexin V/propidium iodide (PI) and 4'-6-diamidino-2-phenylindole (DAPI) staining. Further, we evaluated the growth and survival of line-1 tumor cells following ZOL treatment (1 microg/kg/week) using an animal model. We also examined the in vivo cell-cycle pattern using lacZ-expressing line-1 cells (line-1/lacZ).

RESULTS

ZOL significantly slowed the line-1 tumor growth in a dose-dependent manner in vitro. The treated line-1 tumor cells typically arrested at the S/G2/M-phase of the cell-cycle following ZOL exposure, but no apoptotic cells could be detected by either annexin V/PI or DAPI staining. When the ZOL was washed out, the drug-inhibited cells continued to proliferate again and the cell-cycle prolongation elicited earlier by the drug, then disappeared. Within 72-96 h following drug removal, the cell-cycle of the treated cells revealed a similar distribution to that of the untreated controls. In vivo studies demonstrated that ZOL significantly slowed the line-1 tumor growth. Indeed, mice lived significantly longer when they had been ZOL-treated than was the case for untreated mice (p<0.05). Using line-1/lacZ cells, the in vivo cell-cycle distribution of line-1 tumor cells subsequent to ZOL exposure revealed S/G2/M-phase arrest that was identical to the in vitro culture.

CONCLUSIONS

ZOL maintains the potential to reduce tumor burden and prolong survival for murine pulmonary adenocarcinoma. The flow cytometrical analysis of cell-cycle demonstrated that ZOL induces no apoptosis but is able to arrest line-1 tumor cells at the S/G2/M-phase. Although the clinical relevance of these results warrants verification for human lung cancer patients, ZOL combined with chemotherapy and/or radiotherapy appears to be a new therapeutic strategy for the effective treatment of NSCLC.

Transcutaneous arterial embolization to control massive tumor bleeding in head and neck cancer: 63 patients’ experiences from a single medical center

BACKGROUND

Massive tumor bleeding is a life-threatening complication in patients with head and neck cancer (HNC). Tumor hemorrhage is usually hard to localize, and medical management is often ineffective. Arterial angiography is used to visualize the source of bleeding, and concurrent transcutaneous arterial embolization (TAE) can be done to stop bleeding in some patients. We analyzed the outcome of TAE in HNC patients with massive bleeding at our institution.

METHOD

We retrospectively reviewed 93 angiographic procedures in 63 HNC patients. Factors potentially related to post-hemorrhagic survival were evaluated, including tumor stage (T, N, M), tumor type, previous curative-intent surgery, previous chemotherapy, previous radiotherapy, angiographic findings, the presence of embolization, and the embolization methods.

RESULT

A total 56 TAEs were done in 93 angiographic procedures in 63 HNC patients. The overall median post-hemorrhagic survival after angiography was 16 days (range 0-644 days). Median post-hemorrhagic survival for patients receiving TAE was 26 days (range 0-644 days), while patients who received angiography alone survived 8 days (range 0-144 days; p = 0.008). No factors other than TAE predicted post-hemorrhagic survival, and there were no major adverse events after TAE.

CONCLUSION

In our hands, TAE was associated with a low incidence of toxicities commonly attributable to the procedure such as stroke. Patients who were able to undergo TAE lived longer than those who were not candidates for the procedure.

Clodronate alleviates cachexia and prolongs survival in nude mice xenografted with an anaplastic thyroid carcinoma cell line

Cancer cachexia is one of the most common manifestations of advanced malignant disease and is frequently associated with decreased survival. Previously, we reported the establishment of a new anaplastic thyroid carcinoma cell line, Thena, and its mouse xenograft, Thena-Nu, which induced cachexia in athymic nude mice. Subsequent studies showed that the addition of clodronate to Thena-Nu cultures reduced cell proliferation as well as cytokine production in a dose- and time-dependent manner. Weekly administration of clodronate induced tumor cytostasis, attenuation of cachexia, as well as prolongation of survival in Thena-Nu-bearing mice. Reduced serum interleukin 6, tumor necrosis factor-alpha, and granulocyte colony stimulating factor levels were detected, whereas, serum leukemia inhibitory factor levels were not reduced. Liver necrosis, observed in tumor-bearing mice, was also improved following clodronate treatment. Discontinuation of clodronate treatment, however, resulted in progressive tumor growth and weight loss. Our results demonstrated that clodronate could exert therapeutic efficacy on amelioration of cancer cachexia in the hosts. Nevertheless, this study also points out that a longer period of treatment is required to maintain these effects.

Signal transduction pathways of nitric oxide release in primary microglial culture challenged with gram-positive bacterial constituent, lipoteichoic acid

Between one-third and one-half of all cases of sepsis are known to be caused by gram-positive microorganisms through the cell wall component, e.g. lipoteichoic acid (LTA). Gram-positive bacteria are also known to induce encephalomyelitis and meningeal inflammation, and enhance the production of nitric oxide (NO) via expression of inducible nitric oxide synthase (iNOS) in murine tissue macrophages. It remains to be explored if LTA could activate microglia considered to be resident brain macrophages. We report here that LTA derived from gram-positive bacteria (Staphylococcus aureus) significantly induces NO release and iNOS expression in primary microglia. LTA-induced NO accumulation was detected at 2 h in microglial culture and was significantly attenuated by pretreatment with anti-CD14, complement receptor type 3 (CR3) or scavenger receptor (SR) antibodies. LTA activated mitogen-activated protein kinases (MAPKs) such as extracellular signal-regulated kinase, p38 MAPK or c-Jun N-terminal kinase in cultured microglia. LTA-elicited microglial NO production was also drastically suppressed by SB203580 (p38 MAPK inhibitor) or pyrrolidine dithiocarbamate (an inhibitor of nuclear factor kappaB), indicating that p38 MAPK and nuclear factor kappaB were involved in microglial NO release after LTA challenge. These results suggest that gram-positive bacterial product such as LTA can activate microglia to release NO via the signal transduction pathway involving multiple LTA receptors (e.g. CD14, CR3 or SR), p38 MAPK and nuclear factor kappaB. The in vivo study further confirmed that administered intracerebrally LTA induced considerable noticeable iNOS, phospho-IkappaB and phospho-p38 MAPK expression in microglia/macrophages.

Malignant melanoma in Taiwan: a prognostic study of 181 cases

This study was performed to determine the characteristics and clinical outcome of patients with cutaneous malignant melanoma in Taiwan. The medical records of patients with primary cutaneous melanoma between 1992 and 2001 at Chang Gung Memorial Hospital (CGMH) were retrieved from the cancer registry. Survival was analysed by the Kaplan-Meier method. Univariate and multivariate analyses of factors associated with survival were performed using the Cox proportional hazard model. One hundred and eighty-one cases were retrieved from the cancer registry of CGMH. The male to female ratio was 1 : 1.13. The most common age of onset was the sixth decade. The median age of onset was 61 years (2-95 years). There were 105 cases (58%) of acral lentiginous melanoma (ALM), 55 cases (30.4%) of nodular melanoma (NM), 19 cases (10.5%) of superficial spreading melanoma (SSM) and two cases (1.1%) of lentigo maligna melanoma. The median survival of the 181 patients was 3.71 years, and the 5-year survival rate was 45.63%. Five-year survival rates of patients with stages I, II, III and IV disease were 84.39%, 56.03%, 34.7% and 0%, respectively. Sex, Breslow thickness, Clark's level, pathological type and age were significant prognostic factors. There were no survival differences between ALM and NM. Both ALM and NM were associated with a poor prognosis when compared with SSM. In conclusion, ALM is the most common type of cutaneous malignant melanoma in Taiwan. The prognostic factors in Taiwan are similar to those in melanoma-prevalent countries.

Ovarian metastasis originating from bronchioloalveolar carcinoma: a rare presentation of lung cancer

Ovarian metastasis originating from bronchioloalveolar carcinoma (BAC) has not been reported previously. We report a 63-year-old Chinese woman who was diagnosed as BAC with pleural metastasis in 1997. Four years later, she complained of vaginal bleeding, and a pelvic mass was discovered by an abdominal computerized tomography scan. Tumor debulking and total hysterectomy with bilateral salpingo-oopherectomy were performed. Pathology disclosed well-differentiated adenocarcinoma, with abundant clear cytoplasm, in the ovaries. Furthermore, immunohistochemical staining revealed that the tumor cells from the ovary and pleura were reactive to thyroid transcription factor 1 (TTF-1) and cytokeratin-7 (CK-7) but were negative for cytokeratin-20 (CK-20). The results of immunohistochemical staining, clinical course, and pathological features were compatible with the diagnosis of BAC with ovarian metastasis. In conclusion, to investigate the primary site of a metastatic ovarian cancer, clinicians should not forget the lungs since the incidence of lung cancer in females is increasing. Moreover, a monoclonal antibody panel for TTF-1, CK-7, and CK-20 may facilitate discrimination between primary and metastasized ovarian adenocarcinomas and/or identifying tumors of pulmonary origin.

Microangiopathic hemolytic anemia in a patient with recurrent anal cancer and liver metastasis

Microangiopathic hemolytic anemia (MAHA) is a late but fatal complication in advanced cancers (cancer-associated). It may also appear in complete remission after chemotherapy (chemotherapy-related). Mucin-producing adenocarcinoma has been extensively studied in relation to this phenomenon. Squamous cell carcinoma with MAHA, on the other hand, has not often been reported in the English literature. Because of the difficulty of case collection, understanding of the association of MAHA and anal squamous cell carcinoma remains vague. We present a 60-year-old woman with anal cancer and liver metastasis. This patient received chemotherapy (mitomycin C, 5-fluoruracil, and cisplatin) and reached a good partial response. MAHA developed 2 months later, and tumor recurrence with rapid deterioration appeared 5 months later. The patient died 5 months after MAHA was diagnosed. We consider that the MAHA in this patient is chemotherapy-related. However, the possibility of cancer-associated MAHA could not be excluded.

Gender discrepancy observed between chemotherapy-induced emesis and hiccups

The aim of this paper was to describe striking gender differences observed between emesis and hiccups in patients receiving cisplatin-based chemotherapy (CT) and one of two dexamethasone-containing anti-emetic regimens. Four hundred patients were evaluated in a crossover study with two arms. Patients in arm A received three doses of ondansetron 8 mg i.v. at 4-h intervals plus dexamethasone 20 mg i.v. from the start of CT, followed by dexamethasone 5 mg i.v. every 12 h, until CT was complete, after which dexamethasone was discontinued. For patients in arm B the treatment was the same as in arm A except that the three doses of ondansetron 8 mg i.v. were given at 24-h intervals. There were 363 patients in arm A and 358 patients in arm B. Vomiting/nausea/hiccups were observed in 30.3%/41.6%/23.7% of patients in arm A and 28.8%/39.1%/23.7% of patients in arm B, respectively. Comparison showed that the rates for complete control of vomiting and nausea on days 1 through 6 were significantly lower in women (P<0.0001 and =0.0004 in arm A and P<0.0001 and <0.0001 in arm B, respectively). Men had a significantly higher incidence of hiccups (P<0.0001 in both arms), but no apparent associations with age, cisplatin dose, tumor type, and the presence of vomiting and nausea during CT were found. Hiccups usually began 24 h after cisplatin administration and persisted for some days. Women had significantly higher rates of vomiting and nausea. The cause of the gender discrepancy is unknown.

Dietary iron induces rapid changes in rat intestinal divalent metal transporter expression

The divalent metal transporter (DMT1, also known as NRAMP2 or DCT1) is the likely target for regulation of intestinal iron absorption by iron stores. We investigated changes in intestinal DMT1 expression after a bolus of dietary iron in iron-deficient Belgrade rats homozygous for the DMT1 G185R mutation (b/b) and phenotypically normal heterozygous littermates (+/b). Immunofluorescent staining with anti-DMT1 antisera showed that DMT1 was located in the brush-border membrane. Duodenal DMT1 mRNA and protein levels were six- and twofold higher, respectively, in b/b rats than in +/b rats. At 1.5 h after dietary iron intake in +/b and b/b rats, DMT1 was internalized into cytoplasmic vesicles. At 1.5 and 3 h after iron intake in +/b and b/b rats, there was a rapid decrease of DMT1 mRNA and a transient increase of DMT1 protein. The decrease of DMT1 mRNA was specific, because ferritin mRNA was unchanged. After iron intake, an increase in ferritin protein and decrease in iron-regulatory protein binding activity occurred, reflecting elevated intracellular iron pools. Thus intestinal DMT1 rapidly responds to dietary iron in both +/b and b/b rats. The internalization of DMT1 may be an acute regulatory mechanism to limit iron uptake. In addition, the results suggest that in the Belgrade rat DMT1 with the G185R mutation is not an absolute block to iron.