Use of epigenetic aberrant promoter methylation in serum DNA for detection of pneumoconiosis-associated lung cancer

20059

Background: Pneumoconiosis is known to be associated with an independent increased risk of lung cancer. However, it is difficult to detect lung cancer radiographically in patient with pneumoconiosis because of pre-existing diffuse pulmonary shadows. The purpose of this study is to evaluate the usefulness of serum DNA methylation for detection of pneumoconiosis-associated lung cancer. Methods: We investigated to identify promoter methylation status of RAR-beta, p16INK4a, MGMT, DAPK, and RASSFIA gene in serum DNA using methylation-specific PCR. Sera were obtained from 31 control patients with non-malignant-non-pneumoconiotic pulmonary disease (Group I), 36 with pneumoconiosis (Group II), and 5 with pneumoconiosis-associated lung cancer (Group III). DNA was extracted using QIAamp DNA Blood Midi Kit (Qiagen, CA). Following DNA bisulfite modification using CpGenome DNA Modification Kit (Intergen, NY), PCR was performed with primers for methylated or unmethylated promoter sequences. Results: Median (range) age of patients were 61 (26–78), 71 (49–86), and 69 (56–78) for Group I, II, and III respectively. Median (range) duration of silica and asbestos exposure were 33 (3–47) years and 33(32–40) years for Group II and III respectively. All of 5 pneumoconiosis-associated lung cancer were adenocarcinoma. Eleven patients (35.5%) in Group I, 19 patients (52.8%) in Group II, and 5 patients (100%) in Group III were shown to have methylation of at least one gene. The total number of methylated genes per patient were, 0.35, 0.69, and 1.20 for groups I, II, and III respectively (p = 0.013, Kruskal-Wallis analysis). In Group II, methylation status did not correlate with duration of occupational exposure, smoking history, radiographic findings, and age. Conclusions: In patients with pneumoconiosis, monitoring of aberrant promoter methylation of serum DNA might be useful for assessing the risk of lung cancer and early detection of lung cancer.

No significant financial relationships to disclose.

Pirarubicin (THP) therapy for elderly aggressive non-Hodgkin’s lymphoma— T-COP vs reduced CHOP, and reduced T-COP in the patients with poor physical status

17571

Background: We have previously reported that T-COP using pirarubicin (THP) is useful in treatment of NHL in elderly patients. In the present study on elderly aggressive NHL, the usefulness and safety were compared between THP and ADM using the optimum dose of THP (ML1). In patients with poor physical status, reduced dose T-COP was conducted (ML2). Methods: ML1 protocol: PS 0–3 and Alb ≥ 3.0 g/dl Patients in their 70s were assigned randomly to either T-COP (A group) or CHOP (B group) receiving THP (A) or ADM (B) 40 mg/m2,CPA 650 mg/m2, VCR 1 mg/m2dayl, P 40 mg/m2dayl -5. Patients in their 80s were assigned randomly to either T-COP (C) or CHOP (D) receiving THP (C) or ADM (D) 30, CPA 400, VCR 1, P 30. ML2 protocol: PS 4 or Alb < 3.0 g/dl. Patients in their 70s (E group) received THP 26, CPA 430, VCR 1, P 40. Patients in their 80s (F group) received THP 20, CPA 260, VCR 1, P 30. Each group underwent 3 courses every 3 weeks. CR (CR+CRu) patients underwent 6 courses or more. Results: Analyzed as competent cases were 173 out of 207 patients who were registered between Aug 99 and Dec 03. The CR rates were A: 83% (39/47), B: 74% (37/50), C: 67% (14/21), D: 74% (14/19), E: 58% (7/12), F: 33% 2/6, and 78% in T-COP (A + C) and 74% in CHOP (B + D). The 5-year survival rates were A: 50%, B: 35% (p < 0.05) and C: 26% D: 55% (p < 0.05.), demonstrating that T-COP in their 70s and CHOP in their 80s were significantly higher. The 5-year survival rate in ML1 was 41%. In multivariate analysis, factors influencing the survival (p < 0.01) in ML1 were age, the primary effect and treatment method. There were no significant differences in PS, CS, LDH and lesions outside nodes. Conclusions: Patients aged 70 years or older had the CR rate at 75.9% and a 5-year survival rate at 41%, demonstrating satisfactory outcomes. The results suggested that in 70s, THP 40 mg/m2 was more effective than ADM 40 mg/m2. In their 80s, ADM30 mg/m2 was more effective than THP30 mg/m2. ML2 was feasible in elderly patients with poor physical status.

No significant financial relationships to disclose.

Clinical factors affecting the late resistance to gefitinib in patients with non-small cell lung cancer (NSCLC)

7191

Background: The mechanism of late resistance of NSCLC to gefitinib is unclear. In this study, we assessed clinical factors affecting the late resistance in patients with NSCLC. Methods: Between 2000 and 2004, 197 consecutive patients with NSCLC underwent treatment with gefitinib in our institutions. Of those, 56 patients who had received a prior chemotherapy and continued treatment with gefitinib during at least 6 months were included in this study. The characteristics of these patients were as follows: median age, 62.5 years (range, 28 to 77 years); male/female, 22/34 patients; PS 0/1/2/3/4, 15/31/8/0/2 patients; and adeno/nonadenocarcinoma, 52/4 patients. Thirty-two patients never smoked and 24 were former or current smokers. Nineteen patients underwent surgical resection of NSCLC. Numbers of chemotherapy regimens were one in 31 patients, two in 18, three in 6, four in 1, respectively. Results: Of 56 patients, three achieved a CR and 39 attained a PR, with an overall response rate of 75% (95% CI, 69.2 to 80.8%). The remaining 14 patients had a long SD. At a median follow-up time of 21.6 months (range, 7.7 to 59.7 months), median time to progression was 19.5 months, with progression-free survival rates of 68.5% at 1-year, 33.6% at 2-year, and 21.2% at 3-year, respectively. In a univariate analysis regarding progression-free survival, presences of metastasis to brain (p = 0.008), bone (p = 0.025), liver (p = 0.046), and adrenal (p = 0.008), decreased levels of hemoglobin (p = 0.021) and albumin (p = 0.017), and use of multiple chemotherapy regimens prior to treatment with gefitinib (p = 0.026) were significant factors. In a multivariate analysis using Cox proportional hazard model, presence of brain metastasis was a significant factor clinically affecting the late resistance to gefitinib (hazard ratio, 2.14; 95% CI, 1.10 to 4.17, p = 0.025). In addition, decreased hemoglobin level (p = 0.074) and prior multiple chemotherapy regimens (p = 0.069) were tended to be significant. Conclusions: In patients undergoing treatment with gefitinib, presence of brain metastasis was an important factor indicative of the emergence of late resistance in this study. It is needed to confirm this finding in a large cohort of patients with NSCLC.

No significant financial relationships to disclose.

S-carboxymethylcysteine normalises airway responsiveness in sensitised and challenged mice

S-carboxymethylcysteine (S-CMC) has been used as a mucoregulator in respiratory diseases. However, the mechanism of action of S-CMC on allergic airway inflammation has not yet been defined. In the present study, BALB/c mice were initially sensitised and challenged to ovalbumin (OVA) and, weeks later, re-challenged with OVA (secondary challenge). S-CMC (5-100 mg.kg-1) was administered from 2 days before the secondary challenge through to the day of assay. Mice developed airway hyperresponsiveness (AHR) 6 h after the secondary challenge and increased numbers of neutrophils were present in the bronchoalveolar lavage (BAL) fluid. At 72 h after secondary challenge, mice again developed AHR, but the BAL fluid contained large numbers of eosinophils. S-CMC treatment was found to reduce AHR and neutrophilia at 6 h, as well as eosinophilia and AHR at 72 h. These effects appeared to be dose dependent. Goblet cell hyperplasia, observed at 72 h, was reduced by S-CMC. In BAL fluid, increased levels of interferon-gamma, interleukin (IL)-12 and IL-10 and decreased levels of IL-5 and IL-13 were detected. In conclusion, the data indicate that S-carboxymethylcysteine is effective in reducing airway hyperresponsiveness and airway inflammation at two distinct phases of the response to the secondary allergen challenge in sensitised mice.

Reference profiling of the genomic response induced by an antimicrotubule agent, TZT-1027 (Soblidotin), in vitro

TZT-1027 is an antimicrotubule agent targeting beta-tubulin that is undergoing clinical development. The genomic response of cancer cells to TZT-1027 was profiled to evaluate its biochemical activity. A lung cancer cell line, PC-14, was exposed to antimicrotubule agents including dolastatins, Vinca alkaloids and taxanes at an equivalent toxicity level. Alterations in the TZT-1027-induced gene expression of approximately 600 genes were then examined using microarray technology and the resulting gene profiles were compared with those for cells exposed to the other antimicrotubule agents. A principle component analysis using the whole gene set demonstrated that TZT-1027 produced similar gene profiles to those produced by dolastatin 10, but that these gene profiles differed from those produced by other agents. The agents were classified according to their induced genomic response in a molecular structure-dependent manner. Genes whose expression profiles differed according to drug class included intermediate filaments, extracellular matrix protein and Rho regulatory genes that may be involved in cytoskeletal and angiogenesis processes that are regulated by microtubule dynamics. TZT-1027 produces a unique genomic response profile distinct from that of Vinca alkaloids and taxanes, suggesting that this agent has a different mechanism of action. The selected genes may act as pharmacodynamic biomarkers allowing the unique mode of action of TZT-1027 to be discriminated from those of other antimicrotubule agents.

Continued gefitinib treatment after disease stabilisation prolongs survival of Japanese patients with non-small-cell lung cancer: Okayama Lung Cancer Study Group experience

BACKGROUND

This study aimed to investigate the survival outcome of patients with non-small-cell lung cancer (NSCLC) who had obtained disease stabilisation with gefitinib treatment and to clarify the effect of continued treatment with gefitinib on prognosis.

PATIENTS AND METHODS

We reviewed the clinical records of 365 Japanese patients with NSCLC who received gefitinib (250 mg/day).

RESULTS

Of 324 (89%) patients assessable for response, 147 (45%) obtained disease stabilisation and 71 (22%) patients achieved an objective response. Overall survival in patients obtaining disease stabilisation was significantly longer than in patients with progressive disease (median survival time 12.1 versus 4.4 months; P <0.0001). In patients obtaining disease stabilisation, those who continued gefitinib treatment until disease progression tended to have longer overall and progression-free survival compared with those discontinuing gefitinib treatment (1-year survival rate 52.1% versus 36.6%, P = 0.08; 1-year progression-free survival rate 31.8% versus 5.2%, P = 0.001). Multivariate analysis showed discontinuing gefitinib was an independent risk factor for progression-free survival (hazard ratio 1.66; 95% confidence interval 1.07-2.56; P = 0.022) but not for overall survival.

CONCLUSIONS

Our findings indicate the importance of achieving disease stabilisation with gefitinib treatment and continued gefitinib treatment in Japanese patients with disease stabilisation, although further studies are required to confirm these findings.

Isolation and transplantation of highly purified autologous peripheral CD34+ progenitor cells: purging efficacy, hematopoietic reconstitution in non-Hodgkin's lymphoma (NHL): results of Japanese phase II study

The purging efficacy of positive selection of autologous CD34+ PBSC with a clinical scale method of magnetic-activated cell sorting system (CliniMACS) was investigated in 48 patients with non-Hodgkin's lymphoma (NHL). The median purity and recovery rate of the CD34+ cells post-selection were 93.3% (range 32.6-99.3) and 72.2% (range 20.5-309.8), respectively. The real-time PCR method to detect the patient-specific monoclonal immunoglobulin heavy chain gene rearrangement (minimal residual tumor; MRT) and CD19 and CD20 positivities were used for the detection of contaminating NHL cells before and after CD34+ selection. After selection, the median (range) depletion rate of MRT was 2.53 (1.52-4.78) log, and that of CD19+ cell and CD20+ cell was 2.46 (0.74-3.64) log and 2.32 (0.40-4.01) log, respectively. In 41 patients, high-dose chemotherapy was performed, followed by the transplantation of the isolated CD34+ cells. Rapid neutrophil recovery as well as platelet recovery was seen with a median time to reach 0.5 x 10(9)/l neutrophils of 10 days (range 8-13) and 20 x 10(9)/l platelets of 14 days (range 10-34), respectively. The present study demonstrated that CliniMACS is a highly effective positive selection method and a high purging efficacy could be obtained without compromising the hematopoietic reconstitution capacity of the graft in NHL patients undergoing high-dose chemotherapy.

Addition of platinum compounds to a new agent in patients with advanced non-small-cell lung cancer: a literature based meta-analysis of randomised trials

BACKGROUND

Single new agents reportedly produce promising response and survival effects, but platinum-based doublets remain the standard chemotherapy for advanced non-small-cell lung cancer (NSCLC). The aim of this study was to evaluate the effectiveness of platinum for advanced NSCLC by carrying out a meta-analysis of trials that compared platinum-based doublets with single new agent therapy alone.

METHODS

We carried out a literature search to identify trials, conducted between 1994 and 2003, comparing a doublet of platinum plus a new agent with a new agent alone in previously untreated patients with advanced NSCLC. Outcomes analysed were response, survival and toxicity.

RESULTS

Eight trials encompassing 2374 patients were identified. Platinum-based doublets produced an approximately two-fold higher overall (complete and partial) response rate than the new agent alone [odds ratio = 2.32; 95% confidence interval (CI)=1.68-3.20]. Platinum-based doublet therapy was also associated with a 13% prolongation of survival (hazard ratio = 0.87; 95% CI = 0.80-0.94, P <0.001). Despite significant increases in the frequencies of various toxic effects in patients receiving platinum-based doublets, no significant difference in treatment-related mortality was observed.

CONCLUSION

This is the first published meta-analysis demonstrating the importance of combining platinum with single new agents in the treatment of advanced NSCLC.

Retroviral vector backbone immunogenicity: identification of cytotoxic T-cell epitopes in retroviral vector-packaging sequences

Retroviral vectors are the frequently applied gene delivery vehicles for clinical gene therapy, but specificity of the immunogenicity to the protein encoded by the inserted gene of interest is a problem which needs to be overcome. Here, we describe human cytotoxic T-lymphocyte (CTL) clones recognizing epitopes derived from the protein encoded by the retroviral vector backbone, which were established during the course of our attempts to generate CTLs against cytomegalovirus (CMV) or human papilloma virus (HPV) in vitro. In the case of healthy CMV-seronegative donors, CTL lines specific for retrovirally transduced cells were generated in four out of eight donors by stimulating CD8 T cells with CD40-activated B (CD40-B) cells retrovirally transduced with CMV-pp65. Two CTL clones derived from one of the CTL lines were found to recognize epitopes from gag in the context of HLA-B(*)4403 and -B(*)4601, respectively. Similarly, an HLA-B(*)3501-restricted CTL clone from a cervical cancer patient recognized an epitope located in the junctional regions of the gag and pol sequences. These results show that polypeptides encoded by components of the retroviral vector backbone are in fact immunogenic, generating CTLs in vitro in human cells. Thus, potential CTL responses to retroviral products should also be considered in clinical settings.

Randomized Trial of Cefepime Monotherapy or Cefepime in Combination with Amikacin as Empirical Therapy for Febrile Neutropenia

A multicenter open randomized trial was conducted to compare cefepime monotherapy with cefepime/amikacin combination (dual) therapy in treating febrile neutropenic patients with hematologic disorders. Among the 189 evaluable patients, 5.8% had microbiologically and 10.6% had clinically documented infections. Excellent response was seen in 32.6% and 45.7% of monotherapy and dual therapy recipients, respectively, at day 3 (P=.065). At day 3, patients with neutrophil counts of <500/ mu L receiving dual therapy had a better response than did those receiving monotherapy (45% vs. 27.6%; P=.024). The same was true for patients with leukemia. Adverse events were minimal, and early death was observed in 7 patients in the dual therapy group and 5 patients in the monotherapy group. Overall, cefepime monotherapy is as effective as dual therapy for the initial treatment of febrile neutropenic patients. Further study is warranted for patients with severe neutropenia and leukemia who may benefit from dual therapy.

Congenital giant aneurysm of the left innominate vein: is surgical treatment required?

Congenital aneurysms of the thoracic venous system are rare. In particular, innominate venous aneurysms are extremely rare. We describe a 16-year-old girl whose chest x-ray suggested a mediastinal tumor. Three-dimensional contrast-enhancement magnetic resonance venography showed a giant sacciform aneurysm of the left innominate vein and dilatation of the right innominate vein. The patient was asymptomatic, and there were no significant physical findings. Therefore, the patient is being followed without surgical treatment.

Tacrolimus instead of cyclosporine used for prophylaxis against graft-versus-host disease improves outcome after hematopoietic stem cell transplantation from unrelated donors, but not from HLA-identical sibling donors: a nationwide survey conducted in Japan

Despite recent advances, graft-versus-host disease (GVHD) remains the main cause of treatment failure for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Tacrolimus (FK506) has been increasingly used in place of cyclosporine (CSP), and several studies have shown that FK506 reduces the incidence of acute GVHD more effectively than does CSP. However, no survival benefits have been demonstrated, and no established consensus exists on the choice of these immunosuppressive agents. To compare a CSP-based and an FK506-based regimen, we performed a large-scale retrospective study by using the data of 1935 patients who underwent HSCT from HLA-identical sibling donors (SIB-HSCT) and 777 patients who underwent HSCT from unrelated donors (UD-HSCT). For patients undergoing UD-HSCT, FK506 significantly reduced the risk of acute GVHD and treatment-related mortality (TRM) without an increase in relapse, thus improving overall survival (OS) (hazard ratio (HR): 2.20, 95% confidence interval (CI): 1.60-3.04, P<0.0001 for grade II-IV acute GVHD; HR: 1.81, 95% CI: 1.32-2.48, P=0.0003 for TRM; HR: 1.62, 95% CI: 1.23-2.14, P=0.0007 for OS). This superiority of FK506 was not observed in SIB-HSCT cases. These findings indicate that the use of FK506 instead of CSP for GVHD prophylaxis is beneficial for patients undergoing UD-HSCT.