[A randomized clinical trial of preoperative neoadjuvant chemotherapy followed by surgery in the treatment of stage III non-small cell lung cancer]

BACKGROUND

To explore the feasibility and toxicity of preoperative neoadjuvant chemotherapy followed by surgery in the treatment of stage III NSCLC and to evaluate its effects on tumor response, resection rate, tumor downstaging, and survival rate.

METHODS

From Jan. 1990 to Jan. 2001, 624 patients were randomly devided into group A ( preoperative neoadjuvant chemotherapy group) and group B ( control group, without neoadjuvant chemotherapy) . Group A had 314 patients and group B had 310 cases. The patients in group A were give 2 cycles of neoadjuvant chemotherapy, and operations were performed in 4 weeks after finishing the last chemotherapy. Twenty-one patients were given bronchial artery intervensional chemotherapy. The other 293 cases were given intravenous chemotherapy. The regimens included MVP in 68 cases, CAP in 36 cases, EP in 67 cases, VIP in 20 cases, Gem+ DDP in 30 cases, NVB+ DDP in 32 cases, Taxol+ NVB in 30 cases, and Taxol+ DDP in 10 cases. The patients in group B were firstly operated. Thoracic radiation therapy of 50-55 Gy was g iven in the patients with N1 and N2 disease both in group A and group B.

RESULTS

The tumor response to induction chemotherapy was 73. 57%( 231/ 314) in group A. The tumor downstaging was 43. 63%( 137/ 314) . The histological complete response was 15. 92%( 50/ 314) . The resection rate was 97. 69% in group A, and 91. 94% in group B. No significant differences of blood loss, operative complications and mortality were observed between the group A and group B. The 1-, 3-, 5- and 10-year survival rates were 89. 35%, 67. 46% , 34. 39% and 29. 34% in group A, and 87. 53%, 51. 54%, 24. 19% and 21. 64% in group B respectively. The long-term survival rate in group A was remarkably higher than that in group B ( P < 0. 01) .

CONCLUSIONS

The results demonstrate that the preoperative neoadjuvant chemotherapy is safe and effective. It is helpful to decrease the tumor staging , to increase the resection rate of the tumor, and to improve the long-term survival rate and life qualities of patients with stage III NSCLC.

Spatiotemporal image correlation-derived volumetric Doppler impedance indices from spherical samples of the placenta: intraobserver reliability and correlation with conventional umbilical artery Doppler indices

OBJECTIVE

Volumetric impedance indices derived from spatiotemporal image correlation (STIC) power Doppler ultrasound (PDU) might overcome the influence of machine settings and attenuation. We examined the feasibility of obtaining these indices from spherical samples of anterior placentas in healthy pregnancies, and assessed intraobserver reliability and correlation with conventional umbilical artery (UA) impedance indices.

METHODS

Uncomplicated singleton pregnancies with anterior placenta were included in the study. A single observer evaluated UA pulsatility index (PI), resistance index (RI) and systolic/diastolic ratio (S/D) and acquired three STIC-PDU datasets from the placenta just above the placental cord insertion. Another observer analyzed the STIC-PDU datasets using Virtual Organ Computer-aided AnaLysis (VOCAL) spherical samples from every frame to determine the vascularization index (VI) and vascularization flow index (VFI); maximum, minimum and average values were used to determine the three volumetric impedance indices (vPI, vRI, vS/D). Intraobserver reliability was examined by intraclass correlation coefficients (ICC) and association between volumetric indices from placenta, and UA Doppler indices were assessed by Pearson's correlation coefficient.

RESULTS

A total of 25 pregnant women were evaluated but five were excluded because of artifacts observed during analysis. The reliability of measurement of volumetric indices of both VI and VFI from three STIC-PDU datasets was similar, with all ICCs ≥ 0.78. Pearson's r values showed a weak and non-significant correlation between UA pulsed-wave Doppler indices and their respective volumetric indices from spherical samples of placenta (all r ≥ 0.23). VOCAL indices from specific phases of the cardiac cycle showed good repeatability (ICC ≥ 0.92).

CONCLUSION

Volumetric impedance indices determined from spherical samples of placenta are sufficiently reliable but do not correlate with UA Doppler indices in healthy pregnancies.

Investigation of space-time clusters and geospatial hot spots for the occurrence of tuberculosis in Beijing

OBJECTIVE

To characterise the geographic and spatiotemporal distribution of confirmed tuberculosis (TB) cases in Beijing between 2005 and 2009.

DESIGN

The yearly notification rate maps were used to describe the distribution of confirmed adult TB patients. Spatial autocorrelation (Moran's I) and hot-spot analysis were adopted to detect the clusters and hot spots of TB.

RESULTS

The TB incidence rate (cases per 100,000 population) in Beijing increased from 29.8 in 2005 to 35.0 in 2009. The incidence rate was significantly higher in the Urban Development New District and the Ecologic Reservation Development District (>30/100,000) than in the other districts. There was a significant spatial autocorrelation throughout the city (u = 2.58, P = 0.01). Evident clusters were observed in the Capital Functional Core District and the Urban Function Extension District (G(i)* > 1).

CONCLUSION

Spatial autocorrelation and hot-spot analysis may serve as efficient tools to detect space-time clusters and geospatial hot spots of TB incidence. Between 2005 and 2009, TB incidence in Beijing showed population density and mobility-dependent and eco-social status-dependent space-time clusters and geospatial hot spots.

Deficiency in TLR2 but not in TLR4 impairs dendritic cells derived IL-10 responses to schistosome antigens

The purpose of this study was to observe the diverse functions of Toll-like receptors (TLRs) in responses to specific schistosome antigens. Bone marrow-derived dendritic cells (BMDCs) from TLR2-deficient (TLR2(-/-)) or TLR4-deficient (TLR4(-/-)) mice were activated with soluble schistosomule antigen (SSA) or soluble egg antigen (SEA). TLR2 mRNA expression was significantly increased in B6 BMDCs following SEA stimulation. TLR2-deficient BMDCs showed enhanced MHCII expression following SSA and SEA stimulation. TLR2-deficient but not TLR4-deficient BMDC failed to produce IL-12p70 and IL-10 in response to schistosome antigens. TLR2-deficient BMDCs induced a stronger CD4(+) T cell proliferative response. IL-4 and IL-10 expression was inhibited in CD4(+) T cells primed with TLR2-deficient BMDCs, while enhanced in TLR4-deficient BMDCs-primed CD4(+) T cells. These results suggest that TLR2 is essential for the establishment of the DC production of IL-12p70 and IL-10.

Ontogenesis of Ap-2γ expression in rat testes

Searching for useful markers of spermatogonial stem cells and their differentiation, we used rat testes from ages representing different stages of testicular maturation to investigate the expression profile of transcription factor activation protein-2γ (Ap-2γ). The immunohistochemical and immunocytochemical evaluation using Ap-2γ and promyelocytic leukemia zinc finger in combination with sorting of CD9 and CD90 positive cells (undifferentiated spermatogonia) by fluorescence-activated cell sorting was performed. Our experiments revealed that Ap-2γ is detectable in testes of late fetal age and up to 60 days postnatally and is expressed in gonocytes and spermatogonia from late fetal age throughout all maturational stages. Restricted nuclear expression of Ap-2γ to undifferentiated male germ cells was verified by coexpression of Ap-2γ with promyelocytic leukemia zinc finger in sections of paraffin-embedded testes as well as in cells sorted positive for CD9 and CD90 expression. Our study demonstrated clearly that nuclear expression of Ap-2γ is a useful marker for identifying undifferentiated male germ cells, although its functional role is yet to be fully explored.

Real-time detection of auditory steady-state responses

Detection of the auditory steady-state responses (ASSRs) is a difficult task, its main technical impediment is no other than the excessively lengthy recording time required for the estimation process due to the extremely low signal-to-noise ratio (SNR). To improve the detection rate of ASSRs, a new observer-based real-time ASSR detector is derived as an alternate solution to the existing methods. The ASSR detector has a simple structure, and provides fast and reliable signal detection. Simulation and experimental recorded data were used to evaluate the performances of the proposed approach. Compared with the conventional methods, the proposed method requires shorter recording time which could be proven as a valuable hearing screening or diagnostic tool.

Promoter Methylation and Phosphorylation Status of PTEN in Taiwanese Breast Cancer

Background: The PTEN (phosphatase and tensin homolog deleted on chromosome Ten) gene is a novel candidate of tumor suppressor that plays an important role in cell cycle regulation and apoptosis by modulating protein kinase-B/AKT activity. In western breast cancer population, PTEN downregulation is frequently associated with high-grade tumor, distant metastases and poorer disease-free survival. It is also noted that the methylation of the PTEN promoter results in PTEN inactivation in a subset of breast cancers. Taiwan is the low-incidence area of breast cancer. However, breast cancer has been jumped to the first place in the incidence of female malignancies in the past 3 years. Hence, we aim to explore the potential role of PTEN in Taiwanese breast cancer.Material and Method: Firstly, we used tissue microarrays containing 192 specimens (PTEN) and 193 samples (p-PTEN) from the Department of Pathology, Kaohsiung Medical University to analyze the expression patterns of PTEN and p-PTEN (Ser380/Thr382/Thr383) protein by immunohistochemistry (anti-PTEN antibody, A2B1, and anti-p-PTEN R, Santa Cruz). Clinical data, such as stage, grade, recurrence, lymph-node metastasis, and patient's age, tumor-specific survival (in months) and others were included in our statistic analysis. The genomic DNA (1 μg) obtained from 318 fresh specimens containing 159 matched cancer and non-cancer tissues were treated with sodium bisulfite for 16 hours and purified using methylation-specific PCR (MSP) kit (Millipore). Separate primers were used for amplification of methylated and unmethylated promoter regions. Primers that amplified a region of the promoter specific to PTEN gene but not the PTEN pseudogene were used. Primers used to amplify the methylated PTEN promoter were 5'-GTATTTCGAGTAAAGGAAGAAGACG-3' and 5'-GATAAAAAACTACAACC CAACGAA-3'; those used to amplify the unmethylated promoter were 5'- TATTTTGAGTA AAGGAAGAAGATGA-3' and 5'-CAATAAAAAACTACAACCCAACAAA-3'.Results: Our results showed that an increased nuclear expression of PTEN was positively correlated with an increased tumor staging (p=0.010). Furthermore, an increased p-PTEN expression in the cytoplasm was inversely correlated with tumor staging (p=0.003), while the decreased expression of p-PTEN in the nucleus was significantly correlated with positive recurrence rate (p=0.009) and metastasis to lymph node (p=0.033). Notably, the expression level of p-PTEN was positively correlated with that of PTEN. We also observed that the methylation of PTEN promoter was increased in 70% of breast cancer tissues as compared with the matched non-cancer breast tissues. Moreover, the increased methylation of PTEN promoter was positively correlated with tumor grade (p=0.037).Discussion: Taken together, our results suggest that an altered PTEN expression through methylation or phosphorylation may have potential roles in Taiwanese breast cancer. The underlying mechanism requires further investigation.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4060.

Efficacy and Safety Data of Taiwan Breast Cancer Patients Enrolled in the Lapatinib Expanded Access Program (LEAP)

Background: LEAP is a single-arm, open-label, expanded access study of lapatinib in combination with capecitabine in 42 countries. The primary objective of LEAP was to provide patients with pre-approval access to lapatinib based on positive clinical data from a pivotal Phase III trial.Methods: Enrolled patients had locally advanced or HER2 positive metastatic breast cancer (MBC), progressive disease (PD, by modified RECIST) following prior therapy with anthracycline-, taxane-, and trastuzumab-containing regimens, including some patients previously treated with capecitabine, and were ineligible for ongoing lapatinib trials. Patients received lapatinib (1250 mg/day) and capecitabine (2000 mg/m2/day, days 1-14, every 21 days). Baseline characteristics, including prior therapies, were collected. Response was assessed using RECIST criteria.Results: From Mar 2007 to Sep 2008, 238 patients were enrolled at 10 centers in Taiwan. At the 11 June 2009 data cut-off, data were collected and analyzed for 166 patients. Patients received an average of 5 prior cytotoxic therapies, including trastuzumab and capecitabine.Of 166 patients, 3 (2%) had complete response, 49 (30%) had partial response, 62 (37%) had stable disease, 42 (25%) had PD, and 10 (6%) were unknown. The median duration of treatment was 5.5 mo and the median time to progression was 5.3 mo, respectively. Per protocol, only serious adverse events (SAEs) were reported. Thirty SAEs were reported for 238 patients; 6 (20%) were considered treatment-related by investigators, were not fatal, and included stomatitis (2), vomiting (2), diarrhea (1), and cellulitis (1). As of 11 June 2009, 66 (40%) patients were alive and 149 withdrew from LEAP, the majority (85%) because of progressive disease.Conclusion: Although data were collected retrospectively via case report forms, these results reflect the real world setting in Taiwan for the treatment of erbB2+ MBC patients and confirms that lapatinib, in combination with capecitabine, demonstrates efficacy in this patient population including those who are heavily pretreated.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5093.

Gefitinib versus platinum contained doublet chemotherapy in chemotherapy-naive patients with stage IIIb or IV non-small cell lung cancer of adenocarcinoma histology: A retrospective case control study

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Background: The results of the ISEL study in non-small cell lung cancer (NSCLC) suggest greater benefit of gefitinib among Asian patients and non-smokers compared with the overall trial population. Methods: We conducted a retrospective case-control study to compare outcomes for gefitinib versus platinum doublet chemotherapy as first line treatment in selected NSCLC patients (stage IIIB/IV adenocarcinoma, PS 0–2). Patient receiving platinum chemotherapy were selected on the basis of disease stage (IIIB or IV), gender, smoking history, WHO performance status (PS) (0–1, or 2) and age (< 60ys or ≥ 60ys) being matched to patients receiving gefitinib. Gefitinib and chemotherapy arm patients were selected by 1:2 ratio in order to increase statistical power. The study was approved by local institute review board. Results: 99 chemo-naïve adenocarcinoma patients treated in our institute from January 2006 to December 2007 were collected: 33 received gefitinib and 66 received chemotherapy. The baseline characteristics are listed in table 1 . The median duration of follow-up was 10 months. Patients receiving gefitinib experienced significantly higher ORR and DCR, and prolonged PFS ( table 1 ). Patients receiving chemotherapy experienced more frequent grade 3–4 neutropenia (42.4% vs 0%), thrombocytopenia (21.2% Vs 0%), febrile neutropenia (7.5% vs 0%) and nausea (24.2% vs 3.0%). The most commonly recorded adverse events in the gefitinib arm were rash/acne (9.1%), diarrhea (3.0%), nausea (3.0%) and anemia (3.0%). Conclusions: The limitations of case-control studies are acknowledged, yet these results were supported by IPASS. Gefitinib as first-line treatment confers clinically relevant benefit in Asian NSCLC patients with adenocarcinoma histology versus platinum based chemotherapy.

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[Table: see text]