Abstract OT3-02-06: Femara plus ribociclib or placebo as neo-adjuvant endocrine therapy for women with ER+, HER2-negative early breast cancer - The Feline trial

Background:

In early ER+ breast cancer, neo-adjuvant (NA) endocrine therapy (ET) may identify a subset of patients with endocrine sensitive disease with excellent outcomes without chemotherapy. In patients receiving a NA aromatase inhibitor, on- therapy, short term (day 14) Ki-67 of <10% and post NA pre-operative endocrine prognostic index (PEPI) 0 at surgery are associated with low relapse rates without chemotherapy. Ribociclib, a novel CDK4/6 inhibitor is active in ER+ metastatic breast cancer. We hypothesize that ribociclib+letrozole as NA ET for stage II-III breast cancer will increase the number of women with a PEPI 0 at surgery.

Trial Design:

Randomized, placebo-controlled, multi-center, phase II, investigator initiated trial of NA letrozole +/- ribociclib in postmenopausal women with ER+, HER2-, breast cancer. Subjects will be randomized 1:1:1 to letrozole 2.5 mg daily + placebo, letrozole 2.5mg daily + ribociclib 600mg daily on D1-21 of a 28 day cycle (intermittent dosing), or letrozole 2.5mg daily + ribociclib 400mg daily (continuous dosing). Treatment will be continued for 6 months followed by surgery. Research core biopsies and blood will be collected at baseline, at day 14, and at surgery. A Ki67 >10% at day 14 will result in discontinuation of the subject from the protocol as this may be an early indicator of resistance to endocrine therapy. An MRI will be done after 2 months of therapy to assess response/progression. Primary endpoint is a PEPI score of 0 at surgery.

Key Eligibility Criteria:

Postmenopausal (natural or surgical) women with stage II/III ER+, HER2- breast cancer. Must have a palpable breast mass of at least 2 cm. Multicentric/contralateral invasive disease not allowed. Ipsilateral/contralateral DCIS is allowed. Inflammatory breast cancer is excluded.

Specific Aims:

Primary objective: To determine if ribociclib+letrozole as a 24 week NA ET increases rate of PEPI score of 0 at surgery compared to letrozole. Secondary objectives: To determine if ribociclib+letrozole as a 24 week NA ET increases the proportion of tumors with complete cell cycle arrest compared to letrozole; to determine if ribociclib in combination with letrozole for 24 weeks results in improved 5 year RFS compared to letrozole; to examine differences in response rates between the two ribociclib containing arms vs letrozole.

Statistical Methods:

The two ribocilib containing arms (n=80) will be combined for analysis against placebo + letrozole (n=40). Assuming that addition of ribociclib will increase the rate of PEPI 0 by 20%, and setting Type I error rate at 10% and Type II error rates at 20% in the final analysis, a sample size of 80 women in the treatment arms (40 in each arm) and 40 women in the control arm are needed to show significance.

Patient accrual and target accrual:

Participating sites include The Univ of Kansas Med Ctr, City of Hope National Med Ctr, Massachusetts General Hospital, University of Miami Sylvester Comprehensive Cancer Ctr, University of Arkansas for Medical Sciences, and University of Wisconsin. The trial has accrued 16 patients with a target accrual of 120 patients. Accrual should be complete in 2/2017.

Contact information: Qamar Khan, MD (qkhan@kumc.edu).

Citation Format: Khan QJ, Prochaska LH, Mohammad J, Yuan Y, O'Dea A, Bardia A, Wisinski K, Hard M, Baccaray S, Makhoul I, Wagner J, Laura S, Ma C, Sharma P. Femara plus ribociclib or placebo as neo-adjuvant endocrine therapy for women with ER+, HER2-negative early breast cancer - The Feline trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-02-06.

[Epidemic profile of mumps in China during 2004-2013]

OBJECTIVE

To analyze the epidemiological characteristics of mumps in China from 2004 to 2013.

METHODS

Data of mump cases occurring between 2004 and 2013 were gathered from the national notifiable disease reporting system in China (excluding Hong Kong, Macao, and Taiwan); only cases classified as "final card" , laboratory confirmed, or clinical diagnosis were included. Descriptive epidemiology techniques were used to analyze features of sex, age, trends over time, and geography.

RESULTS

Average incidence of mumps between 2004 to 2013 was 24.20/100 000. Peaks were in 2011 and 2012, with incidence 33.9/100 000 (454 385/1.340 million) and 35.6/100 000 (479 518/1.347 million). Two seasonal peaks occurred regularly in years, one from April to July in the first year, and the other from November to January in the next year. During the study period, provinces with the highest incidence were Ningxia, Tibet, Xinjiang, and Guangxi; incidences were 72.1/100 000 (4 425/6.13 million), 48.5/100 000 (1 396/3 million), 51.7/100 000 (10 887/21.04 million), and 40.8/100 000 (19 179/46.99 million), respectively. Guangdong (28 078), Sichuan (21 924), Guangxi (21 616), and Zhejiang (20 000) provinces reported the highest number of mumps cases. Beijing, Tianjin, and Shanghai showed a consistently low incidence. Mumps cases occurred primarily among children aged 5-9 years, with incidence ranging from 118.2/100 000 to 281.4/100 000. In 2004-2008, the peak age was 6-8 years (174.1/100 000) and in 2009-2013, peak age was 5-7 years (234.5/100 000).

CONCLUSION

The highest incidences of mumps in China were reported in 2011 and 2012, with children of school age constituting the majority of cases.

Pre-harvest foliar application of ethephon strengthens gibberellins-induced fruit expansion in Pyrus pyrifolia

To identify the roles of ethylene in fruit development in Japanese pear Pyrus pyrifolia 'Niitaka', one of the non-climacteric genotypes, source-sink strength and fruit development during fruit expansion were investigated when ethephon was applied after a conventional gibberellic acid (GA) lanolin paste treatment on the pedicel. The results demonstrate that the conventional GA treatment during the early stage of fruit expansion resulted in larger fruit size and advanced fruit maturation, but pre-harvest foliar application of ethephon only advanced fruit maturation. However, pre-harvest foliar application of ethephon with a preceding conventional GA treatment during the early stage of fruit expansion dramatically improved fruit size and advanced fruit maturation over GA or ethephon alone. Moreover, the early foliar application of ethephon showed a better efficacy in increasing fruit size than the late spraying. A further study revealed that when ethephon was applied after the conventional GA treatment, it improved source-sink strength associated with leaf photosynthesis and the specific rate of [¹³C] accumulation in fruit, and also strengthened cell expansion more than did GA or ethephon alone.

Association between alpha-adducin gene rs4963 polymorphism and hypertension risk in Asian population: a meta-analysis

Some studies investigated the association between ADD1 rs4963 polymorphism and hypertension risk. However, the results remained inconclusive. Thus, we performed a meta-analysis. Published reports were searched in PubMed and Google Scholar. The strength of association was assessed by calculating odds ratios (OR) and 95% confidence interval (CI). Twelve studies with 5097 cases and 5937 controls were conducted in this study. Individuals with ADD1 rs4963 polymorphism showed an increased hypertension risk (OR = 1.21; 95%CI, 1.11-1.33; P < 0.0001). Subgroup analyses were performed according to country and age. The results showed that Chinese with ADD1 rs4963 polymorphism showed an increased hypertension risk (OR = 1.28; 95%CI, 1.09-1.51; P = 0.003). However, subjects in Japan and India did not have increased hypertension risk. In the subgroup analysis by age, older subjects, but not younger subjects, with ADD1 rs4963 polymorphism showed an increased hypertension risk (OR = 1.19; 95%CI, 1.07-1.32; P = 0.001). In conclusion, this meta-analysis suggested that ADD1 rs4963 polymorphism might be associated with increased hypertension risk.

[Comparison of results between fenestration discectomy associated with annulus repair and fenestration discectomy for lumbar disc herniation in the adolescents]

OBJECTIVE

To compare the preliminary clinical outcomes of fenestration discectomy associated with annulus repair (FDAR) and fenestration discectomy (FD) for lumbar disc herniation in the adolescents.

METHODS

The data of 26 adolescent patients with single segment lumbar disc herniation who were admitted to the Department of Orthopedics, Xuzhou Central Hospital from October 2012 to October 2014 were retrospectively studied. All patients were divided into 2 groups, including 12 patients undergoing FDAR and 14 patients undergoing FD respectively. The factors including the length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. The indentation of dura were measured from MRI. Pfirrmann grading system was used for assessment of lumbar disc degeneration preoperatively and 1 year later. The visual analogue scale (VAS), the oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) scores were used to measure the clinical outcomes. Simultaneously, surgical complications, and postoperative recurrence of lumbar disc herniation were recorded.

RESULTS

There were no significant differences in the observational factors such as the skin incision length, amount of intraoperative bleeding, operation time, and duration of hospitalization between the FDAR and FD groups (P>0.05). The indentation of the dura significantly reduced after surgery in each group [FDAR: (7.3±2.6) vs (1.3±0.8) mm; FD: (7.4±3.1) vs (2.9±0.7) mm; both P<0.05]. The postoperative lumbar disc degeneration in FDAR group was the same as that of in FD group. The postoperative VAS scores and ODI scores at each follow-up time point in both groups were significantly improved when compared with the preoperative ones (P<0.05). There were no statistically significant differences between the 2 groups in the JOA score improvement rate (FDAR: 88.5%, FD: 87.2%; P>0.05). According to the modified MacNab criteria, there were no statistically significant differences between the 2 groups in the excellent and good rate (FDAR: 89.3%, FD: 88.5%; P>0.05). There were no dural tears, disc space infection, hematoma formation in the spinal canal and other serious complications in both groups. But there was one patient regaining the back and leg pain in the FD group, whereas recovering by conservative treatment.

CONCLUSION

The preliminary clinical efficacy of both FDAR and FD in the treatment of single segment lumbar disc herniation in the adolescents is satisfactory.

[Spatial autocorrelation analysis of measles in China, 2005-2014]

OBJECTIVE

To detect the spatial features of measles in China by means of spatial statistical analysis.

METHODS

Data of prefecture-level measles cases and incidence from 2005 to 2014 were collected from the China Information System for Disease Control and Prevention. Information collected from the system included demographic characteristics, spatial distribution information, and diagnostic reports. Cases of unconfirmed measles and those with unknown address were ruled out. Cases from Hong Kong, Macao, Taiwan, and foreign countries were not included in this study. Maps were obtained from geographical boundary data at prefecture level from the Chinese Center for Disease Control and Prevention and demographic data from the National Bureau of Statistics. Based on different measures of measles elimination, we divided the data from 2005 to 2014 into three stages: stage 1 (2005-2008), stage 2 (2009-2012), and stage 3 (2013-2014). ArcGIS software was used to describe the spatial distribution and for global and local spatial autocorrelation analysis.

RESULTS

The total number of confirmed measles cases reported in the system was 650 222, with average incidence 0.46/100 000. The highest reported incidence was in 2008 (9.95/100 000) and the lowest in 2012 (0.46/100 000). Average incidences for stages 1, 2, and 3 were 8.87/100 000, 1.99/100 000 and 2.96/100 000, respectively. Global Moran's I coefficients from 2005 to 2014 were 0.31, 0.08, 0.36, 0.56, 0.26, 0.48, 0.34, 0.20, 0.29 and 0.52, respectively; all were significant (P<0.05). Average incidences for high-high (H-H) clusters in 2005-2008, 2009-2012, and 2013-2014 were 33.02/100 000, 7.06/100 000, 11.91/100 000, respectively. Western China had high-value clustering consistently throughout all three periods; however, the number of prefectures covered by high-value clusters and discrepancy in the incidence between western and eastern regions were low. Northeast and northern China had H-H clustering in stages 2 and 3.

CONCLUSION

In this study, measles incidence was spatially autocorrelated at the prefecture level from 2005 to 2014. Although China has made great progress in the elimination of measles, H-H clusters were consistently present. A need remains in China for targeted measles prevention and control measures.

Transcriptome analysis of maize resistance to Fusarium graminearum

BACKGROUND

Gibberella stalk rot caused by Fusarium graminearum is one of the most destructive soil-borne diseases of maize (Zea mays L.). Chemical means of controlling Gibberella stalk rot are not very effective; development of highly resistant hybrids is the best choice for disease control. Hence, understanding of the molecular basis underlying maize resistance against Gibberella stalk rot would undoubtedly facilitate the resistance breeding for stalk rot.

RESULTS

Two quantitative trait loci (QTL), qRfg1 and qRfg2, conferring resistance to Gibberella stalk rot were detected in our previous study. Three near-isogenic lines (NILs) of maize with either qRfg1 (NIL1) or qRfg2 (NIL2), or neither (NIL3) were generated and subjected to RNA sequencing to study the transcriptional changes after F. graminearum inoculation at 0 (control), 6, and 18 h post-inoculation (hpi). In total, 536,184,652 clean reads were generated, and gene expression levels were calculated using FPKM (fragments per kilobase of exon model per million mapped reads). A total of 7252 differentially expressed genes (DEGs) were found in the three NILs after F. graminearum inoculation. As many as 2499 DEGs were detected between NIL1 and NIL3 at 0 hpi, of which 884 DEGs were more abundant in NIL1 and enriched in defense responses. After F. graminearum inoculation, 1070 and 751 genes were exclusively up- and downregulated, respectively, in NIL1 as compared to NIL3. The 1070 upregulated DEGs were enriched in growth/development, photosynthesis/biogenesis, and defense-related responses. Genes encoding putative auxin-induced proteins and GH3 family proteins in auxin signaling pathway were highly induced and lasted longer in NIL3. Genes involved in polar auxin transport (PAT) were more abundant in NIL3 as compared with NIL2.

CONCLUSIONS

The qRfg1 confers its resistance to Gibberella stalk rot through both constitutive and induced high expression of defense-related genes; while qRfg2 enhances maize resistance to the disease via relatively lower induction of auxin signaling and repression of PAT. The defense-related transcriptional changes underlying each QTL will undoubtedly facilitate our understanding of the resistance mechanism and resistance breeding for maize stalk rot.

Frequencies of red blood cell major blood group antigens and phenotypes in the Chinese Han population from Mainland China

Alloantibodies directed to red blood cell (RBC) antigens play an important role in alloimmune-mediated haemolytic transfusion reactions and haemolytic disease of the foetus and newborn. The frequencies and phenotypes of RBC antigens are different in populations from different geographic areas and races. However, the data on major blood group antigens in the Chinese Han population from Mainland China are still very limited; thus, we aimed to investigate them in this study. A total of 1412 unrelated voluntary Chinese Han blood donors were randomly recruited. All donors were typed for blood group antigens: D, C, c, E, e, C(w) , Jk(a) , Jk(b) ,M, N, S, s, Le(a) , Le(b) , K, k. Kp(a) , Kp(b) , Fy(a) , Fy(b) , Lu(a) , Lu(b) , P1 and Di(a) using serological technology. Calculations of antigen and phenotype frequencies were expressed as percentages and for allele frequencies under the standard assumption of Hardy-Weinberg equilibrium. Amongst the Rh antigens, D was the most common (98.94%) followed by e (92.28%), C (88.81%), c (58.43%), E (50.78%) and C(w) (0.07%) with DCe/DCe (R1 R1 , 40.72%) being the most common phenotype. In the Kell blood group system, k was present in 100% of the donors and a rare phenotype, Kp (a+b+), was found in 0.28% of the donors. For the Kidd and Duffy blood group systems, Jk (a+b+) and Fy (a+b-) were the most common phenotypes (44.05% and 84.35%, respectively). In the MNS blood group system, M+N+S-s+ (45.54%) was the most common, whereas M+N-S-s- and M-N+S-s- were not found. The rare Lu (a-b-) and Lu (a+b+) phenotypes were identified in 0.43% and 1.13% of the donors, respectively. Le(a) and Le(b) were seen in 17.92% and 63.03% of donors, respectively. The frequency of Di(a) was 4.75%, which was higher than in the Chinese population in Taiwan region or the Caucasian and Black populations (P < 0.0001). This study systematically describes the frequencies of 24 blood group antigens in the Chinese Han population from Mainland China. The data can be helpful in creating a donor database for preparation of indigenous cell panels and providing antigen-negative blood to patients with multiple alloantibodies.

Is there a significant interaction effect between apolipoprotein E rs405509 T/T and ε4 genotypes on cognitive impairment and gray matter volume?

BACKGROUND

Evidence demonstrates that the T allele of the single-nucleotide polymorphism rs405509 in the apolipoprotein E (APOE) promoter is a risk factor for Alzheimer's disease. However, it is unknown whether rs405509 T allele synergizes with the APOE ε4 allele in influencing cognition and brain structure.

METHODS

We analyzed the interaction effect of the rs405509 T allele and the APOE ε4 allele on cognitive ability and brain gray matter volume among elderly people. The subjects were grouped into four groups according to APOE and rs405509 genotypes.

RESULTS

Significant interaction effects were found between rs405509 and APOE on general mental status, memory and attention. Analysis of the whole brain gray matter showed a significantly positive interaction effect between rs405509and APOE on the right inferior temporal gyrus and right fusiform gyrus (alphasim correction P < 0.001). In addition, there was a significant relationship between cognitive ability and gray matter volume.

CONCLUSIONS

The data indicate that the APOE rs405509 T homozygote modulates the effect of APOE ε4 on both cognitive performance and brain gray matter structure.