Racial differences in acute toxicities of FEC 100 chemotherapy in patients with breast cancer

e11515

Background: Racial disparities in breast cancer outcomes are attributed to differences in baseline tumor characteristics, stage, and socioeconomic factors. However, little is known about racial differences in treatment-related toxicities. We hypothesized that racial and ethnic differences result in differential tolerance to chemotherapy and possibly compromise to the dose intensity of adjuvant/neoadjuvant chemotherapy. Methods: Data was collected from 4 international collaborating centers (University of Miami, JBCRG (Japan Breast Cancer Research Group), University of Hong Kong, and Tom Baker Cancer Center) at which patients of different ethnic background have been treated for non metastatic breast cancer with same adjuvant or neoadjuvant chemotherapy of FEC 100: fluorouracil 500 mg/m2, epirubicin 100 mg/m2, and cyclophosphamide 100 mg/m2). Racial/ethnic differences in toxicities were assessed by first episode of grade 2 or higher toxicity. Analysis of data was performed at the University of Miami. Results: Treatment-related toxicities are compared according to four race/ethnicity groups (120 Caucasian from USA and Canada (C), 16 African American (AA) from USA and Canada, 141 Japanese Asian (JA), and 23 Asian from Hong Kong (HKA)) (Table). JA and HKA had a significant higher rate of grade 3 or higher toxicity compared with C or AA women; 65%, 61%, 28%, and 31% respectively. However, there were no significant differences in chemotherapy dose intensity or density across the 4 race/ethnicity groups. Conclusions: This unique study noted racial differences in acute toxicity in women with breast cancer who were treated with FEC 100 chemotherapy. However, there are several limitations including the retrospective nature of our study, differences in practice across four countries, and different number of patients available for comparison. This study is ongoing and further statistical analyses are planned when a larger sample size is reached.

[Table: see text]

No significant financial relationships to disclose.

Feasibility and economic viability of home-based supportive care

e20741

Background: Oncological treatment is becoming more complex and more costly. When their symptoms worsen, many patients seek an Emergency Room and arrive without a good performance-status. This causes insecurity to the attending physician, and it also represents a huge chance that this patient would receive an avoidable admission. With the appropriate home-support it is possible to attend the majority of patient's demands, offering a good quality clinical support.Home administration of some drugs is more comfortable and helps to eliminate some taxes that are commonly charged by private clinics. Methods: We performed an analysis of a private healthcare company's database.To avoid seasonality and high impact on costs of terminally ill patients occurring at an analyzed month, we selected a six months interval, from January to June 2008. Results: About 500 patients are active each month at the home-care program. They received from simple monitoring to 24 hour home nursing support. Hematological malignancies, as expected, require more resources.Home based supportive care could prevent the majority of avoidable hospital admissions. Conclusions: Home based supportive care can meet the basic needs of clinical support during chemotherapy and the demands of comfort at the end of life, in order to reduce avoidable hospital admissions. This contributes to reducing the cost of treatment.

[Table: see text]

Work-based social networks and health status among Japanese employees

BACKGROUND

Despite the worldwide trend towards more time being spent at work by employed people, few studies have examined the independent influences of work-based versus home-based social networks on employees' health. We examined the association between work-based social networks and health status by controlling for home-based social networks in a cross-sectional study.

METHODS

By employing a two-stage stratified random sampling procedure, 1105 employees were identified from 46 companies in Okayama, Japan, in 2007. Work-based social networks were assessed by asking the number of co-workers whom they consult with ease on personal issues. The outcome was self-rated health; the adjusted OR for poor health compared employees with no network with those who have larger networks.

RESULTS

Although a clear (and inverse) dose-response relationship was found between the size of work-based social networks and poor health (OR 1.53, 95% CI 1.03 to 2.27, comparing those with the lowest versus highest level of social network), the association was attenuated to statistical non-significance after we controlled for the size of home-based social networks. In further analyses stratified on age groups, in older workers (> or =50 years) work-based social networks were apparently associated with better health status, whereas home-based networks were not. The reverse was true among middle-aged workers (30-49 years). No associations were found among younger workers (<30 years).

CONCLUSIONS

The present study suggests a differential association of alternative sources of social support on health according to age groups. We hypothesise that these patterns reflect generational differences in workers' commitment to their workplace.

A low number of tumor infiltrating FOXP3-positive cells after primary systemic chemotherapy is correlated with favorable relapse-free survival in breast cancer patients

Abstract #5043

Background: Cancer cells induce proliferation and local accumulation of immunosuppressive cells such as FOXP3-positive cells which known as regulatory T cells (Tregs). Tregs prevent the maturation of dendritic cells and their capacity to present tumor antigens to cytotoxic T lymphocytes (CTLs) and leads to tumor-induced tolerance. Although cancer chemotherapy was usually considered as immunosuppressive, some chemotherapeutic agents have recently been shown to activate an anticancer immune response, which is involved in the curative effect of these treatments. Therefore, we hypothesized that number of tumor infiltrating FOXP3-positive cells during primary systemic chemotherapy is correlated with therapeutic results in breast cancer patients.&#x2028; Methods: To test the hypothesis, between September 2000 and January 2005, breast cancer patients treated with primary systemic chemotherapy (PSC) (n=93) were included in the study. Three cases were excluded because main tumors were resected before PSC and three cases of pathological complete reaction were excluded because they were hard to define “tumor infiltrating” Tregs. To compare the number of FOXP3 positive cells in the tumors before and after PST, both core-needle biopsy (CNB) and surgical resected specimens were stained with FOXP3 monoclonal antibody. Numbers of tumor infiltrating FOXP3-positive cells were counted in 3 and 5 randomly chosen high power fields (CNB and surgical specimens, respectively). A median cutoff of &gt;16.3 and &gt; 6.6 defined patients with high numbers of Tregs (CNB and surgical specimens, respectively). We also divided the patients into four groups (high numbers of FOXP3 positive cells in both CNB and surgical specimens; HH, low numbers in the both specimens; LL, high numbers in CNB and low in the surgical specimens; HL, and low in CNB and high in surgical specimens; LH). All patients were treated with anthracyclin containing therapy and 79.3 %( n=69) of them were added taxanes sequentially.&#x2028; Results: In the tumors after PST, numbers of Tregs were significantly higher in lymphvessel invasion positive tumors (P=0.01) and ER negative tumors (P=0.02) but there was no correlation between lymph node involvement and numbers of Tregs (P=0.8). As for the comparison of four groups, LL group shows the longest relapse-free (P=0.04) and overall survival (P=0.09) and HH group shows the shortest relapse-free and overall survival among four groups. Interestingly, HL group shows better outcome than HH group and LH group shows worse one than LL.&#x2028; Conclusions: These findings suggest that the control of Tregs in the tumor is important for the control of the disease and Tregs might be an important therapeutic target for breast cancer. Furthermore, it is suggested that some chemotherapeutic agents could be a potential inhibitor of the Tregs in tumor and show antitumor effects addition to their direct cytotoxicity against cancer cells.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5043.

[Evaluation of tracheobronchoplasty for lung cancer]

Tracheobronchoplasty has become one of the standard procedures for lung cancer. In this study, we examined the incidence of complications and survival of tracheobronchoplasty and compared with these of pneumonectomy. In 119 patients underwent tracheobronchoplasty, bronchopleural fistula occurred in 6 (5.0%) and anastomotic stenosis occurred in 5 (4.2%). Five-year survival rate of 119 patients underwent tracheobronchoplasty was 47.3%, and the median survival time was 49.3 months. We compared the sleeve or wedge lobectomy and pneumonectomy, the incidence of complications and 30-days death were similar, but the rate of in-hospital death and the prognosis of the sleeve or wedge lobectomy were better than these of pneumonectomy. So to preserve a respiratory function, we should use a bronchoplastic procedures to avoid pneumonectomy.

The structure of collagen

A knowledge of the structure of collagen fibrils is important for any rational discussion of the occurrence and treatment of fibrosis. The different genetic types of collagen, and the structure of the triple-helical molecule as refined from X-ray fibre diffraction data, are described. The problem of determining molecular arrangement in native tissues is discussed. The various models proposed for the molecular arrangement of type I collagen are compared and an account is given of the quasi-hexagonal model. A detailed analysis of the X-ray diffraction patterns from native type I collagen fibres is used to provide a quantitative description of the quasi-hexagonal model. Parameters such as molecular positions, azimuthal orientation and axial shift can be estimated from the diffraction patterns. These parameters refer to the helix main-chain. Side-chain conformations can then be built in by molecular graphics and the predicted X-ray pattern for the complete model compared with the observed pattern.

[The effect of the histoculture drug response assay (HDRA) based perioperative chemotherapy for non-small cell lung cancer]

In this study we analyze the usefulness of the histoculture drug response assay (HDRA) based perioperative chemotherapy for non-small cell lung cancer. From 2001 to 2006, we examined the chemosensitivity of 70 lung cancer tissues to cisplatin (CDDP), carboplatin (CBDCA), paclitaxel, docetaxel, gemcitabine and irinotecan. In 16 patients with stage III lung cancer who treated induction therapy, the response rate was 100% of 5 patients treated chemotherapy using 2 HDRA-positive drugs, 50% of 8 patient treeated using 1 positive drugs and 0% of 3 patients treated using negative drugs, respectively. The 3-year survival rate of the 5 patients treated using 2 positive drugs was better than that of 11 patient treated using 1 or non positive drugs (p = 0.07). In 39 patients with stage III lung cancer who treated adjuvant chemotherapy, the survival rate of the 14 patients treated chemotherapy using 2 positive drugs was significantly better than that of 25 patients treated using 1 or non positive drugs (p = 0.03). Therefore, HDRA may useful to the improvement of the response to chemotherapy and survival.

Predictive factors of transcatheter arterial chemoembolization for hepatocellular carcinoma

4541

Background/Aim: Although transcatheter arterial chemoembolization (TACE) has been widely used for the treatment of unresectable hepatocellular carcinoma (HCC), the optimal indication of the TACE has not been fully elucidated. Methods: The treatment outcomes after TACE were analyzed retrospectively to determine predictive factors of anti-cancer effect on HCC. The patient (pts) selection criteria were: 1) admission between 1992 and 2005, 2) diagnosis of fresh HCC, 3) no extrahepatic metastasis and 4) primary treatment with TACE. TACE was performed by selectively introducing a catheter into the hepatic artery and injecting gelatin sponge particles following an emulsion consisting of 2–5 ml of iodized oil (Lipiodol) and 20–50 mg doxorubicin hydrochloride. Lipiodol accumulation in tumors was regarded as an indication of necrosis. We defined complete response (CR) as disappearance or 100% necrosis of all tumors, and partial response (PR) as more than 50% reduction and/or more than 50% necrosis. Results: There were 270 pts who fulfilled the above criteria. According to Japan Integrated Staging, the number of T1, T2, T3 and T4 was 10, 59, 171 and 30, respectively. There were 52 CRs, 113 PRs, 77 who remained SD and 28 who showed PD/NE. The median survival months of CR, PR, SD and PD/NE were 50, 30, 15 and 5, respectively, and there was a significant differences between them. The logistic regression analysis revealed tumor multiplicity and vascular invasion (VI) were significantly associated with the objective response (CR or PR). The response probability of patients with solitary tumor without VI was 85%, that with multiple tumors without VI was 63%, that with solitary tumor with VI was 33% and that with multiple tumors with VI was 16%. The small tumor (<5 cm) was another favorable factor which was significantly associated with CR. Among 231 patients without VI, the CR probability of patients with a solitary tumor <5 cm or >5 cm was 46% or 40%, respectively; although that of those with multiple tumors <5cm or >5cm was 21% or 5%, respectively. Conclusion: TACE is recommended for HCC patients without VI, and is optimally indicated for those with a solitary tumor or those with multiple tumor <5 cm among them.

No significant financial relationships to disclose.

PRTFDC1, a possible tumor-suppressor gene, is frequently silenced in oral squamous-cell carcinomas by aberrant promoter hypermethylation

Array-based comparative genomic hybridization (array-CGH) has good potential for the high-throughput identification of genetic aberrations in cell genomes. In the course of a program to screen a panel of oral squamous-cell carcinoma (OSCC), cell lines for genomic copy-number aberrations by array-CGH using our in-house arrays, we identified a 3-Mb homozygous deletion at 10p12 in 1 of 18 cell lines (5.6%). Among seven genes located within this region, expression of PRTFDC1 mRNA was not detected in 50% (9/18) or decreased in 5.6% (1/18) of OSCC cell lines, but detected in normal oral epithelia and restored in gene-silenced OSCC cells without its homozygous loss after treatment with 5-aza-2'-deoxycytidine. Among 17 cell lines without a homozygous deletion, the hypermethylation of the PRTFDC1 CpG island, which showed promoter activity, was observed in all nine cell lines with no or reduced PRTFDC1 expression (52.9%). Methylation of this CpG island was also observed in primary OSCC tissues (8/47, 17.0%). In addition, restoration of PRTFDC1 in OSCC cells lacking its expression inhibited cell growth in colony-formation assays, whereas knockdown of PRTFDC1 expression in OSCC cells expressing the gene promoted cell growth. These results suggest that epigenetic silencing of PRTFDC1 by hypermethylation of the CpG island leads to a loss of PRTFDC1 function, which might be involved in squamous cell oral carcinogenesis.

Rituximab inhibits the constitutively activated PI3K-Akt pathway in B-NHL cell lines: involvement in chemosensitization to drug-induced apoptosis

Rituximab (chimeric anti-CD20 monoclonal antibody) is currently being used, alone or in combination with chemotherapy, in the treatment of B-non-Hodgkin's lymphoma (B-NHL). We have reported that rituximab treatment of B-NHL cell lines sensitizes the drug-resistant tumor cells to apoptosis by various chemotherapeutic drugs and chemosensitization was, in large part, owing to the selective inhibition of the anti-apoptotic Bcl-(XL) gene product. The constitutive activation of the Akt pathway in B-NHL results in overexpression and functional activation of Bcl-(xL). Hence, we hypothesized that rituximab-induced inhibition of Bcl-(xL) expression and chemosensitization may result, in part, from its inhibitory activity of the Akt pathway. This hypothesis was tested using the drug-resistant Ramos and Daudi B-NHL cell lines. Time kinetic analysis revealed that treatment with rituximab inhibited phosphorylation of Akt, but not unphosphorylated Akt, and the inhibition was first detected at 6 h post-rituximab treatment. Similar time kinetics revealed rituximab-induced inhibition of p-PDK1, p-Bad, p-IKKalpha/beta and p-Ikappabetaalpha and no inhibition of unphosphorylated proteins. In addition, rituximab treatment resulted in significant increase of Bcl-(xL)-Bad heterodimeric complexes as compared to untreated cells. The role of the Akt pathway in the regulation of resistance was corroborated by the use of the Akt inhibitor, LY294002, and by transfection with siRNA Akt. Treatment of tumor cells with LY294002 or with Akt siRNA, but not control siRNA, resulted in inhibition of Bcl-(xL) expression and sensitization to drug-induced apoptosis. Although rituximab did not inhibit the Akt pathway nor sensitized the rituximab-resistant Ramos RR1 clone, treatment with LY294002 or Akt siRNA sensitized the clone to drug-induced apoptosis. The present findings demonstrate for the first time that rituximab inhibits the constitutively activated Akt pathway in B-NHL cell lines, and this inhibition contributes to sensitization of drug-resistant cells to apoptosis by chemotherapeutic drugs. The findings also identify the Akt pathway as target for therapeutic intervention in the reversal of rituximab and drug-resistant B-NHL.

Exploratory aspirin resistance trial in healthy Japanese volunteers (J-ART) using platelet aggregation as a measure of thrombogenicity

Aspirin prevents the production of thromboxane A2 (TXA2) by irreversibly inhibiting platelet cyclooxygenase, exhibiting antiplatelet actions. This agent has been reported to prevent relapse in patients with ischemic heart disease or cerebral infarction via this action mechanism. However, there are individual differences in this action, and aspirin is not effective in some patients, which is referred to as 'aspirin resistance'. In this study, we analyzed laboratory aspirin resistance by platelet aggregation in 110 healthy adult Japanese males using 24 single-nucleotide polymorphisms (SNPs) of nine genes involved in platelet aggregation/hemorrhage. Among SNPs involved in platelet aggregation, aspirin was less effective for 924T homozygote of a TXA2 receptor, 924T>C, and 1018C homozygote of a platelet membrane glycoprotein GPIbalpha, 1018C>T, suggesting that 924T and 1018C alleles are involved in aspirin resistance.

Inhibition of macrophage activation and phagocytosis by a novel NF-κB inhibitor, dehydroxymethylepoxyquinomicin

Previously, we designed and synthesized a new NF-kappaB inhibitor, dehydroxymethylepoxyquinomicin (DHMEQ). In the present research we looked into the effect of DHMEQ on the activation of macrophages, especially on the phagocytotic activity of cells of the mouse macrophage-like cell line RAW264.7. DHMEQ inhibited lipopolysaccharide (LPS)-induced NF-kappaB activation by inhibiting its nuclear translocation from the cytoplasm. It also inhibited the expression of inducible NO synthase (iNOS) and nitric oxide (NO) production induced by LPS and interferon-gamma. Using enzyme-linked immunosorbent assays (ELISAs) we showed DHMEQ to inhibit LPS-induced secretion of IL-6, IL-12, interleukin-1beta (IL-1beta), and TNF-alpha. Furthermore, DHMEQ also inhibited the phagocytosis of fluorescently labeled Escherichia coli by RAW264.7 cells treated with LPS or IL-1beta, thus being the first evidence for the involvement of NF-kappaB in the regulation of phagocytosis by use of this inhibitor. Deletion of p65 by siRNA also inhibited the phagocytosis. DHMEQ inhibited the LPS-induced but not IL-1beta-induced phagocytosis of glass beads, indicating that activation of not only NF-kappaB but also Toll-like receptor 4 (TLR-4) is essential for the phagocytosis of E. coli. Previously we found that DHMEQ inhibited type 2 collagen-induced rheumatoid arthritis and the growth of various human carcinomas in mice. It is thus likely that inhibition of macrophage activation is involved in the mechanism of these anti-inflammatory and antitumor activities of DHMEQ in mice.

Age frequency distribution of joint ER/PR phenotypes in primary breast cancer patients: An analysis of 3,620 cases at a single Japanese institute

597

Background: Hormone receptor (HR) expression may reflect the different subtypes of breast cancer. Recent clinical trials have reported that joint Estrogen receptor (ER)/Progesterone receptor (PR) phenotypes in breast cancer have specific spectrum for treatment response. To analyze the epidemiologic character of ER/PR subtypes in Japanese patients, a retrospective data survey was conducted for 3,620 breast cancer patients treated at a single institute during 1975–2005. Methods: Patients records were obtained from cancer registration of the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital and analyzed with SAS software. Among 3,620 operated patients, data of ER/PR subtypes were available in 2,707 cases. HRs were evaluated by ligand binding assay (LBA) or enzyme immuno assay (EIA) from 1975 to 2000 (n=1721), and by immunohistochemistry (IHC) after that (n=986). Results: Both mean and median of patient’s age increased through the operated year (p<0.0001). Therefore, all analysis related to distribution of age were adjusted by the operated year. As reported before, ER+ population showed liner trend with age by LBA/EIA (p<0.0001), while this was not observed by IHC. ER-/PR+ population was 10.6% by LBA/EIA, whereas it decreased to 2.1% by IHC. These are due to the increase of ER+ population with IHC analysis, since marginal distribution between two methods in the patients tested by both assays was significantly different for ER, but not for PR (n=181, p=0.0038 and n=175, p=0.1944). Irrespective of assay methods, peak age frequency of ER+/PR+ was between 46 and 50 years of age, whereas that of ER+/PR- was 56–60. For ER/PR phenotypes there was a significant difference of odds ratio across the age (<55 vs. ≥55, p=0.04 for IHC, p=0.0002 for LBA/EIA). Conclusion: Changes of standard assay from LBA/EIA to IHC affected the population of ER+ and lead the decrease of ER-/PR+ subtype. Japanese women’s peak age frequency of ER+/PR+ was in the premenopausal period compared to that of non-Hispanic white women in the postmenopausal age (Anderson WF, JCO 2001). Difference of most frequent age of each subtype among the races may be taken into account for the development of chemoprevention strategy with anti-estrogens.

No significant financial relationships to disclose.

Proposal of a new staging system for hepatocellular carcinoma based on the treatment strategy: An analysis of 1,084 patients

4137

Background: Although several prognostic models have been proposed for hepatocellular carcinoma (HCC), they are not useful for conducting treatment strategy. Methods: Between July 1992 and May 2005, consecutive 1084 patients (pts) with naïve HCC were treated in our hospital. Based on our treatment strategy, we set our own HCC stage as follows: stage 1; Child-Pugh A or B, N0M0, solitary tumor without vascular invasion (VI), stage 2; Child-Pugh A or B, N0M0, multiple tumors without VI, stage 3; Child-Pugh A or B, N0M0, solitary tumor with VI, stage 4A; Child-Pugh A or B, N0M0, multiple tumors with VI, stage 4B; Child-Pugh A or B, N1 or M1, any T, stage 4C; Child-Pugh C, any TNM. Generally, treatments for stage 4C, 4B, & 4A were observation, chemotherapy trials or aggressive local therapies in selected pts, & hepatic arterial infusion chemotherapy. For the pts with stage 1–3, the priority of treatment options was hepatectomy first, percutaneous ablation (PA) second, and transcatheter arterial chemoembolization third. PA was indicated for 3 or fewer HCC nodules without VI, of which the largest diameter were smaller than 3 cm. Treatment outcomes were retrospectively analyzed according to the above staging system. Results: The overall survival rate was 50% at 3 yrs, 33% at 5 yrs, 24% at 7 yrs & 13% at 10 yrs. The median survival in stage 1, 2, 3, 4A, 4B & 4C was 5.5 yrs (N = 444), 2.9 yrs (N = 397), 0.8 yr (N = 36), 0.5 yr (N = 109), 0.3 yr (N = 76) & 0.2 yr (N = 22), respectively. Most of the definitive local therapy (91% of 371 hepatectomies with curative intent & 99% of 191 PAs) were classified in stage 1 or 2. The prognosis was also well predicted by the other 6 staging systems (Okuda, AJCC, CLIP, JIS, Tokyo and BCLC). However, hepatectomy with curative intent & PA were distributed into a CLIP score of 0–5 & 0–3, respectively, & into a JIS score of 0–4 & 0–3, respectively. Conclusions: The present staging system was simple & predicted prognosis well. Although other scoring systems caused various heterogeneities (hepatic reserve & tumor status) in each score, our staging system consisted of homogenous hepatic reserve & simple tumor status, so it might be useful for conducting treatment plan. Validation study is warranted in other population.

No significant financial relationships to disclose.

Engineering of Escherichia colil-serine O-acetyltransferase on the basis of crystal structure: desensitization to feedback inhibition by l-cysteine

L-Serine O-acetyltransferase (SAT) from Escherichia coli catalyzes the first step of L-cysteine synthesis in E.coli and is strictly inhibited by the second step product, L-cysteine. To establish a fermentation process to produce L-cysteine, we embarked on a mutational study of E.coli SAT to desensitize the feedback inhibition by L-cysteine. The crystal structure and the reaction mechanism of SAT from E.coli have shown that the substrate L-serine and the inhibitor L-cysteine bind to the identical region in the SAT protein. To decrease the affinity for only L-cysteine, we first built the structure model of L-serine-binding SAT on the basis of the crystal structure with bound L-cysteine and compared these two structures. The comparison showed that the Calpha of Asp92 underwent a substantial positional change upon the replacement of L-cysteine by L-serine. We then introduced various amino acid substitutions at positions 89-96 around Asp92 by randomized, fragment-directed mutagenesis to change the position of the Asp92. As a result, we successfully obtained mutant SATs which have both extreme insensitivity to an inhibition by L-cysteine (the concentration that inhibits 50% activity; IC(50) = 1,100 micromol/l, the inhibition constant; K(i) = 950.0 micromol/l) and extremely high emzymatic activities.