Delay in Treatment Does Not Predict Outcome in Inflammatory Breast Cancer

Aim: Inflammatory breast cancer (IBC) is an extremely aggressive form of breast cancer that fortunately has proven to be increasingly controlled by modern multimodal chemotherapy. Many doctors consider the immediate use of chemotherapy as critical to the outcome, and delays in treatment due to diagnostic issues have on occasion led to law suits. One such law suit led us to examine the relative importance of delay in diagnosis and other potential prognostic factors in a series of well documented IBC patients.Methods: 134 patients reported to the North American IBC Registry were evaluated for prognostic factors related to disease outcome. Relevant information included the time intervals between onset of symptoms and first medical visit, first medical visit to onset of chemotherapy, and progression free survival (PFS). Other parameters included initial response to chemotherapy, cell surface receptors and extent of disease at diagnosis. Patients were categorized according to the extent of clinical breast involvement and the presence or absence of dermal lymphatic invasion (DLI).Results: Patients with a delay of diagnosis of 60 days or less had a mean PFS of 4.41 years (N=62) while those with a delay >60 days had a mean PFS of 4.58 years (N=58). Initial response to chemotherapy was an important predictor of outcome: 31 patients with a complete clinical response had a median PFS of 5.12 years vs. 4.38 years for 71 patients that had a partial clinical response and 4.01 years for 15 patients with no significant response or progression of disease. The detection of dermal lymphatic invasion (RR: 2.77; 95%CI: 1.4-5.46) and clinical metastases at diagnosis (RR 2.81. 95% CI:1.16-6.80) were also significantly associated with a poorer outcome. The presence or absence of hormone receptors and HER2-neu markers were not predictive of outcome.Conclusion: Delay in initiating chemotherapy was not a significant factor in determining outcome of IBC. Initial extent of disease and response to chemotherapy were the two most imnportant factors in predicitng outcome of treated patients.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2012.

Characteristics of patients infected with common Neisseria gonorrhoeae NG-MAST sequence type strains presenting at the Edinburgh genitourinary medicine clinic

OBJECTIVE

Characterisation of population groups infected with common Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST) sequence types, presenting at the Edinburgh genitourinary medicine clinic.

METHODS

All patients with gonococcal infection attending over a 2-year period were reviewed. Patients infected with unique, paired and clustered gonococcal sequence types were compared. The characteristics of patients infected with common sequence types were analysed. The concordance of gonococcal strains between sexual partners was examined.

RESULTS

There were 78 unique, 17 paired and 34 clustered sequence types: the three groups varied significantly in relation to patient gender and origin/location of recent sexual contacts. There were nine large sequence type clusters (containing 11-24 isolates each) and these varied in terms of patient gender, sexual orientation and HIV prevalence. There was high concordance (94%) of sequence types between sexual contacts.

CONCLUSION

There was a trend towards significance when comparing the risks of carriage/contact with HIV between different sequence type clusters. Further research is therefore warranted to determine if NG-MAST data can be used to help identify high-risk sexual networks.

Activity of cediranib, a highly potent and selective VEGF signaling inhibitor, in alveolar soft part sarcoma

10523

Background: Alveolar soft part sarcoma (ASPS) is a rare entity making up <1% of soft tissue sarcomas (STS). It is typically indolent but with a high incidence of metastatic disease, usually to lungs, but also to sites such as the brain. Response to conventional chemotherapy is poor (overall response rates are approximately 7% [Reichardt P et al,Eur J Cancer.2003;39:1511–1516]). This is a preliminary report of the activity of cediranib, a highly potent and selective VEGF signaling inhibitor, in this disease. Methods: Efficacy and tolerability data were collected for seven patients with ASPS. One patient was treated in a phase II randomized trial of cediranib ± prophylactic antihypertensive therapy and six were treated in a Phase II study in patients with imatinib-refractory gastrointestinal stromal tumors or other STS. Cediranib was administered orally, once daily at an initial dose of 45 mg. Response was assessed using RECIST (Response Evaluation Criteria in Solid Tumors). Results: Median age at diagnosis was 39 years (range: 26–49). All patients had pulmonary metastases and two had additional sites of disease (brain, bone, intra-abdominal) at study entry. Adverse events were generally CTC grade 1–2 and manageable. The most common adverse events were fatigue (n = 6), diarrhea (n = 5), stomatitis (n = 4), headache (n = 3), and hypertension (n = 3). Four patients had a best response of partial response, two patients had a confirmed reduction in maximum tumor diameter of ≥10% and <30% and one patient experienced stable disease. As of November 2008, three patients remain on treatment with a median (range) time on study of 61 weeks (49–74). Time to progression and progression-free survival will be calculated and available at the time of presentation. Conclusions: These data demonstrate the promising preliminary activity and safety of chronic administration of cediranib in this disease. Further investigation is warranted, particularly as there is no effective systemic treatment for patients with advanced ASPS.

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Breast cancer treatment delay in African American women in Washington, DC

Abstract #4164

Background: Delays in follow-up after a positive breast cancer screen are thought to contribute to racial/ethnic disparities in breast cancer outcomes. The goal of this study was to determine the relative impact of self-identified race and other relevant socio-demographic and logistic variables on time to diagnosis after an abnormal mammogram, and time to first treatment after a cancer diagnosis within the context of data collection for a large research study of the effectiveness of patient navigation.&#x2028; Methods: Our sample includes 168 African-American and non-Hispanic white women with a documented invasive breast cancer diagnosis at an urban academic medical center during 2006 and 2007. The outcome variables were the number of days from abnormal mammogram to cancer diagnosis and from diagnosis to first treatment.&#x2028; Results: The median number of days to breast cancer diagnosis following an abnormal mammogram was 20.5 days for African-Americans compared to 15 days for non-Hispanic white women. Median days to first treatment after diagnosis was 21 days for African-American women compared to 16 days for non-Hispanic white women. Neither difference was statistically significant. In addition, 76% of African-American women had private insurance versus 81% of non-Hispanic white women.&#x2028; Conclusions: The identification of specific risk factors associated with a delay in diagnosis noted elsewhere in the literature and suggested in these preliminary findings could provide useful information regarding characteristics of women who are most likely to benefit from enhanced patient navigation efforts. Thus far, no statistically significant differences have been identified but the variety of factors that could contribute to the longer delay in disease management in African-American women compared to non-Hispanic white women, such as insurance status, provider location, household income, cultural issues, and other barriers to health care access, should be evaluated with a larger patient population.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4164.

Sliding mode control of dissolved oxygen in an integrated nitrogen removal process in a sequencing batch reactor (SBR)

This paper presents a sliding mode controller (SMC) for dissolved oxygen (DO) in an integrated nitrogen removal process carried out in a suspended biomass sequencing batch reactor (SBR). The SMC performance was compared against an auto-tuning PI controller with parameters adjusted at the beginning of the batch cycle. A method for cancelling the slow DO sensor dynamics was implemented by using a first order model of the sensor. Tests in a lab-scale reactor showed that the SMC offers a better disturbance rejection capability than the auto-tuning PI controller, furthermore providing reasonable performance in a wide range of operation. Thus, SMC becomes an effective robust nonlinear tool to the DO control in this process, being also simple from a computational point of view, allowing its implementation in devices such as industrial programmable logic controllers (PLCs).

Reactivity in the Venereal Diseases Research Laboratory test and the Mercia IgM enzyme immunoassay after treatment of early syphilis

The aim of the study was to compare reactivity in the Mercia immunoglobulin M enzyme immunoassay (IgM EIA) and the Venereal Disease Research Laboratory (VDRL) after treatment of 229 previously untreated patients with early syphilis. At three months, the VDRL and the IgM EIA were negative in 41 (38%) and 71 (62%) cases, respectively; a four-fold or greater decrease in VDRL titre occurred in 106 (99%). At six months, the VDRL and the IgM EIA were negative in 45 (48%) and 69 (71%) patients, respectively; a four-fold or greater decrease in VDRL titre occurred in 88 (95%) and an eight-fold or greater decrease in 80 (86%). At 12 months, the VDRL and the IgM EIA were negative in 35 (70%) and 55 (92%) patients, respectively; a four-fold or greater decrease in VDRL titre occurred in 49 (98%) and an eight-fold or greater decrease in 47 (94%). The Mercia IgM EIA is as sensitive as the VDRL in monitoring treatment of primary syphilis but not as sensitive as the finding of a four-fold or eight-fold decrease in VDRL titre in patients treated for secondary or early latent infection.

Qualitative and quantitative aspects of the serological diagnosis of early syphilis

Summary:

The aim of the present study was to evaluate the use of various serological tests in the diagnosis of early syphilis. The Murex enzyme immunoassay (EIA) test was used for screening; the Venereal Diseases Research Laboratory (VDRL) test, the Treponema pallidum particle agglutination assay (TPPA) and the Mercia antitreponemal IgM EIA were used in all the patients with a positive screening test and in those with suspected syphilis or in known contacts. In 89 cases of primary syphilis, the Murex EIA screening test was positive in 67 (75%) patients, the Mercia IgM EIA in 80 (90%) cases, the VDRL in 60 (67%) cases and the TPPA in 85 (96%) cases. All the tests were positive in 68 patients with secondary syphilis. In 72 cases of early latent syphilis, the Murex EIA screening test was positive in 68 (94%) patients, the Mercia IgM EIA in 50 (69%) cases, the VDRL in 61 (85%) cases and the TPPA in 68 (94%) cases. The Mercia IgM EIA was the only test positive in four (6%) of these cases; these four patients were known contacts. Antibody titres in the VDRL and TPPA increased as the infection progressed.

Prediction of antibiotic resistance using Neisseria gonorrhoeae multi-antigen sequence typing

OBJECTIVES

To establish whether antibiotic resistance in Neisseria gonorrhoeae is uniform within a given sequence type as determined by N gonorrhoeae multi-antigen sequence typing (NG-MAST).

METHODS

Antibiotic susceptibility testing and typing was performed on all N gonorrhoeae isolated in Scotland over a 2-year period. Antibiotic susceptibility to seven antibiotics was determined using the agar dilution method and NG-MAST was performed.

RESULTS

Isolates from 1762 episodes of infection were tested, of which 8.0% were penicillinase-producing N gonorrhoeae, 8.4% were tetracycline-resistant N gonorrhoeae, 2.7% had chromosomal penicillin resistance, 30.5% had chromosomal tetracycline resistance, 2.0% had decreased susceptibility to azithromycin and 25.3% were ciprofloxacin resistant (including 1.7% with intermediate resistance). Resistance to spectinomycin or decreased susceptibility to ceftriaxone or cefixime was not observed. Of 405 sequence types, 169 contained two to 85 isolates accounting for 1526 isolates. The overall concordance between sequence type and antibiotic susceptibility category was 98.1% (95% CI 97.8 to 98.3). The concordance for penicillin (chromosomal and plasmid-mediated resistance) was 97.1% (95% CI 96.1 to 97.8), for ciprofloxacin it was 99.5% (95% CI 99.1 to 99.8), for azithromycin it was 97.8% (95% CI 96.9 to 98.5) and for tetracycline (chromosomal and plasmid-mediated resistance) it was 92.0% (95% CI 90.5 to 93.3).

CONCLUSIONS

Antibiotic resistance in N gonorrhoeae was usually uniform within a given sequence type. Therefore the sequence type of an isolate allows the presence of antibiotic resistance to be predicted with a high degree of accuracy. Further studies on the geographical variation and temporal stability of antibiotic susceptibility patterns within sequence types are required.

Willingness of gynaecologists, doctors in family planning, GPs, practice nurses and pharmacists to adopt novel interventions for treating sexual partners of women with chlamydia

OBJECTIVE

To determine willingness of health professionals to adopt new interventions for treating sexual partners of women with chlamydia.

DESIGN

Anonymous, self-administered questionnaires of doctors, practice nurses and community pharmacists regarding novel testing/treatment options for partners of women with chlamydia.

SETTING

Local (Scotland) and national (UK) clinical meetings in reproductive health, and community pharmacy (Lothian).

POPULATION

Doctors (general practice, gynaecology, family planning) and practice nurses who were delegates at selected meetings in reproductive health and community pharmacists attending pharmacy meetings.

METHODS

Doctors and nurses were invited to complete a questionnaire indicating their preferred strategy for testing/treating sexual partners of women with chlamydia if given choice of partner notification, postal testing kit (PTK), patient delivered partner medication (PDPM) with azithromycin or combined PDPM and PTK. Community pharmacists were invited to complete a questionnaire regarding their willingness to introduce chlamydia testing and treatment services.

MAIN OUTCOME MEASURES

Reported preferences of doctors and nurses for partner testing/treatment strategies and willingness of pharmacists to offer new services.

RESULTS

Questionnaires were completed by 211 doctors, 73 practice nurses and 50 pharmacists. The most popular choice of doctors (30%) and nurses (23%) was a combination of PDPM with PTK, with partner notification the least popular (8 and 3%, respectively). One in four doctors had previously used PDPM for treating partners. Most pharmacists were willing to supply free PTKs (98%), offer testing (75%) and treatment services (100%) and give women PDPM for partners (80%).

CONCLUSION

Relevant health professionals, who are increasingly involved in managing chlamydia, are largely in favour of introducing new strategies for treating sexual partners.

CT appearances of congential and acquired abnormalities of the superior vena cava

A wide spectrum of congenital and acquired abnormalities can affect the superior vena cava (SVC). Congenital anomalies can present either as incidental findings or be associated with underlying cardiac abnormalities; these include left-sided or double SVCs and anomalous venous drainages. Acquired conditions involving the SVC, including SVC obstruction syndrome, can be secondary to extrinsic compression or intrinsic occlusion. The CT appearances, the incidence, and associations of these conditions are discussed.

The treatment of pharyngeal gonorrhoea with a single oral dose of cefixime

An audit of the efficacy treatment of pharyngeal gonorrhoea with a single oral dose of 400 mg of cefixime was undertaken; 83% of patients also received a single oral dose of azithromycin to treat possible concurrent anogenital chlamydial infection. Of the 54 patients studied, only one of 45 patients who attended for at least one test of cure had a positive culture seven days after treatment; the possibility of reinfection could not have been excluded. Two tests of cure were obtained from 18 patients. Cefixime, therefore, seems to be effective in the treatment of pharyngeal gonorrhoea.