Phase II trial of sequential subcutaneous interleukin-2 plus interferon alpha followed by sorafenib in renal cell carcinoma (RCC)

PURPOSE

Immunotherapy (IL-2 and INF-α) was the treatment of choice for advanced renal cell carcinoma (RCC) until antiangiogenic therapy with tyrosin kinase inhibitors was developed in the early 2000s. This clinical trial explored the efficacy and toxicity of sequential treatment of IL-2 plus INF-α followed by sorafenib.

METHODS

Eligibility criteria included measurable, non-resectable, histologically confirmed predominantly clear cell RCC, no prior systemic treatment, and ECOG PS 0-2. The treatment regimen was a 6-week cycle of subcutaneous IL-2 at 9 × 10(6) IU on days 1-6 of weeks 1, 2, 4 and 5 plus s.c. INF-α at 6 × 10(6) IU on days 1, 3 and 5 of weeks 1-6. Responders received 6 additional weeks of this regimen. All patients received oral sorafenib (400 mg bid) after immunotherapy until disease progression. The primary endpoint was progression-free survival.

RESULTS

Forty-one patients were enrolled, median age 57 years. ECOG was 0/1 in 17/20 patients, 35 patients had prior nephrectomy and 18 patients pure clear cell cancer. Median PFS was 7.4 months (95 % CI 6.5-13.1) and OS was 16.6 months (95 % CI not reached). In 36 patients evaluable for response, ORR was 44.4 % and control rate was 94.4 %. Most adverse events (AEs) were Grade 1 or 2 toxicities (84.7 %). During immunotherapy the most common AEs were pyrexia (82.9 %), asthenia (56.1 %) and anorexia (46.3 %), whereas during sorafenib were diarrhoea (48.8 %) and hand-foot syndrome (46.3 %).

CONCLUSIONS

A sequential regimen of IL-2 and INF-α followed by sorafenib showed effectiveness and manageable toxicity in patients with advanced RCC.

Precise determination of the unperturbed 8B neutrino spectrum

A measurement of the final state distribution of the (8)B β decay, obtained by implanting a (8)B beam in a double-sided silicon strip detector, is reported here. The present spectrum is consistent with a recent independent precise measurement performed by our collaboration at the IGISOL facility, Jyväskylä [O. S. Kirsebom et al., Phys. Rev. C 83, 065802 (2011)]. It shows discrepancies with previously measured spectra, leading to differences in the derived neutrino spectrum. Thanks to a low detection threshold, the neutrino spectrum is for the first time directly extracted from the measured final state distribution, thus avoiding the uncertainties related to the extrapolation of R-matrix fits. Combined with the IGISOL data, this leads to an improvement of the overall errors and the extension of the neutrino spectrum at high energy. The new unperturbed neutrino spectrum represents a benchmark for future measurements of the solar neutrino flux as a function of energy.

Phase II Clinical Trial With Pegylated Liposomal Doxorubicin (CAELYX(R)/Doxil(R)) and Quality of Life Evaluation (EORTC QLQ-C30) in Adult Patients With Advanced Soft Tissue Sarcomas: A study of the Spanish Group for Research in Sarcomas (GEIS)

BACKGROUND

Pegylated liposomal doxorubicin (PLD), a formulation with pharmacokinetic differences with respect to doxorubicin (DXR), might benefit patients with advanced soft tissue sarcoma (STS) pretreated with DXR.

PATIENTS AND METHODS

Patients with measurable and progressive STS received PLD at 35 mg/(2) every 3 weeks. Quality of life before and during treatment was assessed with EORTC QLQ-C30.

RESULTS

Twenty-eight patients, 22 DXR-pretreated, were given 140 cycles (median 3, range 1-18). Activity in 27 patients (5 GIST): one complete and one partial remission (both non-GIST and without prior DXR), 12 stabilizations and 13 progressions (response rate 7.4%, 95% CI: 0-17%). Grade 3 toxicity: palmar-plantar erythrodysesthesia (19% of patients), stomatitis (4%) or cutaneous (4%). Neutropenia grade>/=3 was detected in 16% of patients. Median relative dose intensity was 95%. Progression-free rate at 3 and 6 months was, respectively, 48 and 22%, median progression-free survival 5.8 months and median overall survival 8.7 months. QLQ-C30 at baseline and at weeks 6-11 in 23 and 13 patients, respectively, showed good reliability and validity. Quality of life did not seem to worsen during therapy.

CONCLUSIONS

PLD did not induce objective remissions in 22 STS patients pretreated with DXR, but progression-free rate figures support the use of this agent in patients who have not progressed under a DXR-containing regimen. The toxicity observed was comparable to that of other PLD schedules.

Phase II Trial of Doxorubicin Plus Escalated High-Dose Ifosfamide in Patients With Advanced Soft Tissue Sarcomas of the Adult: A Study of the Spanish Group for Research on Sarcomas (GEIS)

Background. To explore the tolerance and the activity of high-dose ifosfamide (IFOS) combined with doxorubicin (DXR) at 50 mg/m² every 4 weeks in patients with soft tissue sarcomas. Methods. DXR was given IV bolus and IFOS by continuous infusion at 2 g/m²/day. Initial IFOS dose (12 g/m²) was adjusted to 10, 13, or 14 g/m² according to toxicity. Results. Seventy patients received 277 cycles (median 3 cycles, range 1–10), 34% with IFOS dose increased, 30% decreased, and 48% delivered at 12 g/m². Toxicity grade 4 occurred on granulocytes (67% of patients) or platelets (19%), 54% had febrile neutropenia, 31% grade 3/4 asthenia, and 26% abandoned the study due to toxicity. Three toxic deaths occurred. In 57 non-GIST patients objective activity was 45.6% (95% CI, 32 to 58%). Conclusion. At least 4 cycles were tolerated by 71% of patients, most receiving DXR 50 mg/m² plus IFOS 10–12 g/m², with substantial toxicity.

Theoretical studies on iron surface coating: adsorption of furan derivatives over Fe(n) clusters (n = 1-4)

In the transition from small molecules to solids, atomic clusters are studied widely not only because they can own unique properties due to the nanosized effect but also because they represent an intermediate stage. A systematic study on the structures and properties of clusters as a function of size could give information on the transition from clusters to bulk and determine at what size a cluster can mimic the bulk solid at least to some extent. The adsorption capability of furan derivatives 2-furfurylamine, 2-furfuryl alcohol and 2-furfuryl mercaptan with different iron-clusters was studied by DFT. The results show that since the compounds possess suitable structural and electronic parameters for the metal adhesion, it is observed that the functional group (NH2, OH and SH) of furan derivatives strongly adsorb over the metal clusters. Moreover, the calculated binding energy supports the existence of a bond between furan derivatives and metal, indicating the transfer of high charge density which in the delocalization region of furan ring to the metal (L(sigma) --> Fe). In the molecular orbital studies by detecting the overlap of HOMO (furan ring and functional group) with LUMO (iron), the binding nature of the compounds is then confirmed.

Content uniformity studies in tablets by NIR-CI

Near infrared chemical imaging (NIR-CI) is attracting growing interest in pharmaceutical analysis by virtue of its ability to provide a wealth of information from a single sample. Among others, NIR-CI has enabled the determination of the quantitative composition and distribution of acetylsalicylic (ASA) from the analysis of commercial tablets. In this work, we analyzed ASA commercial tablets of four different brands purchased at local chemists. The nominal ASA concentration for the brands was calculated from the nominal content and averaged weight of tablets. The tablets were found to span an ASA concentration range of 71-82%, and to differ in size and composition between brands. The API content and its homogeneity distribution were determined by applying quantitative algorithm to global hyperspectral image of ten tablets. Multivariate curve resolution-alternating least squares (MCR-ALS) is used to quantify each pixel in the images to obtain appropriate concentration maps. No prior calibration or reference data were needed for quantitation and results are close to the nominal content used as reference. Application to an image for 10 tablets and an individual tablet quantitation of the API allowed us to obtain the Accepted Value (AV) as defined by the European Pharmacopoeia. We conclude that all brands meet the pharmacopoeia specifications.

First Report of Bacterial Speck of Tomato Caused by Pseudomonas syringae pv. tomato Race 1 in Portugal

Protected and open field tomato crops are economically important for Portuguese agriculture. In 1983, Pseudomonas syringae pv. tomato (Okabe, 1933) Young, Dye & Wilkie, 1978 was first reported affecting protected crops (3) and then later under open field conditions (1). In the 2009 spring/summer season, several outbreaks of bacterial speck of tomato showing an unusual degree of severity were observed in open fields from the Tagus Valley Region. Typical symptoms included necrotic specks surrounded by a yellow halo on younger and older leaves with losses higher than 60% due to the heavy floral bud abortion. Abnormal lesions on the stems, as well as on the petioles and fruits, together with reduced growth of the entire plant, which is normally uncommon, were frequently observed in affected plants from distinct tomato cultivars (H-9665, H-9776, and CDX 255), two of them carrying the Pto resistance gene. Samples collected from different fields and cultivars were observed and used for isolation of the causal agent on King's medium B. The isolates were characterized (2) and Koch's postulates were fulfilled by carrying out pathogenicity tests. Ten plants from three commercial cultivars carrying the Pto resistance gene (CXD 255, Defender F1, and H-9775) were inoculated by spraying bacterial water suspensions (10⁸ CFU ml^-1) and kept under environmental conditions favorable for disease development. Positive and negative controls were also performed using P. syringae pv. tomato type strain (CFBP 2212T; race 0) and sterile distilled water, respectively. Cultural and biochemical characterization of the isolates showed their ability to produce levan, use sucrose, and induce a hypersensitivity reaction on tobacco leaves. Moreover, the isolates were oxidase negative, did not hydrolyze arginine nor produce soft rot on potato slices, and did not use erythritol as well as dl-lactate, identifying them as P. syringae pv. tomato. Typical and severe bacterial speck symptoms were produced in the Pto resistant tomato plants 4 days after inoculation and the isolates could be recovered after reisolation. Negative control plants showed no disease symptoms and CFBP 2212 was unable to produce typical lesions, except for a few in the older leaves. Altogether these results pointed to P. syringae pv. tomato race 1 as the disease causative agent. Further confirmation was achieved by partial sequencing of the rpoD gene using primers PsrpoD FNP1 and PsrpoDnprpcr1 (4). rpoD sequences, obtained from two isolates (CPBF 1288, GenBank HM368535; CPBF 1290, GenBank HM368537), were compared by nucleotide BLAST at NCBI displaying a 100% level of DNA similarity with strain Pto T1 belonging to P. syringae pv. tomato race 1. To our knowledge, this is the first report of the occurrence of Pseudomonas syringae pv. tomato race 1 in Portugal. References: (1) L. Cruz et al. ATTI Giornate Fitopatol, 2:399, 1992. (2) R. Lelliott and D. Stead. Methods for the Diagnosis of Bacterial Diseases of Plants. Blackwell Scientific Publications, Oxford, 1987. (3) H. Oliveira and J. Santa-Marta. Pseudomonas syringae pv. tomato (Okabe, 1933) Young, Dye & Wilkie, 1978. Uma nova bacteriose do tomateiro em Portugal. Publicação do Laboratório de Patologia Vegetal "Veríssimo de Almeida", 1983. (4). S. Sarkar et al. Genetics 174:1041, 2006.

Two-stage first-trimester screening for trisomy 21 by ultrasound assessment and biochemical testing

OBJECTIVES

This study was carried out to examine the performance of a contingent policy in first-trimester screening for trisomy 21, in which the estimated risk was first derived by a combination of maternal age, fetal nuchal translucency (NT) thickness, presence/absence of the nasal bone, blood flow in the ductus venosus or flow across the tricuspid valve, and biochemical testing was carried out only in those who were found to have an intermediate risk. We also examined the performance of a policy in which the estimated risk was first derived by a combination of maternal age and biochemical testing, and ultrasound examination was carried out only in those with an intermediate risk.

METHODS

The data for this study were derived from prospective screening for trisomy 21 in singleton pregnancies, using, as markers, a combination of maternal age, fetal NT thickness and maternal-serum free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A), in a one-stop clinic for first-trimester assessment of risk at 11 + 0 to 13 + 6 weeks of gestation. Assessment of the fetal nasal bone, ductus venosus flow and tricuspid flow were also routinely performed by appropriately trained sonographers. The performance of different screening policies was examined.

RESULTS

The study population consisted of 19 614 pregnancies with a normal karyotype or delivery of a phenotypically normal baby (euploid group) and 122 cases of trisomy 21. The best performance was achieved by a contingent policy in which first-stage screening was based on maternal age, fetal NT thickness and either tricuspid valve or ductus venosus blood flow, followed by biochemical testing only those with an intermediate risk, of 1 in 51 to 1 in 1000 (which constituted about 20% of the total). The performance of contingent screening in which first-stage testing relies on biochemistry was poorer than when first-stage screening was performed by ultrasound examination because, in order to achieve the same detection rate, the false-positive rate was twice as high.

CONCLUSION

Effective first-trimester screening for trisomy 21 can be achieved by a contingent policy in which first-stage testing is based on ultrasound examination and second-stage biochemical testing is carried out in only 20% of the patients.

Effect of temperature on free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A concentration

OBJECTIVE

To examine the effect of the duration of storage of serum and whole blood at different controlled temperatures on the concentrations of both serum free-beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in first-trimester screening for aneuploidies.

METHODS

The concentrations of free beta-hCG and PAPP-A were measured in samples collected from 10 pregnant women and stored as whole blood or serum for 1-8 days at 4, 20 or 40 degrees C. The concentrations measured were adjusted to take day-to-day variations into account and were expressed as a percentage of the values on day 0. In a second study involving 10 pregnant women, free beta-hCG was measured at 10 min and at 2, 4, 8 and 12 h after collection and storage at 30 or 40 degrees C, either as separated serum or as whole blood.

RESULTS

The change in the levels of PAPP-A in the separated serum at all three temperatures and in whole blood at 4 degrees C was always less than 10% throughout the 8 days of storage. In whole blood stored at 20 and 40 degrees C, the percentage variation was less than 10% only if the storage period was shorter than 4 days. The concentration of free beta-hCG was not altered by storage of either whole blood or separated serum at 4 degrees C throughout the 8 days of storage. At 20 degrees C, reliable results were obtained only if the maximum storage time was 2 days for separated serum and 1 day for whole blood. At 30 degrees C, reliable results were obtained only if the samples were analyzed within 2 h of collection, and at 40 degrees C the concentrations increased by more than 50% within 2 h and by about 500% after 1 day of storage.

CONCLUSION

In first-trimester screening for aneuploidies, analysis of blood samples should be undertaken within a few minutes of collection, otherwise the samples should be refrigerated at 4 degrees C throughout the interval between collection and analysis.

[Pulmonary arteriovenous malformations in Rendu-Osler-Weber disease. Case report]

The authors report the clinical case of a 59 year-old woman who was incidentally diagnosed as having arteriovenous pulmonary malformation (AVPM). Through clinical history a diagnosis of Rendu-Osler-Weber disease (ROWD) was made, a disease manifesting itself through the existence of vascular malformations in the skin, mucosae and viscera (like the lungs, liver and brain). The surgical therapy offered to the patient had no complications. The essential aspects of pathofisiology, clinical manifestations and treatment of AVPM and ROWD are discussed.

The 11-13-week scan: diagnosis and outcome of holoprosencephaly, exomphalos and megacystis

OBJECTIVE

To determine the prevalence and outcome of fetuses with holoprosencephaly, exomphalos and megacystis diagnosed at 11-13 weeks of gestation.

METHODS

As part of a prospective screening study for trisomy 21 in singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation, transabdominal ultrasound examination was performed to diagnose holoprosencephaly, exomphalos and megacystis. Fetal karyotype and pregnancy outcome in fetuses with these defects were examined.

RESULTS

Screening was carried out in 57 119 pregnancies. The prevalence of holoprosencephaly, exomphalos and megacystis was 1 : 1298, 1 : 381 and 1 : 1632, respectively. Chromosomal abnormalities, mainly trisomies 18 and 13, were found in 65.9% of fetuses with holoprosencephaly, in 55.3% with exomphalos and in 31.4% with megacystis. There was spontaneous resolution of the defect by 20 weeks in 92.5% of euploid fetuses with exomphalos containing only bowel and in 90% of the euploid fetuses with megacystis and bladder length of < or = 15 mm.

CONCLUSIONS

A high proportion of fetuses with holoprosencephaly, exomphalos and megacystis diagnosed at 11-13 weeks of gestation are aneuploid, but in the majority of cases exomphalos and megacystis represent temporary abnormalities that resolve spontaneously.

Evidence of "regional hyperemia" in patients with severe closed head injury using single-photon emission computed tomography

Regional cerebral blood flow (rCBF) was assessed in 32 patients with acute/subacute (n = 18) or chronic (n = 14) head injury using single-photon emission computed tomography (SPECT) and (99m)Tc-hexamethylpropylenenamine oxime (HMPAO) (n = 20) or (123)I-IMP (n = 12). Twelve of the 18 patients with acute/subacute head injury were studied with a high-resolution three-head camera and (99m)Tc-HMPAO. Twenty-eight SPECT studies showed regional abnormalities of tracer uptake. In all cases in which computed tomography (CT) and/or magnetic resonance imaging (MRI) (n = 30) were available for comparison, SPECT showed similar or more extensive abnormalities with high agreement on the laterality of the lesions. Particularly in the 18 patients with acute/subacute head injury, SPECT revealed more and larger lesions than the anatomical scans. In 9 of the 12 patients, at least one region with increase in HMPAO uptake reflecting "hyperemia" was detected (mean study time after injury, 6.3 ± 2.7 days). Follow-up SPECT scans in two patients showed decreased tracer uptake in the previous hyperemic regions and encephalomalacia in the anatomical scan. Thus, hyperemia may reflect "luxury perfusion" in early phases of head injury. In three patients with diffuse axonal injury, a generalized reduction in cortical tracer activity, especially in occipital/parietal regions, was observed. The typical finding in chronic head injury was observation of lesions of similar sizes and high agreement in focal abnormalities between SPECT and CT and/or MRI. However, in nine patients with behavioral disturbances, a decrease in the cortical/basal ganglia was detected. Thus, our study confirms the presence of hyperemia in acute/subacute head injury and demonstrates the value of SPECT for assessing functional impairment in these patients.

Phenol-Explorer: an online comprehensive database on polyphenol contents in foods

A number of databases on the plant metabolome describe the chemistry and biosynthesis of plant chemicals. However, no such database is specifically focused on foods and more precisely on polyphenols, one of the major classes of phytochemicals. As antoxidants, polyphenols influence human health and may play a role in the prevention of a number of chronic diseases such as cardiovascular diseases, some cancers or type 2 diabetes. To determine polyphenol intake in populations and study their association with health, it is essential to have detailed information on their content in foods. However this information is not easily collected due to the variety of their chemical structures and the variability of their content in a given food. Phenol-Explorer is the first comprehensive web-based database on polyphenol content in foods. It contains more than 37 000 original data points collected from 638 scientific articles published in peer-reviewed journals. The quality of these data has been evaluated before they were aggregated to produce final representative mean content values for 502 polyphenols in 452 foods. The web interface allows making various queries on the aggregated data to identify foods containing a given polyphenol or polyphenols present in a given food. For each mean content value, it is possible to trace all original content values and their literature sources. Phenol-Explorer is a major step forward in the development of databases on food constituents and the food metabolome. It should help researchers to better understand the role of phytochemicals in the technical and nutritional quality of food, and food manufacturers to develop tailor-made healthy foods. Database URL: http://www.phenol-explorer.eu