Abstract P6-17-14: Eribulin, trastuzumab, and pertuzumab as first-line therapy for patients with HER2-positive metastatic breast cancer: A multicenter, collaborative, open-label, phase II clinical trial for the SBCCSG-36 investigators

Background: Docetaxel, trastuzumab, and pertuzumab (DTP) therapy is established first-line therapy for patients with HER2-positive metastatic breast cancer (HER2 + MBC). However, the poor tolerability of docetaxel impedes its long-term administration. The safety of eribulin, trastuzumab, and pertuzumab (ETP) therapy for HER2 + MBC has been confirmed in Japan. We examined the primary endpoint—overall response rate, the secondary endpoints—time to treatment failure, progression-free survival, and overall survival, as well as adverse events (AEs) of ETP therapy. (University Hospital Medical Information Network identifier:000021585)

Methods: Eribulin 1.4 mg/m2/day iv (days 1 and 8), trastuzumab 8 mg/kg iv over 90 min (initial dose) and 6 mg/kg iv over 30 min (second and subsequent doses), and pertuzumab 840 mg/body over 60 min (initial dose) and 420 mg/body over 30 min (second and subsequent doses) were administered. Cycles consisting of 2 doses of eribulin and 1-week drug holiday were repeated. Patients were treated with trastuzumab and pertuzumab when AEs developed that did not allow medication continuation by reducing the dose of eribulin. Antitumor effect was assessed according to RECIST version 1.1. and toxicities to CTCAE Japanese version 4.0. All patients provided written informed consent before enrollment. The study protocol was approved by the Institutional or Central Ethics Committee, and the study was conducted in accordance with the Declaration of Helsinki, Good Clinical Practice, and local ethical and legal regulations.

Results: 25 female patients (median age: 57 years [41-75]) were enrolled from April 18, 2016, through November 22, 2017. Twenty-four had performance status (PS) 0, 1 PS 1, 8 stage 4 breast cancer, and 17 metastatic breast cancer. Anthracycline, taxane, and trastuzumab were administered as neoadjuvant and adjuvant pharmacotherapies to 13, 15, and 14 patients, respectively. Primary tumor was positive for estrogen and progesterone receptors in 12 and 6 patients, respectively. Lung, liver, and bone metastases occurred in 9, 9, and 6 patients, respectively. Three (12%), 17 (68%), 1 (4%), 1 (4%), and 2 (8%) patients showed complete response (CR), partial response (PR), long-term stable disease (LSD; stable disease ≥24 weeks), stable disease (SD; stable disease <24 weeks), and progression disease (PD), respectively; 1 (4%) was unassessable because ETP therapy could not be conducted due to the grade 3 infusion reaction of pertuzumab. Major AEs were neutropenia, anemia, fatigue, peripheral neuropathy, alopecia, and anorexia. The overall response rate (CR+PR) was 80.0% (95% confidence interval 59.3-93.2%). The median follow-up was 10.1 months [3.9-21.5]. Six and 3 patients showed tumor deterioration and died of breast cancer, respectively.

Conclusions: Similar to DTP, ETP showed high response rates and good safety as first-line therapy for HER2 + MBC.

Citation Format: Inoue K, Ninomiya J, Okubo K, Nakakuma T, Yamada H, Kimizuka K, Higuchi T, Saito T. Eribulin, trastuzumab, and pertuzumab as first-line therapy for patients with HER2-positive metastatic breast cancer: A multicenter, collaborative, open-label, phase II clinical trial for the SBCCSG-36 investigators [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-14.

Abstract P3-10-16: Predicting pathological complete response by the combination of microRNAs in patients with HER2-positive primary breast cancer who received neoadjuvant combination therapy of trastuzumab, lapatinib and paclitaxel: Results from JBCRG-16 (NeoLath) study

[Background] JBCRG-16 (NeoLath) study is a five-arm study to evaluate the efficacy and safety of lapatinib and trastuzumab (6 weeks) followed by lapatinib and trastuzumab plus weekly paclitaxel (12 weeks) with/without prolongation of anti-HER2 therapy prior to chemotherapy (18 vs. 6 weeks), and with/without endocrine therapy in patients with HER2+ and/or estrogen receptor (ER)+ disease. The primary endpoint was pathological complete response (pCR) rate and pCR rate was 47.9% (Masuda N, et al. Breast Cancer, 2018). It is recently reported that microRNAs (miRNAs) are stably present in serum and potentially useful in the diagnosis and evaluation of treatment of cancer. We performed exploratory analysis of detecting pCR by comprehensive analysis of serum miRNAs.

[Materials and Methods] Serum samples were obtained from study participants who received neoadjuvant systemic therapy with trastuzumab, lapatinib and paclitaxel. Before profiling of miRNAs, the overall serum samples were randomly devided in two sets, namely the training set and the testing set with pCR or non-pCR. Pathological complete response (pCR) was defined as the absence of residual invasive cancer of the resected breast specimen and all sampled regional lymph nodes. Total RNA was extracted from a 300 ul serum sample using 3D-Gene® RNA extraction reagent from a liquid sample kit. A comprehensive quantitative expression analysis of miRNA was performed using the by DNA chip 3D-Gene®, which was designed to detect 2565 miRNA sequences registered in miRBase release 21 (http://www.mirbase.org/). The expression level of miRNAs were normalized by internal control (miR-2861, miR-149-3p and miR-4463). Clinicopathological data was retrieved from trial data.

[Results] A total of 112 samples were obtained. Seventy were used in the training set and others were used in the testing set. Median age was 54 years (range 26-70). Sixty-five (58%) patients were pre-menopausal. ER was positive in 59 patients (52.7%). Fourteen (12.5%) were T1c, 78 (69.6%) were T2 and 20 (17.9%) were T3. Fifty-seven (50.9%) patients were node-positive. Fifty-nine (52.7%) patients achieved pCR. The formula with the combination of three miRNAs (miR-A, miR-B, miR-C) was found to be able to predict pCR. This set had a sensitivity of 62.5%, specificity of 86.7% and accuracy of 71.8% in the testing cohort. Area under curve of receiver operationg characteristic curve was 0.753.

[Conclusion] The combination of three miRNAs has potential to predict pCR in patients who received neoadjuvant combination therapy of trastuzumab, lapatinib and paclitaxel in HER2-positive primary breast cancer. The further analysis of changing expression of miRNAs during neoadjuvant therapy is underway and further results will be presented in the symposium.

Citation Format: Shimomura A, Masuda N, Kawauchi J, Takizawa S, Ichikawa M, Matasuzaki J, Kuroi K, Hara H, Yamamoto N, Inoue K, Suganuma N, Aogi K, Ohno S, Tamura K, Ochiya T, Toi M. Predicting pathological complete response by the combination of microRNAs in patients with HER2-positive primary breast cancer who received neoadjuvant combination therapy of trastuzumab, lapatinib and paclitaxel: Results from JBCRG-16 (NeoLath) study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-10-16.

Abstract P5-12-17: Prognostic and predictive value of serum level of vascular endothelial growth factor-A in metastatic breast cancer patients treated with bevacizumab plus paclitaxel

Background

Several studies showed that first-line bevacizumab plus chemotherapy for HER2-negative metastatic breast cancer improves progression-free survival and tumor response rate but not overall survival. MERiDiAN trial evaluated plasma vascular endothelial growth factor-A (VEGF-A) prospectively as a predictive biomarker for bevacizumab efficacy in metastatic breast cancer. However, results of this trial do not support using baseline plasma VEGF-A to identify patients benefitting most from bevacizumab. We measured baseline serum VEGF-A level from stored blood samples of metastatic breast cancer patient with treated bevacizumab plus paclitaxel as fist-line and later line therapy, and evaluated a correlation between serum VEGF-A level and efficacy of bevacizumab and prognosis of breast cancer patients tread with bevacizumab, retrospectively.

Patients and methods

We examined blood samples from 57 metastatic breast cancer patients treated with bevacizumab and paclitaxel, after obtaining written informed consent. And, we evaluated a correlation between baseline serum VEGF-A level and time to treatment failure (TTF) and overall survival (OS). We also compared the serum VEGF-A level of response group (CR and PR) and that of non-response group (SD and PD).

Results

Baseline serum level of VEGF-A ranged from 80 to 2079 pg/ml. Cases of treatment line were as follows: first-line, 22 cases (38.6%); second line, 11 cases (19.3%) and third-line and the later line, 24 cases (42.1%). The cutoff identified by ROC curve analysis that was able to differentiate response group and non-response group in first-line setting was 360pg/ml for serum VEGF-A. And, we separated high serum VGEF-A group and low serum VEGF-A group of patients treated with bevacizumab plus paclitaxel.

In patients treated as first line therapy, median TTF was 4.0 months with high serum VGEF-A group versus 5.0 months with low serum VEGF-A group, and median OS was 12 months with high serum VGEF-A group versus 11months with low serum VEGF-A group. There were no significant differences in both TTF and OS in first line setting. In patients treated as second line and later line therapy, median TTF was 2.8 months with high serum VGEF-A group versus 7.1 months with low serum VEGF-A group, and median OS was 6.4 months with high serum VGEF-A group versus 12.7 months with low serum VEGF-A group. The prognosis of high serum VEGF-A group was significantly worse than that of low serum group in both TTF and OS.

The serum VEGF-A level of response group was tend to be higher than that of non-response group in first line setting, and was lower in second and later line setting. However, there were no significant differences.

Conclusion

In this study, serum VEGF-A cannot be a predictor for efficacy of bevacizumab plus paclitaxel as first line therapy for metastatic breast cancer patients. On the other hand, there was a possibility that high serum level of VEGF-A can be a poor prognostic factor in late line therapy setting of bevacizumab.

Citation Format: Tozuka K, Nagai SE, Matsumoto H, Hayashi Y, Kubo K, Tsuboi M, Sato A, Takai K, Wang X, Yamada Y, Inoue K. Prognostic and predictive value of serum level of vascular endothelial growth factor-A in metastatic breast cancer patients treated with bevacizumab plus paclitaxel [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-12-17.

Radiocesium and 40K distribution of river sediments and floodplain deposits in the Fukushima exclusion zone

In this study, radiocesium and ⁴⁰K analysis were accomplished for samples of riverbed sediments and floodplain deposits collected from five rivers in the vicinity (<20 km) of the damaged Fukushima Daiichi Nuclear Power Plant after seven years of the accident. Sediment particle size distribution and major oxide content were determined also for six selected samples to understand the retention and migration process of radiocesium in river environments. The radiocesium activity concentration varied from 103 ± 6 Bq·kg^-1 to 22,000 ± 500 Bq·kg^-1 in riverbed sediments and from 92 ± 5 Bq·kg^-1 to 117,000 ± 2000 Bq·kg^-1 in floodplain deposits. The ¹³⁴Cs/¹³⁷Cs ratio (decay corrected to 15 March 2011) was 1.02 in the both samples. Compared to monitoring results in 2011, it was proved that the radiocesium distribution pattern had been changed remarkably during seven years. The radiocesium was primarily attached to fine clay particles but its sorption on sand and coarse sand particles was also considerable. The sorption process of radiocesium was not affected by the presence of water and moreover, after seven years of the Fukushima accident, a significant radiocesium migration cannot be expected without particle migration. Consequently, radiocesium will remain for a long time in the river environments and its redistribution is mainly affected by the erosion process of the sediments. The average ⁴⁰K activity concentration of riverbed sediment and floodplain deposit samples was 640 ± 152 Bq·kg^-1 changing from 319 ± 18 Bq·kg^-1 to 916 ± 41 Bq·kg^-1. In the river estuary zones, significant activity concentration decrements were observed for both radionuclides. This suggests that seawater intrusion has a decreasing effect on both natural and artificial radionuclides via wash-out of particulate radiocesium and ⁴⁰K, and desorption of these radionuclides, but to reveal the detail of this process further investigations are required. The analysis of ⁴⁰K can help in a simple and easy way to reveal the mineral composition differences of sediment samples.

Electricity Generation from Rice Bran by a Microbial Fuel Cell and the Influence of Hydrodynamic Cavitation Pretreatment

Single-chamber microbial fuel cells (MFCs) were constructed using rice bran (carbon source) and pond bottom mud (microbial source). The total electric charge obtained in the MFC combining rice bran with pond bottom mud was four times higher than that in MFC using only rice bran. Phylogenetic analyses revealed dominant growth of fermentative bacteria such as Bacteroides and Clostridium species, and exoelectrogenic Geobacter species in the anode biofilms, suggesting that mutualism of these bacteria is a key factor for effective electricity generation in the MFC. Furthermore, rice bran, consisting of persistent polysaccharide, was pretreated by the hydrodynamic cavitation system to improve the digestibility and enhance the efficiency in MFC, resulting in 26% increase in the total production of electricity.

Novel Self-Transmissible and Broad-Host-Range Plasmids Exogenously Captured From Anaerobic Granules or Cow Manure

Novel self-transmissible plasmids were exogenously captured from environmental samples by triparental matings with pBBR1MCS-2 as a mobilizable plasmid and Pseudomonas resinovorans as a recipient. A total of 272 recipients were successfully obtained as plasmid host candidates from granules of an anaerobic methane fermentation plant and from cow manure. The whole nucleotide sequences of six plasmids were determined, including one IncP-1 plasmid (pSN1104-59), four PromA-like plasmids (pSN1104-11, pSN1104-34, pSN0729-62, and pSN0729-70), and one novel plasmid (pSN1216-29), whose incompatibility group has not been previously identified. No previously known antibiotic resistance genes were found in these plasmids. In-depth phylogenetic analyses showed that the PromA-like plasmids belong to subgroups of PromA (designated as PromAγ and PromAδ) different from previously proposed subgroups PromAα and PromAβ. Twenty-four genes were identified as backbone genes by comparisons with other PromA plasmids. The nucleotide sequences of pSN1216-29 share high identity with those found in clinical isolates. A minireplicon of pSN1216-29 was successfully constructed from repA encoding a replication initiation protein and oriV. All the captured plasmids were found to have a broad host range and could be transferred to and replicated in different classes of Proteobacteria. Notably, repA and oriV of pSN1216-29 showed high similarity with one of two replication systems of pSRC119-A/C, known as a plasmid with multidrug resistance genes found in Salmonella enterica serovar Senftenberg. Our findings suggest that these “cryptic” but broad-host-range plasmids may be important for spreading several genes as “vehicles” in a wider range of bacteria in natural environments.

Anti-β2 -glycoprotein I antibody with DNA binding activity enters living monocytes via cell surface DNA and induces tissue factor expression

Autoantibodies characteristic for anti‐phospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are anti‐β₂‐glycoprotein I (β₂GPI) antibodies and anti‐DNA antibodies, respectively, and almost half of APS cases occur in SLE. Anti‐β₂GPI antibodies are recognized to play a pivotal role in inducing a prothrombotic state, but the precise mechanism has not been fully elucidated. In a widely accepted view, binding of anti‐β₂GPI antibodies to cell surface β₂GPI in monocytes and endothelial cells triggers the Toll‐like receptor 4‐myeloid differentiation primary response 88 (TLR)‐4‐MyD88) signaling pathway which leads to activation of p38 mitogen‐activated protein kinase (MAPK), mitogen‐activated protein kinase kinase 1/extracellular signal‐regulated kinases (MEK‐1/ERK) and/or nuclear factor kappa B (NF‐κB) and expression of tissue factor (TF). However, resting cells do not express substantial amounts of TLR‐4. Previously, we generated a mouse monoclonal anti‐β₂GPI antibody WB‐6 and showed that it induced a prothrombotic state – including TF expression on circulating monocytes – in normal mice. In the current study, we aimed to clarify the mechanism of interaction between WB‐6 and resting monocytes, and found that WB‐6 exhibits binding activity to DNA and enters living monocytes or a monocytic cell line and, to a lesser extent, vascular endothelial cells. Treatment of the cells with DNase I reduced the internalization, suggesting the involvement of cell surface DNA in this phenomenon. Monocytes harboring internalized WB‐6 expressed TF and tumor necrosis factor (TNF)‐α which, in turn, stimulated endothelial cells to express intercellular adhesion molecule 1 (ICAM‐I) and vascular cell adhesion molecule 1 (VCAM‐I). These results suggest the possibility that a subset of anti‐β₂GPI antibodies with dual reactivity to DNA possesses ability to stimulate DNA sensors in the cytoplasm, in addition to the cell surface receptor‐mediated pathways, leading to produce proinflammatory and prothrombotic states.

Effect of attention bias modification on event-related potentials in patients with irritable bowel syndrome: A preliminary brain function and psycho-behavioral study

BACKGROUND

Attention bias modification normalizes electroencephalographic abnormalities in alpha and beta power percentages related to attention in patients with irritable bowel syndrome (IBS). Yet, it is unknown whether ABM contributes to the normalization of event-related potentials (ERP) in these patients. We hypothesized that ERP related to attention deficit would be normalized after ABM implementation in individuals with IBS.

METHODS

Thirteen patients with IBS and 10 control subjects completed a 2-month intervention that included five ABM sessions. Each session included 128 trials, resulting in a total of 640 trials during the study period. Event-related potentials were measured at the first and fifth sessions. As per the international 10-20 system for electroencephalographic electrode placement, right parietal P4 was evaluated to measure the attention component of facial expression processing.

KEY RESULTS

A group comparison of P100 latency at P4 revealed that latencies were significantly different between groups in session 1 (IBS vs control, 108 ± 8 vs 97 ± 14; t = -2.51, P = .0203). This difference was absent in session 5 (94 ± 11 vs 93 ± 11, respectively; t = -0.397, P = .6954, r = .09), indicating an effect of ABM in the IBS group.

CONCLUSIONS AND INFERENCES

Attention bias modification may have clinical utility for normalizing brain function and specifically attentional abnormalities in patients with IBS.

Aspects of splice site selection in constitutive and alternative pre-mRNA splicing

RNA splicing is an indispensable step for expression of many eukaryotic genes. Combinations of 5' and 3' splice sites should be correctly selected in both constitutive and alternative splicing. Recent studies have revealed mechanisms of alternative splicing in some systems, in which specific regulators play vital roles in splice site selection. On the other hand, essential splicing factors such as SR proteins modulate splice site usage of general machinery. Specific regulators and splicing factors such as SR proteins have some common structural features. With these related components, a similar machinery of splice site selection is involved in constitutive and alternative splicing.