Abstract OT3-04-01: A phase I of olaparib with radiation therapy in patients with inflammatory, loco-regionally advanced or metastatic TNBC (triple negative breast cancer) or patient with operated TNBC with residual disease

Background and discussion: TNBC shares clinical and pathological features with hereditary BRCA1-related breast cancers, and in sporadic TNBC; dysregulation of BRCA1 has been frequently observed together with other defects in homologous recombination pathways. Preclinical studies have shown that breast cancer cell lines with a triple-negative phenotype are more sensitive to PARP1 inhibitors compared with non-TNBC cells. These lines of evidence provide a strong rationale for developing a new therapeutic approach to TNBC based on targeting the DNA-repair defects via PARP inhibition in these cancers that the most aggressive are the inflammatory, loco-regional advanced and metastatic breast cancer, as well as operated patients with residual disease (after primary systemic treatment-PST).

The aim of this study is to determine the Maximal Tolerated Dose of Olaparib administered with concurrent loco regional RT in the previously described population of patients.

Trial design: Olaparib (oral administration) will be administered at a starting dose of 50 mg bid. The other dose levels will be: 100 mg bid, 150 mg bid, 200 mg bid. The 25 mg bid dose will be included in the model to deal with unexpected high toxicity of the starting dose. Seven days prior to their first fraction of radiation therapy, patients will begin taking Olaparib at the assigned dose twice daily each day. All patients will receive radiotherapy on day 8 after the start of Olaparib of 50 Gy to the whole breast (or chest wall) with or withour lymph nodes (LN) in 25 daily fractions and 5 weeks.

Eligibility Criteria: Women aged >18 years with histologically confirmed TNBC with loco-regional RT indication as :

Non-operated:

Inflammatory and/or advanced BC (T≥3 and/or N≥1) BC in progression during PST (containing anthracyclines or taxanes or the combination of both or containing platinium-based chemotherapy) or inoperable after PST.

Non operable metastatic BC (all T, all N, M1; with evaluable disease).

Or patients operated after PST and surgery with residual disease (non-pCR and pN+ disease, evaluable according to RECIST 1.1 criteria).

Specific aims

To assess the safety profile of Olaparib administered with concurrent RT.

This study should be completed by a methylation study of BRCA1 and RAD51 promoters.

Statistics Phase I dose-finding based on toxicity will be conducted in a sequential and adaptive Bayesian scheme, using the method of Time-to-event Continual Reassessment Method to determine the Maximum Tolerated Dose (MTD) of Olaparib associated with RT. The primary endpoint is Dose-Limiting Toxicity (DLT) occurring within 6 weeks after the end of RT (12 -13 weeks from the first drug intake, depending on the period of the radiotherapy treatment). Dose allocation will be centrally defined, based on DLT observed in all patients previously evaluated, by modeling the probability of DLT. An empiric model will be used for the dose-toxicity relationship. No intra-patient dose-escalation is permitted. No dose skipping in escalation is permitted. The MTD is defined as the dose associated with 25% of DLT.

Target accrual: Twenty-four to 30 pts are expected to be enrolled.

Contact: youlia.kirova@curie.fr

Citation Format: Kirova YM, Ezzalfani M, Rodrigues M, Pierga J-Y, Salomon A, Stern M-H, Laki F, Mosseri V, Berger F, Neffrati S, Armanet S, Fourquet A. A phase I of olaparib with radiation therapy in patients with inflammatory, loco-regionally advanced or metastatic TNBC (triple negative breast cancer) or patient with operated TNBC with residual disease [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-04-01.

Multitarget therapy of mycophenolate mofetil and cyclosporine A for induction treatment of refractory lupus nephritis

Standard induction therapy for lupus nephritis (LN) with mycophenolate mofetil (MMF) or cyclophosphamide (CYC) is often ineffective. Evidence on rescue induction regimens is scarce. We analyzed efficacy and tolerability of multitarget immunosuppression with MMF and cyclosporine A (CsA) as induction treatment for LN (class III/IV/V) refractory to CYC and/or MMF. We included all six refractory LN patients (class IV = 3, class V = 2, class III = 1) from our 400-patient tertiary Lupus Clinic observed between 2012 and 2015. Four patients had previously received pulse CYC. All six received MMF as first or second induction therapy and CsA was added once failure to reach remission was established. Daily dose of MMF was 2–3 g and CsA was dosed up to 2.6–3.7 mg/kg/day. Mean proteinuria was reduced from 2407 mg/24 hours at the start of the MMF+CsA regimen to 544 mg/day after six months. The mean prednisolone dose was reduced from 17.5 to 6 mg/day after six months of MMF+CsA. Four patients achieved a complete renal response, one patient had a partial renal response and one failed to respond. None of the patients presented with adverse events. These data suggest that adding CsA to MMF can induce complete remission of refractory LN and is well tolerated.

Development of 100 Mo -containing scintillating bolometers for a high-sensitivity neutrinoless double-beta decay search

This paper reports on the development of a technology involving 100 Mo -enriched scintillating bolometers, compatible with the goals of CUPID, a proposed next-generation bolometric experiment to search for neutrinoless double-beta decay. Large mass ( ∼ 1 kg ), high optical quality, radiopure 100 Mo -containing zinc and lithium molybdate crystals have been produced and used to develop high performance single detector modules based on 0.2-0.4 kg scintillating bolometers. In particular, the energy resolution of the lithium molybdate detectors near the Q-value of the double-beta transition of 100 Mo (3034 keV) is 4-6 keV FWHM. The rejection of the α -induced dominant background above 2.6 MeV is better than 8 σ . Less than 10 μ Bq/kg activity of 232 Th ( 228 Th ) and 226 Ra in the crystals is ensured by boule recrystallization. The potential of 100 Mo -enriched scintillating bolometers to perform high sensitivity double-beta decay searches has been demonstrated with only 10 kg × d exposure: the two neutrino double-beta decay half-life of 100 Mo has been measured with the up-to-date highest accuracy as T 1 / 2 = [6.90 ± 0.15(stat.) ± 0.37(syst.)] × 10 18 years . Both crystallization and detector technologies favor lithium molybdate, which has been selected for the ongoing construction of the CUPID-0/Mo demonstrator, containing several kg of 100 Mo .

Mining noise affects loud call structures and emission patterns of wild black-fronted titi monkeys

Anthropogenic noise pollution is increasing and can constrain acoustic communication in animals. Our aim was to investigate if the acoustic parameters of loud calls and their diurnal pattern in the black-fronted titi monkey (Callicebus nigrifrons) are affected by noise produced by mining activity in a fragment of Atlantic Forest in Brazil. We installed two passive acoustic monitoring devices to record sound 24 h/day, 7 days every 2 months, for a year; one unit was close to an opencast mine and the other 2.5 km away from it. Both sites presented similar habitat structures and were inhabited by groups of black-fronted titi monkeys. We quantified the noise at both sites by measuring the equivalent continuous sound level every 2 months for 1 year and quantified the emission of loud calls by titi monkeys through visual inspection of the recordings. The close site presented higher ambient noise levels than the far site. The quantitative comparison of loud calls of black-fronted titi monkeys between the two sites showed less calling activity in the site close to the mine than in the site further away. Approximately 20 % of the calls detected at the site close to the mine were masked by noise from truck traffic. Loud calls were longer at the site far from the mine and the diurnal patterns of vocal activity differed in the amount of calling as well as in the timing of peak calling activity between the two sites. Our results indicate that mining noise may constrain titi monkeys' long-distance vocal communication. Loud calls occupy a similar frequency band to mining noise, and an increase in ambient noise may be triggering black-fronted titi monkeys to adjust their long-distance communication patterns to avoid masking of their calls. Given that vocalizations are an important means of social interaction in this species, there are concerns about the impact of mining noise on populations exposed to this human activity.

A psychiatric liaison team at the university medical services: A pilot experience

Introduction

University students represent a specific population with concerns, burdens and worries that differ from other age and occupation groups. Students’ experiences are often exciting and empowering, yet facing multiple stressors that may trigger various forms of psychopathology. Our psychiatry department created a specific liaison service for university students in order to provide an easy and quick access to this medical speciality, included at the Multidisciplinary University Medical Services.

Aims

To characterize a sample of college student users of our Psychiatry Liaison Unit regarding socio-demographic and clinic variables.

Methods

Socio-demographic and clinic characterization was undertaken in all students observed during sixteen months (1st April 2015–30th July 2016).

Results

Fifty-three outpatients were observed: 35 females (66%) and 18 males (34%), aged between 18 and 39 years old (average: 23.94; median: 23). The majority was Portuguese and lived originally in urban areas. A total of75.3% were displaced and 60% lived with colleagues while 84.9% attended an undergraduate degree, and 38% studied at faculty of Science and Technology. Clinically, 79.2% were referenced by the University Medical Services, and adjustment disorders (ICD-10 F43.2) were the most frequent diagnosis. Relatively to suicidal behaviors and self-harm, 5.7% did self-cutting, 49.1% took an antidepressant combined with another psychotropic drugs, and 81.1% maintained cognitive-behavioral interventions.

Conclusions

The typical university students’ psychiatry outpatient was of female gender, in an undergraduate degree, displaced and living without their family. The most frequent diagnosis was adjustment disorder, and about a quarter were successfully discharged. Multidisciplinary University Medical Services located near to students can easily refer patients to Psychiatry Liaison Units, allowing diagnosis and intervention at early stages of mental disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Central nervous system vasculitis in systemic lupus erythematosus: a case series report in a tertiary referral centre

Central nervous system (CNS) vasculitis (CNS) in systemic erythematosus lupus (SLE) is a rare and challenging diagnosis. We report four cases of CNS vasculitis that occurred 5 to 16 years after the diagnosis of SLE. Magnetic resonance imaging (MRI) detected different features suggestive of CNS vasculitis: enhancement and thickening of the vascular wall, vascular stenosis, ischemic brain lesions and intracerebral haemorrhage unlikely to correspond to other mimic aetiologies. Three patients received combination therapy with glucocorticoids (GC) and cyclophosphamide (CYC). Intravenous human immunoglobulin (IVIG) was administered when the patient had a past history of serious adverse event to CYC or high infectious risk. All patients showed imagiological improvement, at least partially, 5 to 23 days after starting treatment. We discuss the management of CNS in SLE including the role of magnetic resonance imaging (MRI).

Association of ADAMTS7 gene polymorphism with cardiovascular survival in coronary artery disease

Recent genetic studies have revealed an association between polymorphisms at the ADAMTS7 gene locus and coronary artery disease (CAD) risk. Functional studies have shown that a CAD-associated polymorphism (rs3825807) affects ADAMTS7 maturation and vascular smooth muscular cell (VSMC) migration. Here, we tested whether ADAMTS7 (A/G) SNP is associated with cardiovascular (CV) survival in patients with established CAD. A cohort of 1,128 patients with angiographic proven CAD, who were followed up prospectively for a mean follow-up period of 63 (range 6–182) mo, were genotyped for rs3825807 A/G. Survival statistics (Cox regression) compared heterozygous (AG) and wild-type (AA) with the reference homozygous GG. Kaplan-Meier (K-M) survival curves were performed according to ADAMTS7 genotypes for CV mortality. Results showed that 47.3% of patients were heterozygous (AG), 36.5% were homozygous for the wild-type allele (AA) and only 16.2% were homozygous for the GG genotype. During the follow-up period, 109 (9.7%) patients died, 77 (6.8%) of CV causes. Survival analysis showed that AA genotype was an independent risk factor for CV mortality compared with reference genotype GG (HR = 2.7, P = 0.025). At the end of follow-up, the estimated survival probability (K-M) was 89.8% for GG genotype, 82.2% for AG and 72.3% for AA genotype ( P = 0.039). Carriage of the mutant G allele of the ADAMTS7 gene was associated with improved CV survival in patients with documented CAD. The native overfunctional ADAMTS7 allele (A) may accelerate VSMC migration and lead to neointimal thickening, atherosclerosis progression and acute plaque events. ADAMTS7 gene should be further explored in CAD for risk prediction, mechanistic and therapeutic goals.