Management of lobular carcinoma in-situ and atypical lobular hyperplasia of the breast--a review

OBJECTIVES

To determine the incidence of malignancy (invasive carcinoma or DCIS) in patients diagnosed with lobular neoplasia (B3) on core needle biopsy (CNB) of breast lesions by reviewing the published literature.

METHODS

Medline, Embase, OVID-database and reference lists were searched to identify and review all English-language articles addressing the management of LN diagnosed on CNB. Studies on mixed breast pathologies were excluded.

RESULTS

Of 1229 LN diagnosed on CNB, 789 (64%) underwent surgical excision. 211 (27%) of excisions contained either DCIS or invasive disease. 280 of the excision specimens were classified as ALH, 241 as LCIS, 22 as pleomorphic LCIS and 246 unspecified LN on the original CNB. After surgical excision, 19% of the ALH cases, 32% of the LCIS cases and 41% of the PLCIS cases, contained malignancy. 29% of the unspecified LNs were upgraded to malignancy. The higher incidence of malignancy within excision specimens for LCIS and PLCIS compared to ALH was significant (P < 0.04, <0.003 respectively).

CONCLUSION

There is a significant underestimation of malignancy in patients diagnosed with breast LN on CNB. 27% cases of CNB-diagnosed LN were found to contain malignancy following surgical excision. All patients diagnosed with LN on CNB should be considered for surgical excision biopsy.

Lung dosimetry for inhaled long-lived radionuclides and radon progeny

The current version of the stochastic lung dosimetry model IDEAL-DOSE considers deposition in the whole tracheobronchial (TB) and alveolar airway system, while clearance is restricted to TB airways. For the investigation of doses produced by inhaled long-lived radionuclides (LLR) together with short-lived radon progeny, alveolar clearance has to be considered. Thus, present dose calculations are based on the average transport rates proposed for the revision of the ICRP human respiratory tract model. The results obtained indicate that LLR cleared from the alveolar region can deliver up to two to six times higher doses to the TB region when compared with the doses from directly deposited particles. Comparison of LLR doses with those of short-lived radon progeny indicates that LLR in uranium mines can deliver up to 5 % of the doses predicted for the short-lived radon daughters.

Growth monitoring still has a place in selected populations of children

In 1998, a multiprofessional group developed a consensus on growth monitoring in the UK. While routine serial measurements were not recommended in healthy children, it is clear that there is a subset of children at increased risk of growth-modifying disease who may benefit from growth monitoring. This subset includes children with genetic disorders at increased risk of thyroid dysfunction. Symptoms and signs of thyroid dysfunction are non-specific in the early stages of disease and are easily mistaken for features of an underlying genetic disorder. In this article, we report the case of a 2.8-year-old girl with 18q deletion syndrome who was profoundly weak, hypotonic and poorly responsive at diagnosis of Grave's disease. She was tall and her bone age was 2 years advanced, indicating long-standing disease. Growth monitoring of this patient should have enabled earlier diagnosis and avoided a serious and potentially fatal episode.

Phase II study of XL184 in a cohort of patients (pts) with castration-resistant prostate cancer (CRPC) and measurable soft tissue disease

127

Background: XL184 is an oral, potent inhibitor of MET and VEGFR2. MET pathway activation promotes tumor growth, invasion and metastasis. Overexpression of MET and/or its ligand HGF are associated with prostate cancer metastasis. In preclinical studies, androgen ablation upregulates MET signaling. Preliminary data from the open label Lead-in Stage of an ongoing adaptive design phase II randomized discontinuation trial are presented.

Methods: Eligible pts had CRPC, measurable disease with or without bone metastasis, and disease progression on ≤1 prior non-hormonal systemic treatment. XL184 was administered orally for 12 weeks (wks). Tumor (RECIST) and bone scan response (complete or partial resolution) were assessed every 6 wks. Primary endpoint is objective response rate at wk 12. Pts with SD at wk 12 will enter a placebo-controlled randomized phase.

Results: As of 10/4/10, 72 pts have been enrolled. Median time on study was 50 days (range, 6+-350+ days). Median age was 69 yrs; 45% of pts were docetaxel-pretreated. All pts had measurable disease, including 69% with visceral metastases. To date, there are 24 response evaluable pts, defined as enrolled ≥12 wks prior to data cutoff. 5/24 (21%) pts had a partial response (≥30% reduction) in measurable disease with 3 responses confirmed at 12 wks and 2 unconfirmed responses ongoing. 6/24 (25%) had PSA declines of ≥50%. 13 of 15 (87%) pts with known bone metastases had either complete or partial resolution of lesions on bone scan. Bone scan responses were associated with investigator-reported improvement in bone pain in 11/15 (73%) with pain at baseline. Effects on osteoclast and osteoblast activity were observed: plasma C-telopeptide declined ≥50% in 8/12 (66%) pts and serum total alkaline phosphatase (tALP) declined ≥50% in 5/8 (63%) pts with bone metastases and baseline elevated tALP. The most common AEs ≥Grade 3 severity (related) were fatigue (10%), diarrhea (3%) and elevated AST (3%).

Conclusions: XL184 results in tumor responses, partial or complete resolution of lesions on bone scan, and symptom relief in pts with metastatic CRPC, including those pretreated with docetaxel. XL184 also decreased biomarkers of both osteoblast and osteoclast activity.

[Table: see text]

A randomized phase II study of pazopanib in castrate-sensitive prostate cancer: A University of Chicago phase II consortium/DoD Prostate Cancer Clinical Trials Consortium study

170

Background: Intermittent androgen suppression (IAS) has been studied as a way of minimizing toxicity from long term androgen deprivation therapy (ADT). Based on previous studies with similar agents, we hypothesized that inhibition of VEGFR would result in prolonged time to PSA progression (TTPP) and allow for longer periods off ADT.

Methods: Men with biochemically recurrent, progressive prostate cancer and no evidence of macroscopic metastases were enrolled. They received 6 months of ADT. If at the end of that time the PSA was <0.5 ng/mL (with castrate testosterone levels), they were randomized to pazopanib 800 mg/d or observation. The primary outcome was TTPP, defined as time to a PSA >4.0 ng/mL, at which time they were restarted on ADT.

Results: 37 pts met randomization criteria. 18 were randomized to pazopanib. Only 4 pts met the endpoint criteria of TTPP, whereas 13 (72%) pts went off study for other reasons with 1 pt on treatment at study closure. Reasons for discontinuation included drug toxicity (grade 1/2, 9 pts) and patient preference (2 pts). No grade 3/4 toxicity was noted. 1 pt was removed due to pulmonary embolus, 1 pt due to MD discretion and 1 pt due to noncompliance. 19 pts were randomized to observation of which 12 were off treatment when the study was stopped. Only 5 pts met criteria for TTPP, whereas 7 of 12 (58%) dropped out for other reasons, including the frequency of protocol related blood draws and visits (3 pts) and randomization to observation (2 pts), 1 pt was removed per MD discretion and 1 pt transferred care. Due to high dropout rates in both arms, accrual was halted as the primary endpoint could not be measured robustly.

Conclusions: Minimizing the long term toxicities of ADT is an unmet need in prostate cancer therapy. Hence clinical interventions in concert with IAS represent an attractive area for drug development. This trial has outlined several barriers that exist in studying this patient population and might help to optimize future studies. Future trial design in this arena should investigate drugs with minimal toxicity and employ a design that maximizes patient convenience while anticipating the low threshold for patient drop out.

No significant financial relationships to disclose.

Phase II study of AT-101 to abrogate Bcl-2-mediated resistance to androgen-deprivation therapy (ADT) in patients (pts) with newly diagnosed androgen-dependent metastatic prostate cancer (ADMPC)

137

Background: Preclinical studies demonstrate that Bcl-2 is over-expressed in most pts with prostate cancer, causes drug resistance to ADT, and that modulation of Bcl-2 improves sensitivity of tumor cells. We are conducting a phase II study for men with ADMPC to test the hypothesis that AT-101, a small molecule Bcl-2 inhibitor, improves clinical results of pts initiating ADT for metastatic prostate cancer. Building on results from SWOG 9346 (Hussain JCO 2006) demonstrating that PSA nadir after 7 mo of ADT predicts survival, we are using a novel phase II trial design, in which the primary endpoint is the percentage of patients with PSA ≤ 0.2 ng/ml at 7 mo of ADT plus AT-101.

Methods: Pts had ADMPC, PSA > 5.0 ng/ml within 12 wks prior to registration and no prior ADT for metastatic disease. ADT with LHRH agonist and bicalutamide started 6 wks prior to initiation of oral AT-101, 20 mg/day for 21 days of 28 day cycle. Pts received up to 8 cycles of ADT and AT-101. A total of 55 pts were enrolled (to obtain 48 evaluable pts) to in a two stage design with null hypothesis 48% versus alternative 68% with PSA ≤ 0.2 at 7 mo. With α = 0.1 and β = 0.9, > 27 pts meeting this endpoint are required to recommend further study.

Results: 55 pts were enrolled, median age 61.5 y; Gleason score (GS) 6 (5%),GS 7 (30%), GS 8 (24%), and GS 9 (41%). 3 pts had visceral mets and the remaining pts had bone or nodal metastasis. 42 pts have discontinued (9 toxicity, 9 progression, 1 withdrew) or completed (n = 23) 7 mo of treatment. In intention to treat analysis, 11 of 42 pts (26%) met the primary endpoint 10, of 42 (23%) pts had PSA > 0.2 and < 4.0 ng/ml after 7 mo. Grade 1/2 toxicities (%) included fatigue (36/9), nausea (20/9), vomiting (13/7), anorexia (15/2), AST/ALT (25/5), hypercalcemia (9/0), constipation (13/3), dry skin (9/0), anemia (18/0), sensory neuropathy (7/7), vomiting (12/7), hyperglycemia (7/4). Grade 3 toxicities were sensory neuropathy 2 pts, GI obstruction 1 pt, syncope 1 pt.

Conclusions: Although final study results are pending the analysis of pts currently on therapy, 26% of pts achieved an undetectable PSA at 7 mo in a population with aggressive disease (66% GS ≥ 8).

No significant financial relationships to disclose.

A phase II trial of neoadjuvant ABI-007, carboplatin, and gemcitabine (ACG) in patients with locally advanced carcinoma of the bladder

244

Background: Neoadjuvant cisplatin-based chemotherapy benefits patients with bladder cancer, particularly in the 30% with pathologic complete response (pCR) at cystectomy. Many patients with bladder cancer are not candidates for cisplatin. Taxane-based regimens have activity in urothelial cancer. ABI-007 is an albumin-bound paclitaxel with increased activity and decreased toxicity compared to standard paclitaxel preparations.

Methods: Eligible pts have T2-4,N0,M0 or Tany,N1- 3,M0 bladder cancer with ECOG PS 0-1, and adequate marrow (granulocyte count > 1,500/mm3, platelet > 100,000/mm3, and hemoglobin > 9.0 g/dl), hepatic (transaminases < 2.5 X upper limit of normal, alkaline phosphatase < 2.5 X upper limit of normal, and bilirubin < 1.5 mg/dl) and renal function (serum creatinine < 2.0 mg/dl and/or creatinine clearance > 40 ml/min). Pts are treated with intravenous ABI-007 260 mg/m2 and carboplatin (target area under the curve=5) on day 1 with gemcitabine 800 mg/m2 on days 1 and 8, followed by radical cystectomy after three cycles of therapy. The primary study endpoint is the proportion of patients with pCR at cystectomy.

Results: 27 patients have been enrolled. By clinical staging, 20 had T2 disease, 5 had T3, 2 had T4, and 2 had nodal enlargement. All are evaluable for toxicity with 22 evaluable for response (exclusions-3 for change in dose schedule, 1 each for refusal of cystectomy and withdrawal from study). 25/27 patients received all three cycles (78 total cycles) with doses reduced in 26 cycles for toxicity. All patients had transient grade 3-4 neutropenia and 17 received filgrastim, but only two had febrile neutropenia. Six pts had pCR with an additional 5 having residual carcinoma in situ (CIS) and 1 with T1 disease at cystectomy. 54% of evaluable patients had no muscle invasive disease at cystectomy.

Conclusions: Neoajuvant ACG is active in bladder cancer with pCR rate nearing 30% and nearly as many patients with CIS but no residual invasive disease. Marrow toxicity is significant but manageable.

[Table: see text]

Evidence of peste des petits ruminants in serology of sheep and goats from Sindh, Pakistan

The following is the first detailed description of laboratory confirmed evidence of peste des petits ruminant virus (PPRV) in 14 districts of Sindh province, Pakistan. Sindh is the 2nd largest province of Pakistan in terms of human population and livestock. Livestock are the main origin of the people's livelihood. Samples were collected during the surveillance programme from sheep and goats showing severe respiratory signs and mouth lesions. Competitive enzyme-linked immuno-sorbant assay (cELISA) was performed to detect the presence of antibodies in the serum against PPRV. Findings suggested that the overall PPR sero-prevalence in sheep was 49.5% when compared to goats, which was 56.3%. As we observed during an 18 months' period, most of the cases that occurred emerged with the start of hot season and peaked during the months of April, May, June and July, and then the prevalence dropped. Among various age groups, the animals that showed the higher prevalence of antibodies to PPRV were >2 years. In the age group <1 year, there was a significant difference in the prevalence which was 48.6% in goats when compared to 32.1% in sheep. Similarly, it was the same in the second age group (1-2 years), 46.9% in sheep when compared to 55.3% goats. There was little variation in the third age group (>2 years), being around 61.7% in goats when compared to 63.4% in sheep. The highest sero-prevalence was in Tharparkar followed by Mirpur Khas and Tando Allahyar. The study indicated the scenario of PPRV circulation in the population of the two domestic ruminant species (sheep and goats) with frequent disease outbreaks.

Evaluation of charged particle induced reaction cross section data for production of the important therapeutic radionuclide 186Re

186Re is an important radionuclide having a half-life of 3.72 d that is suitable for radioimmunotherapy. Its production in no-carrier-added form is done via charged particle induced reactions and the data are available in EXFOR library. We evaluated two charged particle induced reactions, namely 186W(p,n) 186Re and 186W(d,2n) 186Re. In the first case, analysis was done up to about 70 MeV but in the latter only up to about 50 MeV. A statistical procedure supported by nuclear model calculations using the codes STAPRE, EMPIRE and TALYS was used to validate and fit the data. The recommended sets of data derived together with 95% confidence limits are reported. The application of those data, particularly in the calculation of integral yields is discussed. The 186W(p,n) 186Re reaction on highly enriched 186W is presently the method of choice for production of no-carrier-added 186Re and, taking into account the radionuclidic purity, the maximum recommended proton energy is 18 MeV. The formation of the very long-lived isomer, 186mRe, is briefly discussed. The 186W(d,2n) 186Re reaction could also be interesting if a high-intensity accelerator would be available.

Epigenomic alterations and gene expression profiles in respiratory epithelia exposed to cigarette smoke condensate

Limited information is available regarding epigenomic events mediating initiation and progression of tobacco-induced lung cancers. In this study, we established an in vitro system to examine epigenomic effects of cigarette smoke in respiratory epithelia. Normal human small airway epithelial cells and cdk-4/hTERT-immortalized human bronchial epithelial cells (HBEC) were cultured in normal media with or without cigarette smoke condensate (CSC) for up to 9 months under potentially relevant exposure conditions. Western blot analysis showed that CSC mediated dose- and time-dependent diminution of H4K16Ac and H4K20Me3, while increasing relative levels of H3K27Me3; these histone alterations coincided with decreased DNA methyltransferase 1 (DNMT1) and increased DNMT3b expression. Pyrosequencing and quantitative RT-PCR experiments revealed time-dependent hypomethylation of D4Z4, NBL2, and LINE-1 repetitive DNA sequences; up-regulation of H19, IGF2, MAGE-A1, and MAGE-A3; activation of Wnt signaling; and hypermethylation of tumor suppressor genes such as RASSF1A and RAR-beta, which are frequently silenced in human lung cancers. Array-based DNA methylation profiling identified additional novel DNA methylation targets in soft-agar clones derived from CSC-exposed HBEC; a CSC gene expression signature was also identified in these cells. Progressive genomic hypomethylation and locoregional DNA hypermethylation induced by CSC coincided with a dramatic increase in soft-agar clonogenicity. Collectively, these data indicate that cigarette smoke induces 'cancer-associated' epigenomic alterations in cultured respiratory epithelia. This in vitro model may prove useful for delineating early epigenetic mechanisms regulating gene expression during pulmonary carcinogenesis.

Splenic torsion: a case report

INTRODUCTION

Torsion of the spleen is a rare cause of abdominal pain. Predisposition occurs following abnormal development of splenic suspensory ligaments. We report a case of splenic torsion in a spleen sited in a normal anatomical position and discuss the latest treatment options. To the best of our knowledge, this has not been reported in the literature to date.

CASE PRESENTATION

A 73-year-old Caucasian woman presented to our department with sudden onset, severe, left-upper abdominal pain. An enhanced computed tomography revealed an unenhancing spleen. She underwent an urgent laparotomy and splenectomy for 360 degrees torsion of her spleen.

CONCLUSIONS

Splenic torsion in a wandering spleen has been described with an incidence of < 0.2%. Symptoms vary from asymptomatic to an acute surgical abdomen. Diagnosis is commonly made using colour Doppler sonography or enhanced computed tomography. Surgery is guided by clinical setting, with preservation of the spleen as the goal.

Evaluation of excitation functions of proton and deuteron induced reactions on enriched tellurium isotopes with special relevance to the production of iodine-124

Cross-section data for the production of medically important radionuclide (124)I via five proton and deuteron induced reactions on enriched tellurium isotopes were evaluated. The nuclear model codes, STAPRE, EMPIRE and TALYS, were used for consistency checks of the experimental data. Recommended excitation functions were derived using a well-defined statistical procedure. Therefrom integral yields were calculated. The various production routes of (124)I were compared. Presently the (124)Te(p,n)(124)I reaction is the method of choice; however, the (125)Te(p,2n)(124)I reaction also appears to have great potential.

Measurement of the depth of maximum of extensive air showers above 10{18} eV

We describe the measurement of the depth of maximum, X{max}, of the longitudinal development of air showers induced by cosmic rays. Almost 4000 events above 10;{18} eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106{-21}{+35}) g/cm{2}/decade below 10{18.24+/-0.05} eV, and (24+/-3) g/cm{2}/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm{2}. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.

A review of 50 cases of aphakic detachment in Peshawar, North West Frontier Province of Pakistan

BACKGROUND

This prospective study was conducted at Khyber Teaching Hospital Peshawar, North West Frontier Province (NWFP) of Pakistan over the period of 16 months. It was to assess the demographic pattern, mode of presentation, treatment modalities and postoperative result of aphakic retinal detachment. This study also compared the incidence of aphakic retinal detachment in intracapsular versus extracapsular cataract extraction as well as the duration between cataract surgery and retinal detachment.

PATIENTS AND METHOD

A total of 50 patients were recruited in this prospective study. A Proforma was specially designed for this purpose. Detailed history with reference to age, sex, presenting complaints, spectacle wear, previous ocular surgery, duration of surgery/laser treatment, systemic and family history was taken. All patients had detailed ophthalmic examination, underwent conventional retinal reattachment surgery, and were followed up for 6 months.

RESULTS

Of the total number studied, 86% of the patients were males; only 14% were females, with a mean age of 58 years. The overall anatomical success was achieved in 40 (80%) eyes. The visual acuity of 6/12 and better was achieved in 8 (16%) eyes. 20 (40%) eyes attained a vision of 6/18 to 6/36. 12 (24%) eyes had a vision between 6/60 to CF 3m. The vision could not be improved beyond CF 3m in 10 (20%) eyes.

CONCLUSION

Vitreous loss during cataract surgery is the most common cause of aphakic retinal detachment. The risk is maximal in the first and second year. The overall anatomical attachment achieved through conventional retinal detachment surgery is 80%.

Retinopathy: variable clinical spectrum and post-endarterectomy changes

BACKGROUND

The Carotid Artery Insufficiency Retinopathy (CAIR) is an uncommon sign of carotid artery obstruction. It is mainly found in patients with complete occlusion or severe obstruction of internal Carotid Artery (ICA). Retinopathy is caused by progressive and chronic hypoxia to ocular tissues. The purpose of the study is to describe the variable presentation of CAIR in patients with internal carotid artery stenosis and to asses the resolution of retinopathy in patients who had carotid endarterectomy.

METHODS

Records of the patients with confirmed internal carotid artery stenosis were reviewed. Patients' demographic data and way of presentation to ophthalmologist was recorded. Associated systemic vascular diseases were also recorded on the proforma. Records of the patients with confirmed internal carotid artery stenosis were reviewed.

RESULTS

Thirteen eyes of 10 patients were included in study with male to female ratio of 9:1. Patients' clinical presentation ranged from scattered blot haemorrhages to ocular ischemic syndrome. Patients presented with retinopathy at different stages. The presentation of retinopathy varied from scattered blot haemorrhages to ocular ischemic syndrome. Endarterectomy resolved CAIR in 2 out of 3 patients, with one patient having bilateral resolution.

CONCLUSION

CAIR should be suspected if retinopathy is unilateral. On the other hand patients with asymptomatic Carotid artery stenosis should be examined for signs of ocular ischemia. All patients with CAIR should be investigated for cardiovascular diseases. Endarterectomy in selected patients can resolve CAIR.

Charged particle induced reaction cross section data for production of the emerging medically important positron emitter64Cu: A comprehensive evaluation

The radionuclide64Cu (T1/2=12.7 h) is an important non-standard positron emitter, suitable for combining PET imaging and targeted therapy. Its production in no-carrier-added form is doneviacharged particle induced reactions, and considerable amount of cross section data are available in the literature. We evaluated seven reactions, namely64Ni(p,n)64Cu,64Ni(d, 2n)64Cu,68Zn(p, αn)64Cu,66Zn(p, 2n)64Cu,64Zn(d, 2p)64Cu,66Zn(p, α)64Cu andnatZn(d,x)64Cu. Data analysis was generally limited up to about 25 MeV and the consistency check of experimental data was carried out using the nuclear model codes STAPRE, EMPIRE and TALYS. In a few cases experimental data were available up to 100 MeV; the consistency check in the high energy region was done only using the code TALYS. A statistical procedure (supported by nuclear model calculations) was then used to fit the data. The derived recommended sets of data, together with 95% confidence limits, are reported. The integral yields calculated from those data are also given. A critical comparison of the various production routes of64Cu is presented. The64Ni(p,n)64Cu reaction, utilizing a highly enriched target, is the method of choice.

European S3-guidelines on the systemic treatment of psoriasis vulgaris

Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a safe and very effective treatment option for moderate to severe forms of psoriasis vulgaris. The onset of clinical effects occurs within 2 weeks. Of the unwanted side effects, UV erythema from overexposure is by far the most common and is observed frequently. With repeated or long-term use, the consequences of high, cumulative UV doses (such as premature aging of the skin) must be taken into consideration. In addition, carcinogenic risk is associated with oral PUVA and is probable for local PUVA and UVB. The practicability of the therapy is limited by spatial, financial, human, and time constraints on the part of the physician, as well as by the amount of time required by the patient. From the perspective of the cost-bearing institution, phototherapy has a good cost-benefit ratio. However, the potentially significant costs for, and time required of, the patient must be considered.

Kerosene lamp "Kupi": lights the house, but may bring darkness to life

In terms of mortality and morbidity, childhood burn comprises a significant public health problem in Bangladesh, especially in rural poor families who use kerosene-lamp "Kupi" for lighting and traditional mud-made open oven for cooking. They lack optimum safety measures. A total of 100 patients in the age group of 01 to 15 years who got admitted into the burn unit of Dhaka Medical College Hospital during the first half of 2005 were enrolled in the study. Data on socio-demographic variables and information on events and consequences of burn were extracted and analyzed. The results identified flame burn from kerosene lamp "Kupi" as the major cause and source of burn in affected children. Both electrical burn and burn by ash were seen to happen in older male and toddler boys respectively. There were 02 deaths in the series; both were females and were the victims of massive flame burn-one from Kupi and other form oven fire during cooking. Pediatric burn imposes stress on the physique, psyche and socio-economic status of the affected personnel and families. Effective measures are needed to prevent this unfortunate injury in children which is preventable to a large extent.

Expression and activation of ADAM15 in bladder cancer

e16010

Background: ADAM15 is a member of the disintegrin family of metalloproteinases. These molecules function as membrane-bound proteases, and, when activated, cleave important membrane anchored growth factors such as heparin binding epidermal growth factor and cell adhesion molecules such as E-cadherin. This proteolysis may contribute to bladder cancer growth through release of growth factors and progression by altering cell adherence. We evaluated ADAM15 expression in bladder cancer cell lines and tissues. Methods: ADAM15 expression was assessed in human bladder cell lines, normal bladder and bladder cancer tissues. A datamining program (Oncomine) was used to evaluate previous array studies in bladder cancer. ADAM15 activation results in the release of a prodomain fragment. Expression and activation of ADAM15 in bladder cancer cell lines were monitored by enzyme-linked immunosorbent assay and western blotting using ADAM15 antibody (Millipore). Staining was performed on formalin-fixed, paraffin-embedded human tissues using ADAM15 antibody (Millipore) and the peroxidase- avidin-biotin complex (ABC) method. Results: Of 7 bladder cancer cell lines, 6 demonstrated expression of full length (100 kD) and “active” (90kD) ADAM15 molecules. Four of these cell lines showed release of the ADAM15 prodomain fragment, and 5 cell lines provided evidence for proteolytic activity, indicated by release of 80kD soluble E-cadherin molecule. Immunostaining of a bladder cancer tissue microarray revealed that normal urothelium expressed low levels of ADAM15, but focal overexpression of ADAM15 was observed in 17/29 bladder cancer specimens. Datamining of independent microarray analysis revealed that ADAM15 mRNA is upregulated in bladder cancer. Conclusions: ADAM15 is expressed in the majority of human bladder cancer specimens. Cell line studies indicate that ADAM15 can be activated, as indicated by release of the ADAM15 prodomain fragment. These results suggest that ADAM15 may be a therapeutic target to modulate bladder cancer growth and progression. Future studies will continue evaluation of the biology of ADAM15 in bladder cancer and evaluate if the soluble ADAM15 prodomain can be detected in plasma, serum or urine from patients with bladder cancer.

No significant financial relationships to disclose.

Prostate cancer clinical trials consortium: A multicenter mechanism for the rapid design, development, and implementation of early phase clinical trials

e16065

Background: Leading investigators in prostate cancer have hypothesized that clinical trials (CT) are optimally conducted as multicenter studies. To test this, the Prostate Cancer Clinical Trials Consortium (PCCTC) was formed with support from the Prostate Cancer Foundation (PCF) and the Department of Defense Clinical Consortium Award (DOD). Since the PCCTC's inception in 2006, members have cooperatively designed, carried out, and evaluated phase 1 and 2 multicenter studies in prostate cancer. Methods: PCF and DOD awards support a consortium of 13 cancer research centers. Memorial Sloan-Kettering Cancer Center serves as the coordinating center and is charged with creating an infrastructure to conduct early phase, multicenter trials. Annually, each participating center is required to introduce at least one CT for consideration by the PCCTC and accrue at least 35 patients to PCCTC studies. Investigators meet face-to-face twice per year to discuss the PCCTC's progress, and hold monthly conference calls to discuss scientific objectives, trial design, and ongoing studies. Results: Since inception, the PCCTC has expanded from 8 to 13 leading research centers. Through September 2008, it has opened 47 trials and accrued 1,282 patients at member sites. Members utilize a CT management system for protocol tracking, electronic data capture, and data storage. A legal framework has been instituted, and standard operating procedures, administrative structure, editorial support, centralized budgeting, and mechanisms for scientific review have been established. Each year, the number of trials presented and patients accrued increases, and three concepts have progressed to the next phase of clinical testing. Conclusions: The PCCTC fulfills a congressional directive to create a CT instrument dedicated to rapid accrual to early-phase, multicenter studies in prostate cancer. The member institutions have built a shared administrative, informatics, legal, financial, statistical, and scientific infrastructure to support this endeavor. As the PCCTC has expanded and taken an increasingly active role in designing and evaluating protocols, clinical trials continue to open and accrue in excess of federally mandated goals.

No significant financial relationships to disclose.

Maintenance sunitinib postchemotherapy (CT) in patients (pts) with advanced urothelial carcinoma (UC): A randomized placebo controlled phase II trial

5073

Background: Although response to CT is common in pts with advanced UC it is rarely durable. Sunitinib is an oral small molecule inhibitor of receptor tyrosine kinases regulating angiogenesis including VEGFR-1, -2, -3, and PDGFR-α, -β with demonstrated antitumor activity in a variety of solid tumors. Inhibition of angiogenesis following CT may delay disease progression. Therefore, we are evaluating maintenance sunitinib in a phase II study. Methods: Pts with advanced UC, > stable disease (SD) after 4–6 cycles of CT, a performance status (PS) 0–2, adequate organ function and < 42 days from last CT dose were randomized to sunitinib 50 mg or placebo; 4 weeks (wks) on 2 off in 6 wk cycles. Pts were stratified by response to CT. Disease was assessed every 12 wks. Pts were unblinded for progression or unacceptable adverse events (AEs), with placebo pts offered open label sunitinib. The primary end point is 6 month progression rate using a modified version of the randomized selection design (Simon 1985). 42 pts/arm are to be accrued to allow selection of the superior arm with 90% probability. Other endpoints include safety, response rate (RR), time to progression, median survival, RR to open label sunitinib and correlation of changes in serum VEGF and sVEGFR-2 levels with outcome. Results: To date, 28 pts have been registered and 26 have completed > 12 wks of therapy. Median age is 69 years (48–81) and PS is 1 (37% PS 0, 52% PS 1). 12% had a complete response (CR) to prior CT, 46% a partial response (PR) and 42% SD. 14 pts have progressed after a median of 2 cycles (range 1–12). 7 pts received open label sunitinib at progression, 1/7 remains on treatment. Median duration on open label therapy is 2.2 months (11 days-15 months). Best response to open label therapy to date is progressive disease (2 pts), SD (2 pts) for 24 wks, PR in 1 pt through 60 weeks and 2 pts have not reached first assessment. Grade 3 AEs on open label sunitinib included: bladder hemorrhage, increased creatinine, fatigue, thrombocytopenia and hand-and-foot syndrome. No grade 4 or 5 AEs were observed. Conclusions: Preliminary results indicate that maintenance sunitinib post CT is feasible in advanced UC pts and is associated with clinical activity. Supported by Pfizer.

[Table: see text]

Phase I study of vorinostat plus docetaxel in patients with solid tumor malignancies

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Background: Vorinostat is an inhibitor of histone deacetylase 6, which results in the acetylation of tubulin and the stabilization of microtubules. Since taxanes bind to stabilized microtubules, the administration of vorinostat followed by docetaxel, we hypothesized, should result in synergistic cytotoxicity. A phase I trial was conducted to determine the dose level of vorinostat plus docetaxel that would result in dose-limiting toxicity (DLT) in ≤ 30% of patients (pts). Methods: Eligible pts had castration-resistant prostate cancer (CRPC) or relapsed urothelial or non-small-cell lung cancer (NSCLC) after ≥1 prior chemotherapy regimen not containing docetaxel, a performance status of 0–2 and adequate organ function. Vorinostat was given orally for 14 days beginning on day 1 of a 21-day cycle. Docetaxel was given intravenously over 1 hour on day 4. The time-to-event continuous reassessment method guided dose escalation. Dose levels (DL) -1, 0, 1 and 2 corresponded to vorinostat 100, 100, 200 and 200 mg plus docetaxel 50, 60, 60, and 75 mg/m2, respectively. Blood was collected on days 1 and 4 of cycle 1 to measure drug levels by HPLC. Results: 12 pts were enrolled: median age 65 yrs (49–74); gender 9M:3F; 4 CRPC, 5 urothelial, 3 NSCLC. The median number of cycles was 2. 2 pts were treated at DL -1, 4 pts at DL 0, 5 pts at DL 1 and 1 pt at DL 2. 5 DLTs occurred in 5 pts: grade 4 neutropenic fever/sepsis (n = 2), anaphylactic reaction (n = 1), myocardial infarction (n = 1) and GI bleed (n = 1). Other toxicities included grade 4 neutropenia (n = 2), pulmonary embolus (n = 1) and GI bleed (n = 1). The estimated probability of DLT for DL -1 was .32 (90% posterior probability interval [PI], .11 to .53) for DL 0, .38 (90% PI, .16 to .58) and for DL 1, .43 (90% PI, .23 to .64). The trial was stopped due to excessive toxicity. No responses were noted. Conclusions: Combination vorinostat plus docetaxel was poorly tolerated with excessive DLTs requiring study termination. PK analysis will be presented. Supported in part by a grant from Merck & Co., Inc.

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The epidemiology of peste des petits ruminants in Pakistan

Peste des petits ruminants (PPR) is an acute and highly contagious viral disease of small ruminants, which is newly emerging in Pakistan. Information provided by participatory disease surveillance teams was used to develop a database for PPR outbreaks in Pakistan. Twenty-four villages were selected throughout the country and field investigations were conducted in each village to study the dynamics of the disease. In each area, flocks with a history of PPR were identified and serological sampling was conducted. Some 1,463 small ruminants (sheep and goats) were sampled and 1,096 tested positive for the presence of antibodies against PPR. These results clearly indicate that PPR is prevalent throughout Pakistan.