Standardized treatment and follow-up protocol of hepatocellular carcinoma with transcatheter arterial chemoembolization: Survival, clinical, and tumor control outcome over 12 years at a U.S. center

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Background: To report the outcome of the care of patients with hepatocellular carcinoma (HCC) treated with standardized transcatheter arterial chemomembolization (TACE), with a focus on tumor response according to Response Evaluation Criteria in Solid Tumors (RECIST), progression of underlying cirrhosis [Child-Pugh (CP) score], time to progression (TTP) and survival from 1996 to 2008. Methods: TACE was performed on 365 patients in 1,035 sessions. According to a standardized protocol, all patients received imaging (MRI and/or CT) at baseline and at 4–6 weeks after each session and were clinically, biochemically and radiologically evaluated before each session. Liver disease status was evaluated before and at the end of the treatment period with the CP class system and tumor size measurements according to the RECIST. The Barcelona Clinic Liver Cancer (BCLC) classification was employed to stage patients. Three chemotherapeutic agents and lipiodol, followed by non-occlusive embolization were utilized during TACE. Complete vessel occlusion was avoided at all times. Overall survival and TTP were calculated according to the Kaplan-Meier method. The log-rank test was used to calculate differences between groups in the subgroup analysis. Results: All patients (78% male, mean age: 63.5 years) received an average of 3 TACE sessions (range: 1–10 and average interval between sessions: 75 days). Sixty six percent of patients had 3 or more tumors, with a mean tumor size at presentation of 6.9 cm. Partial response was achieved in 32 % of patients, while 65% remained stable over the course of 3 TACEs. CP class remained unchanged for 75% of patients over the above course of treatment. Median survival for the entire cohort was 20 months and TTP was 14 months. Interestingly, advanced BCLC patients achieved similar tumor response (PR:33%), TTP of 13.4 months and median survival of 13.7 months. Conclusions: Patients with HCC treated with the aforementioned standardized TACE and follow-up protocol showed durable survival, stable liver disease and effective tumor control.

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Weight cycling in a very low-calorie diet programme has no effect on weight loss velocity, blood pressure and serum lipid profile

BACKGROUND

Many dieters lose and regain weight many times. It is unclear whether weight cycling is associated with adverse metabolic alterations or becomes more difficult with each attempt.

METHODS

From 1988 to 2000, 2474 obese patients enrolled in our outpatient weight loss programme using a very low-calorie diet. Caloric intake consisted of meal replacement supplying 700-800 cal/day.

RESULTS

Our search distinguished 480 patients who had restarted the weight reduction programme at least once and up to four times (restarts). All subjects remained on the programme for 2 weeks or more each time. Mean initial weight loss was 21.3 kg for women and 28.8 kg for men. Rate of weight loss on first restart was not different from initial weight loss for women [1.6 vs. 1.4 kg/week; not significant (NS)] or for men (2.2 vs. 2.1 kg/week; NS). Of the 480 patients, 85 women and 51 men entered the programme three times. Rate of weight loss was similar for all three entries (1.4, 1.6 and 2.1 kg/week for first, second and third entry in women, NS; 2.1, 2.1 and 2 kg/week for men, NS). Only 20 women and 18 men entered the programme four times. The rate of weight loss was again similar for both men (NS) and women (NS) during each re-entry. Cardiovascular risk factors including lipid profile and blood pressure were not adversely affected by weight cycling. In fact, lipid levels were lower at each restart.

CONCLUSIONS

The present study refutes the hypothesis that repeated dieting makes further dieting efforts more difficult.

Feasibility of a low-fat/high-fiber diet intervention with soy supplementation in prostate cancer patients after prostatectomy

OBJECTIVES

To evaluate the feasibility and long-term compliance with a low-fat diet supplemented with soy protein in men at increased risk for recurrence after radical prostatectomy.

DESIGN

Randomized, control study.

SETTING

Academic center in USA.

SUBJECT

Forty men who had undergone radical prostatectomy and were at increased risk for recurrence.

INTERVENTION

Low-fat (15% fat), high-fiber (18 g/1000 kcal) diet supplemented with 40 g soy protein isolate (n=26) was compared to USDA recommended diet (n=14).

RESULTS

Over 4 years, subjects in the intervention group but not in the control group made and sustained significant changes in their diet as measured by the dietary assessment instruments and urinary isoflavone excretion. In the intervention group, dietary fat intake was reduced from 33.46+/-1.27% energy/day to 21.04+/-1.74% (P<0.05), fiber intake increased from 14.6+/-1.06 to 21.05+/-2.29 g/day. The insulin growth factor-1 (IGF-1) level was decreased from 260.4+/-8.6 ng/ml at baseline to 220.5+/-7.9 ng/ml at 6 months (P<0.05) in the intervention group with no significant change in the control group. An ex vivo assay demonstrated inhibition of LNCaP cell growth (-20.0+/-7.7%, P<0.05) by sera from patients in the intervention group after 6 months of dietary change compared to baseline.

CONCLUSION

These data suggest that long-term low-fat dietary interventions as part of prospective randomized trials in prostate cancer survivors are feasible, and lead to reductions in circulating hormones or other growth factors stimulating prostate cancer growth ex vivo.

Increased target specificity of anti-HER2 genospheres by modification of surface charge and degree of PEGylation

Genospheres are cationic lipid-nucleic acid nanoparticles prepared by the assembly of the lipids and nucleic acids from an aqueous/organic liquid monophase that independently dissolves the components, where the resultant particles are homogeneously sized (70-110 nm), with efficiently incorporated and protected DNA. In the present study, we demonstrate pH-dependent modulation of the Genosphere surface charge using pH-titratable lipids. By incorporation of the lipids with titratable anionic or imidazole headgroups, Genospheres with neutral or anionic surface charge at neutral pH were produced and compared for cellular uptake and transfection of a reporter gene (luciferase) in culture of breast cancer cells. The extent of particle-cell association was also studied by fluorescent microscopy and quantified by cytofluorometery. The effects of Genosphere surface modification with poly(ethylene glycol) (molecular weight 2000) at low (0.5 mol %) and high (5 mol %) grafting densities, as well as the effects of HER2-receptor-directed targeting by an internalizable anti-HER2 scFv F5, linked via PEG spacer, were also studied. Inclusion in the Genosphere formulation of pH-titratable lipids CHEMS (cholesteryl hemisuccinate), CHIM (1-(3-(cholesteryloxycarbonylamino)propyl)imidazole), or DSGG (1,2-distearoyl-sn-glycero-3-hemiglutarate) rendered the particles surface-charge neutral or slightly anionic at neutral pH, and cationic at mildly acidic pH, as shown by zeta-potential measurements. In HER2-targeted systems, transfection activity and target specificity with HER2-overexpressing SKBR-3 breast cancer cells were dependent on Genosphere surface charge and PEGylation. The highest target specificity correlated with low cationic charge at neutral pH, while incorporation of 5 mol % PEG-lipid had only minor effects on Genosphere-cell association, internalization, and transfection activity. The implications of this work for potential in vivo applications are discussed.