Natural and synthetic flavonoids, novel blockers of the volume-regulated anion channels, inhibit endothelial cell proliferation

Natural flavonoids are ubiquitous in dietary plants and vegetables and have been proposed to have antiviral, antioxidant, cardiovascular protective, and anticancer effects. Volume-regulated anion channels (VRACs), which are essential for cell volume regulation, have been proposed to play a key role in cell proliferation and migration, apoptosis, transepithelial transport, and cancer development. In this study, we screened a group of 53 structurally related natural flavonoids and three synthetic flavonoids for their inhibitory activities on VRAC currents. A whole-cell patch technique was used to record VRAC currents in the human embryonic kidney (HEK) 293 and human umbilical vein endothelial (HUVEC) cells. The 5'-bromo-2-deoxyuridine (BrdU) assay technique was used to investigate cell proliferation. At 100 μM, 34 of 53 compounds significantly inhibited hypotonic extrasolution-induced VRAC currents by > 50% in HEK293 cells. Among these compounds, luteolin, baicalein, eupatorin, galangin, quercetin, fisetin, karanjin, Dh-morin, genistein, irisolidone, and prunetin exhibited the highest efficacy for VRAC blockade (the mean inhibition > 80%) with IC₅₀s of 5-13 μM and E_maxs of about 87-99%. We also studied the effects of three synthetic flavonoids on VRAC currents in HEK293 cells. Flavoxate showed high inhibition efficacy toward VRAC currents (IC₅₀ = 2.3 ± 0.3 μM; E_max = 91.8% ± 2.7%). Finally, these flavonoids inhibited endogenous VRAC currents and cell proliferation in endothelial cells. This study demonstrates that natural and synthetic flavonoids are potent VRAC current inhibitors, and VRAC inhibition by flavonoids might be responsible for their anti-angiogenic effects.

Prognostic value of EGFR family expression in lymph node-negative esophageal squamous cell carcinoma patients

The human epidermal growth factor receptor (EGFR) family has been widely studied in cancer, however, the prognostic role of EGFR family expression in lymph node-negative esophageal squamous cell carcinoma (ESCC) patients have not been invalidated. This study was designed to determine the prognostic value of EGFR family expression in a population of lymph node-negative ESCC patients treated with curative resection. EGFR family protein expression was examined by immunohistochemical analysis of tissue microarrays of 94 patients with lymph node-negative ESCC after radical esophagectomy with three-field lymphadenectomy. Survival differences were compared using Kaplan-Meier analysis. Cox regression analyses were performed to determine the prognostic factors for overall survival and disease-free survival (DFS). ErbB4 expression was found to be an independent prognostic factor for DFS in patients without lymph node metastasis; increased ErbB4 expression was associated with decreased DFS. Additionally, patients with high ErbB4 expression tended to have worse overall survival. EGFR, ErbB2 and ErbB3 expression were not significantly associated with survival in lymph node-negative ESCC patients. Increased ErbB4 immunohistochemical expression was associated with poor prognosis in lymph node-negative ESCC patients.

Inhibition of myocardial hypertrophy by magnesium isoglycyrrhizinate through the TLR4/NF-κB signaling pathway in mice

Magnesium isoglycyrrhizinate (MgIG) is a magnesium salt of the 18-α glycyrrhizic acid stereoisomer that has exhibited hepato-protective effects and has anti-inflammatory, antioxidant, and antiviral activities. Here, we have investigated the effects and potential mechanisms of action of MgIG, with respect to myocardial fibrosis induced by isoproterenol (ISO) in mice. Mice were administered MgIG for 14days, with concurrent ISO dosing, and were sacrificed two weeks later. Lactate dehydrogenase (LDH) and creatine kinase (CK) concentrations were measured in the blood. Pathological changes in the myocardium were observed via light microscopy. In addition, the expression of the Bax and Bcl-2 genes, and the basic fibroblast growth factor (bFGF) protein were measured via an immunohistochemical method. The RNA expression of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), c-fos, and c-jun mRNA were quantified by reverse transcription-polymerase chain reaction (RT-PCR) in the myocardial tissue. The protein expression of toll-like receptor (TLR) 4, and nuclear factor kappa B (NF-κB) (p65) were measured using Western blot assays. Compared with the control group, the ISO group showed significant increases in bFGF, Bax, Bcl-2, TLR4, and NF-κB (p65) expressions, as well as increased serum levels of LDH and CK. MgIG had a protective effect on ISO-induced myocardial fibrosis, which might be ascribed, at least in part, to the inhibition of the TLR4/NF-κB (p65) signaling pathway.

Is a clinical target volume (CTV) necessary for locally advanced non-small cell lung cancer treated with intensity-modulated radiotherapy? -a dosimetric evaluation of three different treatment plans

Background

The aim of this study was to determine the feasibility of omitting the clinical target volume (CTV) in patients with locally advanced non-small cell lung cancer (NSCLC) treated with intensity-modulated radiotherapy (IMRT) by comparing dosimetric characteristics of three different IMRT plans with or without CTV implementation.

Methods

Thirteen patients with stage III NSCLC were reviewed. Target volumes were contoured such that the planning target volume (PTV) derived from the gross tumor volume (GTV) directly was named PTV_g and that from GTV plus CTV margin was named PTV_c. The PTV margin to generate PTV_g or PTV_c was the same within each case. Three IMRT plans were retrospectively generated to deliver: (I) 60 Gy to PTV_g in plan_routine; (II) 60 Gy to PTV_c in plan_CTV, and (III) 50 Gy to PTV_c while the dose was simultaneously escalated to 60 Gy to PTV_g in plan_SIB, achieved using the simultaneous integrated boost (SIB) technique. Optimization was performed to minimize the dose volumes of the irradiated normal lung, heart, esophagus, and spinal cord. Dose distributions and dosimetric indexes for the target volumes and critical structures in the three plans were computed and compared.

Results

In plan_routine, the 50-Gy isodose line covered at least 95% of the GTV plus CTV margins in all 13 patients. The statistics showed better sparing of the organs at risk (OAR) in plan_routine than in plan_CTV, and the best OAR sparing in plan_SIB.

Conclusions

In patients with locally advanced lung cancer, IMRT planning without CTV implementation provides sufficient dose coverage of subclinical disease while reducing the dose to normal tissues. The omission of CTV was feasible in our cohort of patients. However, when CTV was implemented, IMRT planning that included the SIB technique had further dosimetric benefits to the patients. This strategy thus merits further evaluation in clinical trials.

Magnesium isoglycyrrhizinate ameliorates doxorubicin-induced acute cardiac and hepatic toxicity via anti-oxidant and anti-apoptotic mechanisms in mice

The present study investigated the effects and potential mechanisms of action of magnesium isoglycyrrhizinate (MgIG) in doxorubicin (DOX)-treated mice. Histopathological analysis and western blot analysis were conducted in the liver and heart tissues and biochemical analysis of the serum was performed. The results revealed that MgIG (10, 20 and 40 mg/kg/day) could protect the structure and functions of the liver and heart by inhibiting the activities of the myocardial enzymes creatine kinase (CK), CK-MB and lactate dehydrogenase and the hepatic-specific enzymes aspirate aminotransferase and alanine aminotransferase, increasing the activities of the antioxidants superoxide dismutase and glutathione peroxidase, and inhibiting cellular apoptosis induced by DOX (30 mg/kg). These results demonstrate that inhibiting lipid peroxidation and reducing myocardial and hepatocyte apoptosis may be one of the mechanisms by which MgIG exhibits hepatoprotective and cardioprotective effects in DOX-treated mice.

A nomogram based on phosphorylated AKT1 for predicting locoregional recurrence in patients with oesophageal squamous cell carcinoma

Background: The AKT signalling pathway controls survival and growth in many malignant tumours. However, the prognostic value of phosphorylated AKT1 (p-AKT1) for locoregional-progression free survival (LPFS) in oesophageal squamous cell carcinoma (ESCC) has not been established. Our aim was to develop a nomogram to predict local recurrence using p-AKT1 and main clinical characteristics in patients with thoracic ESCC undergoing radical three-field lymph node dissection.

Methods: Immunohistochemistry was performed to examine p-AKT1 expression in 181 thoracic ESCC patients. The Kaplan-Meier method was used to calculate LPFS. Cox regression analysis was also performed to evaluate prognostic factors. A nomogram comprising biological and clinical factors was established to predict LPFS.

Results: The 5-year LPFS rate was 63.9%. Multivariate analysis revealed that expression of p-AKT1 (p<0.001), pathologic N category (p=0.004) and number of lymph nodes retrieved (p=0.001) were independent prognostic factors for LPFS. Increased expression of p-AKT1 was associated with decreased LPFS in patients with ESCC. In addition, a nomogram was established based on all significant independent factors for locoregional recurrence risk. Harrell's c-index for predicting LPFS was 0.78.

Conclusion: Activation of AKT1 was associated with poor locoregional control in ESCC patients. The nomogram, based on p-AKT1 expression and clinically significant parameters, could be used as an accurate stratification model for predicting locoregional recurrence in patients with ESCC after radical resection.

Bufalin, a bufanolide steroid from the parotoid glands of the Chinese toad, suppresses hERG K+ currents expressed in HEK293 cells

In this study, we investigated the effect of bufalin on the human ether-à-go-go-related gene (hERG) K⁺ channels using the perforated patch recording technique. We measured a half-maximal inhibitory concentration (IC₅₀ ) of 24.83 μM and maximal inhibitory effect of 39.45 ± 1.14% with bufalin. These findings suggest that bufalin is a potent hERG K⁺ channel blocker and may provide a new way for understanding Chan Su-induced arrhythmia.

Biomarkers used in studying air pollution exposure during pregnancy and perinatal outcomes: a review

PURPOSE

This review focuses on studies among pregnant women that used biomarkers to assess air pollution exposure, or to understand the mechanisms by which it affects perinatal outcomes.

METHODS

We searched PubMed and Google scholar databases to find articles.

RESULTS AND CONCLUSIONS

We found 29 articles, mostly consisting of cohort studies. Interpolation models were most frequently used to assess exposure. The most consistent positive association was between polycyclic aromatic hydrocarbon (PAH) exposure during entire pregnancy and cord blood PAH DNA adducts. Exposure to particulate matter (PM) and nitrogen dioxide (NO₂) showed consistent inverse associations with mitochondrial DNA (mtDNA) content, particularly in the third trimester of pregnancy. No single pollutant showed strong associations with all the biomarkers included in this review. C-reactive proteins (CRPs) and oxidative stress markers increased, whereas telomere length decreased with increasing air pollution exposure. Placental global DNA methylation and mtDNA methylation showed contrasting results with air pollution exposure, the mechanism behind which is unclear. Most studies except those on PAH DNA adducts and mtDNA content provided insufficient evidence for characterizing a critical exposure window. Further research using biomarkers is warranted to understand the relationship between air pollution and perinatal outcomes.

Protective effects of tannic acid on pressure overload-induced cardiac hypertrophy and underlying mechanisms in rats

Objectives

The aim of this study was to examine the cardioprotective effects and latent mechanism of tannic acid (TA) on cardiac hypertrophy.

Methods

Abdominal aortic banding (AAB) was used to induce pressure overload-induced cardiac hypertrophy in male Wistar rats, sham-operated rats served as controls. AAB rats were treated with TA (20 and 40 mg/kg) or captoril.

Key findings

Abdominal aortic banding rats that received TA showed ameliorated pathological changes in cardiac morphology and coefficients, decreased cardiac hypertrophy and apoptosis, a reduction in over expressions of angiotensin type 1 receptor (AT1R), angiotensin type 2 receptor (AT2R), phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2) and transforming growth factor-β (TGF-β) mRNA, and modified expression of matrix metal proteinase-9 (MMP-9) mRNA in AAB rat hearts. Furthermore, TA treatment contributed to a decrease in malondialdehyde (MDA) and endothelin-1 (ET-1) activities and content, while it caused an increase in superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), nitric oxide (NO) and endothelial NO synthase (e-NOS). Furthermore, TA downregulated expression of tumour necrosis factor-α (TNF-α), interleukin-1β (IL-1β), bax, caspase-3 and upregulated expression of bcl-2.

Conclusions

Tannic acid displayed obvious suppression of AAB-induced cardiac hypertrophy in rats. The cardioprotective effects of TA may be attributed to multitargeted inhibition of oxidative stress, inflammation, fibrosis and apoptosis in addition to an increase in NO levels, decrease in ET-1 levels, and downregulation of angiotensin receptors and the phosphorylation of ERK1/2.

Radiographic features of metastatic brain tumors from non-small cell lung cancer with ALK rearrangement

e20533

Background: Approximately 5% of Non-Small Cell Lung Cancer (NSCLCs) have ALK rearrangement, in which brain metastases are common. The radiographic features of metastatic brain tumors have not been previously studied. Finding the features of brain metastasis could help establishing the treatment pattern for the ALK-rearranged NSCLC patients. Methods: All NSCLC patients with ALK rearrangement (132 patients) were detected from March 2008 through December 2016. The metastatic brain tumors (34 patients) detected from July 2014 through December 2016 were divided into metachronous brain metastasis (MBM) and synchronous brain metastasis (SBM) groups according to the diagnosis time. All patients were followed up using brain magnetic resonance imaging (MRI). The number of brain tumors, size of the largest brain tumors, and size of peritumoral brain edema were compared between the two groups. Results: Thirty-four patients were observed.The number of brain tumors in ALK-rearranged NSCLC patients is 4.6 with 41.07mm Peritumoral Brain Edema Size (PBES). Only one patient has the military brain metastases. All patients were divided into two groups: metachronous (15 patients) and synchronous (19 patients). The two groups had rare active and former smoker. The SBM group had more female patients. The SBM group had larger number of brain tumors (6.1 VS 2.8), but there was no significant difference ( P= 0.0672). The MBM group had smaller brain tumors (14.2mm vs 20.9mm, P= 0.0798) with smaller PBES (25.7mm vs 53.2mm, P= 0.0018) and Peritumoral Brain Edema Index (PBEI) (0.9 vs 1.9, P= 0.0201) than the SBM group. Conclusions: Only one patient in SBM group has the military brain metastases. The SBM group has larger brain tumors with larger peritumoral brain edema and PBEI. The MBM patients have smaller ones. Our studies show that ALK-rearranged NSCLC patients have a small number brain tumors and relatively large PBES.

Effects of salvianolic acid B on L-type calcium channels and myocardial contractility in isolated rat ventricular myocytes and hERG K+ channels expressed in HEK293 cells

Salvianolic acid B (Sal B), one of the chief water-soluble constituents in Radix Salviae Milthiorrhizae, has often been reported to possess considerable cardiovascular regulatory effects. However, the underlying biochemical and cellular mechanisms of its cardioprotection remain unclear. This study was designed to evaluate the role of Sal B regulation in L-type Ca²⁺ channel currents (I_Ca,L) and cell contractility in rat cardiomyocytes and hERG K⁺ channels expressed in HEK293 cells with the patch-clamp and Ca²⁺ imaging techniques to clarify its underlying cardioprotective mechanisms. Exposure to Sal B blocked I_Ca,L with IC₅₀ of 2.07 × 10^-5 M, shifted the curves of current and voltage upwards, shifted the curves of activation and inactivation to the left, and significantly inhibited the amplitude of the cell shortening, but the regulatory effects of Sal B on the expressed rapidly activating delayed rectifier potassium current (I_Kr) did not reach a significant level. These results indicate that the cardioprotective mechanisms of Sal B may be related to the attenuation of calcium overload by directly inhibiting I_Ca,L and consequently decreasing myocardial contractility without causing drug-induced long QT syndrome (LQTS).

Paeoniflorin suppresses lipid accumulation and alleviates insulin resistance by regulating the Rho kinase/IRS-1 pathway in palmitate-induced HepG2Cells

In this study, we evaluated the effects of paeoniflorin (PF) on palmitate (PA)-induced insulin resistance and explored the potential molecular mechanisms in HepG2 cells. HepG2 cells were pre-treated with 3μM, 30μM, or 100μM PF for 1h followed by immediate stimulation with 0.25mM palmitate for 24h to induce hepatic steatosis. PF treatment could decrease PA-induced intracellular lipid deposition via inhibiting de novo lipid synthesis. PF treatment also restored insulin sensitivity by suppressing the activation of Rho kinase (ROCK) and the expression of serine phosphorylation of insulin receptor substrate (IRS)-1, thereby promoting Akt and glycogen synthase kinase (GSK)-3β phosphorylation. These results suggest that PF alleviates PA-induced hepatic steatosis and insulin resistance in HepG2 cells. Furthermore, the effect of PF may be associated with its role in inhibiting de novo lipid synthesis and in regulating the ROCK/IRS/Akt signalling pathways.

[Efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model]

Objective: To explore the efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model. Methods: This study was a prospective randomized controlled study, 80 patients from Beijing Electrical Power Hospital and Beijing Jingmei Group General Hospital with acute coronary syndrome were included from June to December 2015 and divided into 2 groups. Patients in rehabilitation group (n=52) received tertiary hospital(Peiking University Peoples' Hospital) guided and community-driven family self-help cardiac rehabilitation for 3 months, and patients in control group (n=28) received routine secondary treatment for 3 months. Following parameters including 6 minutes walk distance, score of life quality (evaluated by Short Form-12), score of anxiety (evaluated by Generalized Anxiety Disorder-7), score of depression (evaluated by Perceived Health Questionnaire-9), self-management competency (evaluated by questionnaire) were collected at baseline and after treatment for 3 months. Results: Compared with control group, 6 minutes walk distance was longer in rehabilitation group((60.2±6.8) meters vs. (24.9±10.5)meters, P<0.01). The difference values between after and before intervention of life quality scores((0.14±3.90)scores vs.(-7.44±5.85)scores, P>0.05), anxiety scores((-0.16±2.12 ) scores vs.(0.70±1.13)scores, P>0.05) and depression scores((-1.17±2.79) scores vs.(0.60±0.36)scores, P>0.05) were similar between the 2 groups. The amplification of patients with regular exercise (50.26% vs. 0, P<0.05), limit sugary foods usually and always (53.22% vs. 3.98%, P<0.05), eat 200-400 g fruits usually and always (78.61 % vs. 0, P<0.05), eat 300-500 g vegetables usually and always (9.74% vs. 0, P<0.05), and answering very confident to questions such as let the physicians know about your diseases (40.17% vs. 5.00%, P<0.05), know how to take medicines (44.52% vs. 5.00%, P<0.05), know how much exercise was right for yourself (26.43% vs.0, P<0.05) were significantly higher in rehabilitation group than in control group. There were no cardiac rehabilitation training related cardiovascular events. Conclusion: Tertiary hospital guided and community-driven family self-help cardiac rehabilitation model is an effective and safe management model of cardiovascular disease in chronic phase, and it is necessary to further expand the study population to verify the efficacy of this model.

Beneficial effects of paeoniflorin on non-alcoholic fatty liver disease induced by high-fat diet in rats

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent form of chronic liver diseases. This study sought to evaluate the insulin-sensitizing effect of paeoniflorin (PF) on high-fat diet-induced NAFLD and possible molecular mechanisms. Male Sprague Dawley rats were fed a high-fat diet (HFD) for 10 weeks to establish the NAFLD model, and PF (20 mg/kg/d) was gavaged to the NAFLD rats for another four weeks. Our results demonstrated that HFD resulted in hepatocellular ballooning, micro-/macrovesicular steatosis, and oxidative stress in the liver, accompanied by increased serum total cholesterol (TC), triglyceride (TG), free fatty acid (FFA), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels and homeostasis model of insulin resistance (HOMA-IR) index. PF treatment improved the biochemical and histopathological changes in NAFLD rats. Moreover, we also found that PF could inhibit lipid ectopic deposition via regulating lipid metabolism (inhibiting lipid synthesis of cholesterol and de novo pathway), and exert insulin sensitizing effect by regulating the insulin signaling pathway IRS/Akt/GSK3β and anti-oxidation. The study findings suggest that PF has therapeutic potential against NAFLD and that it acts through multiple signaling pathways.

Abstract P5-08-27: Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry

Introduction In 2010, the cutoff for HR positivity in breast cancer was established as ≥1% of cells staining HR+, previously having varied from 1% to 10%. The impact of this change on treatment patterns and outcomes is poorly understood. SystHERs is a prospective, observational cohort registry of patients (pts) with HER2+ metastatic breast cancer (MBC) that commenced enrollment in 2012. To our knowledge, SystHERs is the largest registry to collect and analyze data for the HER2+ subgroup. We report baseline characteristics, treatment patterns, and early outcomes by %HR+ (1–9% vs 10–100%).

Methods SystHERs enrolled pts aged ≥18 years and within 6 months of HER2+ MBC diagnosis. For pts with locally-determined HR+ disease, defined as HR+ in primary or metastatic tissue, %HR+ is the highest percentage of ER+ or PR+ tissue in early breast cancer or MBC. The percentage of ER+ or PR+ cells was not reported for pts considered HR– by the investigator. Median overall survival (OS; Kaplan–Meier) and hazard ratios (Cox regression) were estimated.

Results As of Feb 1, 2016, data were available for 872 eligible pts with known HR status, of whom 608 (70%) had HR+ disease. Of the 608 pts, 53 (9%) had 1–9%HR+ and 496 (82%) had 10–100%HR+; %HR+ was not reported for 59 pts. Baseline characteristics were similar between %HR+ subgroups (Table 1).

As shown in Table 2, the 1–9%HR+ subgroup was less likely to receive first-line hormonal therapy (26%) than the 10–100%HR+ subgroup (56%). 87% and 79% of pts received chemotherapy, respectively.

Median time from MBC diagnosis was 16.5 months (range, 0.4–49.4 months). Median OS was not reached at the data cutoff. The number of deaths was 13 (25%) in the 1–9%HR+ subgroup, and 68 (14%) in the 10–100%HR+ subgroup (log-rank P=0.025). The OS hazard ratio (0.514, 95% CI 0.283–0.931) favored the 10–100%HR+ subgroup. OS did not differ significantly between pts with 1–9%HR+ vs HR– disease (log-rank P=0.582, hazard ratio 1.185, 95% CI 0.647–2.169).

Table 1. Baseline characteristics 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)Age at MBC diagnosis, median yrs (range)54 (30–86)57 (21–86)55 (28–88)Race, %   White838372Black151320Premenopausal, %282522ECOG performance status, %   04654441463942≥2878MBC diagnosis type, %   De novo404958Recurrent605142Visceral, %*686275*Non-hepatic abdominal, ascites, CNS, liver, lung, or pleural effusion sites of metastasis

Table 2. First-line treatment 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)HER2-targeted therapy, %969391Chemotherapy, %877989Hormonal therapy, %26564

Conclusions These preliminary observational data suggest potential differences in treatment patterns and survival outcomes in low vs moderate/high HR+ expressers, with the former being less likely to receive hormonal therapy (26% vs 56%). Furthermore, low HR positivity was associated with poorer OS and was similar to OS observed in pts with HR– disease.

Citation Format: Jahanzeb M, Tripathy D, Rugo H, Swain S, Kaufman PA, Mayer M, Hurvitz S, O'Shaughnessy J, Mason G, Yardley DA, Brufsky A, Chu L, Antao V, Beattie M, Yoo B, Cobleigh M. Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-27.

Abstract P5-08-24: How do real-world treatment patterns compare to guideline recommendations for first-line metastatic breast cancer patients in US community clinics?

Background:

Treatment (txt) guidelines are based on trial data from a small minority of patients (pts). Linked electronic health records (EHRs) are a novel approach to examine txt patterns and outcomes in larger and more generalizable populations. Given the increasing importance of real world data and real world outcomes, we utilized linked EHRs from a network of US community clinics to examine how real world txt patterns compare to metastatic breast cancer (mBC) txt guideline recommendations.

Methods:

The Flatiron database provides real world clinical data collected from EHRs used by US cancer care providers. The Flatiron network comprises ~15% of US cancer pts and is geographically and demographically diverse.

Using EHR from Jan 2016 mBC database, we evaluated first-line (1L) txt patterns in mBC by molecular subtype. Pts were selected if they received mBC txt within 60 days of mBC diagnosis between 01Jan2011-31Dec2015, had ≥2 visits within the Flatiron Network on or after 01Jan2013, and were ≥18 years (yrs). Analyses were conducted to describe pt and clinical characteristics and 1L txt by HER2 and/or hormone receptor (HR) status.

Results:

Among 2509 mBC pts identified, 58.9% were HR+/HER2-, 17.7% HER2+, 11.6% HR-/HER2- (triple negative, TNBC), 7.4% HER2 equivocal, and 4.3% 'not done/unknown HER2 status'. Txt patterns in the latter two groups were not analyzed. Selected pt and disease characteristics by subtype are shown in Table 1. Median follow-up since mBC diagnosis was 1.1 yrs (range 0-5 yrs). The 1L mBC txts by subtype are shown in Table 2. Pts with HR+/HER2- subtype were treated primarily with hormonal therapy (68%) and/or chemotherapy (chemo) (35%). Among HER2+ pts, the 1L mBC txt patterns include trastuzumab+pertuzumab with chemo (31%), trastuzumab with chemo (22%), trastuzumab with hormonal therapy (9%), ado-trastuzumab (4%), lapatinib with chemo (3%), and lapatinib with hormonal therapy (1%). For TNBC, the majority received chemo (95%), such as paclitaxel (21%), nab-paclitaxel (13%) and docetaxel (12%).

Conclusion:

This study advances our current understanding of real world 1L patterns of care by molecular subtype among mBC pts and how these compare to guideline recommendations. While the majority of pts are receiving therapy per guidelines, up to 22% of HER2+ of pts are not receiving targeted therapy in 1L mBC

Table 1. Patient and disease characteristics by subtypeN (%)HR+/HER2- (N=1479)HER2+ (N=445)TNBC (N=291)Age at mBC diagnosis (yrs), median (range)66 (24-85)60 (27-85)60 (33-85)Sex   Female1459 (99)441 (99)289 (99)Race   White995 (67)274 (62)168 (58)Black112 (8)44 (10)42 (14)Asian19 (1)14 (3)5 (2)Other179 (12)50 (11)36 (12)Missing173 (12)63 (14)40 (14)MBC type   De novo418 (28)172 (39)94 (32)Recurrent881 (60)225 (51)178 (61)Unknown180 (12)48 (11)19 (7)HR Status   Positive1479 (100)300 (67)--Negative--145 (33)291 (100)

Table 2. 1L mBC treatments by subtypeN (%)HR+/HER2- (N=1479)HER2+ (N=445)TNBC (N=291)Any Targeted Therapy*77 (5)346 (78)12 (4)Any Chemotherapy521 (35)283 (64)276 (95)Any Hormonal Therapy1010 (68)115 (26)16 (6)*Targeted therapy includes trastuzumab, pertuzumab, ado-trastuzumab emtansine, lapatinib and bevacizumab

Citation Format: Chu L, Yoo B, Carrigan G, Lai C, Beattie M, Reyes C. How do real-world treatment patterns compare to guideline recommendations for first-line metastatic breast cancer patients in US community clinics? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-24.

[Clinical analysis of 24 cases of aortic dissection during pregnancy]

Objective: To investigate the management and perinatal outcome of aortic dissection during pregnancy. Methods: 24 pregnant women with aortic dissection who delivered in Beijing Anzhen Hospital Affiliated to Capital Medical University from January 1st, 2006 to February 29th, 2016 were recruited. The clinical data, the management and the perinatal outcome were analyzed retrospectively. Results: (1) Clinical features: The average age of the patients was (29±4) years old. The clinical symptoms occurred from 5 gestational weeks to 1 month after delivery. The major symptoms were chest pain, and some complained migratory or radiating pains. There were 17 Stanford type A cases and 7 type B cases. The aortic widths were 2.9-10.0 cm, with the average of (5.6±1.7) cm. D-dimer level was 448-6 421 μg/L, with the average of (1 097±1 209) μg/L, and the fibrin degradation products were 4.1-52.1 mg/L, with the average of (10.2±9.5) mg/L.The white blood cell ranged (6.8-36.4)×10(9)/L, with the average of (29.4±4.2)×10(9)/L; and the neutrophil rate was 76.0%-97.6%, with the average of (84.6±6.3) %. (2) The treatment: ①19 patients underwent aorta surgeries. The surgeries included aortic root replacement with total aortic arch replacement plus stented elephant trunk implantation (Bentall+Sun's surgery), aortic root replacement (Bentall surgery), stent implantation, thoracic and abdominal aorta replacement. The aortic operation time of the 19 patients were 5 gestational weeks to 1 month after delivery. The relation between aortic operation and the termination of pregnancy: 4 patients underwent aorta surgery after termination of pregnancy, 9 patients had cesarean section and aorta surgery at the same time, 6 patients underwent aorta surgery before cesarean section. ② 5 patients did not receive arota surgery, 2 patients of type A dissection and 1 patient of type B dissection died before the surgery; 2 cases of type B dissection underwent conservative treatment. The termination time of pregnancy was 6-37 gestational weeks, with the average of (26±10) weeks. (3)Maternal and fetal outcomes: 20 patients survived after treatment (83%, 20/24) and 4 patients died (17%, 4/24). 10 cases were live births, including 4 full-term infants and 6 preterm premature infants. The birth weight of the neonates was 1 080-3 800 g, with the average of (2 302±764) g. Three of them were very low birth weight infants and 1 was low birth weight infant; 3 neonates had mild asphyxia. The neonates were followed up for 0.5 to 10 years, with the average time of (1.4±1.7) years. So far the infants' development was good. Conclusions: Pregnancy with aortic dissection is pernicious. Early identification, prompt diagnosis and prompt interventing of the vascular surgery are necessary to the safety of mother and fetus.