Measurement of |V(cb)| and the form-factor slope in B --> Dl- nu(l) decays in events tagged by a fully reconstructed B meson

We present a measurement of the Cabibbo-Kobayashi-Maskawa matrix element |V(cb)| and the form-factor slope rho2 in B --> Dl- nu(l) decays based on 460x10(6) BB events recorded at the Upsilon(4S) resonance with the BABAR detector. B --> Dl- nu(l) decays are selected in events in which a hadronic decay of the second B meson is fully reconstructed. We measure B(B- --> D0 l- nu(l))/B(B- --> Xl- nu(l)) = (0.255+/-0.009+/-0.009) and B(B0 --> D+ l- nu(l))/B(B0 --> Xl- nu(l)) = (0.230+/-0.011+/-0.011), along with the differential decay distribution in B --> Dl- nu(l) decays. We then determine G(1)|V(cb)| = (42.3+/-1.9+/-1.4)x10(-3) and rho2 = 1.20+/-0.09+/-0.04, where G(1) is the hadronic form factor at the point of zero recoil.

Severity of CIND and MCI predict incidence of dementia in an ischemic stroke cohort

BACKGROUND

The utility of poststroke cognitive status, namely dementia, cognitive impairment no dementia (CIND), mild cognitive impairment (MCI), and no cognitive impairment (NCI), in predicting dementia has been previously examined. However, no studies to date have compared the ability of subtypes of MCI and CIND to predict dementia in a poststroke population.

METHODS

A cohort of ischemic stroke patients underwent neuropsychological assessment annually for up to 5 years. Dementia was defined using the DSM-IV criteria. Univariate and multivariable Cox proportional regression was performed to determine the ability of MCI subtypes, CIND severity, and individual domains of impairment to predict dementia.

RESULTS

A total of 362 patients without dementia were followed up for a mean of 3.4 years (17% drop out), with 24 developing incident dementia. Older age, previous and recurrent stroke, and CIND and MCI subtypes were significant predictors of dementia. In multivariable analysis controlling for treatment allocation, patients who were older, had previous or recurrent stroke, and had either CIND moderate or multiple domain MCI with amnestic component were at elevated risk for dementia. In multivariable domain analysis, recurrent strokes, age, and previous strokes, verbal memory, and visual memory were significant predictors of dementia. Receiver operating characteristic curve analysis showed that CIND moderate (area under the curve: 0.893) and multiple domain MCI with amnestic component (area under the curve: 0.832) were significant predictors of conversion to dementia. All other classifications of cognitive impairment had areas under the curve less than 0.7.

CONCLUSION

Stroke patients with cognitive impairment no dementia (CIND) moderate are at higher risk of developing dementia, while CIND mild patients are not at increased risk of developing dementia.

Search for invisible decays of the Upsilon(1S)

We search for invisible decays of the Upsilon(1S) meson using a sample of 91.4 x 10(6) Upsilon(3S) mesons collected at the BABAR/PEP-II B factory. We select events containing the decay Upsilon(3S) --> pi(+)pi(-)Upsilon(1S) and search for evidence of an undetectable Upsilon(1S) decay recoiling against the dipion system. We set an upper limit on the branching fraction B(Upsilon(1S) --> invisible) < 3.0 x 10(-4) at the 90% confidence level.

LRRK2 variant associated with Alzheimer's disease

Overlapping neurodegenerative pathologies (including Alzheimer's disease, AD) have been described in Parkinson's disease (PD) patients with leucine-rich repeat kinase-2 (LRRK2) mutations. We analyzed a LRRK2 PD (R1628P) risk variant in a group of 885 subjects comprising of AD and controls. The frequency of the R1628P allele was higher in AD compared to controls (3.5% vs. 1.6%, OR 2.3, 95 CI 1.2-4.4, p=0.018). In vitro, the mean percentage of apoptosis and cell death observed for the R1628P transfected human cell lines was higher compared to wild type 21.8 ± 1.9, vs. 17.1 ± 1.3, p<0.05, 30.2 ± 2.2 vs. 25.7 ± 1.3, p<0.05). The LRRK2 R1628P variant increases the risk of AD in our population and our in vitro findings suggest that it is a functional variant and predisposes to apoptosis.

Diffusion-Weighted MRI in Predicting the Efficacy of Neoadjuvant Chemotherapy of Breast Cancer

Objective: To approach the apparent diffusion coefficient(ADC) obtained on diffusion weighted imaging (DWI) in predicting the response of breast cancer to neoadjuvant chemotherapy.Methods: 53 locally advanced breast cancer patients participated in this prospective study on neoadjuvant chemotherapy. All patients were treated with weekly neoadjuvant paclitaxel plus carboplatin for 4 cycles. DWI and ADC value were examined before chemotherapy(the first time point), after the first and the forth cycle of chemotherapy(the second and the third time point). Patients were categorized as high responders if their ADC at the second time point were higher by 2 times the standard deviation than the mean pre-chemotherapy ADC, and otherwise the patients were considered as low responders. Logistic regression was conducted to examine the independent factors predictive of clinical complete response(CR) and pathologic complete response(pCR).Results: CR was documented in 13 patients (24.5%); partial response in 36 patients (67.9%); stable disease in 4 patients (7.5%) and no patient had progressive disease. 11 patients(20.8%) have achieved pCR. There was a strong positive correlation between the percentage changes in ADC value at the third time points and the degree of the tumor reduction. A significant increase in ADC value was observed at the second time point compared with the first time point (1.104±0.117×10-3mm2/s, 1.220±0.158×10-3mm2/s, P&lt;0.001), while the decrease of the longest diameter of the tumors measured by physical examination, ultrasound or MRI or the tumor volumn measured by MRI were not (P&gt;0.05). Logistic regression revealed that percentage changes of ADC value at the second time point were significantly associated with CR(P=0.022, hazard ratio[HR] =1.08, 95% confidence interval[CI]: 1.01∼1.16) and pCR(P=0.022, HR =1.11, 95%CI: 1.02∼1.21). The AUC value of the receiver operating characteristic curve were 0.721(95%CI: 0.512∼0.931, P=0.017) and 0.775(95%CI: 0.598∼0.952, P=0.005) in the two diagnostic tests for CR and pCR, and the sensitivity and specificity were 76.9%, 63.6% and 77.5%, 90.5%, respectively. According to categorizing system described above, 10 patients(18.9%) were considered as high responders and 43 patients(81.1%) low responders. 7 patients(70%) of the high responders have achieved clinical CR and pCR while for the low responders there were only 6 patients(14.0%) and 4 patients (9.3%) proven to have CR and pCR. The difference have both reached statistical significance(P=0.001, P&lt;0.001). Logistic regression confirmed that the categorizing system was independently predictive of CR(P=0.006, HR=42.26, 95%CI: 2.86∼624.08) and pCR(P=0.013, HR=25.19, 95%CI: 2.00∼318.91). Taking this categorizing system as a dignostic test, the sensitivity and specificity were 53.8% and 92.5% for CR and 63.6% and 92.9% for pCR, respectively.Conclusions: The change of ADC value obtained on DWI after the first cycle of neoadjuvant chemotherapy occured prior to the morphologic changes of the tumor and at this time ADC value could to some extent predict the efficacy of neoadjuvant chemotherapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4025.

Estrogen Receptor Expression: Possible Predictor of Pathological Complete Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Patients

BackgroundEstrogen receptor(ER) status has been found to correlate inversely to pathologic complete response (pCR) rates of neoadjuvant chemotherapy(NAC) of breast cancer. However, not all ER-positive breast cancer respond equally to NAC. The present study aimed to determine the relationship between different ER expression level with pCR in locally advanced breast cancer(LABC) patients who have received NAC.MethodsA retrospective study of 332 female unilateral LABC patients undergoing NAC was performed. All patients were confirmed as invasive breast cancer before treated with NAC, including VE (vinorelbine, epirubicin), CEF (cyclophosphamide, epirubicin, fluorouracil) and PCb regimen (paclitaxel, carboplatin). All patients underwent radical surgery and pCR was defined as the absence of invasive breast cancer in both breast and axillary lymph nodes. ER status were checked using the established immunohistochemical(IHC) method and defined as negative, weakly positive(1+), medium positive(2+) and strongly positive(3+). Binary logistic regression was performed to determine the independent predictors of pCR.ResultsER negativity, 1+, 2+ and 3+ were found in 156, 108, 37 and 31 patients, of which 42(26.9%), 21(19.4%), 3(8.1%) and 1 patients(3.2%) have achieved pCR. Binary logistic regression showed that different ER expression level(P=0.021) and HER2 status(P=0.007, hazard ratio[HR] =2.557, 95% confidence interval[CI]: 1.297∼5.038) were significantly associated with the pCR rates. pCR was much more likely to occur in patients with ER-negative(P=0.024, HR =13.119, 95% CI: 1.402∼122.774) or ER 1+(P=0.025, HR=12.928, 95% CI: 1.388∼120.390) tumors than those with ER 3+ tumors.ConclusionER weekly positive patients also gain considerable benefit from NAC, which is probably less effective in ER strongly positive patients in terms of pCR.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1104.

Phase II Trial with Gemcitabine, Paclitaxel and Bevacizumab for the First Line Treatment of Metastatic Breast Cancer

Background: Both gemcitabine and paclitaxel in combination, and paclitaxel and bevacizumab in combination, have shown higher response rates and improved time to progression (TTP) over single agent paclitaxel for the first line treatment of metastatic breast cancer. This phase II study was initiated to evaluate the efficacy and tolerability of combination gemcitabine, paclitaxel and bevacizumab as first line treatment for HER2 negative metastatic breast cancer.Methods: Women with HER2 negative metastatic breast cancer who have not received prior chemotherapy for metastatic disease are eligible for the study. The primary end point is time to progression (TTP). Secondary endpoints include duration of response, objective response rate and toxicities. Patients receive gemcitabine 1000 mg/m2 IV on days 1, 8, & 15, paclitaxel 80 mg/m2 IV on days 1, 8, & 15, and bevacizumab 10 mg/kg on days 1 & 15, on an every four week cycle. Patients are evaluated with imaging studies including CT and bone scan at baseline and every 3 months. Response to treatment is evaluated using RECIST methods. Treatment continues until disease progression or unacceptable toxicities and at which point the drug thought to cause the toxicity will be discontinued.Results: As of January 2009, 21 patients with a median age of 54 years (range: 30-76) have been enrolled. Estrogen and progesterone receptor was positive in 16 and 10 patients, respectively and 4 patients were negative for both. Among 17 evaluable patients, the clinical benefit rate (CR+PR+SD ≥ 24 weeks) is 88%. 10 patients have reached the study endpoint with a median TTP of 12 months (mean TTP of 13.3 months). In addition, the combination treatment with bevacizumab has been well tolerated without clinically significant bleeding and with less than 10% of patients experiencing grade 3 peripheral neuropathy, grade 3 hypertension and less than 5% experiencing grade 3 proteinuria. 4 patients experienced a thrombotic event, of which 2 were catheter-related. The primary toxicities were hematological which were expected. 16 patients experienced grade 3/4 hematological toxicities and responded to dose reductions. 9 patients remain on treatment.Discussion: The addition of bevacizumab to combination chemotherapy with gemcitabine and paclitaxel is well tolerated for first line therapy of HER2 negative metastatic breast cancer. Clinical activity has been observed and phase II enrollment is ongoing.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6089.

Lymph Node Transplantation in Breast Reconstruction Using Perforator Flaps

Introduction: For many women undergoing breast reconstruction, the negative impact of upper extremity lymphedema outweighs the benefits of breast reconstruction.Patients with lymphedema present a challenging problem, and typically is not addressed during the reconstruction process. Lymph node dissections have decreased secondary due to the advent of the sentinel node biopsy. However, 7% of patients undergoing sentinel lymph node biopsy develop lymphedema. Previous treatments options have not proved to be highly successful, and include lymphatic massage and lymphaovenous anastomosis. We introduce a combined treatment for breast reconstruction using deep inferior epigastric perforator flap (DIEP) along with lymph node transplantation for lymphedema.Methods: Beginning in 2007, 23 patients have undergone bilateral breast reconstruction using the DIEP along with simultaneous lymph node transplantation. Each patient had demonstrated upper extremity lymphedema by measurements and subjective findings. Of the 23 patients 18 had radiation therapy and five had sentinel node dissection. The lymph node flap was harvested surrounding the superficial circumflex vessels in conjunction with the DIEP. The combined DIEP and lymph nodes were anastomosed to the internal mammary artery. Preparation of the axilla included removal of scar tissue, and fixation of the lymph nodes into the axilla.Results: Each patient had an uncomplicated postoperative course. These patients started to experience resolutions of lymphedema as early as ten days after surgery and continued up to six months. Currently, 15 patients no longer need lymphatic massage nor wear compression garment. One patient had a recurrence of breast cancer. Each patient reported their arm circumference had improved and decreased morbidity associated with lymphedema.Conclusion: Lymph node transplantation is a relatively new and exciting option for the management of lymphedema. Women who undergo breast reconstruction using perforator flaps can have simultaneous lymph node transplantation with minimal morbidity. These patients experienced an overall 89% improvement of symptoms.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3112.

Dose-Dense (dd) Doxorubicin and Cyclophosphamide (AC) Followed by Weekly Paclitaxel (P) with Trastuzumab (T) and Lapatinib (L) in Early Breast Cancer (EBC); Troponin I and C-Reactive Protein as Biomarkers of Cardiotoxicity

BackgroundThe early detection of cardiotoxicity and congestive heart failure (CHF) from anthracyclines and anti-HER2 agents is currently limited to measuring changes in left ventricular ejection fraction (LVEF) at arbitrary time points. This approach has limited sensitivity and specificity and has led to the investigation of putative biomarkers such as cardiac Troponin I (TnI), a highly specific marker of myocardial damage and C-reactive protein (CRP), a sensitive inflammatory marker. In a pre-planned analysis we investigated these as biomarkers of cardiotoxicity within a prospective study testing the feasibility of ddAC- followed by weekly P with T and L.Materials and MethodsPatients (pts) with HER2+ EBC enrolled at MSKCC and DF/HCC and received ddAC (A 60mg/m2 + C 600mg/m2) x 4 → weekly P (80mg/m2) x 12 + T + L (1000mg/day). T+L continued for a total of 1yr. At baseline pts had LVEF ≥50%. Pts with unstable angina, CHF, recent MI, uncontrolled arrhythmia, grade 3 QT prolongation were excluded. LVEF was assessed by MUGA scan at mths 0, 2, 6, 9 and 18. TnI and CRP were measured every 2 wks right before treatment (Rx) during ddAC-PTL, then at mths 6, 9 and 18. TnI was categorized as “undetectable” (&lt; 0.06 ng/ml; MSKCC, &lt;0.04 ng/ml; DF/HCC), “minimally elevated” (&lt;0.31 ng/ml) and “elevated” (&gt;0.31ng/ml). Elevated CRP was defined as (&gt;0.8mg/dl; MSKCC, &gt;0.3mg/dl; DF/HCC). Investigators were blinded to these results until pts completed 18mth follow-up (F/U).ResultsFrom Apr 07- Apr 08, 95 pts were enrolled; 39/95 (41%) withdrew due to PTL toxicities (incl. 3 with asymptomatic LVEF (aLVEF) declines and 3 with CHF). Final biomarker results were available in 84 pts (88%) and 11 pts (12%) continue on study. During Rx, minimal elevations in TnI occurred in 55 pts (65%). One pt had ↑TnI above normal range with AC#4; MUGA 1 wk later was unchanged (LVEF 75%), but she died from sepsis during subsequent Rx without evidence of CHF. Elevations in TnI occurred only during chemoRx and no pt had a ↑TnI during TL or at 18mth F/U. Of 55pts with elevated TnI, 25 (45%) had aLVEF declines (3 ↓ ≥16%, 10 ↓ 10-15%, 12 ↓ 5&lt;10%). Of 29 pts with undetectable TnI, 7 (24%) had aLVEF declines (1 ↓ ≥16%, 4 ↓ 10-15%, 2↓ 5&lt;10%). Elevations in CRP occurred in 61/84 (73%) pts during chemoRx but only in 22 (26%) during TL or at 18mth F/U. Three pts discontinued Rx for aLVEF ↓ at mths 4, 5 and 7 respectively; 2 (66%) had rises in CRP and 2 had minimal elevation in TnI. Three pts developed CHF at mths 3, 6, and 12 respectively, all had rises in CRP; 1 pt had a single ↑TnI of 0.08 ng/ml during chemoRx, and 2pts had no ↑TnIs.ConclusionsIn pts receiving ddAC-PTL fluctuations in TnI and CRP are common but do not persist after chemoRx (during TL). These biomarkers do not appear to predict for CHF. One possibility is that the timing of the drawing of these biomarkers (immediately preceding the specified treatment cycle and after Rx completion) may have been suboptimal. We plan to assess for potential biomarkers by assessing both immediately preceding and following therapy in a planned trial. Updated results will be presented.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3088.

Sunitinib (SU) in Combination with Trastuzumab (T) for the Treatment of Advanced Breast Cancer (ABC): Activity and Safety Results from a Phase II Study

Background: SU is an oral, multitargeted tyrosine kinase inhibitor of VEGFRs, PDGFRs, KIT, RET, FLT3, and CSF-1R, with single-agent activity in patients (pts) with heavily pretreated ABC (locally recurrent or metastatic breast cancer). T is approved for 2nd-line monotherapy and in combination with taxane-based therapies for 1st-line ABC. The combination of SU + T in HER2+ ABC pts was investigated.Materials and methods: Eligible pts with HER2+ ABC received a starting dose of oral SU 37.5 mg/d (continuous daily dosing [CDD]) and either T administered wkly (iv loading 4 mg/kg then wkly 2 mg/kg) or q3w (loading 8 mg/kg then q3w 6 mg/kg). Due to changing standard of care, the trial was amended to include pts having prior chemotherapy in the 1st-line setting. Previous treatment (tx) with T (± lapatinib) was permitted. The primary endpoint was objective response rate (ORR). Secondary endpoints included safety, progression-free survival (PFS), pharmacokinetics (PK) and quality of life (QoL).Results: As of April 2009, 60 pts were enrolled (6 on the original protocol and 54 under the amendment). Of 54 pts enrolled post-amendment, 6 pts continue on study and 48 have discontinued, 12 due to AEs. Most (n=31; 57%) pts received SU + T as 1st-line tx and 11/31 pts were completely tx-naïve. Pts received a median of 5 cycles (range: 1–16) of SU and 4 cycles (range: 1–15) of T. SU was dose reduced from 37.5 mg/d to 25 mg/d in 39% of pts. All pts were evaluable for safety and 52 pts were evaluable for efficacy. ORR was 34.6% and clinical benefit rate was 48% (2 CR; 16 PR; 7 SD ≥24 wks). Of the 18 responders, 5 pts were completely tx-naïve and 9 pts were 1st-line. Median PFS was 25.3 wks (95% CI, 19.3, 29.1). Most AEs were G1/2. G3 non-hematologic AEs in ≥10% pts were asthenia (17%) and hypertension (11%) and 3 G4 events occurred (LVEF decline, pulmonary embolism, and pancreatitis). Hematologic AEs (G3/4 in ≥10% pts) were neutropenia (22%) and thrombocytopenia (17%). One G5 event (cardiogenic shock) was reported. LVEF decline/LV dysfunction occurred in 21 pts (6 pts had ≥G3 AEs); 18/21 pts (86%) had received prior anthracycline and 12 pts (57%) prior T. There was no significant on-tx change from baseline in the QoL domain. Mean (SD) steady state level for SU was 46.1 (25.9) ng/mL in agreement with prior observations.Conclusions: The combination of SU (37.5 mg/d; CDD schedule) + T (wkly or q3w) showed acceptable tolerability and antitumor activity in HER2+ ABC pts without adversely affecting overall QoL.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 201.

Precise measurement of the e+e- --> pi+pi-(gamma) cross section with the initial state radiation method at BABAR

A precise measurement of the cross section of the process e(+)e(-) --> pi(+)pi(-)(gamma) from threshold to an energy of 3 GeV is obtained with the initial state radiation (ISR) method using 232 fb(-1) of data collected with the BABAR detector at e(+)e(-) center-of-mass energies near 10.6 GeV. The ISR luminosity is determined from a study of the leptonic process e(+)e(-) --> mu(+)mu(-)gamma(gamma). The leading-order hadronic contribution to the muon magnetic anomaly calculated using the pipi cross section measured from threshold to 1.8 GeV is (514.1 +/- 2.2(stat) +/- 3.1(syst)) x 10(-10).

Measurement of B-->K{*}(892)gamma branching fractions and CP and Isospin asymmetries

We present an analysis of the decays B{0}-->K{*0}(892)gamma and B{+}-->K{*+}(892)gamma using a sample of about 383 x 10{6} BB[-over ] events collected with the BABAR detector at the PEP-II asymmetric energy B factory. We measure the branching fractions B(B{0}-->K{*0}gamma)=(4.47+/-0.10+/-0.16) x 10{-5} and B(B{+}-->K{*+}gamma)=(4.22+/-0.14+/-0.16) x 10{-5}. We constrain the direct CP asymmetry to be -0.033<A(B-->K{*}gamma)<0.028 and the isospin asymmetry to be 0.017<Delta{0-} < 0.116, where the limits are determined by the 90% confidence interval and include both the statistical and systematic uncertainties.

Measurement of D{0}-D[-over]{0} mixing from a time-dependent amplitude analysis of D{0}-->K+pi{-}pi{0} decays

We present evidence of D{0}-D[-over ]{0} mixing using a time-dependent amplitude analysis of the decay D{0}-->K+pi{-}pi;{0} in a data sample of 384 fb{-1} collected with the BABAR detector at the PEP-II e+e{-} collider at the Stanford Linear Accelerator Center. Assuming CP conservation, we measure the mixing parameters x{Kpipi{0}}{'}=[2.61{-0.68}{+0.57}(stat)+/-0.39(syst)]%, y{Kpipi;{0}}{'}=[-0.06{-0.64}{+0.55}(stat)+/-0.34(syst)]%. This result is inconsistent with the no-mixing hypothesis with a significance of 3.2 standard deviations. We find no evidence of CP violation in mixing.

Activation of complement in the discordant heart xenotransplantation of pig-to-monkey model and the impact of intrathymic inoculation of xenogeneic antigen combined with whole-body gamma-radiation

OBJECTIVE

This study investigated changes in complement in discordant heart xenotransplantation using a pig-to-monkey model as well as the impact of intrathymic inoculation (IT) with xenogeneic antigen combined with whole-body gamma-radiation (WBI).

METHODS

In this experiment, pigs and monkeys selected as donors and recipients, respectively, were randomly divided into three groups: a blank group (group A), a whole-body irradiation group (group B) and an irradiation plus intrathymic injection group (group C). In every group, monkeys underwent heterotopic heart xenotransplantation.

RESULTS

The results showed that the survival of donor hearts in group C was significantly longer than that of group A (P < .01). In mixed lymphocyte reactions, there was a significant reduction of the stimulation index in group C compared with group A. After xenotransplantation, the level of xenoreactive antibody in group C rose slower than that in group A or group B (P < .01). After rejection, the levels of CD46 and C3 declined greatly.

CONCLUSIONS

These results suggested that pretreatment with IT and WBI induced T-cell immunosuppression, restraining elicited xenoreactive antibody production of both immunoglobulin M and immunoglobulin G classes. However, it did not hinder complement activation via the classical pathway during hyperacute rejection and consequent xenograft rejection.