Biological therapy of cancer

Hormonally-regulated proteins in breast secretions are markers of target organ sensitivity

Anti-oestrogen therapy is being used in an attempt to prevent breast cancer but no intermediate end points of the effect of tamoxifen on the normal breast are available. Therefore, the purpose of this study was to develop a physiological measure of oestrogen action on the breast. We measured oestrogen-stimulated and -inhibited proteins in breast secretions from women on and off anti-oestrogen therapy. Two oestrogen-stimulated proteins (pS2 and cathepsin D) and oestrogen-inhibited proteins (CP15, gross cystic disease fluid protein 15; Apo,: apolipoprotein D) were measured. Premenopausal women had significantly higher pS2 and cathepsin D in association with lower Apo D and CP15 secretion levels compared to post-menopausal women. Sequential nipple aspirates from women treated with the luteinizing hormone releasing hormone agonist goserelin (n = 9), tamoxifen (n = 9) and hormone replacement therapy (HRT) (n = 26) were measured. Following treatment with goserelin, median nipple secretion levels of pS2 fell (P < 0.02) and Apo D and CP15 rose significantly (P < 0.03 and P < 0.05 respectively). Similar changes were seen on tamoxifen therapy but not in untreated control women. Treatment with HRT resulted in a rise of pS2 (P < 0.001) and a fall in Apo D (P < 0.05). Measurement of pS2 and Apo D in nipple aspirates may prove useful intermediate end point of breast responsiveness to anti-oestrogens.

Human breast cancer: concerted role of diet, prolactin and adrenal C19-delta 5-steroids in tumorigenesis

The low incidence of breast cancer in Japan disappears within 2 generations in migrant Japanese in the USA. This is of fundamental importance if we are to understand, and perhaps reverse, the high rate seen in Western countries. Diet is the most likely factor involved, and a review of the topic of diet, body mass index, and gain in adult body mass, supports a relationship between these factors and breast-cancer risk in post-menopausal, but not pre-menopausal, women. A direct link between nutritional factors and secretion of the hormones prolactin and dehydroepiandrosterone sulfate is proposed. An estrogen 5-androstene-3 beta, 17 beta-diol is formed peripherally from the latter steroid, and in Western women attains a blood concentration at which it is biologically active. Thus diet/fat provides factors, viz., fatty acids, prolactin and estrogen, which in concerted fashion provide a milieu conducive to mammary tumorigenesis.

Tumor-targeted delivery of 8-hydroxyquinoline

RIF-1 mouse tumors express high levels of beta-glucuronidase activity relative to most normal tissues. The high activity can be exploited for targeting specific drugs preferentially to tumor tissues. In this study we examined the kinetics of 8-hydroxyquinoline (8-OHQ) accumulation in tumor and in several normal tissues resulting from the in vivo deconjugation of 8-hydroxyquinolyl-glucuronide (8-OHQ-GlcA). Tumors were acidified with D-glucose and NaHCO3 prior to the administration of 8-OHQ-GlcA; subsequently the deconjugated aglycone, 8-OHQ, accumulated preferentially in tumors and reached peak levels between 30 and 60 min after the 8-OHQ-GlcA injection. Mild hyperthermia of 30 min at 43 degrees C to the tumors further increased their peak 8-OHQ levels by a factor of 2-3. Some normal tissues, mostly kidney, liver, and colon, also accumulated 8-OHQ, but the aglycone appeared early in the normal tissues (near 30 min post-injection) and was significantly reduced by 60 min when 8-OHQ remained high in the tumor. Administration of 8-OHQ-GlcA alone, without prior tumor acidification, failed to produce measurable accumulations of 8-OHQ in tumors and in normal tissues. Tissue clearance of 8-OHQ is mediated primarily by the enzymatic reconjugation of 8-OHQ via UDP-glucuronosyltransferase (UDPGT). UDPGT activity was high in liver, kidney, and bowel, but low in the RIF tumor, spleen, muscle, and brain. Hyperthermia had only a modest effects on UDPGT activity: a heat dose of 30 min at 45 degrees C reduced activity less than 60%. Thus, preferential accumulation and prolonged retention of 8-OHQ in RIF tumors may be caused by a combination of factors: a) high tumor beta-glucuronidase activity, b) selective tumor acidification during hyperglycemia, c) low tumor UDPGT activity, and d) other factors, such as tumor blood flow.

Revisions in the risk-based Breast Cancer Screening Program at Group Health Cooperative

To pursue the goal of achieving regular use of mammography in women 40 years of age and older, a risk-based selective approach to screening was implemented at a 400,000-member managed health care system in the Northwest in 1985. This article describes the context for this approach to selective screening and reviews revisions in the algorithm used to determine when and how a woman should be screened. Changes made in 1988 with respect to age criteria, intervals for mammography, and which risk factors to include are discussed. The result of these changes is that 83% of women 40 years of age and older are now eligible for regular mammography compared with 57% under the former system. The total use of mammography in any given year remains unchanged. The results of this analysis have implications for other organizations attempting to promote the use of mammography.

Hormones are ambiguous risk factors for breast cancer

Women with breast cancer whose blood and urinary androgens are at the lower end of the normal range have an early age at diagnosis, a rapid recurrence rate after mastectomy and tumours that are unresponsive to endocrine therapy. The most plausible explanation for these results is that the androgens are not involved in tumour initiation but control tumour growth rates after the malignant transformation has occurred. If this is so, endocrine case/control studies in which growth rates are not measured are an inefficient way of studying the endocrinology of breast cancer. It is suggested that the oestrogens and androgens should be considered as a single functional unit in future research.

Oral contraceptives and breast cancer. A review

Case-control and cohort studies published between 1977 and 1988 were reviewed with the purpose to evaluate the relationship between use of oral contraceptives (OC-use) and breast cancer risk, tumour biology and tumour prognosis with special emphasis on early OC-use. The risk of breast cancer was assessed in 30 case-referent studies and 5 cohort studies, and the prognosis of breast cancer had been studied in 9 reports. Definition of OC-use, prevalence of OC-use, latency time between start of OC-use and tumour diagnosis, case identification and choice of referents, study size, study quality were assessed. The outcome of the studies is presented. From the results of the analyses the author concludes that there is no overall risk for breast cancer among OC-users. However, with the emphasis on early OC-use, consistent results seem to emerge showing an increased risk of premenopausal breast cancer, when the possible bias of different latency times is taken into account. Also results on breast cancer incidence in early exposed age groups, tumour biology and prognosis in early OC-users with breast cancer support a genuine risk relationship. The effects of different OC-brands and dose, and the risk of peri- and postmenopausal breast cancer after early OC-use can at present not be assessed.