Efficacy of dual checkpoint inhibitors in a patient with a mixed hepatocellular cholangiocarcinoma

A woman in her 60s was diagnosed with a metastatic, unresectable rare histological type of liver cancer; combined hepatocellular cholangiocarcinoma. She had palliative chemotherapy, initially with gemcitabine and cisplatin, and then with oxaliplatin, L-folinic acid and fluorouracil. Both treatment strategies demonstrated disease progression, and somatic mutation profiling revealed no actionable mutations. The patient was started on immuno-oncology (IO) with nivolumab and ipilimumab, followed by maintenance nivolumab. She has achieved a sustained ongoing partial response since the start of this therapy for at least 12 months. The outcome in this patient is in keeping with the growing evidence of the role that IO agents have in metastatic biliary tract cancer and also serves to highlight their importance in mixed histology liver tumours.

First-in-human phase I dose escalation trial of the first-in-class tumor microenvironment modulator VT1021 in advanced solid tumors

BACKGROUND

VT1021 is a cyclic peptide that induces the expression of thrombospondin-1 (TSP-1) in myeloid-derived suppressor cells (MDSCs) recruited to the tumor microenvironment (TME). TSP-1 reprograms the TME via binding to CD36 and CD47 to induce tumor and endothelial cell apoptosis as well as immune modulation in the TME.

METHODS

Study VT1021-01 (ClinicalTrials.gov ID NCT03364400) used a modified 3 + 3 design. The primary objective was to determine the recommended Phase 2 dose (RP2D) in patients with advanced solid tumors. Safety, tolerability, and pharmacokinetics (PK) were assessed. Patients were dosed twice weekly intravenously in 9 cohorts (0.5-15.6 mg/kg). Safety was evaluated using CTCAE version 5.0 and the anti-tumor activity was evaluated by RECIST version 1.1.

RESULTS

The RP2D of VT1021 is established at 11.8 mg/kg. VT1021 is well tolerated with no dose-limiting toxicities reported (0/38). The most frequent drug-related adverse events are fatigue (15.8%), nausea (10.5%), and infusion-related reactions (10.5%). Exposure increases proportionally from 0.5 to 8.8 mg/kg. The disease control rate (DCR) is 42.9% with 12 of 28 patients deriving clinical benefit including a partial response (PR) in one thymoma patient (504 days).

CONCLUSIONS

VT1021 is safe and well-tolerated across all doses tested. RP2D has been selected for future clinical studies. PR and SD with tumor shrinkage are observed in multiple patients underscoring the single-agent potential of VT1021. Expansion studies in GBM, pancreatic cancer and other solid tumors at the RP2D have been completed and results will be communicated in a separate report.

A blood-based metabolomic signature predictive of risk for pancreatic cancer

Emerging evidence implicates microbiome involvement in the development of pancreatic cancer (PaCa). Here, we investigate whether increases in circulating microbial-related metabolites associate with PaCa risk by applying metabolomics profiling to 172 sera collected within 5 years prior to PaCa diagnosis and 863 matched non-subject sera from participants in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cohort. We develop a three-marker microbial-related metabolite panel to assess 5-year risk of PaCa. The addition of five non-microbial metabolites further improves 5-year risk prediction of PaCa. The combined metabolite panel complements CA19-9, and individuals with a combined metabolite panel + CA19-9 score in the top 2.5th percentile have absolute 5-year risk estimates of >13%. The risk prediction model based on circulating microbial and non-microbial metabolites provides a potential tool to identify individuals at high risk of PaCa that would benefit from surveillance and/or from potential cancer interception strategies.

Abstract P076: Contribution of the microbiome to a metabolomic signature predictive of risk for pancreatic cancer

Purpose: Emerging evidence implicates the microbiome in the development of pancreatic cancer. We investigated whether increased levels of microbial-related metabolites in circulation are associated with pancreatic cancer risk. Methods: We applied metabolomics profiling to sera from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cohort to quantify and build a model based on 14 microbial-related metabolites. The study involved samples collected from 172 subjects within five years prior to diagnosis and 863 matched controls. Data from five PLCO centers were used for training and from two centers for validation and model selection. The model was subsequently tested using samples from three independent centers. The contributions of non-microbial-associated metabolites as well as CA19-9 was also assessed. Results: A 3-marker microbial-related metabolite panel yielded in the PLCO testing set an AUC of 0.64 (95% CI: 0.53-0.76) for 5-year probability of pancreatic cancer. Five additional non-microbial metabolites were identified that when combined with the microbiome panel yielded an AUC of 0.79 (95% CI: 0.71-0.88) for 5-year probability of pancreatic cancer in the PLCO testing set. The combined metabolite panel and CA19-9 yielded an AUC of 0.86 (95% CI: 0.77-0.95) for 2-year probability of pancreatic cancer in the PLCO testing set, which was improved compared to CA19-9 alone (AUC: 0.70 (95% CI: 0.57-0.82), p< 0.001). Conclusion: We developed a metabolite panel derived in part from the microbiome for risk assessment of pancreatic cancer, which has relevance to prevention and early detection.

Citation Format: Johannes F. Fahrmann, Ehsan Irajizad, Ana Kenney, Tiffany Tang, Jody Vykoukal, Ranran Wu, Jennifer B. Dennison, Marta Sans Escofet, James P. Long, Maureen Loftus, John A. Chabot, Michael D. Kluger, Fay Kastrinos, Lauren Brais, Ana Babic, Kunal Jajoo, Linda S. Lee, Thomas E. Clancy, Kimmie Ng, Andrea Bullock, Jeanine M. Genkinger, Anirban Maitra, Kim-Anh Do, Bin Yu, Brian M. Wolpin, Samir Hanash. Contribution of the microbiome to a metabolomic signature predictive of risk for pancreatic cancer. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P076.

Response in BRCA1 mutation carrier with metastatic pancreatic adenocarcinoma treated with FOLFIRINOX

A woman in her 50s previously treated for early-stage breast cancer, parotid mucoepidermoid carcinoma and Caroli's disease was diagnosed with stage IV pancreatic ductal adenocarcinoma (PDAC) metastatic to the liver and was found to harbour a BRCA1 germline mutation. She had palliative chemotherapy, initially with 5-fluorouracil, leucovorin, irinotecan and oxaliplatin, and then FOLFIRI and capecitabine, achieving a sustained near-complete response for at least 86 months. Chemotherapy was eventually discontinued when she was diagnosed with a tongue squamous cell carcinoma. Despite withholding systemic therapy, she has maintained a durable response. This is the first report in the English literature showing a sustained duration of response in a patient with PDAC and BRCA1 germline mutation.

Is the post-registration foundation programme fit for purpose for community pharmacists? An exploration of pharmacist experiences

Introduction

The two-year, NHS Education for Scotland (NES) post-registration foundation programme supports early career pharmacists in patient-facing sectors of practice. The experiential programme, based on an eight-element competency framework, also includes webinars, online resources, and tutor support. Learners complete an online evidence portfolio and undertake a summative OSCE.

Aim

The aim of this paper is to report the experiences of the community-pharmacist participants, with a focus on the ‘fitness-for-purpose’ of the programme.

Methods

This was a longitudinal mixed-methods study theoretically underpinned by Miller’s triangle and social cognitive theory. Eligible participants were all pharmacists registering for the programme in Scotland in September 2017 and February 2018, all participating Welsh community-pharmacists, and all tutors. Invitation packs were emailed by NES/HEIW staff with names forwarded to researchers following signed consent. Focus groups/interviews (face-to-face or virtual according to participant preference) were undertaken at start, mid-point and exit of programme, to explore expectations (benefits, social gains, professional identify), experiences (challenges, facilitators, meeting of learners’ needs) and barriers. Proceedings were digitally recorded, transcribed verbatim and managed using NVivo. Thematic analysis (1) was based on social cognitive theory (transferable behavioural skills and professional attitudes). An inductive analysis additionally identified emergent themes. Participants in Scotland were invited to complete an on-line base-line questionnaire to describe their self-assessed competence against the NES Foundation framework (personal and professional practice, membership of healthcare team, communication, patient centred approach to practice). Data was analysed in SPSS using descriptive statistics. Themes from qualitative and quantitative data were integrated. IRAS ethical approval was not required; NHS Research & Development approval was given.

Results

96 pharmacists registered for the programme: 18 community-pharmacists in Scotland (11 health boards); 14 community pharmacists in Wales. In Scotland 15 community-pharmacists completed questionnaires: 9 expected an ‘increase in confidence’ and 11 to provide ‘better patient care’. Self-assessed competence against the framework was generally high. Across Scotland and Wales, 12 focus-groups (involving 19 community-pharmacists), 12 community-pharmacist interviews, 10 tutor focus-groups (8 community-pharmacist tutors) and 3 community-pharmacist tutor interviews were conducted.

At midpoint and exit pharmacists and tutors reported increased confidence, the ability to reflect and pride in their achievement. Barriers: included lack of protected time; workload; and lack of support (tutor and employer). There were also programme issues (practicalities of portfolio; workplace-based assessment, no access to medical records); and cultural issues in community-pharmacy (‘speed & safety’; lack of recognition). Reasons for dropping out of the programme included: moved geographical area; too experienced; workload pressures; no incentive; no employer support. Four community-pharmacists in Scotland and none in Wales completed the programme.

Conclusion

Study limitations include the small numbers, programme delivery limited to Scotland and Wales, and limited response rate to focus-groups/interviews, exacerbated by COVID19. Overall community pharmacist expectations were met, and they perceived the programme was fit-for-purpose and worthwhile. However, barriers particularly related to the community pharmacy context, may have led to the high drop-out rate. These findings should be considered as the new UK-wide RPS curriculum for foundation pharmacists (2) is implemented in Scotland, to optimise its successful delivery.

References

(1) Braun, V. and Clarke, V. Using thematic analysis in psychology. Qualitative Research in Psychology. [Internet]. 2006; 3 (2): 77-101. ISSN 1478-0887 Available from: http://eprints.uwe.ac.uk/11735

(2) Post- registration Foundation Programme for Newly Qualified Pharmacists in Scotland [Internet] https://nes.scot.nhs.uk/our-work/post-registration-foundation-programme-for-newly-qualified-pharmacists-in-scotland-autumn-2021-onwards Accessed October 12, 2021.

CTIM-06. CLINICAL EFFICACY AND BIOMARKER ASSESSMENT OF VT1021, A CD36/CD47 DUAL-TARGETING AGENT, IN RECURRENT GLIOBLASTOMA

Glioblastoma (GBM) is the most common and aggressive primary brain malignancy in adults and recurs after treatment in >90% of all patients. Prognosis of patients with recurrent GBM (rGBM) is poor with a median progression free survival of ~1.8 months and median overall survival of 8-10 months. VT1021, a cyclic peptide derived from prosaposin, induces the expression of thrombospondin-1 (TSP-1) in myeloid derived suppressor cells (MDSCs), which are heavily recruited to the tumor microenvironment. Following completion of the Phase 1 Dose Escalation study and determination of the RP2D, an expansion study was conducted in a heavily pretreated rGBM population. The results of the expansion study reveal that VT1021 is safe and well tolerated in rGBM. Pharmacodynamic response to VT1021 was observed by induction of TSP-1 in circulating MDSCs and in the tumor microenvironment. VT1021 demonstrated significant single agent activity. Among 22 evaluable GBM subjects, 3 had complete response (CR), 1 had partial response (PR), and 7 had stable disease (SD) with an average study duration of over 120 days. The overall disease control rate (DCR) was 50%. Among the 3 CR, 2 showed complete radiological regression of the target lesion, the third was found to have no evidence of disease upon pathological examination following surgery. Nine of the 19 (47%) evaluable subjects with available biopsy samples showed high expression levels of both CD36 AND CD47. Among these 9 subjects, 3 achieved CR, representing an overall response rate of 33.3%, with another 3 patients achieving SD for a DCR of 67%. In conclusion, VT1021 demonstrates promising single-agent clinical activity in rGBM, particularly in subjects with high expression levels of CD36 and CD47. Additional clinical studies have been planned to further investigate the efficacy of VT1021 in rGBM and other solid tumor indications.

Treatment burden of robotic gastrectomy for locally advanced gastric cancer (LAGC): a single western experience

Background

This study compares standard of care (SOC) open and robotic D2-gastrectomy for locally advanced gastric cancer (LAGC) in the Western context of low disease prevalence, reduced surgical volume, and neoadjuvant chemotherapy (NAC). We hypothesized that robotic gastrectomy (RG) after NAC reduces treatment burden for LAGC across multiple outcome domains vs. SOC.

Methods

Single institution, interrupted time series comparing SOC (2008–2013) for LAGC (T2–4Nany/TanyN+) vs. NAC + RG (2013–2018). Treatment burden was a composite metric of narcotic consumption, oncologic efficacy, cumulative morbidity, and 90-day resource utilization. Predictors were evaluated via multivariate modeling. Learning curve analysis was done using CUSUM.

Results

After exclusions, 87 subjects with equivalent baseline characteristics, aside from male sex, were treated via SOC (n=55) or NAC + RG (n=32). All four domains of treatment burden were significantly reduced in the NAC + RG cohort compared to SOC (P=0.003). The odds ratio for excess treatment burden in the NAC/RG was 0.23 (95% CI: 0.07–0.72, P=0.0117) vs. SOC upon multivariable modeling, whereas the extent of resection (total/subtotal), tumor size, T-stage, sex, and early learning curve had no effect. Differences in treatment burden persisted in subgroup analysis for NAC (n=51).

Conclusions

NAC + RG was associated with decreased treatment burden relative to SOC for LAGC. Frequencies of unfavorable hospitalization, adverse oncological outcomes, major morbidity, and narcotic consumption all decreased in this interrupted time series.

369 Clinical update of VT1021, a first-in-class CD36 and CD47 targeting immunomodulating agent, in subjects with pancreatic cancer and other solid tumors stratified by novel biomarkers

Background

One barrier to treating pancreatic cancer is the immunosuppressive tumor microenvironment (TME). VT1021 is a cyclic peptide derived from prosaposin and stimulates thrombospondin-1 (Tsp-1) production in myeloid derived suppressor cells. Tsp-1 binds to CD36 on macrophages to convert M2 macrophages to anti-tumorigenic M1 macrophages; on tumor cells to induce apoptosis; and increases the CD8+/Treg ratio. Tsp-1 also binds to CD47 on tumor cells to block the ”do not eat me signal”. In a recently completed phase I/II clinical study (NCT03364400), VT1021 had no major adverse events and a predictable pharmacokinetic profile.

Methods

To evaluate potential predictive biomarkers of VT1021, CD36/CD47 levels were analyzed on pre-treatment biopsy samples and on-study tumor biopsies collected during the treatment using immunohistochemistry (IHC). Samples were stained and scored by software-based image analysis and manual review (figure 1). Induction of Tsp-1 in circulating peripheral blood mononuclear cells (PBMCs) by ELISA was correlated with Tsp-1 induction in on-study biopsy samples via IHC, and with clinical responses. To be considered ”evaluable”, subjects completed ≥1 cycle of VT1021 treatment and tumor imaging during cycle 2.

Results

In the pancreatic cancer expansion study, 21 of 32 enrolled subjects (66%) had dual high (DH) expression of CD36/CD47. There were 5 subjects with stable diseases among 15 evaluable subjects with disease control rate of 33%. Of the 13 subjects with measurable disease, all 5 subjects with reduction of tumor burden were DH CD36/CD47 and remained on study for an average of 105 days. Moreover, paired tumor biopsies revealed increased Tsp-1 expression, CTL infiltration and M1:M2 ratio among subjects that obtained disease control with DH baseline CD36/CD47 expression.To identify other solid tumor indications that could benefit from VT1021 treatment based on CD36/CD47 expression, commercially available tumor tissue microarrays from 16 different indications were evaluated. Several indications demonstrated high percentage of DH CD36/CD47, including gastric (59%), head and neck (57%), and pancreatic cancers (56%).

Abstract 369 Figure 1

Expression intensities of CD36/CD47 in subjects with pancreatic cancer

Conclusions

Pancreatic cancer subjects who were DH for CD36/CD47 were more likely to have a reduction in tumor burden and stay on study longer than non-DH subjects. Increased Tsp-1 induction in circulating PBMCs and in the TME was confirmed. Remodeling of the TME by VT1021 to be more immune sensitive via CTL and M1 accumulation was demonstrated. Based on these findings, the DH expression of CD36/CD47 could be a useful predictive biomarker to stratify subjects for inclusion in future trials in pancreatic cancer, and in other solid tumor indications.

Trial Registration

Trial Registration

NCT03364400

479 AGEN1181, an Fc-enhanced anti-CTLA-4 antibody, alone and in combination with balstilimab (anti-PD-1) in patients with advanced solid tumors: Initial phase I results

Background

AGEN1181 is a novel anti-CTLA-4 antibody with enhanced FcyR-dependent functionality, engineered to bind high and low binding alleles of FcyRIIIA, promoting superior T cell priming, memory responses, and depletion of intratumoral T regulatory cells. Further, AGEN1181 avoids complement recruitment, predictive of better tolerability. Here we report initial safety and efficacy findings from a phase I/Ib study of AGEN1181 as monotherapy and in combination with balstilimab (BAL; anti-PD-1).

Methods

Eligible patients (pts) had advanced solid tumors refractory to standard therapies. AGEN1181 was dosed Q3W (0.1–3 mg/kg) or Q6W (1–2 mg/kg) as monotherapy, or Q6W (0.1–2 mg/kg) in combination with BAL Q2W (3 mg/kg).

Results

As of July 16th 2021, 102 pts received AGEN1181 (43 monotherapy, 59 combination). Median age, 63 years (29–83); 50.5% with ≥3 prior lines of therapy. MTD not yet reached with AGEN1181 dosing up to 3 mg/kg Q3W as monotherapy and 2 mg/kg in combination with BAL. The most common treatment-related adverse events (TRAEs) of any grade were fatigue (34.3%), diarrhea (32.4%), and nausea (19.6%) with grade ≥3 events in 21.6% (diarrhea/colitis, 11.8%, fatigue, 2.9%). Notably, no immune-related hypophysitis or pneumonitis has been observed. Discontinuation from AGEN1181 due to TRAEs occurred in 15% of pts. Grade 5 TRAEs occurred in two pts (colitis [chronic], intestinal perforation). The disease control rate in evaluable pts (completed ≥1 on-treatment scan) defined as best overall response of CR, PR, or SD ≥6 weeks was 48.1% for AGEN1181 monotherapy ≥1 mg/kg (1 CR, 3 PR, 9 SD) and 70% for combination (3 PR, 6 unconfirmed PR [uPR], 19 SD). Monotherapy responders include individual pts with MSS endometrial cancer (CR), PD-1-relapsed/refractory cervical cancer (PR), PD-1-relapsed/refractory melanoma (PR), and pancreatic cancer (PR). Enrollment is continuing in several disease expansion cohorts with combination therapy. For MSS CRC, 2 PR, 2 uPR, and 7 SD have been seen in 17 evaluable ≥1 mg/kg patients to date. In the ovarian cohort (n=6), 2 PRs and 3 SD are noted. Additional combination responders include one PR and uPR in MSS endometrial cancer, two uPRs in visceral angiosarcoma (uPRs) and one uPR in PD-1-relapsed/refractory NSCLC (uPR); the majority of the responses are recent and ongoing.

Conclusions

AGEN1181 alone and in combination with BAL demonstrates favorable tolerability and compelling clinical activity, notably in poorly immunogenic tumor types and PD-1-refractory pts. These results underscore the significant potential of AGEN1181 to expand benefit of anti-CTLA-4 therapy to a broader patient population.

Trial Registration

NCT03860272

Ethics Approval

The study obtained ethics approval at each participating center (UT Health Sciences Center at San Antonio, University of Colorado Cancer Center, St John’s Cancer Institute, and HonorHealth under WIRB Study number 1256391; USC Norris Comprehensive Cancer Center, Beth Israel Deaconess Medical Center, and MD Anderson Cancer Center, approval numbers HS19-00277, 19–132, and 140346, respectively). All patients provided written informed consent in accordance with federal, local, and institutional guidelines.

Lead-Time Trajectory of CA19-9 as an Anchor Marker for Pancreatic Cancer Early Detection

BACKGROUND & AIMS

There is substantial interest in liquid biopsy approaches for cancer early detection among subjects at risk, using multi-marker panels. CA19-9 is an established circulating biomarker for pancreatic cancer; however, its relevance for pancreatic cancer early detection or for monitoring subjects at risk has not been established.

METHODS

CA19-9 levels were assessed in blinded sera from 175 subjects collected up to 5 years before diagnosis of pancreatic cancer and from 875 matched controls from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. For comparison of performance, CA19-9 was assayed in blinded independent sets of samples collected at diagnosis from 129 subjects with resectable pancreatic cancer and 275 controls (100 healthy subjects; 50 with chronic pancreatitis; and 125 with noncancerous pancreatic cysts). The complementary value of 2 additional protein markers, TIMP1 and LRG1, was determined.

RESULTS

In the PLCO cohort, levels of CA19-9 increased exponentially starting at 2 years before diagnosis with sensitivities reaching 60% at 99% specificity within 0 to 6 months before diagnosis for all cases and 50% at 99% specificity for cases diagnosed with early-stage disease. Performance was comparable for distinguishing newly diagnosed cases with resectable pancreatic cancer from healthy controls (64% sensitivity at 99% specificity). Comparison of resectable pancreatic cancer cases to subjects with chronic pancreatitis yielded 46% sensitivity at 99% specificity and for subjects with noncancerous cysts, 30% sensitivity at 99% specificity. For prediagnostic cases below cutoff value for CA19-9, the combination with LRG1 and TIMP1 yielded an increment of 13.2% in sensitivity at 99% specificity (P = .031) in identifying cases diagnosed within 1 year of blood collection.

CONCLUSION

CA19-9 can serve as an anchor marker for pancreatic cancer early detection applications.

Effectiveness of a Multimedia Educational Intervention to Improve Understanding of the Risks and Benefits of Palliative Chemotherapy in Patients With Advanced Cancer: A Randomized Clinical Trial

Importance

Despite requirements of informed consent, patients with advanced cancer often receive palliative chemotherapy (PC) without understanding that the likelihood of cure is remote.

Objective

To determine whether a PC educational video and booklet at treatment initiation could improve patients' understanding of its benefits and risks.

Interventions

Regimen-specific PC videos and booklets presenting information about logistics, potential benefits, life expectancy (optional), adverse effects, and alternatives. Videos featured authentic patients sharing diverse experiences. After receiving treatment recommendations, research assistants distributed materials to patients for independent review.

Design, Setting, and Participants

Multicenter randomized clinical trial of patients with advanced colorectal or pancreatic cancer starting first-line or second-line PC in 5 US cancer centers with enrollment from June 2015 to September 2017 and follow-up to December 2019.

Main Outcomes and Measures

The primary outcome was accurate expectations of chemotherapy benefits at 3 months, defined as responding "not at all likely" to "What is your understanding of how likely the chemotherapy is to cure your cancer?" (from the Cancer Care Outcomes Research and Surveillance study). Secondary outcomes included understanding of adverse effects, decisional conflict (SURE test), regret (Decisional Regret Scale), and distress (Functional Assessment of Cancer Therapy-General emotional well-being subscale).

Results

Among 186 patients with advanced colorectal or pancreatic cancer who were starting first-line or second-line PC (94 randomized to usual care, 92 to intervention; mean [SD] age, 59.3 [12.6] [range, 28-86] years; 107 [58%] male; 118 [63.4%] colorectal and 68 [36.6%] pancreatic cancer), most patients wanted "a lot" of information or "as much information as possible" about adverse effects (149, 80.1%), likelihood of cure (148, 79.6%), and prognosis (148, 79.6%). Among the intervention arm, 59 (78%) reviewed the booklet and 30 (40%) reviewed the video within 2 weeks. The primary outcome did not differ between intervention and control arms (52.6%; 95% CI, 40.3%-65.0%; vs 55.5%; 95% CI, 45.1%-66.0%). Accurate adverse effect understanding was more common among intervention than control patients (56.0%; 95% CI, 44.3%-67.7%; vs 40.2%; 95% CI, 29.5%-50.9%; P = .05), although this did not meet the threshold for statistical significance. The intervention did not increase distress, despite frank prognostic information. Other secondary outcomes were similar.

Conclusions and Relevance

Provision of an educational video and booklet did not alter patients' expectation of cure from PC. Alternative delivery strategies, such as integration with nurse teaching, could be explored in future studies.

Trial Registration

ClinicalTrials.gov Identifier: NCT02282722.

The Effect of Disclosing Life Expectancy Information on Patients' Prognostic Understanding: Secondary Outcomes From a Multicenter Randomized Trial of a Palliative Chemotherapy Educational Intervention

CONTEXT

Many advanced patients with cancer have unrealistic prognostic expectations.

OBJECTIVES

We tested whether offering life expectancy (LE) statistics within palliative chemotherapy (PC) education promotes realistic expectations.

METHODS

In this multicenter trial, patients with advanced colorectal and pancreatic cancers initiating first or second line PC were randomized to usual care versus a PC educational tool with optional LE information. Surveys at two weeks and three months assessed patients' review of the LE module and their reactions; at three months, patients estimated their LE and reported occurrence of prognosis and end-of-life (EOL) discussions. Wilcoxon tests and proportional odds models evaluated between-arm differences in LE self-estimates, and how realistic those estimates were (based on cancer type and line of treatment).

RESULTS

From 2015 to 2017, 92 patients were randomized to the intervention and 94 to usual care. At baseline most patients (80.9%) wanted "a lot" or "as much information as possible" about the impact of chemotherapy on LE. Among patients randomized to the intervention, 52.0% reviewed the LE module by two weeks and 66.7% by three months-of whom 88.2% reported the information was important, 31.4% reported it was upsetting, and 3.9% regretted reviewing it. Overall, patients' LE self-estimates were very optimistic; 71.4% of patients with colorectal cancer estimated greater than five years; 50% pancreatic patients estimated greater than two years. The intervention had no effect on the length or realism of patients' LE self-estimates, or on the occurrence of prognostic or EOL discussions.

CONCLUSIONS

Offering LE information within a PC educational intervention had no effect on patients' prognostic expectations.

Examining the obesity paradox: A moderating effect of fitness on adipose endocrine function in older adults

Despite evidence linking obesity with increased mortality, older adults with excessive adiposity seem protected, resulting in a so-called obesity paradox. Obesity is characterized by leptin resistance, which contributes to increased risk of all-cause mortality. Therefore, lifestyle factors, such as physical fitness, that lower leptin independent of adiposity may be confounding the obesity paradox. To investigate this, we evaluated whether physical fitness moderated the relationship between leptin and adiposity. We found older adults with higher fitness had lower body mass (r(39) = -0.43, p < 0.01), leptin (r(39) = -0.29, p = 0.03) and inflammation (IL-1β: (r(39) = -0.69, p < 0.01); TNF-α: (r(39) = -0.30, p = 0.03)). Fitness moderated the relationship between leptin and adiposity (F(5, 37) = 3.73, p < 0.01, R² = 0.33) to reveal the obesity paradox in moderately and high fit individuals (b = 216.24, t(37) = 1.46, p = 0.15; b= -88.10, t(37) = -0.49, p = 0.63) but not in low fit individuals. These results show the link between obesity and mortality may not be dependent on total adiposity, but rather on endocrine function and adipocyte leptin secretion. These results have important implications for older adults struggling to maintain healthy body composition and suggest that fitness may promote overall wellbeing.

Abstract CT119: Organoid sensitivity in pancreatic cancer correlates with clinical response to treatment and reveals utility for reducing toxicity: Preliminary results from the HOPE trial

The HOPE trial (Harnessing Organoids for PErsonalized Therapy) was a pilot study to test the feasibility of generating patient derived organoids (PDOs) from patients with pancreatic cancer under real world conditions, test drug sensitivity against these PDOs, and correlate these findings with clinical outcomes. Biopsies were obtained primarily during routine clinical care from surgical specimens, ascites, fine needle biopsies (FNB) of primary tumors, and IR guided core biopsies of liver and lymph node metastases. PDOs were grown in WNT free media according to our previously published methods. PDO drug sensitivity testing was performed on a panel of drugs, AUC calculated, and sensitivity ranked. Patients were followed clinically and assessed for disease control. At data cutoff (January 2020), we enrolled a total of 76 subjects representing all stages of disease. Drug testing was performed successfully on PDOs generated from 12 of these subjects (16%). Factors contributing to success obtaining sufficient cells for PDO generation included modality, body part, and tumor cellularity. H&E and IHC corresponded in matched PDOs and donor tumors, as did DNA alterations. Transcriptomes of PDOs were classified as both ‘basal' and ‘classical' subtypes. When AUC values were annotated with clinical data, the Jenks break of 1.69 segregated matched PDO/AUC values into disease control and progressive disease. We estimated that a PDO AUC value &lt;1.66 yields a &gt; 99% probability of disease control from a regimen that contains this drug, whereas if all drugs in a regimen had an AUC &gt; 2.75 there is a &gt; 80% probability of accurately predicting resistance. To illustrate the potential of PDO testing to tailor treatment for an individual patient, we described a case of a subject with stage IV PDAC with a KRAS mutation and ERBB2 amplification. The subject had disease control with FOLFIRINOX, which was held for toxicity. The PDO showed resistance to oxaliplatin and the patient subsequently had an extended period of disease control with regimens which did not include oxaliplatin, highlighting the potential of PDO drug sensitivity testing to exclude ineffective treatments from combination chemotherapy and limit toxicity. In conclusion, we have shown the feasibility of collecting material via real-world clinical practice sufficient to develop PDOs suitable for rapidly screening multiple drugs, and have shown a high degree of correlation between clinical outcomes in patients with PDAC and matched PDO drug sensitivity. We determined preliminary criteria based on the AUC of individual drugs in PDOs to predict drug sensitivity in subjects. These results highlight the potential of PDOs to personalize therapy and allow for the exclusion of ineffective drugs from combination regimens thereby reducing toxicity. We anticipate this approach will be used in future trials to prospectively inform treatment selection for patients with PDAC.

Citation Format: Joseph Elan Grossman, Ling Huang, Lakshmi Muthuswamy, Sofia Perea, Dipikaa Akshinthala, Raul Gonzalez, Leo Tsai, Jonah Cohen, Mandeep Sawhney, Douglas Pleskow, Tyler M. Berzin, Bruno Bockorny, Andrea Bullock, Benjamin Schlechter, Mary Linton B. Peters, Catherine Conahan, Supraja Narasimhan, Christine Lim, Roger Davis, Robert Besaw, Martin Smith, Tara Kent, Mark Callery, Senthil K. Muthuswamy, Manuel Hidalgo. Organoid sensitivity in pancreatic cancer correlates with clinical response to treatment and reveals utility for reducing toxicity: Preliminary results from the HOPE trial [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT119.

Real-World Assessment of Health Care Costs for Patients with Metastatic Pancreatic Cancer Following Initiation of First-Line Chemotherapy

BACKGROUND

Management of metastatic pancreatic ductal adenocarcinoma (mPDA) places a significant financial burden on the U.S. health care system because of such factors as treatment with multidrug chemotherapy regimens, management of chemotherapy-related adverse events, and disease- or treatment-related hospitalizations. Depending on functional status, first-line chemotherapy regimens that are guideline recommended include nab-paclitaxel with gemcitabine (AG) and FOLFIRINOX (FFX), the combination of fluorouracil, leucovorin, irinotecan, and oxaliplatin. However, few previous studies have examined overall health care costs associated with mPDA management.

OBJECTIVE

To describe health care costs following initiation of first-line treatment with AG or FFX among patients with mPDA.

METHODS

Retrospective cohorts of first-line AG and FFX initiators were constructed from the MarketScan database (2014-2017). The index date was the date of first-line AG or FFX initiation. Included patients had insurance enrollment for 6 months before the index date. Total cumulative health care costs and costs from outpatient services, inpatient admissions, emergency department visits, chemotherapy administrations, and pharmacy dispensing were assessed within 12 months after the index date (i.e., 0-1, 0-2, …, 0-12 months). Patient-level cost data began accruing from the first paid claim and continued accruing until the censoring date.

RESULTS

A total of 2,199 patients with mPDA initiated first-line AG (n = 1,352) or FFX (n = 847). Compared with AG initiators, FFX patients were younger (mean age 59 vs. 63 years) and had better baseline health status, with fewer having diabetes (43% vs. 57%) or coronary artery disease (12% vs. 22%). Median follow-up was 5.4 and 7.2 months for AG and FFX, respectively. Median first-line treatment duration was 2.1 months with AG and 2.3 months with FFX. Six months following first-line treatment initiation, total cumulative health care costs (median) were $85,714 (95% CI = $79,683-$91,788) and $114,116 (95% CI = $105,816-$119,591) for AG and FFX initiators, respectively. Outpatient services contributed the largest fractional cost for both groups.

CONCLUSIONS

Total health care costs for patients with mPDA who initiated FFX or AG are driven mostly by outpatient rather than inpatient costs. Further research, using comparative methodology, is warranted to fully understand cost drivers and whether higher costs for FFX patients relate primarily to use of FFX or higher underlying use of outpatient care among FFX patients.

DISCLOSURES

This study was funded by Halozyme Therapeutics. Oestreicher and Yeganegi were employees of Halozyme Therapeutics at the time of the study and were involved in study design, data interpretation, and the decision to submit the data for publication. Bullock reports advisory board fees from Eisai, Exelixis, Bayer, and Taiho and consulting fees from Halozyme Therapeutics, outside the submitted work. Rowan reports consulting fees from Halozyme Therapeutics, during the conduct of the study. Chiorean reports grants and consulting fees from Celgene and Halozyme Therapeutics; grants from Lilly, Stemline, Ignyta, Roche, Merck, Boehringer-Ingelheim, Bristol Meyer Squibb, Incyte, Macrogenics, Rafael, and AADi; and consulting fees from Astra Zeneca, Array, Eisai, Ipsen, Five Prime Therapeutics, Seattle Genetics, Vicus, and Legend, outside the submitted work.

0038 The Effects of Morning Blue Light Therapy on Insomnia Severity and PTSD Symptoms in a Clinical Sample

Introduction

Individuals with Post Traumatic Stress Disorder (PTSD) often present with insomnia, which may exacerbate other symptoms of the disorder. Morning Blue Light Therapy (BLT) can regulate circadian rhythms and may even improve sleep and mood in individuals with major depressive disorder. However, it is unclear whether morning BLT could also be an effective treatment for the insomnia associated with PTSD. We investigated whether 6 weeks of daily morning BLT would improve insomnia severity and symptom presentation in individuals with PTSD in comparison to a placebo condition of amber light (ALT). We hypothesized that changes in insomnia severity would correlate with improvement in PSTD symptom severity.

Methods

Forty-one participants with a clinical diagnosis of PTSD were randomized to receive 6 weeks of either daily morning BLT (n=22) or ALT (n=19). Insomnia and PTSD symptom severity were evaluated at pre- and post-treatment using the Insomnia Severity Index (ISI) and the Clinician-Administered PTSD Scale (CAPS) for DSM-5, respectively.

Results

Both groups showed a significant decrease in their PTSD symptom severity (p&lt;0.001) and insomnia severity (p&lt;0.001) over the 6-week treatment period. However, improvement in insomnia severity significantly predicted improvements in PTSD symptom severity for the BLT group only (BLT: r =0.542, p=0.009; ALT: r=-0.095, p=0.699). The difference between the two correlation coefficients was significant (Z=-2.07, p=0.039).

Conclusion

The results suggest that morning BLT may be effective in improving PTSD symptoms by regulating the circadian rhythm and improving sleep. While ALT also led to improved PTSD symptom severity, it appears that those changes cannot be explained by improved sleep and may have other underlying mechanisms (e.g., placebo effect). Morning BLT may be a promising adjunctive method to bolster current treatment approaches for PTSD. Because of its ease of administration, it could be easily added to ongoing treatment as usual. This approach warrants further research.

Support

US Army Medical Research and Materiel Command: W81XWH-14-1-0570

1083 Nightmares Are Negatively Associated With Immediate Memory And Visuospatial Performance In Individuals With Ptsd

Introduction

Disturbing dreams and nightmares are common in individuals with post-traumatic stress disorder (PTSD). At present, little research has investigated the associations between nightmares and cognition in these individuals. However, a robust body of research has shown memory and attention impairments among those with PTSD. The present study sought to investigate the potential relationships between cognitive performance and nightmares in this population.

Methods

Seventy-five individuals (49 female; Mage=31.8, SDage=8.8) were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the PTSD Checklist for the DSM-5 (PCL-5), the Insomnia Severity Index (ISI), the Functional Outcomes of Sleep Questionnaire (FOSQ), the Clinician-Administered PTSD Scale (CAPS), and the Disturbing Dreams and Nightmares Index (DDNSI). Five linear regressions were conducted with index scores on the RBANS subscales (immediate memory, visuospatial/constructional, language, attention, and delayed memory) as the dependent variables and PCL-5, ISI, FOSQ, CAPS symptom class subscales (intrusion, avoidance, cognition, and arousal), and DDNSI scores entered stepwise.

Results

A linear regression revealed that nightmares predicted 15% of the variance in RBANS immediate memory scores (R2 change=.152, β=-.390, p=.003). A second linear regression revealed that nightmares predicted 9.6% of the variance in RBANS visual memory scores (R2 change=.096, β=-.310, p=.019). No other independent variables added to either model. None of the independent variables predicted any variance in language, attention, or delayed memory scores.

Conclusion

Our analysis revealed a unique contribution of nightmares to immediate memory and visuospatial performance in individuals with PTSD. This finding was not better explained by variation in PTSD severity or sleep. Because sleep and dreams are implicated in memory consolidation, one explanation for our finding is that highly distressing trauma-related dreams (i.e. nightmares) may lack the same memory-improving qualities as ordinary dreams. Additionally, given that immediate memory and visuospatial functioning utilize working memory, perhaps nightmares and deficits in working memory share similar mechanisms.

Support

W81XWH-14-1-0570

1076 Self-referential Language In Trauma Narratives Predicts Shorter Sleep Duration In Women With Ptsd

Introduction

The use of self-referential language, defined as first-person singular pronouns (e.g. I, me, my), in trauma narratives has been found to predict post-traumatic stress disorder (PTSD) severity. Additionally, taking a self-immersed perspective correlates with higher blood pressure reactivity than a self-distanced perspective. Given this relationship between self-immersed perspectives and physiological processes, we investigated the relationship between self-referential language and sleep in people with PTSD, as dysfunctional sleep is a major treatment target in this disorder.

Methods

Seventy-five participants (49 females; Mage=31.8, SDage=8.8) meeting DSM-5 criteria for PTSD were administered the PTSD Checklist for the DSM-5 (PCL-5) and the Pittsburg Sleep Quality Index (PSQI). Sleep duration was assessed with the PSQI. Participants provided typed descriptions of their traumatic event, which were then analyzed using the Linguistic Inquiry and Word Count 2015 software to count instances of first-person singular pronouns (“I” words). Linear regression, with PCL-5 scores and “I” words entered stepwise, was used to predict scores on the PSQI sleep duration subscale. Use of “I” words between the sexes was also compared.

Results

For females but not males, PTSD severity significantly predicted sleep duration (R2=.207, p=.001). Additionally, the number of “I” words in the trauma narratives predicted an additional 8% of the variance in sleep duration for females (R2 change=.083, β=.288, p=.029) but not males. Females used significantly more self-referential language in their narratives (M=11.84, SD=8.42) compared to males (M=5.25, SD=6.10, p=.001).

Conclusion

After controlling for PTSD severity, self-referential language in trauma narratives significantly predicted shorter sleep duration in females. While speculative, this finding suggests that treatment approaches for PTSD may benefit from a focus on targeting self-referential processes to improve sleep and PTSD in females but not males. As dysfunctional sleep is a hallmark of PTSD, further investigation into this relationship may illuminate a new treatment avenue for this disorder.

Support

W81XWH-14-1-0570

0081 Habitual Sleep Duration is Negatively Correlated with Emotional Reactivity within the Rostral Anterior Cingulate Cortex in Individuals with PTSD

Introduction

Sleep difficulties, such as insomnia, are highly prevalent in individuals with Post-Traumatic Stress Disorder (PTSD). However, sleep deprivation can also increase emotional reactivity to positive (as well as negative) stimuli. While the effects of sleep loss on emotional perception healthy individuals has been documented, it remains unclear how lack of sleep in individuals with PTSD may affect their emotional reactivity to positive stimuli. We hypothesized that lower habitual sleep duration would be associated with greater functional brain activation changes in response to subliminally presented happy faces in brain areas of the reward network, such as the rostral anterior cingulate cortex (rACC).

Methods

Thirty-nine individuals with DSM-5 confirmed PTSD were administered the Pittsburgh Sleep Quality Index (PSQI) as a measure of their average nightly sleep duration over the past month. Participants then underwent fMRI imagining while viewing subliminal presentations of faces displaying happiness, using a backward masked facial affect paradigm to minimize conscious awareness of the expressed emotion. Brain activation to masked happy expressions was regressed against sleep duration in SPM12.

Results

There was a negative correlation between habitual sleep duration and activation within the rACC in response to the masked happy faces (x=14,y=40,z=0; k=102, pFWE-corr= 0.008).

Conclusion

Individuals with PTSD who average less sleep at night showed greater emotional reactivity, as indexed by greater functional brain activation changes within an area of the reward network, than individuals who obtained more sleep per night. Future research involving actual sleep duration manipulation will be necessary to determine whether this finding reflects the well-known antidepressant effect of sleep deprivation or a form of greater emotional expression error monitoring among traumatized patients when lacking sleep. Regardless, these findings suggest that insufficient sleep could affect unconsciously perceived emotion in faces and potentially affect social and emotional responses among individuals with PTSD.

Support

US Army Medical Research and Materiel Command: W81XWH-14-1-0570

1077 The Association Between Sleep Problems And Risk-taking Behavior Differs Between Racial Majority And Minority Groups

Introduction

Individuals with Post-Traumatic Stress Disorder (PTSD) often experience poor sleep quality and elevated self-destructive behaviors. Among healthy individuals, poor sleep quality can lead to increased risk-taking behavior through decreased inhibition and/or increased willingness to take risks. However, it is unclear whether racial/ethnic background may influence this relationship, in particular among individuals with PTSD. We examined whether the relationship between sleep quality and risk propensity would differ between majority and minority racial groups in individuals with PTSD.

Methods

Seventy-six individuals (61.8% female; mean age=31.7, SD=8.8) with a clinical diagnosis of PTSD were administered the Functional Outcomes of Sleep Questionnaire (FOSQ) as a measure of sleep-related functional impairment of daily activities, and the Evaluation of Risk (EVAR) Scale as a measure of risk-taking propensity. Forty-seven individuals identified with the majority racial group (Caucasian) and 29 individuals identified themselves within the minority.

Results

There were no significant group differences for FOSQ and total EVAR risk-taking scores. However, the strength of association between measures differed significantly between groups (Z=1.95, p=.051). For the racial/ethnic majority, functional impairments due to lack of sleep were positively associated with risk-taking propensity (r=.460, p=.001); this relationship was not present for the minority group (r=.016, p=.936).

Conclusion

Self-reported functional impairments due to sleep loss significantly correlated with risk-taking propensity for those who identified themselves as part of the majority racial group but not for individuals who identified as part of a racial minority. Findings suggest that broad conclusions regarding the association between sleep disruption and risk-taking may not apply equally across racial/ethnic groups and such factors should be considered when evaluating studies of sleep and risk behaviors. Whether these differing effects are due to cultural factors or stable differences in biology is not known and will require additional research.

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A randomized phase II trial of nab-paclitaxel and gemcitabine with tarextumab or placebo in patients with untreated metastatic pancreatic cancer

Purpose

Notch signaling dysregulation is implicated in the development of pancreatic adenocarcinoma (PDAC). Tarextumab is a fully human IgG2 antibody that inhibits Notch2/3 receptors.

Patients and Methods

Aphase 2, randomized, placebo‐controlled, multicenter trial evaluated the activity of tarextumab in combination with nab‐paclitaxel and gemcitabine in patients with metastatic PDAC. Patients were stratified based on ECOG performance score and Ca 19‐9 level and randomized 1:1 to nab‐paclitaxel, gemcitabine with either tarextumab or placebo. Based on preclinical and phase Ib results suggesting a positive correlation between Notch3 gene expression and tarextumab anti‐tumor activity, patients were also divided into subgroups of low, intermediate, and high Notch3 gene expression. Primary endpoint was overall survival (OS) in all and in patients with the three Notch3 gene expression subgroups (≥25th, ≥50% and ≥75% percentiles); secondary end points included progression‐free survival (PFS), 12‐month OS, overall response rate (ORR), and safety and biomarker investigation.

Results

Median OS was 6.4 months in the tarextumab group vs 7.9 months in the placebo group (HR = 1.34 [95% CI = 0.95, 1.89], P = .0985). No difference observed in OS in the Notch3 gene expression subgroups. PFS in the tarextumab‐treated group (3.7 months) was significantly shorter compared with the placebo group (5.5 months) (hazard ratio was 1.43 [95% CI = 1.01, 2.01]; P = .04). Grade 3 diarrhea and thrombocytopenia were more common in the tarextumab group.

Conclusions

The addition of tarextumab to nab‐paclitaxel and gemcitabine did not improve OS, PFS, or ORR in first‐line metastatic PDAC, and PFS was specifically statistically worse in the tarextumab‐treated patients.

Clinical trial registry no

NCT01647828.

Spontaneous regression of pancreatic cancer with liver metastases

Spontaneous cancer regression is a rare event, scarcely reported among gastrointestinal malignancies. Pancreatic adenocarcinoma regression has been documented in five previous cases, none of which included liver metastases, and the mechanism by which this occurs is not known. A 56-year-old woman with history of discoid lupus, homocysteinemia and peripheral vascular disease was diagnosed with stage IV pancreatic ductal adenocarcinoma (PDA) metastatic to the liver. She received palliative chemotherapy with 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (FOLFIRINOX) for 6 months, complicated by mucositis, diarrhoea, vomiting and two Clostridium difficile colitis episodes. Cancer initially responded to chemotherapy. However, due to substantial toxicities, she decided to discontinue cytotoxic chemotherapy and focus on palliation alone. Thereafter, CT and carbohydrate antigen (CA) 19-9 showed further response and ultimately complete cancer regression that has persisted for 33 months after cessation of chemotherapy. This is the first report in the English literature showing spontaneous regression of a PDA with liver metastases. Two possible mechanisms are proposed: antitumoral autoimmunity and tumour hypoxia related to vascular disease.

What Patients Look for When Browsing Online for Pancreatic Cancer: The Bait Behind the Byte

BACKGROUND

Suitability is a patient-centered metric defined as how appropriately health information is targeted to specific populations to increase knowledge. However, suitability is most commonly evaluated exclusively by healthcare professionals without collaboration from intended audiences. Suitability (as rated by intended audiences), accuracy and readability have not been evaluated on websites discussing pancreatic cancer.

METHODS

Ten healthy volunteers evaluated fifty pancreatic cancer websites using the suitability assessment of materials (SAM instrument) for the materials' overall suitability. Readability and accuracy were correlated.

RESULTS

Ten recruited volunteers (ages 23-63, 50% female) found websites to be on average "adequate" or "superior" in suitability. Surgery, radiotherapy and nonprofit websites had higher suitability scores as compared to counterparts (p ≤ 0.03). There was no correlation between readability and accuracy levels and suitability scores (p ≥ 0.3). Presence of visual aids was associated with better suitability scores after controlling for website quality (p ≤ 0.01).

CONCLUSION

Suitability of websites discussing pancreatic cancer treatments as rated by lay audiences differed based on therapy type and website affiliation, and was independent of readability level and accuracy of information. Nonprofit affiliation websites focusing on surgery or radiotherapy were most suitable. Online information should be assessed for suitability by target populations, in addition to readability level and accuracy, to ensure information reaches the intended audience.

A First-in-Human Phase I Study of OPB-111077, a Small-Molecule STAT3 and Oxidative Phosphorylation Inhibitor, in Patients with Advanced Cancers

Lessons Learned.

OPB‐111077 is a novel inhibitor of STAT3 and mitochondrial oxidative phosphorylation that exhibited promising anticancer activity in preclinical models.

In this first‐in‐human phase I study of OPB‐111077 in unselected advanced cancers, treatment‐emergent adverse events, most frequently nausea, fatigue, and vomiting, were generally mild to moderate in intensity and could be medically managed.

Overall, only modest clinical activity was observed after OPB‐111077 given as monotherapy. Notable antitumor activity was seen in a subject with diffuse large B‐cell lymphoma.

Background.

OPB‐111077 is a novel inhibitor of STAT3 and mitochondrial oxidative phosphorylation with promising anticancer activity in preclinical models.

Methods.

Open‐label, phase I trial of OPB‐111077 in advanced cancers with no available therapy of documented benefit. Initial dose escalation in unselected subjects was followed by dose expansion. Patients received oral OPB‐111077 daily in 28‐day cycles until loss of clinical benefit.

Results.

Eighteen subjects enrolled in dose escalation, and 127 in dose expansion. Dose‐limiting toxicities were observed at 300 mg and 400 mg QD; maximum tolerated dose was defined as 250 mg QD. Frequently reported treatment‐emergent adverse events (TEAEs) included nausea, fatigue, and vomiting. TEAEs were generally mild to moderate and could be medically managed. OPB‐111077 reached micromolar drug concentrations, had an elimination half‐life of approximately 1 day, and reached steady‐state by day 8. A durable partial response was observed in one subject with diffuse large B‐cell lymphoma. Seven subjects with diverse tumor types had stable disease or minor responses for at least eight treatment cycles (224 days).

Conclusion.

OPB‐111077 is generally well tolerated, and its pharmacokinetic profile is sufficient for further clinical development. Notable clinical activity was observed in a subject with diffuse large B‐cell lymphoma. Overall, modest efficacy was observed against unselected tumors.

Culture and its influences on dental education

INTRODUCTION

Culture is an important factor influencing how students develop learning and how educators provide support to students. The aim of this paper is to explore a concept of national European cultures, and relationships between culture and educational practice with the intention of helping the dental profession gain a better understanding of effective teaching and learning in dentistry.

CONTENT

Culture represents the collective behaviours, values and beliefs of people in a society. How people react to education is partly explained by culture. Students utilise different culturally based strategies to develop learning. We apply Hofstede's model to explore European cultures and implications for dental education and educational practice. Most Western students possess assimilating learning styles enabling them to learn effectively in student-centred contexts while most Eastern students have accommodating learning styles and are more familiar with teacher-centred learning. Eastern students may need to adapt their approach to learning to better benefit from student-centred learning.

CONCLUSION

Culture influences students' learning and educational practice. Dental educators should be aware of such influences and provide support that acknowledges students' different cultural backgrounds. Cultural competence is fundamental for effective teaching and learning in dentistry.

Roles and competences for educators of undergraduate dental students: a discussion paper

INTRODUCTION

Dental educators are important people who contribute to the development of every aspect of dental education. In part due to the lack of understanding of their roles and competences, dental educator development has so far received little consideration. With the aim of enhancing the dental profession's contribution to the development of undergraduate dental education, this article explores common roles of educators of undergraduate dental students and the competences needed to be effective educators.

METHODS

This is a discussion paper based on a wide reading of the literature on the education of health professionals with a specific focus on roles and competences of educators.

RESULTS AND DISCUSSION

Roles of educators of undergraduate dental students typically encompass four areas: teaching, research, administration and providing healthcare. Educators may not be involved in every role; they normally perform the roles relevant to their work contexts. Competences for dental educators based on the four main roles comprise 12 domains: educational theories and principles; modes of education; learner issues; educational materials and instructional design; assessment and feedback; curriculum matters; evaluation; educational research; educational management; quality assurance; patient care and healthcare system and professionalism. Not all competences are required by all educators although educators need to be competent in the areas related to their roles and duties.

CONCLUSION

Understanding the roles and competences for educators of undergraduate dental students can help individual educators to improve their personal effectiveness and institutions to tailor staff development programmes appropriate to the needs of their staff. Faculty development contributes to sustained enhancement of undergraduate dental education.

Capecitabine and oxaliplatin as first and second line treatment for locally advanced and metastatic pancreatic ductal adenocarcinoma

Background

There are limited treatment options available for patients with advanced pancreatic ductal adenocarcinoma (PDAC). We conducted a phase II study evaluating the efficacy and safety of capecitabine/oxaliplatin (CAPOX) in patients with locally advanced and metastatic PDAC treated in the first and second lines.

Methods

Forty subjects with advanced PDAC and ECOG performance status ≥2 were enrolled. Treatment consisted of capecitabine 2,000 mg/m² orally in two divided doses daily for 14 days and oxaliplatin 130 mg/m² intravenously day 1 every 21 days. The primary endpoint was response rate (RR); secondary endpoints included safety analysis, progression free survival (PFS) and overall survival (OS).

Results

The overall RR was 12.5% (N=3); the disease control rate was 67% (N=16). Due to the protocol definition for eligibility of response evaluation, only 60% (N=24) were evaluable for the primary endpoint. Median progression free survival (mPFS) was 3.8 months (95% CI: 1.3, 6.2); median OS (mOS) was 7.4 months (95% CI: 4.8, 12.2). The most common grade 3/4 toxicities included: fatigue (19%), nausea (17%), and diarrhea (14%).

Conclusions

CAPOX is an active regimen in patients with advanced PDAC and is associated with acceptable toxicity. Careful consideration should be given to response endpoints and outcome measures when studying this characteristically ill population.