Rumen digesta and products of fermentation in cows fed varying proportions of fodder beet (Beta vulgaris) with fresh pasture or silage or straw

Context Fodder beet (FB) is a popular feed for dairy cows in temperate climates due to its high yields, high digestibility, low nitrogen (N) content in the dry matter (DM) and convenience of feeding (grazing in situ). However, the risk of ruminal acidosis requires research to design feeding regimes that capture these benefits without compromising animal health. Aims To understand aspects of rumen function when FB is offered in conditions representative of practical feeding in temperate pastoral systems. Methods Two indoor experiments were undertaken; one with cows in late lactation fed fresh perennial ryegrass with three proportions of FB (0, 0.23 and 0.45) and another with non-lactating cows fed pasture silage with 0.65 FB or barley straw with 0.86 FB. Measurements included rumen pH, short-chain fatty acid (SCFA) and ammonia concentrations determined at 2-h intervals, as well as daily individual cow intakes, estimates of microbial growth and rumen dynamics. Key results The inclusion of 0, 0.23 and 0.45 FB with fresh pasture in the did not affect daily DM intakes (~14.6 kg), milk yield (~10.7 kg), microbial synthesis (129 g of N/d) or fractional outflow rates of digesta (0.16/h; 11.2 L/h) of lactating cows. The non-lactating cow ration comprising 0.86 FB with straw was inappropriate and resulted in low intakes and insufficient dietary N. Microbial growth was approximately one-third of that in cows fed pasture silage with 0.65 FB. The ruminal pH reached lower values in all treatments where FB was offered. Rumen ammonia concentrations averaged 4.4 mmol/L in cows fed pasture but was sometimes undetectable in lactating cows fed 0.45 FB and in non-lactating cows. The amount of FB in the diet affected the extent of the circadian changes in molar proportions of SCFA. Conclusions Based on the results presented here, feeding fresh FB to dairy cows should not exceed ~0.4 of their DMI with pasture (late lactation), or ~0.6 of their intake with silage (non-lactating). Implications These findings could support evidence-based recommendations for FB use, considering its effects on aspects of rumen function, such as microbial protein synthesis and pH.

Digestion and nitrogen excretion by Holstein–Friesian cows in late lactation offered ryegrass-based pasture supplemented with fodder beet

Recent changes in New Zealand dairying have included incorporation of fodder beet (FB) into rations. The present trial explored the impact of substituting different proportions of ryegrass-based pasture with FB for cows fed ad libitum in late lactation. The objective was to measure effects of FB on intake, digestion and urinary nitrogen (N) excretion using 16 Holstein–Friesian cows with a permanent rumen fistula. Before the 9-day indoor measurement period, cows were adapted to feeding 0%, 20%, 40% or 60% FB (bulbs and tops) with medium quality ryegrass-based pasture (191 g CP and 517 g neutral detergent fibre (aNDF)/kg DM; DM digestibility 0.634) over 2 weeks. However, it became apparent that a diet of 60% FB was detrimental to cow health, with two cows developing acidosis. The allocation of FB was reduced and the actual intakes were 23% and 45% of DM intake during the trial. Feeding FB substantially reduced N intake and urinary N excretion. The lower level (23%) of FB resulted in greater DM digestibility, albeit with a small reduction in N and aNDF digestibility. However, the higher level (45%) of FB reduced N and aNDF digestibility by 7.1 and 12.1 percentage units respectively, relative to pasture. Daily creatinine excretion was lower than published measurements from cattle fed dry diets, and circadian variation in urinary N:creatinine ratios suggests a need for caution when attempting to predict daily urinary N excretion from spot samples.

Outcomes and predicting response in anaemic chemotherapy patients treated with epoetin alfa. A multicentre, 4-month, open-label study in Australia and New Zealand

BACKGROUND

The aim of the study was to evaluate the effectiveness, safety, and clinical outcomes of erythropoietin therapy in the treatment of anaemic cancer subjects receiving chemotherapy and to examine hypochromic red blood cell measurement as an indicator of functional iron sufficiency and as a predictor of responsiveness or non-responsiveness to erythropoietin therapy.

METHODS

Patients who had a non-myeloid malignancy, had Hb < or = 11.0 g/dL, had a life expectancy of more than 6 months, were 18 years or older, were receiving chemotherapy and would continue to be treated for at least 2 months were given s.c. epoetin alfa three times a week.

RESULTS

Haemoglobin levels increased significantly at all time periods compared with baseline and the number of transfusions received decreased significantly at all time periods compared with baseline. Quality of life as measured by Functional Assessment of Cancer Therapy-Anaemia showed significant increases at months 2 and 4 and there were significant improvements in the fatigue subscale at both time points (P < 0.05). Significant improvements at end-point were observed for the physical, emotional and functional well-being, and additional concern subscales (all P < 0.05). Haematocrit and reticulocytes increased significantly at end-point compared with at baseline (haematocrit 33.4 vs 28.3%, P < 0.001; reticulocytes 105.8 vs 78.6 x 10(9)/dL, P = 0.005). The percentage of hypochromic red blood cells did not show predictive value for response to treatment status.

CONCLUSION

Epoetin alfa improved haemoglobin levels and quality of life in anaemic cancer patients receiving chemotherapy.

Methane emissions from grazing Jersey×Friesian dairy cows in mid lactation

As part of a large quantitative trait loci trial, methane emissions were measured on 698 second and third lactation dairy cows which were the progeny of six bulls. The trial ran over two 4-week periods in January 2004 and 2005. Methane samples were collected over 24 h on each of four consecutive days in 2004 and three consecutive days in 2005. Methane emissions were measured using the sulfur hexafluoride (SF6) tracer dilution technique. During measurement periods, all cows grazed grass–clover pasture with ad libitum herbage allowances. Herbage dry matter intakes (DMI) were calculated using Australian Feeding Standards based on individual cow data of milk yield, liveweight, liveweight change and cow body condition. The average DMI was estimated to be 17.1 kg/day (s.d. = 2.0). Daily methane emissions ranged from 151 to 497 g/day with an average of 311 g/day (s.d. = 43.8) or 18.2 g/kg DMI (s.d. = 2.8); this is 15.7% lower than the figure currently used in the New Zealand national inventory. This study also indicates that there are large differences between cows in methane emissions per kg DMI when estimated using the SF6 tracer technique.

Development and evaluation of a test for tuberculosis in live European badgers (Meles meles) based on measurement of gamma interferon mRNA by real-time PCR

A real-time PCR assay for the measurement of gamma interferon (IFN-gamma) mRNA in European badger (Meles meles) blood cultures was developed. The levels of IFN-gamma mRNA in blood cultures stimulated with either bovine or avian tuberculin or specific mycobacterial antigens were compared with those in a nonstimulated control blood culture as the basis for determining the tuberculosis (TB) status of live badgers. The assay was validated by testing 247 animals for which there were matching data from postmortem examination and culture of tissues. Relative changes in the levels of IFN-gamma mRNA in response to bovine tuberculin and specific antigens were found to be greater among badgers with tissues positive for TB on culture. The test was at its most accurate (87% of test results were correct) by using blood cultures containing bovine tuberculin as the antigen and when the response to avian tuberculin was taken into account by subtracting the avian tuberculin response from the bovine tuberculin response. At a specificity of 90.7%, the test was 70.6% sensitive. At the same specificity, the current serological enzyme-linked immunosorbent assay for TB in badgers was only 53% sensitive. This work demonstrates that measurement of IFN-gamma mRNA by real-time PCR is a valid method for the detection of TB in live badgers and may provide an alternative to the current serological methods of diagnosis, the Brock test. The testing procedure can be completed within 5 h of receipt of the blood culture samples. In addition, the use of a molecular biology-based test offers the potential to fully automate the testing procedure through the use of robotics.

Outcomes and health status of patients undergoing usual care for highly emetogenic chemotherapy

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Background: Chemotherapy-induced nausea and vomiting (CINV) remains a significant issue for patients, especially management of delayed symptoms. The Perugia 2004 antiemetic guidelines recommended that anthracycline/cyclophosphamide (A/C) combination regimens be considered as high risk emetogenic potential. The aim of our study was to determine the extent of CINV, and effect on quality of life for chemotherapy-naïve patients in a practice-based environment. Methods: Eligible patients were receiving their 1st cycle of high risk emetogenic or carboplatin chemotherapy, administered with “standard care” (5HT3 antagonist + dexamethasone) antiemetics (use of NK1 antagonists excluded). Patients completed a daily diary for 5 days post chemotherapy, capturing data on CINV activity and rescue medications usage. Emesis and nausea-specific health status was measured by the Functional Living Index - Emesis (FLIE); general health status was assessed using a 100mm VAS (EQVAS). Results: Of 74 patients, 42 received an A/C regimen, 16 cisplatin and 16 carboplatin. Overall complete response (no vomiting, no use of rescue antiemetics during the study period) was 60% in patients receiving carboplatin, 24% A/C and 21% cisplatin. During the delayed phase, mean total emesis episodes for carboplatin was 0.6, A/C 2.21 and cisplatin 4.08. Patients receiving carboplatin reported less delayed nausea, and better outcomes for FLIE and EQVAS scores. Treatment with either A/C or cisplatin was associated with similar deterioration in nausea control across the study period, and similar impact on FLIE scores (see table ). Conclusions: Our results are consistent with the recommendation that A/C regimens be considered highly emetogenic, with similar impact on patient symptoms and quality of life compared with cisplatin. Delayed CINV remains a target for antiemetic intervention. Similar studies need to be repeated in patients receiving additional NK1 antagonists to assess their impact on CINV outside clinical trials.

[Table: see text]

[Table: see text]

Fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer

PURPOSE

The use of chemotherapy and endocrine therapies in the treatment of premenopausal women carries with it reproductive and gynecologic implications that young women may find distressing and discordant with plans for childbearing. This multicenter study aimed to investigate fertility- and menopause-related information needs among young women with a diagnosis of early-stage breast cancer.

PATIENTS AND METHODS

Two hundred twenty-eight women with a diagnosis of early-stage breast cancer who were aged 40 years or younger at diagnosis and who were 6 to 60 months after diagnosis were entered onto the trial. Participants completed a mailed self-report questionnaire that included a purposely designed fertility- and menopause-related information needs survey and standardized measures of distress, anxiety, quality of life, menopausal symptoms, and information-seeking style.

RESULTS

Seventy-one percent of participants discussed fertility-related issues with a health professional as part of their breast cancer treatment, and 86% discussed menopause-related issues. Consultation with a fertility or menopause specialist was the most preferred method of obtaining this information. Receiving fertility-related information was rated as being significantly more important than receiving menopause-related information at time of diagnosis (P < .001) and at treatment decision making (P = .058). Receiving menopause-related information was rated as being significantly more important than receiving fertility-related information during adjuvant treatment (P < .05), at completion of adjuvant treatment (P < .001), and during follow-up (P < .001). Common questions, sources of information, and correlates of perceived importance were identified.

CONCLUSION

The results of this study suggest that younger women have unmet needs for fertility- and menopause-related information and provide preliminary empirical data to guide the development of better fertility- and menopause-related patient education materials for younger women with a diagnosis of early breast cancer.

A low dietary cation-anion difference precalving and calcium supplementation postcalving increase plasma calcium but not milk production in a pasture-based system

It was hypothesized that a reduction in the dietary cation-anion difference (DCAD) before calving, combined with an increase in Ca intake after calving, would reduce the incidence of periparturient hypocalcaemia and increase milk production in pasture-based dairy cows. Cows (n = 40) were assigned to one of two DCAD levels before calving (i.e., +7 and +50 mEq/100 g). Each group was then assigned to one of two dietary Ca concentrations after calving (i.e., 1.0 and 0.7%) in a 2 x 2 factorial design. The lower DCAD resulted in a nonrespiratory reduction in systemic pH as indicated by a lower urine pH. This acidosis resulted in an increased concentration of Ca in urine before calving. The lower precalving DCAD helped prevent the decline in blood Ca caused by the onset of lactation, even though blood Ca concentration was lower before calving compared with cows receiving a high DCAD. Supplementation of cows with Ca after calving increased plasma Ca concentration on the day of calving and during the subsequent 14 d. Milk production was not affected by pre- or postcalving treatments.

Dietary cation-anion difference and the health and production of pasture-fed dairy cows. 1. Dairy cows in early lactation

Diets offered to lactating dairy cows in the pasture-based dairy systems in southeastern Australia can vary in their dietary cation-anion difference (DCAD) from 0 to +76 mEq/100 g. The effects of such a range of DCAD on the health and production of cows, on a predominantly pasture-based diet, were examined in an indoor feeding experiment. Four groups of five cows were offered a diet of 5 kg of barley and ad libitum pasture, which is a diet representative of what is offered to cows in early lactation in the region. The cows were supplemented twice daily, with varying levels of salt combinations to alter the DCAD, which ranged from +21 to +127 mEq/100 g. Although a reduction in DCAD to +21 mEq/100 g caused a nonrespiratory systemic acidosis, there was a threshold value, above which blood and urine pH did not appear affected, although the strong ion difference of blood and urine and the blood bicarbonate concentration increased linearly (P < 0.05, 0.001, and 0.01, respectively). A DCAD above +21 mEq/100 g linearly reduced dry matter intake (P < 0.1), average daily bodyweight gain (P < 0.05), and milk protein yield (P < 0.05) but did not have a significant effect on the concentration of fat, protein, or lactose in milk. Although data were consistent with a tendency for milk yield to decrease as dietary cation-anion differences increased, this trend was not statistically significant. Urine hydroxyproline to creatinine ratio increased (P < 0.001) as dietary cation-anion difference increased, possibly suggesting an increased rate of uterine involution. It is concluded that a range in the dietary cation-anion difference, above +52 mEq/100 g, may have deleterious effects on dry matter intake and milk production.

Dietary cation-anion difference and the health and production of pasture-fed dairy cows 2. Nonlactating periparturient cows

Anecdotal observations of reduced hypocalcemia due to small reductions in the precalving dietary cation-anion difference (DCAD) are widely reported in Australia and New Zealand. Diets offered to nonlactating, periparturient dairy cows in pasture-based dairy systems in southeastern Australia can vary in their cation-anion difference from 0 to +76 mEq/100 g. The effects of such a range in the DCAD on the health and production of cows, on a pasture-based diet, were examined in an indoor feeding experiment. Four groups of four cows were offered pasture-hay and freshly cut pasture, a periparturient diet typical of that associated with the grazing system in Australia and New Zealand. Varying levels of salt supplementation were used to alter the dietary cation-anion difference, which ranged from -12 to +69 mEq/100 g. Blood and urine pH and mineral concentrations and urine hydroxyproline were measured. The addition of anions to the diet, to produce a negative DCAD, resulted in a nonrespiratory systemic acidosis. With decreasing DCAD, the pH of blood and urine and the strong ion difference of urine decreased curvilinearly, blood bicarbonate decreased linearly and the urinary ratio of Ca to creatinine increased curvilinearly. Although systemic pH was not reduced at a DCAD of +16 mEq/100 g, urine Ca-to-creatinine ratio had begun to rise, probably indicating increased calcium absorption. The absorption and renal excretion of Mg increased with decreasing DCAD. No differences were observed in urine hydroxyproline concentrations and no significant differences in milk production were measured.

Progesterone clearance rate in lactating dairy cows with two levels of dry matter and metabolisable energy intakes

The aim of these studies was to determine the effect of levels of dry matter (DM) and metabolisable energy (ME) intakes on clearance rate of progesterone (P4) in dairy cows. Thirty-two lactating Holstein-Friesian cows were selected for the study and were fed indoors in individual stalls for a period of 5 weeks. They were individually offered a diet of combinations of pasture, hay and pelleted cereal grain to achieve two different levels of DM and ME. In the first trial, 16 cows were allocated to two groups: (i) high DM (HDM), and (ii) low DM (LDM) intakes, while the amount of ME intake was constant. In the second trial, 16 cows were allocated to two groups: (i) high ME, and (ii) low ME intakes with similar amount of DM intake. A GnRH-agonist (deslorelin) was initially implanted in the ear of each cow to block endogenous P4 secretion. Then 3 weeks later, a CIDR device was inserted into the vagina of each cow and left in place for 11 days. Chromic oxide (Cr(2)O(3)) capsules were administered to allow daily faecal output (FO) to be estimated. Daily blood, faecal and milk samples were taken during the period of the experiment for P4 and faecal P4 metabolites analyses. Trial 1: The average milk yield was similar among cows in high and LDM intake groups (26.7 versus 25.0 l per day, P = 0.2). The average daily FO was 7.8 kg DM in the HDM and 5.7 in the LDM cows (P < 0.0001). Average daily DM intakes were 17.3 kg and 15.4 kg in the HDM and LDM groups, respectively (P < 0.0001). The average plasma P4 concentrations were similar between the two groups (1.56 versus 1.60 ng/ml, P = 0.7) but milk P4 concentrations were higher in LDM cows (4.6 versus 3.6 ng/ml, P = 0.02). The average daily excretion rate of P4 into the milk was higher in LDM cows (122.3 versus 88.5 microg, P = 0.002). The concentrations of faecal P4 metabolites (FP4M) were not influenced by the level of daily DM intake (2.85 versus 2.90 microg/g, P = 0.6). The average daily yields of FP4M were higher among cows in the HDM group (23.2 versus 16.3mg, P = 0.01). Trial 2: The average milk yield was 31.2l per day in HME cows compared to 25.0l per day in LME cows (P < 0.0001). The average daily FO was 7.8 kg DM in LME and 5.8 kg DM in HME cows (P < 0.0001), and the average DM content of faeces was higher in LME cows (15.8 versus 12.7%, P = 0.01). The average daily ME intake was 213MJ per day in HME group compared to 183MJ per day in LME group (P<0.0001). The average plasma and milk P4 concentrations were similar between the two groups (plasma P4 = 1.54 versus 1.56 ng/ml, P = 0.4; milk P4: 3.7 versus 3.6 ng/ml, P = 0.6). The average daily excretion rate of P4 into the milk was higher in HME cows (114 versus 88.5 microg, P = 0.03). Concentrations of FP4M were not influenced by the level of daily ME intake (2.5 versus 2.85 micro g/g, P = 0.08). However, daily yields of FP4M were greater in the LME group (23.2 versus 14.4 mg, P = 0.01). In conclusion, this study was unable to establish a relationship between the level of DM and ME in the diet with the excretion rates of FP4M metabolites and plasma P4 concentrations.

Immunological responses of Eurasian badgers (Meles meles) vaccinated with Mycobacterium bovis BCG (bacillus calmette guerin)

Wildlife species, such as the badger (Meles meles), may act as maintenance hosts for Mycobacterium bovis and contribute to the spread and persistence of tuberculosis in associated cattle populations. Targeted vaccination of badgers against tuberculosis is an option that, if successfully employed, could directly facilitate the advancement of bovine tuberculosis eradication in affected areas. In this study, the immunological responses of a group of badgers vaccinated subcutaneously with low doses of Mycobacterium bovis bacillus calmette guerin (BCG) were measured in vitro and compared with non-vaccinated control animals over a period of 42 weeks. Peripheral blood mononuclear cells (PBMC) from badgers which had received repeated booster injections of BCG proliferated in response to culture with PPD-bovine (purified protein derivative of tuberculin). The proliferation was significantly greater than that seen in the non-vaccinated control group. In contrast, the proliferative response of PBMC from vaccinated badgers to PPD-avian declined relative to the control group. These results demonstrate that repeated vaccination of badgers with M. bovis BCG induced a population of T-lymphocytes responsive to specific antigens in PPD-bovine. Throughout the course of the study, the sera from all animals were tested (BrockTest) by an enzyme-linked immunosorbent assay (ELISA) system for the presence of antibodies to MPB83, a serodominant antigen whose expression is high in M. bovis, but very low in BCG (Pasteur). No animals at any stage showed seroconversion to the antigen, consistent with the tuberculosis-free status of the badgers under study.

Phase I clinical trial of the chimeric monoclonal antibody (c30.6) in patients with metastatic colorectal cancer

The murine antibody 30.6 recognizes an antigen that is expressed on a high proportion of colorectal carcinomas and their metastases. We report the results of single-dose escalation studies of the chimeric 30.6 (c30.6) monoclonal antibody in metastatic colorectal cancer, to evaluate its safety, pharmacokinetics, and biodistribution. Recombinant c30.6 (IgG1kappa) antibody was secreted from Chinese hamster ovary cells and purified by a multistep chromatography process. Seventeen patients with metastatic colorectal cancer were enrolled in this dose escalation study. The first four patients were treated with 3 mg of 123I-labeled c30.6, whereas the next 13 received a single dose of unlabeled antibody (maximum dose, 50 mg/m2). The most frequent side effect was a novel syndrome of severe burning and erythema of the face, chest, neck, ears, palms, soles, and genitalia. The frequency of this syndrome was markedly reduced in those patients premedicated with high doses of histamine receptor 1 and histamine receptor 2 blockers. Other side effects were mild and predictable. Biodistribution studies showed a rapid and intensive hepatic uptake. At the 50 mg/m2 level the half-life and maximum serum concentration were 81 +/- 15 h and 7.9 microg/ml, respectively. One patient developed a low-level human anti-c30.6 response. Tumor response was assessed by computed tomography, positron emission tomography scanning, and serial carcinoembryonic antigen measurements. There were no partial responses, although positron emission tomography scanning demonstrated some reduction in tumor activity in three individuals. The chimerized c30.6 antibody is not immunogenic in humans and appears worthy of further study. It does, however, produce a unique profile of side effects that can be well controlled with premedication.

Capecitabine, an oral fluoropyrimidine carbamate with substantial activity in advanced colorectal cancer: results of a randomized phase II study

PURPOSE

To evaluate in patients with advanced colorectal cancer (CRC) three treatment regimens of oral capecitabine in order to select the most appropriate regimen for testing in phase III.

PATIENTS AND METHODS

Three capecitabine schedules were evaluated in a randomized phase II design: arm A, 1,331 mg/m(2)/d bid continuously; arm B, 2,510 mg/m(2)/d bid intermittently (2 weeks on/1 week off); and arm C, 1,657 mg/m(2)/d plus oral leucovorin 60 mg/d bid intermittently (2 weeks on/1 week off).

RESULTS

One hundred nine patients were randomized; 39 patients were assessable for efficacy in arm A, 34 in arm B, and 35 in arm C. Patient characteristics were balanced in the arms. Confirmed tumor responses (partial response [PR] + complete response [CR]) were reported for eight patients with two CRs (21%; 95% confidence interval [CI], 9% to 36%) in arm A, eight patients with one CR (24%; 95% CI, 11% to 41%) in arm B, and eight patients with two CRs (23%; 95% CI, 10% to 40%) in arm C. Median times to progression (TTP) in arms A, B, and C were 127, 230, and 165 days, respectively. Overall, more toxicity was seen with capecitabine plus leucovorin, particularly diarrhea and hand-foot syndrome. There was no grade 3 or 4 marrow toxicity.

CONCLUSION

Capecitabine offers a new, effective treatment option as an oral single agent in advanced CRC. Promising overall response rates were reported for all three regimens. The addition of leucovorin to the intermittent regimen had no marked effect on tumor response or median TTP. The intermittent single-agent capecitabine schedule is proposed for phase III evaluation, based on considerations of toxicity, dose-intensity, response rate, and TTP.

Open label, multi-centre phase II study of raltitrexed ('Tomudex') in patients with inoperable squamous-cell carcinoma of head and neck

BACKGROUND

Raltitrexed ('Tomudex') is a folate based inhibitor of thymidylate synthase which has been registered in Europe and Australia for the treatment of advanced colorectal cancer. In a European phase I trial of raltitrexed anti-tumour activity was seen in two patients with head and neck cancer, prompting the current study.

PATIENTS AND METHODS

From November 1996 to December 1998, 24 patients with metastatic or recurrent squamous-cell carcinoma of the head and neck from 7 Australian centres received raltitrexed, 3 mg/m2 given intravenously over 15 minutes every 3 weeks, for a maximum of 6 cycles. Patients were required to be chemotherapy naïve and have measurable disease, age > 18 years, WHO performance status initially < or = 2, no significant intercurrent illness or organ dysfunction and a life expectancy > 12 weeks.

RESULTS

Twenty-two men and two women, median age 65 years, median performance status 1 were enrolled. Fifteen patients (63%) had received both prior surgery and radiotherapy. In 15 patients (63%) there was recurrent locoregional disease only. Twelve patients (50%) received one cycle of treatment with only four patients (17%) receiving four or more cycles of treatment. No patient achieved a complete or partial response, although 5 patients experienced stable disease which lasted a median of 188 days (range 61-436). The median survival for the whole group was 101 days (range 20436). Raltitrexed was generally well tolerated with minimal antiproliferative toxicity.

CONCLUSIONS

Single-agent raltitrexed does not demonstrate significant anti-tumour response rates in patients with predominantly locally recurrent head and neck cancer.

A lymphocyte transformation assay for the detection of Mycobacterium bovis infection in the Eurasian badger (Meles meles)

The Eurasian badger (Meles meles) is a significant wildlife reservoir of Mycobacterium bovis in Great Britain. Improved control strategies against the disease in badgers require the development of diagnostic tests and vaccines. Here, we report the development of a comparative lymphocyte transformation assay (LTA) using bovine and avian tuberculin as antigen to detect cell-mediated responses in M. bovis-infected badgers. In a pilot study, the performance of this assay was compared with the existing indirect ELISA assay for the detection of tuberculous badgers. The sensitivity of the Comparative LTA was 87.5% compared with 62.5% for the indirect ELISA whereas the ELISA test gave a greater specificity (100% compared with 84.6% for the comparative LTA). Preliminary evidence suggests that for the comparative LTA, the blood may be stored overnight prior to testing and that this procedure might improve the specificity of the assay without compromising the sensitivity.

KRN8602 (MX2-hydrochloride): an active new agent for the treatment of recurrent high-grade glioma

PURPOSE

To assess the efficacy and toxicity of KRN8602 when administered as an intravenous bolus to patients with recurrent high-grade malignant glioma.

PATIENTS AND METHODS

Patients with recurrent or persistent anaplastic astrocytoma or glioblastoma multiforme who had not received recent chemotherapy or radiotherapy and were of good performance status (Eastern Cooperative Oncology Group score < or = 2) were treated with an intravenous bolus of 40 mg/m(2) KRN8602 every 28 days. Tumor responses were assessed radiologically and clinically after every second cycle of therapy. Treatment was continued until documented progression or a total of six cycles.

RESULTS

A median of three cycles (range, one to six cycles) of KRN8602 was administered to 55 patients, 49 of whom received at least two cycles and were, therefore, assessable for response. The overall response rate (disease stabilization or better) was 43% (95% confidence interval, 29% to 58%). There were three complete responses, one partial response, seven minor responses, and 10 patients with stable disease. The median time to progression was 2 months (range, 1.5 to 37 months) and overall survival was 11 months (range, 1.5 to 40 months). Neutropenia was the most common toxicity, although it was generally of brief duration, and there were only seven episodes of febrile neutropenia in 176 cycles delivered. Nonhematologic toxicity was mostly gastrointestinal (nausea and vomiting, diarrhea) and events were grade 2 or lower except for a single episode of grade 3 vomiting.

CONCLUSION

KRN8602 is an active new agent with minimal toxicity in the treatment of relapsed or refractory high-grade glioma. Further studies with KRN8602 in combination with other cytotoxics and in adjuvant treatment of gliomas are warranted.

The significance of anti-sialyl-Tn antibodies in patients with colorectal and breast cancer

The sera of 54 individuals with colorectal or breast cancer, and 50 healthy volunteers were assayed for the presence of anti-bovine submaxillary mucin antibodies using an enzyme linked immunoassay. The serum levels of these antibodies were found to be significantly lower in people with breast (p < 0.001) or colorectal cancer (p < 0.001) with respect to healthy individuals. Within the colorectal cancer group the presence of antibodies was significantly lower in those individuals with poorly differentiated tumors compared to other histological grades (p < 0.05), but did not correlate with the presence of local or distant metastases or anatomical location of the tumor (p > 0.05). No correlation was found with respect to the age of the patient and the level of anti-sialyl-Tn antibodies (p > 0.05). Competition analysis with the anti-sialyl-Tn monoclonal antibody 3C2 indicated that the activity against bovine submaxillary mucin was primarily due to specificity for the sialyl-Tn epitope of the glycoprotein. In contrast to findings with other tumor associated antigens, we could find no evidence of an increase in the level of antibodies against this epitope.

Improved quality of life with megestrol acetate in patients with endocrine-insensitive advanced cancer: a randomised placebo-controlled trial. Australasian Megestrol Acetate Cooperative Study Group

PURPOSE

To investigate the effect of two doses of megestrol acetate (MA) compared with placebo on quality of life (QoL) and nutritional status (NS) in patients with advanced endocrine-insensitive cancer.

PATIENTS AND METHODS

Two hundred forty patients were randomised to double-blind MA 480 mg/day, MA 160 mg/day, or matching placebo for 12 weeks. Nutritional status (including weight, skinfold thickness and midarm circumference) and QoL (using 6 linear analogue self-assessment (LASA) scales) were assessed at randomisation and after four, eight and 12 weeks. A QoL ranking incorporating QoL and death was also used ranging from 1 = dead to 5 = much better QoL.

RESULTS

One hundred seventy-four patients were assessable at week four, 136 at week eight and 103 patients at week 12. Patients receiving MA reported substantially better appetite (P = 0.001), mood (P = 0.001) and overall quality of life (P < 0.001), and possibly less nausea and vomiting (P = 0.08) than patients receiving placebo, based on a test for trend. A larger benefit was seen with the higher dose which (unlike the lower dose) was significantly better in pairwise comparisons with placebo for appetite, mood and overall QoL (each P < or = 0.001). Despite some missing data on QoL scores, QoL ranking was available on 227 (95%) of patients with significantly higher QoL ranking associated with MA (P = 0.002). Improvements in QoL occurred early within four weeks and were sustained. No statistically significant differences were observed in NS measurements, including weight (P = 0.29). Side effects of therapy were minor and did not differ significantly across treatments.

CONCLUSION

Megestrol acetate given at 480 mg/day is useful palliation in patients with endocrine-insensitive advanced cancer. It improves appetite, mood and overall quality of life in these patients, although not through a direct effect on nutritional status.

Tamoxifen reduces bone turnover and prevents lumbar spine and proximal femoral bone loss in early postmenopausal women

Although widely used for its anti-estrogen properties tamoxifen has estrogen like effects on a number of tissues including bone and liver. Previous studies suggest a preservation of lumbar spine density in postmenopausal women but the effect on the hip had not been addressed. To determine whether tamoxifen prevents bone loss in the early postmenopausal period bone mineral density at the lumbar spine and femoral neck was measured using dual energy X-ray absorptiometry at presentation and 6 monthly thereafter for 1 year in a prospective controlled study. Also indices of bone turnover, serum osteocalcin and urinary hydroxyproline excretion, were assessed. Fifteen early postmenopausal women with Stage I or II breast cancer treated with tamoxifen and 21 normal postmenopausal women were studied. Sex hormone binding globulin and antithrombin III levels in serum were also measured as indices of the hepatic estrogenic activity. Tamoxifen (20 mg daily) prevented bone loss at the femoral neck and lumbar spine. Median rates of change in bone mineral density (%/year) for the tamoxifen group were +0.09%/year in the lumbar spine and 1.4%/year in the femoral neck compared with -2.3%/year and -1.8%/year for the control group (P = 0.04 and 0.03, respectively). Tamoxifen resulted in a significant decrease in both serum osteocalcin and urinary hydroxyproline by 6 months of treatment and this effect persisted for the 12 months of observation. An increase in sex hormone binding globulin and a decline in antithrombin III levels was also observed. These data indicate that, in recently, postmenopausal women tamoxifen prevented bone loss at both the lumbar spine and femur and reduced bone turnover.

Dual sequential non-cross-resistant chemotherapy for advanced stage squamous cell carcinoma of the cervix

Forty-three patients with recurrent and metastatic squamous cell carcinoma of the cervix received a program of sequential combination chemotherapy incorporating induction with cisplatin, vinblastine, and bleomycin (PVB) and subsequent consolidation with 5-fluorouracil, doxorubicin, cyclophosphamide, and vincristine (FACV). The overall response rate was 62% and 10 patients (23%) achieved complete remission. Response status was improved in 11 patients at the completion of FACV after initial PVB therapy, including 9 complete remissions. The median survival for all patients in the study was 38 weeks and 50 weeks for the responding patients. Myelosuppression was the principal toxicity encountered and 10 episodes of neutropenic sepsis occurred, including one septic death. However, the only cumulative toxicity was peripheral neuropathy, although this was only moderate to severe in 2 patients. These results are encouraging, but will require confirmation in randomized comparison to cisplatin, presently accepted as standard single-agent therapy.

Metastatic adenocarcinoma of the cervix presenting as an inflammatory breast lesion

The occurrence of an inflammatory breast lesion and wide-spread venous thrombosis in a woman with metastatic adenocarcinoma of the endocervix is reported. Examination of biopsy specimens showed the inflammatory breast mass to be histologically consistent with metastasis from the endocervix. Recurrent venous thrombosis requiring large doses of heparin for control of the phlebitis was also a feature of this patient's illness. The disease was associated with elevation of serum CA 125 levels that did not parallel the patient's clinical course.

Dose intensity and outcome with combination chemotherapy for germ cell carcinoma. Australasian Germ Cell Trial Group

Two hundred and fifty-three patients with advanced stage germ cell carcinoma received induction chemotherapy with vinblastine, bleomycin and cisplatin, sometimes with subsequent surgical resection of residual masses. Overall, 191 patients (76%) achieved complete remission or no evidence of disease after surgery (CR + NED). With 64 months median follow-up only 24 patients have relapsed (13%) and 68% of all patients treated are long-term survivors and 84% of patients entering CR + NED are alive. Toxicity with this chemotherapy was considerable, including seven deaths from leukopenia and septicaemia and eight deaths from bleomycin lung toxicity. Dose reductions or omissions of the drug from the treatment programme was necessary with cisplatin in 8% of patients, with vinblastine in 37% and with bleomycin in 35% of patients. Analysis of these alterations in dose intensity for each drug revealed that initial treatment response and subsequent survival were not compromised by reductions in intended doses of drug administered for either vinblastine or bleomycin. Too few patients had dose reductions of cisplatin for meaningful analysis. This apparent lack of major dose-response effect for either vinblastine or bleomycin in the present treatment programme for germ cell carcinoma has prompted the initiation of a randomized study to determine whether deletion of bleomycin from treatment for patients with good prognostic pretreatment characteristics improves the therapeutic index of this very successful therapy.

Carboplatin and continuous infusion 5-fluorouracil for advanced head and neck cancer

Fifty-one patients with recurrent or advanced squamous cell carcinoma of the head and neck received carboplatin 70 mg/m2/day bolus X 5 days i.v. and 5-fluorouracil (5-FU) 1000 mg/m2/day by continuous infusion i.v. for 5 days as initial chemotherapy. There were four complete responders (CR) and 12 partial responders (PR). Durations of CR were 6.8 months, 7.2+ months and 14.8+ months with one patient lost to follow up after achieving CR. For objective responders the median relapse-free survival from the time of response was 5.3 months and survival from registration 11.7 months. The median survival for all patients was 4.8 months. The major toxicities were myelosuppression and mucositis. Neutropenia (less than 1.0 X 10(9)/l) occurred in 19% of patients, thrombocytopenia (less than 50 X 10(9)/l) in 17% and severe (WHO grade three or four) mucositis was experienced by 28% patients. This combination had less gastrointestinal and nephrotoxicity than platinum containing combinations and can be used in patients with a poorer performance status.

A phase II trial of oral 4'demethoxydaunorubicin in advanced colorectal carcinoma

4'Demethoxydaunorubicin (DMDR), an orally active daunorubicin analogue, was administered to 22 patients with advanced colorectal carcinoma. Patients were stratified into good- and poor-risk categories and received doses of 45 mg/m2 and 40 mg/m2, respectively, at 28-day intervals. Twenty-one patients were evaluable for response. No tumour responses occurred, although six patients had stable disease. Therapy was well tolerated. Mild gastrointestinal toxicity occurred in 45% of patients. Marrow toxicity was common and usually mild. DMDR appears to have no useful activity in colorectal carcinoma.

Phase II study of megestrol acetate for metastatic carcinoma of the prostate

Forty-three males with recurrent and metastatic cancer of the prostate were treated with megestrol acetate (160 mg/day orally) after having failed first-line hormonal treatment (orchiectomy or diethylstilboestrol). Thirty-seven patients were evaluated objectively for response, 28 of whom received the drug for more than 6 weeks. One patient had a partial response (National Prostatic Cancer Project criteria) and seven had stable disease. Toxicity was usually mild, although five patients developed a transient rise in liver enzymes and one patient had a grand mal fit. Three patients showed evidence of tumour "flare". Megestrol acetate has only limited efficacy in patients previously treated for prostatic cancer by hormonal manipulation.

Treatment of advanced gastric carcinoma with mitomycin and doxorubicin

Thirty patients with advanced gastric carcinoma were treated with doxorubicin combined with mitomycin; only four (13%) responded. Myelosuppression was the major toxic effect; there was one toxic death. The overall median survival was 14 weeks (range, 2-42), which is no different from that reported for untreated patients. The combination of doxorubicin and mitomycin alone cannot be recommended for use in patients with advanced gastric carcinoma.

The development of a method for assessing the quality of life of cancer patients

Although the need for a method of measuring the quality of life of patients undergoing therapy for cancer has been widely recognised, no adequately evaluated or feasible method has been established. We describe a method in which 31 items were assessed by patient self report using linear analogue scales. Eighteen items inquiring about general health problems were derived from the Sickness Impact Profile, an established method of assessing the effect of health upon behaviour and function. Thirteen items inquiring about major problems associated with breast cancer were derived from clinical experience and the opinions of patients with this disease. Each item of the measurement method (instrument) has been evaluated for content, feasibility, reliability and validity by methods that are widely used in psychometry but less familiar in medicine. It appeared easy to use, acceptable and reliable in these assessment. Validity was evaluated indirectly since no standard measurements of quality of life exist for comparison. Most items appeared valid when compared to alternative measurement methods including the Sickness Impact Profile and evaluation by a physician in a structured interview. The correlations between items in the instrument were analysed by factor analysis and seemed to fit with the clinical features of breast cancer. The method distinguished between clinically distinct groups of patients and detected changes with time. The study illustrates the possible approaches to the scientific evaluation of methods for measuring subjective features of patients lives. This method appears suitable for some purposes to measure quality of life in breast cancer and is intended to be flexible enough to be modified for other diseases. However, further evaluation, development and refinement will be needed before routine clinical application can be recommended.

Results of treating Hodgkin's disease without a policy of laparotomy staging

Results of the treatment of 780 primary patients with Hodgkin's disease at the Princess Margaret Hospital (PMH) between 1968 and 1977 are analyzed. Treatment decisions were based on the evaluation of the extent of disease by clinical methods. A marked improvement in relapse-free survival and overall survival was observed for 1973-1977 as compared to 1968-1972. This improvement did not result from differences in the distribution of important prognostic attributes (clinical stage, pathology, and age) between the two periods, and there was no improvement in our ability to rescue relapsed patients. Improved relapse-free and overall survival during the second period was observed for all stages in patients less than 50 years of age, but not in the older group. The improved survival of patients treated between 1973 and 1977 is attributed to more effective initial therapy, which reduced the fraction of patients who relapsed. These observations provide indirect evidence that relapse has a negative effect on prognosis, and that the initial treatment of patients with Hodgkin's disease should be designed to reduce the risk of relapse to a minimum without causing an unacceptable increase in late complications. The observed/expected incidence of acute leukemia and non-Hodgkin's lymphoma in the PMH series was increased to 41.9 and 13.9 respectively. The question of whether a policy of doing routine staging laparotomies improves the results of treatment of patients with Hodgkin's disease is considered only in general terms by comparing the total PMH series with the total Stanford Medical Center series of patients treated between 1968 and 1977. Relapse-free survival at 10 years is 48.9% and 66.8% respectively, at the two institutions, while overall survival at 10 years is identified.