Health-Related Quality of Life for Long-Acting Octreotide versus Placebo in Patients with Metastatic Midgut Neuroendocrine Tumors in the Phase 3 PROMID Trial

BACKGROUND

In the phase IIIb PROMID study, octreotide long-acting significantly extended time to tumor progression compared with placebo in treatment-naïve patients with well-differentiated metastatic midgut neuroendocrine tumors. We report post hoc analyses for health-related quality of life (HRQoL).

METHODS

HRQoL was measured with EORTC QLQ-C30, a 30-item self-report questionnaire (5 functional, 1 global, 9 symptom scales). Assessments were completed at baseline and every 12 weeks until tumor progression. Time to definitive deterioration (TDD; worsening of ≥10 points without further improvement) was analyzed with the Kaplan-Meier method. Linear mixed models were fit to assess change from baseline in QLQ-C30 scores by treatment arm over time.

RESULTS

Among 85 patients, 82 (96%) completed the QLQ-C30 at baseline. There were few events of definitive deterioration for many scales. Significantly longer TDD was reported for long-acting octreotide versus placebo for fatigue (median 18.5 months vs. 6.8; p = 0.0006), pain (not reached [NR] vs. 18.2; p = 0.0435) and insomnia (NR vs. 16.4; p = 0.0046). Change from baseline to week 24 fatigue scores were stable for long-acting octreotide (mean 0.78; 95% CI -6.3 to 7.8) but worsened for placebo (mean 9.1; 95% CI 1.9-16.4), and for diarrhea there were improvements for long-acting octreotide (mean -8.0; 95% CI -19.6 to 3.5) and worsening for placebo (mean 11.2; 95% CI -0.7 to 23.1).

CONCLUSIONS

HRQoL was maintained with few deteriorations in long-acting octreotide patients, whereas there was earlier and/or more deterioration in placebo patients. In long-acting octreotide patients, HRQoL was maintained or improved for the clinically important neuroendocrine tumor symptoms such as fatigue, insomnia, diarrhea and pain, whereas placebo patients experienced a deterioration of HRQoL scores for these symptoms.

Diet, body size, physical activity and risk of prostate cancer: An umbrella review of the evidence

The existing literature on the relationship between diet, body size, physical activity and prostate cancer risk was summarised by the World Cancer Research Fund Continuous Update Project (CUP). An evaluation of the robustness of this evidence is required to help inform public health policy. The robustness of this evidence was evaluated using several criteria addressing evidence strength and validity, including the statistical significance of the random effects summary estimate and of the largest study in a meta-analysis, number of prostate cancer cases, between-study heterogeneity, 95% prediction intervals, small-study effects bias, excess significance bias and sensitivity analyses with credibility ceilings. A total of 248 meta-analyses were extracted from the CUP, which studied associations of 23 foods, 31 nutrients, eight indices of body size and three indices of physical activity with risk of total prostate cancer development, mortality or cancer development by stage and grade. Of the 176 meta-analyses using a continuous scale to measure the exposures, no association presented strong evidence by satisfying all the aforementioned criteria. Only the association of height with total prostate cancer incidence and mortality presented highly suggestive evidence with a 4% higher risk per 5 cm greater height (95% confidence interval, 1.03, 1.05). Associations for body mass index, weight, height, dietary calcium and spirits intake were supported by suggestive evidence. Overall, the association of diet, body size, physical activity and prostate cancer has been extensively studied, but no association was graded with strong evidence.

A histochemical study of iron-positive cells in the developing rat brain

The establishment of normal iron levels in the neonatal brain is critical for normal neurological development. Studies have shown that both iron uptake and iron concentration in the brain are relatively high during neonatal development. This histochemical study was undertaken to determine the pattern of iron development at the cellular level in the rat forebrain. Iron-stained cells were observed as early as postnatal day (PND) 3, which was the earliest time point examined. At PND 3, there were four major foci of iron-containing cells: the subventricular zone and three areas within the subcortical white matter. These latter foci are associated with myelinogenic regions. The blood vessels were prominently stained for iron throughout the brain. At PND 7, as in PND 3, the majority of the iron-containing cells were in white matter. However, there were also patches of iron staining located specifically in the layer IV of the somatosensory cortex. These cortical patches were no longer visible by PND 14. At PND 14, numerous iron-stained cells were dispersed throughout white matter regions and the tanycytes aligning the third ventricle were prominently stained. The blood vessel staining was less prominent than at earlier time periods. By PND 28, the adult pattern of iron staining was emerging. Iron-stained cells were aligned in rows in white matter and had an apparent preference for a location near blood vessels. This clustering of iron-positive cells around blood vessels gave the white matter a "patchy" appearance. The pattern of development, cell distribution, and morphological appearance of the iron-stained cells are consistent with that reported for oligodendrocytes. That iron-positive cells in the neonate may be oligodendrocytes is consistent with the reports for iron staining in adult brains. The recent reports that oligodendrocytes are highly susceptible to oxidative damage would be consistent with the high iron levels found in these cells. These results indicate that oligodendrocytes play a major role in the development of iron homeostasis in the brain. The role of iron in oligodendrocytes may be associated with metabolic demands of myelinogenesis, including cholesterol and fatty acid synthesis. However, these cells may be a morphologically similar but functionally distinct subset of oligodendrocytes whose function is to regulate the availability of iron in the brain.