Abstract P4-12-01: Adherence with adjuvant endocrine therapy with or without Palbociclib in the PALLAS trial

Background: As the development and use of oral anticancer agents increases, it is critical to understand patient adherence to both standard and investigational agents. The open label, phase 3 multicenter PALLAS trial investigates whether adding 2 years of the CDK4/6 inhibitor palbociclib (P) to adjuvant endocrine therapy (ET) improves invasive disease-free survival (iDFS) over adjuvant ET alone in patients (pts) with HR- positive, HR2-negative, stage II-III breast cancer. Pts were randomly assigned to either Palbociclib (125 mg/day, 3 weeks on, 1 week off, in a 28-day cycle) plus ongoing provider/patient-choice adjuvant ET (P+ET) versus ET alone. We examined patient-reported adherence to ET +/- P during the first two years of study treatment. Methods: Adherence outcomes were measured in English-speaking pts in the U.S., UK, Ireland and Australia, Spanish-speaking pts in Spain and Mexico, and German-speaking pts in Germany and Austria. Adherence measures included drug diaries completed at each cycle, pill counts (for P only) collected at each study visit, and the Morisky Medication Adherence Scale-4 item and the McHorney Adherence Estimator questionnaires completed at cycles 2, 3, 6, 12, 18, and 24 (22 months). Mean adherence for each cycle was defined as the average proportion of prescribed pills taken (via drug diary) across all patients who initiated that cycle. Persistence was defined as the duration of drug initiation to treatment cessation (via drug diary). Generalized estimating equations were used to model the “most adherent” pts on the Morisky (score = 5 vs score <5) and “low risk” for adherence problems on the McHorney (score=0 vs score >0) to compare the average difference between arms over time for ET, adjusting for baseline demographic and clinical variables. Results: 81% (N=4688) of PALLAS pts were included in this analysis. Median persistence to ET was 23.6 months in P + ET (n=2169), 23.7 months in ET alone (2136) and 20.4 months for P (n=2194). The number of pts who initiated each cycle for ET declined over time and was similar between arms; the decline was more marked for P (Table 1). Mean adherence range as measured by drug diary was 98.2-99.3% for ET in P+ET and 98.0 - 99.4% in ET alone; and for P, ranged from 93.4 - 98.8%. The adherence and persistence results were nearly identical whether measured by drug diary or pill count for P. The observed percent “most adherent” for P measured by the Morisky scale ranged from 71.9% - 79.6% and the percent “low risk” for adherence problems measured by the McHorney scale, 64.0% - 73.4%. The percent of pts “most adherent” and “low risk” for adherence problems to ET was higher, on average over time, in the P+ET group compared to ET alone (75% vs 68%, p<0.01; 75% vs 72%, p=.05, respectively). Conclusions: Self-reported mean adherence for both P + ET and ET alone was strikingly high for pts who remained on therapy; persistence was also high with ET during the 2-year treatment period. Current analyses suggest that nonadherence to either P or ET was likely not a major contributor to the iDFS results seen in the overall PALLAS trial. These results illustrate the importance of measuring and monitoring patient adherence to oral study agents. Support: AFT, Pfizer; ClinicalTrials.gov (NCT02513394) and EudraCT (2014-005181-30). https://acknowledgments.alliancefound.org

Table 1.Adherence and persistence in PALLAS over the 24 month treatment periodPalbocicilb + ETETPalbociclibETETTreatment cycleMean Adherence (SD)N*Mean Adherence (SD)NMean Adherence (SD)N193.4 (13.8)229098.7 (6.1)230999.0 (5.2)2343294.7 (13.3)218198.8 (6.4)220398.4 (7.1)2206397.4 (10.1)211298.7 (7.3)214298.8 (6.3)2168497.6 (10.2)203598.6 (7.8)211099.0 (5.7)2154597.6 (11.1)197598.3 (7.9)209398.1 (8.3)2148698.1 (8.7)189998.7 (6.6)203798.5 (8.2)2116798.1 (9.3)185599.0 (6.3)201298.6 (7.3)2102898.0 (9.1)181098.2 (8.2)199798.1 (8.2)2092998.4 (7.4)173399.0 (6.4)196298.8 (6.8)20511098.3 (8.6)171499.2 (4.9)194699.0 (5.5)20381198.3 (8.0)169198.5 (7.3)193798.2 (8.2)20311298.7 (6.2)161299.1 (5.3)191098.7 (7.5)19861398.5 (7.7)159698.9 (6.4)189398.8 (7.1)19691497.9 (9.3)157698.4 (7.3)188298.0 (9.1)19611598.5 (6.9)151499.2 (4.6)185499.0 (6.0)19281698.2 (8.7)148699.1 (4.6)183599.1 (5.7)19131798.1 (9.8)147998.3 (7.8)182698.5 (6.4)19031898.7 (6.8)141699.3 (4.1)176899.2 (5.3)18601998.7 (7.3)140899.3 (3.8)175699.4 (3.1)18482098.4 (8.9)139798.9 (5.3)174298.7 (5.8)18382198.5 (7.5)130199.0 (6.1)167698.8 (7.1)17842297.8 (9.7)124698.8 (6.2)164799.2 (5.7)17692398.1 (8.8)118098.2 (8.5)161998.4 (8.0)17552498.8 (7.2)108699.0 (6.3)146898.9 (7.1)16192598.8 (6.7)99699.2 (5.2)143298.8 (7.1)15892697.9 (11.2)84599.1 (5.7)140998.6 (8.8)1578ET=Endocrine therapy * Number of pts who initiated the treatment cycle.

Citation Format: Eileen Shinn, David Zahrieh, Angela DeMichele, Nick Zdenkowski, Julie Lemieux, Jun Mao, Vesna Bjelic-Radisic, Michelle Naughton, Georg Pfeiler, Karen Gelmon, Ingrid Mayer, Daniel Egle, Gabriele Zoppoli, Tiffany Traina, Miguel Martin Jiménez, Silvia Antolin Novoa, Tufia Haddad, Arlene Chan, Alistair Edward Ring, Antonio Wolff, Jose JuanPonce Lorenzo, Dhanusha Sabanathan, Hal Burstein, Zbigniew Ireneusz Nowecki, Gunda Pristauz-Telsnigg, Adam Brufsky, Meritxell Bellet-Ezquerra, Theodoros Foukakis, Yelena Novik, Gabor Rubovszky, Karoline Muehlbacher, Otto Metzger, Theodora Goulioti, Ernest Law, Ann Partridge, Lisa Carey, Alex Zoroufy, Dominik Hlauschek, Christian Fesl, Erica Mayer, Michael Gnant. Adherence with adjuvant endocrine therapy with or without Palbociclib in the PALLAS trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-01.

Galenic and Dermopharmaceutical Effectiveness Study of an Emulsified Pharmaceutical form with Retinoic Acid

Retinoic acid constitutes an active that is already being used extensively in the fight against cutaneous aging. After a period in which certain scientific publications questioned its use, today there is no doubt that retinoic acid continues to be an active with wide possibilities of use when it is formulated and administered correctly. In this work we propose a new formulation that, on the basis of a modern self-emulsifying excipient, incorporates retinoic acid in its composition. The work protocol is structured in the following points of study. Rheological assay: Shear rate, shear stress, viscosity, thixotropy, rheodestruction, and extensibility measurements were carried out. Other pharmacotechnical assays: External appearance, interposition type, and pH control were studied. Dermopharmaceutical effectiveness study: Biophysical non-invasive techniques were applied, according to a standardized work method. The following considerations can be made from the results: the layout of the rheograms could fit, in principle, inside a non-Newtonian-shear-thinning flow behavior, with similar rheodestruction profiles. The hysteresis values, as well as the extensibility indexes that were obtained, determined a good degree of applicability. From the whole of results, we could conclude that the formulation proposed is profiled like an emulsified pharmaceutical form with an excellent cosmetological adaptation, eudermic pH, and soft emollient action, which prohibits the loss of superficial water that maintains the retinoic acid action.

Poly‐Epsilon‐Caprolactone Nanocapsules Containing Octyl Methoxycinnamate: Preparation and Characterization

This study investigates the different nanocapsules (NCs) made of poly-epsilon-caprolactone (PCL) containing the lipophilic sunscreen Escalol 557 [octyl methoxycinnamate (OMC)] and analyzes the influence of nanoparticle-based systems on light-induced decomposition of the sunscreen agent. The NCs were designed and prepared by the solvent displacement method. Formulation parameters, such as the nature and volume of the organic and aqueous phase and the nature and concentration of the surfactants and polymer, have relevant implications on NC elaboration. We investigated the influence of several technological (stirring speed: 300-800 rpm) and formulation factors [polymer amount, 195-244.5 mg; surfactant, Tween 85 (Polysorbate 85), Montanox 80 (Polysorbate 80), and Synperonic PE/F68 (Poloxamer 188) as stabilizing agents; and volume of the organic phase, 20-30 mL of acetone] on the particle size and the OMC loading capacity of the formulations--encapsulation efficiency and yield. The sizes of NC obtained were in the range of 309 to 1042 nm, the encapsulation efficiencies ranged from 93.82% to 99.97%, and yields of NC encapsulation ranged from 48.12% to 86.28%. Of all the preset experimental conditions, Montanox 80, 30 mL of acetone, 244.5 mg of polymer, and a stirring speed of 350 rpm have been selected as the best in this experimental design study. The experimental conditions selected to obtain OMC-loaded NC of 374 nm resulted in a high entrapment percentage (97.52%) and yield (82.95%). The PCL nanoparticles loaded with OMC were effective in reducing light-induced degradation of the sunscreen agent.

Influence of encapsulation on the in vitro percutaneous absorption of octyl methoxycinnamate

The purpose of this study was to evaluate the in vitro transdermal permeation and skin accumulation of one ultraviolet (UV) absorber-octyl methoxycinnamate (OMC)-through pig skin and to determine the quantity of OMC in the skin surface and different pig skin layers (stratum corneum, viable epidermis, dermis, and receptor fluid). Four cases have been considered: the application of oil-in-water (O/W) and water-in-oil (W/O) emulsions containing the same filter free and encapsulated in nanocapsules (NC). The influence of the carrier on the percutaneous penetration was studied. Data showed that UV absorber exhibited increases in skin accumulation when is formulated in emulsions in free form. Skin accumulation of OMC-free in the emulsions was significantly (P < 0.05) greater than that of OMC-encapsulated for all formulations investigated. OMC-free skin accumulation ranged from 127.8 +/- 22.8 microg/cm(2) (O/W emulsion) to 172.1 +/- 12.9 microg/cm(2) (W/O emulsion). OMC-encapsulated skin accumulation ranged from 50.3 +/- 13.1 microg/cm(2) to 43.0 +/- 6.5 microg/cm(2) at NC-O/W and NC-W/O, respectively. No significant differences were found in the transdermal permeation of cinnamate for any of the formulations tested. The results of this study demonstrate that the inclusion of OMC-encapsulated in sunscreen formulations decreases the skin accumulation of the cinnamate since the in vitro release mechanism of OMC-nanocapsules is governed by hydrophobicity and crystallinity of the polymer and by the high lipophilicity of the drug. The crystallinity of the polymer have the ability of reflecting and scattering UV radiation on their own thus leading to photoprotection without the need for molecular sunscreens.

Systematic study of the flow behaviour and mechanical properties of Carbopol Ultrez 10 hydroalcoholic gels

Flow behaviour and mechanical properties of 0:100, 15:85, and 30:70 v/v gelled ethanol:water mixtures are studied as a function of pH (4.0-7.0) and Carbopol Ultrez 10 concentration (0.1-0.5%). As previously reported individually for 30% v/v alcoholic Ultrez 10 gels, flow curves were adjusted to the Ostwald's model, and similar sigmoidal dose response functions were obtained to describe the pH dependence of consistency index and mechanical properties of the systems. The concentration dependence of flow indexes was also best adjusted to one-phase exponential decay functions. As a result, the influence of ethanol content on polymer network is meaningfully assessed by means of the obtained empirical parameters: bottom value of each variable (Y(max)), pH value required for a 50% polymer network development (pH(50)), and asymptotic flow index value for the fully structured gels (n(min)). Also, it is assessed the influence of cosolvent on the above-mentioned empirical variables, by studying pH-dependence of gelation in methanol:water, 1-propanol:water and 1-butanol:water 15:85% v/v mixtures. As a result, the alcohol induced variations in consistency and mechanical properties of hydroalcoholic gels were well correlated to modifications in the solubility parameter (delta(T)).

Pharmacotechnical characterization and effectiveness testing of a proposed emulsion for the treatment of dry skin

One of the most important objectives of the Pharmaceutical Industry is the development of new excipients as well as the optimization of other more traditional ones. Also, the investigation of new active substances able to prevent, palliate or treat the cutaneous dehydration is another of the most important of their objectives. Both tendencies are implanted in this experimental work: we propose an emulsion formulated with the base--Neo PCL' (25%), NMF (Lactil', 5%) and a peculiar active--Honey of Rosemary (15%). The working scheme is as follows: 1) Pharmacotechnical Characterization--organoleptic characteristics, Photomicrograph Study, Type of Emulsion, pH, Rheology; 2) Stability Study by means of accelerated tests based on temperature and centrifugation; 3) Effectiveness Study by applying of non-invasive assessment techniques. An emulsified dermopharmaceutical form is obtained (O/W) with a satisfactory organoleptic characteristics and eudermic pH (5.2), attributable to the acid character of Honey. From the rheological study, a very good results are obtained: viscosity (T = 408.8.D0.549), structural recuperation (30%) and thixotropy (AD1/AD2 = 1.36). On the other hand, from the effectiveness results (corneometric--P.I.120 = 43.2%- and sebumetric--E.I. = 33-144 mg/cm2-), a high level of moisturizing is deduced, which is attributable to the synergic action of both Lactil' and Honey. Finally, the proposed emulsion would serve as a treatment for all type of dry skin.

[Focal fatty liver lesions: infrequent ultrasonographic presentation]

We present case of focal fatty liver lesions. Echography images revealed multiple hyperechogenic lesions similar to those observed in metastatic disease. Aspiration was negative and diagnosis was based on the results of liver biopsy alone, carried out during laparoscopy. The difficulty of determining the etiology of this type of lesión by echography is discussed.

Synaptic patterns of rye B chromosomes. IV. The B isochromosomes

Pairing of B isochromosomes in rye was studied by surface spreading of synaptonemal complexes in pollen mother cells from plants containing one small iso-B (iso-BS), one large iso-B (iso-BL), two iso-BL, one iso-BS plus one standard B (iso-BS+stB), one iso-BS plus two standard Bs (iso-BS + 2 stB) and one iso-BL plus two standard Bs (iso-BL + 2 stB). The main characteristics of iso-Bs were as follows. (1) Their location in the surface-spread nuclei was peripheral. (2) Their period of pairing relative to that of the A-set was delayed. (3) The commonest pachytene configuration was a symmetrical hairpin loop, although they could also undergo nonhomologous synapsis. (4) Synapsis could start at the chromosome ends, at the putative centromeric region or at both regions more or less simultaneously. (5) The frequency of iso-BL bivalents was only 46 per cent rather than the 66 per cent predicted by the random-end-pairing model. Interchromosomal pairing was frequent in these configurations. (6) In pairing competition situations involving three and four doses of the short arm of the standard B (iso-BS+stB, iso-BS + 2 stB), a large predominance of self-synapsed iso-BS univalents (63 per cent and 80 per cent respectively) was found. On the other hand, there was no apparent pairing preference among four doses of the long arm of the standard B in the iso-BL + 2 stB combination. Similarities and differences between the synaptic behaviours of iso-Bs of Crepis capillaris and Secale cereale are discussed.

Synaptic patterns of rye B chromosomes. II. The effect of the standard B chromosomes on the pairing of the A set

In order to elucidate the possible effects of rye B chromosomes (Bs) on synapsis and metaphase-I associations of the A set, a comparative study between pachytene and metaphase-I-cells of rye plants carrying different numbers of Bs (0-8) has been carried out. The number of Bs was found to be positively correlated with the frequency of synaptic irregularities of the A set, i.e. multivalents and foldback pairing, and with the frequency of pachytene interlockings. It is proposed that interlockings are the origin of these irregularities because both appeared in close proximity in many nuclei. Examples of A-B pairing are described. The frequency of synaptic abnormalities seems to be unrelated to the mean of A chromosome-bound arms at metaphase I.

Synaptic patterns of rye B chromosomes. II. The effect of the standard B chromosomes on the pairing of the A set

In order to elucidate the possible effects of rye B chromosomes (Bs) on synapsis and metaphase-I associations of the A set, a comparative study between pachytene and metaphase-I-cells of rye plants carrying different numbers of Bs (0-8) has been carried out. The number of Bs was found to be positively correlated with the frequency of synaptic irregularities of the A set, i.e. multivalents and foldback pairing, and with the frequency of pachytene interlockings. It is proposed that interlockings are the origin of these irregularities because both appeared in close proximity in many nuclei. Examples of A-B pairing are described. The frequency of synaptic abnormalities seems to be unrelated to the mean of A chromosome-bound arms at metaphase I.

Synaptic patterns of rye B chromosomes. I: The standard type

Chromosome pairing of standard B chromosomes (Bs) in rye has been studied by synaptonemal complex surface spreading of pollen mother cells containing from one to eight Bs. The main characteristics exhibited by the Bs are: (i) They are often located peripherally in surface spread nuclei and do not show presynaptic alignment. (ii) The period of pairing is delayed relative to that of the A set. (iii) Bs undergo extensive non-homol-ogous pairing at pachytene. (iv) The frequency of trivalents and quadrivalents in plants with 3Bs and 4Bs is about 66% following the expectations on the basis of random pairing among the short and the long arms with a single distal pairing initiation site per arm. Some quadrivalents containing two partner switches were observed, but on the same basis of randomness there was a deficiency of pachytene multivalents in plants with 5-8 Bs. The possible causes of the discrepancy between these observations are discussed. (v) There is a reduction in the frequency of multivalents between pachytene and metaphase I.

Deoxycorticosterone, 18-OH-deoxycorticosterone and corticosterone determination by high performance liquid chromatography in monolayer adrenal cell culture

Reversed-phase HPLC offers a rapid, qualitative as well as quantitative method for separation and determination of deoxycorticosterone, 18-OH-deoxycorticosterone and corticosterone in primary culture of adrenocortical cells. The resolution is sufficient for the purpose of quantitative determination. The limitation of this method lies in its sensitivity for serum steroid determination, but is perfectly applicable at cell cultures where the concentration of these steroids is highest.