Genotype-Phenotype Correlations in Thirty Japanese Patients with Congenital Hypothyroidism Attributable to TG Defects

CONTEXT

Thyroglobulin (Tg), encoded by TG, is essential for thyroid hormone synthesis. TG defects result in congenital hypothyroidism (CH). Most reported patients were born before the introduction of newborn screening (NBS).

OBJECTIVE

We aimed to clarify the phenotypic features of patients with TG defects diagnosed and treated since the neonatal period.

SUBJECTS AND METHODS

We screened 1061 patients with CH for thirteen CH-related genes and identified thirty patients with TG defects. One patient was diagnosed due to hypothyroidism-related symptoms and the rest were diagnosed via NBS. Patients were divided into two groups according to their genotypes, and clinical characteristics were compared. We evaluated the functionality of the seven missense variants using HEK293 cells.

RESULTS

Twenty-seven rare TG variants were detected, including fifteen nonsense, three frameshift, two splice-site, and seven missense variants. Patients were divided into two groups: thirteen patients with biallelic truncating variants and seventeen patients with monoallelic/biallelic missense variants. Patients with missense variants were more likely to develop thyroid enlargement with TSH stimulation than patients with biallelic truncating variants. Patients with biallelic truncating variants invariably required full hormone replacement, whereas patients with missense variants required variable doses of levothyroxine. Loss of function of the seven missense variants was confirmed in vitro.

CONCLUSION

To our knowledge, this is the largest investigation on the clinical presentation of TG defects diagnosed in the neonatal period. Patients with missense variants showed relatively mild hypothyroidism with compensative goiter. Patients with only truncating variants showed minimal or no compensative goiter and required full hormone replacement.

Abstract P2-13-02: Patient-reported outcomes with trastuzumab monotherapy versus trastuzumab plus standard chemotherapy as a postoperative adjuvant therapy in HER2-positive elderly breast cancer patients (RESPECT): A randomized, open-label, phase 3 clinical trial

OBJECTIVE: The RESPECT trial compared 1-year trastuzumab monotherapy with trastuzumab plus standard chemotherapy as a postoperative adjuvant therapy in HER2-positive elderly breast cancer patients. Primary objective of this study was to verify the noninferiority of 1-year trastuzumab monotherapy to trastuzumab plus chemotherapy in terms of disease free survival, and the planned analysis showed that the difference of restricted mean survival time between two groups at 3 years was 0.45 months (reported by Sawaki at ASCO2018). This report assesses the patients-reported outcomes and health-related quality of life (HRQoL).

PATIENTS AND METHODS: The study was done at 99 hospitals in Japan. Elderly women (70 to 80 years old) with HER2-positive, stageI-IIIA invasive breast cancer treated by surgery with clear resection margins were randomly assigned to receive either 1-year trastuzumab or 1-year trastuzumab plus standard chemotherapy, stratified by age, hormone-receptor status, pathological lymph node metastasis and institution. Patients completed questionnaires at baseline, 2 months, 1year, and 3 years after protocol treatment started. The primary outcome was global HRQoL assessed using Functional Assessment of Cancer Therapy-General (FACT-G) total score, and secondary outcomes were chemotherapy-induced peripheral neuropathy (CIPN), instrumental activities of daily living (IADL), anxiety, depression, and subjective happiness. We did the analyses by intention to treat, including patients who completed questionnaires at baseline before start of protocol treatment, and 5point or more change is meaningful in FACT-G total score. This study is registered with ClinicalTrials.gov, NCT01104935.

RESULTS: Between Oct 2009 and Oct 2014, 275 patients were enrolled in the study, of whom 9 patients were excluded: 135 assigned to trastuzumab monotherapy and 131 assigned to trastuzumab plus chemotherapy. We detected significant difference between treatment groups for: clinically meaningful HRQoL deterioration rate at 2 months (31% for trastuzumab monotherapy vs 48% for trastuzumab plus chemotherapy; p=0.016) and at 1year (19% vs 38%; p=0.009), clinically meaningful HRQoL improvement rate at 2 months (38% for trastuzumab monotherapy vs 15% for trastuzumab plus chemotherapy; p<0.01) and at 1year (43% vs 25%; p=0.021), severe sensory CIPN rate at 2months (1.9% for trastuzumab monotherapy vs 14.4% for trastuzumab plus chemotherapy; p=0.001), IADL score at 1year (11.97 for trastuzumab monotherapy vs 11.54 for trastuzumab plus chemotherapy; p<0.042), Hospital Anxiety and Depression Scale score at 2months (8.92 for trastuzumab monotherapy vs 10.79 for trastuzumab plus chemotherapy; p<0.003), and subjective happiness score at 1year (12.8 for trastuzumab monotherapy vs 11.8 for trastuzumab plus chemotherapy; p<0.024).

CONCLUSION: Given the small advantage of adjuvant trastuzumab plus chemotherapy compared to trastuzumab monotherapy for elderly HER-2 positive breast cancer women, decisions about treatment should be informed by the risk for adverse health effects associated with chemotherapy.

Citation Format: Kobayashi K, Taira N, Sawaki M, Sagawa N, Baba S, Saito T, Kawahara T, Hagiwara Y, Uemura Y, Shimozuma K, Ohashi Y, Mukai H. Patient-reported outcomes with trastuzumab monotherapy versus trastuzumab plus standard chemotherapy as a postoperative adjuvant therapy in HER2-positive elderly breast cancer patients (RESPECT): A randomized, open-label, phase 3 clinical trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-13-02.

Abstract P1-11-21: Analysis of cognitive function in elderly HER2-positive breast cancer patients receiving either trastuzumab monotherapy or trastuzumab plus chemotherapy as a postoperative adjuvant treatment: A cognitive function sub-study of a randomized, open-label, phase 3 clinical trial (RESPECT trial)

OBJECTIVE: The effect of trastuzumab(Tmab) or chemotherapy on cognitive function has not been fully understood, especially in elderly breast cancer patients. The RESPECT trial compared 1-year(yr) Tmab monotherapy with Tmab plus standard chemotherapy as adjuvant therapy in elderly patients with HER2-positive breast cancer. The primary objective was to verify the noninferiority of 1-yr Tmab monotherapy compared to Tmab plus chemotherapy in terms of disease-free survival, and the planned analysis showed that the difference of restricted mean survival time between two groups at 3 yrs was 0.45 months (Sawaki at ASCO2018). The goal of this report was to assess the impact of the treatment groups on longitudinal cognitive function.

PATIENTS AND METHODS: The study was performed with patients from 99 hospitals in Japan. Elderly women with HER2-positive, stage I-IIIA invasive breast cancer surgery treated with clear resection margins were randomly assigned to either receive 1-yr Tmab or 1-yr Tmab plus standard chemotherapy. 15 institutions participated in the cognitive sub-study. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline and at 1 and 3 yrs after treatment. The primary outcome was the amount of change in the MMSE score from the baseline. A linear mixed-effects model was used for comparisons of change in the MMSE score between groups, controlling for time and baseline score. Secondary outcomes were the proportion of both suspected mild dementia (MMSE≤27) and dementia (MMSE≤23) at each time point.

RESULTS: Between October 2009 and October 2014, 275 patients were enrolled in the RESPECT trial, and 57 patients were enrolled in the cognitive function sub-study with 2 patients subsequently excluded. The 55-patient sub-study comprised 29 patients assigned to the Tmab monotherapy group and 26 patients assigned to the Tmab plus chemotherapy group. Primary analysis revealed that change in the MMSE score was not significantly different between the two groups (difference −0.6 at 1 yr and −0.9 at 3 yrs; p=0.136), whereas the baseline score was the only significant factor that had an effect on the amount of change in the MMSE score (p<0.001). The proportions of suspected mild dementia at baseline, and at 1 yr and 3 yrs were 15.4, 32.0, and 41.7% in the Tmab monotherapy group, and 45.8, 17.6, and 28.6% in the Tmab plus chemotherapy group. The proportions of suspected mild dementia at baseline were significantly higher in the Tmab plus chemotherapy group (p=0.04). The proportions of suspected dementia at baseline, and at 1 yr and 3 yrs were 0%, 0%, and 4.2% in the Tmab monotherapy group, and 4.2%, 0%, and 4.8% in the Tmab plus chemotherapy group. There were no significant differences in the proportions of suspected dementia between the treatment groups at each time point.

CONCLUSION: Postoperative chemotherapy for elderly breast cancer patients was considered to have little effect on the onset of dementia during the follow-up period of 3 yrs. Further long-term observation is necessary to obtain a significant conclusion.

Citation Format: Takahashi M, Sawaki M, Hagiwara Y, Uemura Y, Kawahara T, Shimozuma K, Ohashi Y, Saito T, Baba S, Kobayashi K, Mukai H, Taira N. Analysis of cognitive function in elderly HER2-positive breast cancer patients receiving either trastuzumab monotherapy or trastuzumab plus chemotherapy as a postoperative adjuvant treatment: A cognitive function sub-study of a randomized, open-label, phase 3 clinical trial (RESPECT trial) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-21.

Abstract P2-01-09: Circulating tumor cells (CTCs) in the venous drainage of the breast in patients with primary breast cancer

Background:

CTCs are shed from tumors and circulate in the peripheral blood after passing through the drainage vein. Axillary lymph node dissection (ALND) provides access to the lateral thoracic vein which flows directly into the axillary vein. In this preliminary study, we evaluated the feasibility of detecting CTCs in the peripheral blood and in the lateral thoracic venous blood for breast cancer patients who underwent ALND.

Methods:

From June 2016 to March 2017, breast cancer patients who underwent ALND in our institute were eligible for this study. A peripheral blood sample,10ml, was drawn just before the surgery or one day before the surgery. A lateral thoracic venous blood sample was taken from the resected breast just after resection. A blood sample of 0.2ml or more was necessary for CTC isolation. The CTCs in the peripheral blood before surgery (periCTC) and in the blood from the lateral thoracic vein of the resected breast (ltvCTC) were quantitatively examined by using a size-selective CTC isolation platform.

Results:

A total of 21 patients with median age 51 years (37-75) were enrolled to the study. Of the 21 patients, 38% were premenopausal, 52% had neoadjuvant chemotherapy. Fifty-seven percent were ER and/or PgR positive, 24% were HER2 positive. Fifty-seven percent were stage II disease and 43% were stage III. In 3 patients, we couldn't obtain sufficient blood samples from the lateral thoracic vein. Of the remaining 18 patients, we were able to obtain the median 0.5ml (0.2-2.0) blood samples from the lateral thoracic vein. CTCs were detected in peripheral blood in 15 patients (71%) and median periCTC count was 1 CTC/10ml (0-39). In lateral thoracic venous blood, CTCs were detected in all patients who had sufficient blood samples and the median ltv CTC count was 35.5 CTC/ml (2.5-370). In 5 of 6 patients whom CTCs in peripheral blood samples were not detected, CTCs could be detected in the blood samples from lateral thoracic vein.

Conclusion:

CTCs can be detected in the peripheral blood and in the blood from lateral thoracic vein in patients with localized breast cancer, and can be detected at a higher rate and at a higher concentration in the blood from lateral thoracic vein than in peripheral blood.

Citation Format: Hattori M, Nakanishi H, Yoshimura A, Adachi Y, Iwase M, Gondo N, Kotani H, Sawaki M, Yatabe Y, Iwata H. Circulating tumor cells (CTCs) in the venous drainage of the breast in patients with primary breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-01-09.

Abstract P2-12-13: Withdrawn

This abstract was withdrawn by the authors.

Abstract P3-11-06: A phase 1 study of KHK2375 (entinostat) as monotherapy and in combination with exemestane in Japanese patients with hormone receptor-positive, HER2-negative, advanced or recurrent breast cancer

Background: Patients (pts) with hormone receptor-positive (HR+) and non-life threatening advanced or metastatic breast cancer (BC) are usually treated with sequential endocrine therapies. Endocrine therapies are continued until tumor cells acquire resistance to them, following which pts are switched to cytotoxic chemotherapy. Entinostat (ENT) is an oral inhibitor of class I histone deacetylases (HDACs) and is expected to be used for endocrine therapy-resistant pts. The efficacy of ENT in combination with an aromatase inhibitor (AI) for HR+ BC was demonstrated in a previous randomized phase 2 study. Because of the lack of data on safety and pharmacokinetics (PK) in Japanese HR+ BC pts, we performed this dose escalation phase 1 study to investigate the safety of ENT monotherapy and combination therapy with exemestane (EXE) in postmenopausal women with advanced or recurrent HR+ BC. Secondary objectives were to assess PK and efficacy.

Methods: This study was based on a 3+3 dose escalation design. Postmenopausal women with advanced or recurrent HR+ HER2- BC previously treated with nonsteroidal AIs and with ECOG PS 0-1 were enrolled. The dose limiting toxicities (DLT) of ENT monotherapy (3 mg/qw, 5 mg/qw, or 10 mg/q2w) in Cohort 1-3 and those of ENT (5 mg/qw or 3 mg/qw) in combination with EXE 25 mg/qd in Cohort 4-5 were assessed for 7 and 28 days, respectively. Pts continued ENT (3 mg or 5 mg) in combination with EXE even after the DLT observation period until disease progression or discontinuation for other reasons. Adverse events (AEs) were graded per NCI-CTCAE version 4.03. Tumor response was evaluated by RECIST version 1.1 every 8 weeks. ENT concentration was measured intensively. Samples of peripheral blood mononuclear cells (PBMC) were collected to measure protein lysine hyperacetylation and for immune subset analysis. Optional tumor biopsies for biomarker assessment were collected before and during treatment.

Results: Twelve pts were enrolled and three each were assigned to Cohort 1-4 between Nov 2015 and Sept 2016. Neither DLT nor grade 3-5 AE occurred. As no DLT occurred in Cohort 4, Cohort 5 was omitted as originally planned. The drug-related AEs observed in ≥2 pts during the DLT observation period were grade 1-2 hypophosphatemia (1 pt each in Cohort 2, 3, and 4), grade 1 nausea (1 pt in Cohort 3 and 2 pts in Cohort 4), and grade 1-2 platelet count decreased (2 pts in Cohort 4). AUC0-168 increased in a dose proportional manner. As of May 2017, 4 pts continue to receive study treatment, including one treated for more than 18 months. Biomarker data including protein lysine hyperacetylation and immune subset in PBMC and results of paired biopsy samples will be reported.

Conclusions: This study showed the tolerability of the combination therapy of ENT 5 mg with EXE 25 mg in Japanese pts. There were no new safety concerns as compared to those reported previously. Following this result, a randomized phase 2 study for Japanese pts is planned.

Clinical trial information : NCT02623751.

Citation Format: Shimomura A, Masuda N, Tamura K, Yasojima H, Sawaki M, Nishimura Y, Saji S, Iwata H. A phase 1 study of KHK2375 (entinostat) as monotherapy and in combination with exemestane in Japanese patients with hormone receptor-positive, HER2-negative, advanced or recurrent breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-11-06.

Abstract P5-18-01: A randomized clinical trial of postoperative adjuvant therapy for elderly breast cancer patients: Conditions of obtaining informed consent and reasons for declining participation

Background: There are few randomized clinical trials examining adjuvant treatment in elderly breast cancer patients. While obtaining informed consent is essential for participation in clinical studies, there is little information on the frequency of agreement to participate among elderly patients. Furthermore, elderly patients might have specific reasons to decline participation.

Patients and Method: The National Surgical Adjuvant Study of Breast Cancer 07 (N-SAS BC 07) is a randomized clinical trial in women over 70 years with HER2-positive primary breast cancer. The primary aim was to investigate the benefit of trastuzumab monotherapy compared with the combination of trastuzumab and chemotherapy. Key inclusion criteria were as follows: women between 70 and 80 years old with HER2-positive breast cancer; underwent curative operation; stage I to IIIA; with sufficient organ function. Patients were randomized to receive either trastuzumab plus chemotherapy or trastuzumab monotherapy. The primary endpoint was disease-free survival, and the secondary endpoints were overall survival, relapse-free survival, safety, health-related quality of life, and cost effectiveness (NCT01104935). It was not possible to predict the number of patients who would agree to participate. In order to comprehensively assess the effect of postoperative adjuvant therapy, we evaluated the reasons why eligible patients declined to participate. The patients were registered in a cohort study to prospectively evaluate the subsequent treatment options and prognosis (07-Cohort). This study examined the obtaining of informed consent for N-SAS BC 07 and the reasons for declining participation, and compared the clinicopathological backgrounds between the N-SAS BC 07 and 07-Cohort groups.

Results: 398 eligible patients have been recruited. Informed consent to participate in N-SAS BC 07 has been obtained from 275 patients (69%) and 123 patients (31%) who declined to participate in the RCT have been registered in the 07-Cohort. The common reasons to decline participation in the RCT were "cannot choose the treatment option (55%)", "refused chemotherapy (16%)", "wanted chemotherapy (9%)", "anxious about clinical studies (9%)" and "family opposition (8%)". The mean ages of the patients in N-SAS BC 07 and 07-Cohort were 73.9 and 74.6 years old, respectively. There were no differences in stage, surgical procedure, lymph node metastasis, or co-morbidities between the groups. ER-positive rate was higher in 07-Cohort group compared with N-SAS BC 07 group (53% vs. 37%, p=0.017, χ2 test).

Conclusion: While we expected the number of registrants to be small, since N-SAS BC 07 investigated whether elderly patients with HER2-positive breast cancer should undergo chemotherapy, almost 70% of the patients accepted informed consent. The most common reason to decline participation in N-SAS BC 07 was "cannot choose the treatment option" and the majority refused chemotherapy. Furthermore, ER-positivity was higher in the 07-Cohort group, which suggested that ER expression in the patients with HER2-positive breast cancer might influence their decision to participate in the study or to choose the treatment option.

Citation Format: Sagara Y, Sawaki M, Taira N, Saito T, Kashiwaba M, Iwata H, Kobayashi K, Nakayama T, Bando H, Mizuno T, Yamamoto Y, Tsuneizumi M, Takahashi M, Yamaguchi M, Kawashima H, Takashima T, Uemura Y, Hozumi Y, Sagawa N, Mukai H, Ohashi Y. A randomized clinical trial of postoperative adjuvant therapy for elderly breast cancer patients: Conditions of obtaining informed consent and reasons for declining participation. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-18-01.

Abstract P4-11-09: A randomized controlled trial of postoperative adjuvant therapy for elderly breast cancer patients: Comparison of health-related quality of life between clinical trial participants and decliners

Background: Health-related quality of life (HRQoL) is one of the important outcomes in cancer control trials and has increasingly become the one of the primary foci. Obtaining informed consent from participants is essential for participation in randomized controlled trials (RCTs), but the participation in these RCTs may directly influence HRQoL, because treatment options are determined according to the allocation schedule. To date, only a few studies have compared HRQoL between clinical trial participants and decliners.

Patients and Method: The National Surgical Adjuvant Study of Breast Cancer 07 (N-SAS BC 07) is a randomized controlled trial in women with HER2-positive primary breast cancer who are over 70 years of age. The primary aim was to investigate the benefit of trastuzumab monotherapy compared with combination therapy using trastuzumab and chemotherapy. The study concept and design were published in concept paper (Sawaki M. et al., Jpn J Clin Oncol. 2011). In this study, patients were randomized to receive either trastuzumab plus chemotherapy or trastuzumab monotherapy. The primary endpoint was disease-free survival, and the secondary endpoints were overall survival, relapse-free survival, safety, HRQoL, comprehensive geriatric assessment (CGA) and cost effectiveness (protocol ID; NCT01104935).

HRQoL and CGA were assessed at registration (baseline), 2 month, 1 year, and 3 years after the start of protocol treatments using the Functional Assessment of Cancer Therapy-General (FACT-G), Hospital Anxiety and Depression Scale (HADS), EuroQol 5 Dimension (EQ-5D), Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence, and the Philadelphia Geriatric Center (PGC) Morale Scale.

The patients who declined to participate in N-SAS BC 07 were registered in a cohort study to prospectively evaluate the subsequent treatment options and prognosis (07-Cohort). The same questionnaire that was used in N-SAS BC 07 was used in 07-Cohort to evaluate HRQoL and CGA at entry.

Results: Patients were enrolled from October 2012 to October 2016. During this period, 275 and 123 patients were registered in N-SAS BC 07 and 07-Cohort, respectively. The mean age at entry of the patients in the N-SAS BC 07 and 07-Cohort groups was 73.9 and 74.6 years, respectively. The questionnaire response rates at baseline in the patients in N-SAS BC 07 and 07-Cohort groups were 89% and 82%, respectively. There were no significant differences in FACT-G, HADS, EQ-5D, or TMIG index of competence at baseline between the groups, but the mean (standard deviation) scores of PGC Morale Scale in N-SAS BC 07 and 07-Cohort groups were 10.8 (3.3) and 9.9 (3.7), respectively, with the scores being significantly greater in the N-SAS BC 07 group (p=0.020, t-test).

Conclusion: The PGC Morale Scale provides a multidimensional approach to assess the psychological state of older people. This study indicated that participation in the RCT did not affect the baseline QoL of elderly patients but suggested that the baseline QoL of the RCT participants was better than decliners.

Citation Format: Saito T, Sawaki M, Hozumi Y, Sagawa N, Iwata H, Kashiwaba M, Kawashima H, Kobayashi K, Taira N, Takashima T, Takahashi M, Tsuneizumi M, Nakayama T, Baba S, Bando H, Mizuno T, Yamaguchi M, Yamamoto Y, Uemura Y, Ohashi Y, Mukai H. A randomized controlled trial of postoperative adjuvant therapy for elderly breast cancer patients: Comparison of health-related quality of life between clinical trial participants and decliners. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-09.

Abstract P5-14-02: Postmastectomy radiation improves loco-regional control for patients with advanced breast cancer treated with neoadjuvant chemotherapy

Purpose

The value of postmastectomy radiation (PMRT) with adjuvant chemotherapy has been established, but the role of PMRT after neoadjuvant chemotherapy remains unclear.

The aim of this study was to evaluate the efficacy of radiation in patients treated with neoadjuvant chemotherapy and mastectomy, and to determine which subsets of patients benefit from PMRT.

Patients and Methods

From 2003 to 2008, 94 patients were treated with neoadjuvant chemotherapy and mastectomy. The median number of lymph nodes removed was 20. 90 patients received anthracycline-based (anthracycline alone: 5, anthracycline followed by taxane: 85) chemotherapy and 4 patients received taxane alone. 82.6 percent (19/23) of the patients with HER2 positive cancer received trastuzumab and 91.3 percent (63/69) of the patients with hormone receptor positive cancer received hormone therapy. In this study, pathological complete response (pCR) was defined as absence of invasive tumor in the breast.

We compared the outcomes of 55 patients who received radiation (PMRT group) from 39 patinets who did not receive radiation (non-PMRT group).

The 5 years rate of loco-regional recurrence (LRR) was calculated according to the Kaplan-Meier method, and comparisons between the two groups were made using the log-rank test.

Results

Median follow-up time was 61.8 months. The breast pCR rate was 17.0% (16/94). 14 patients developed LRR as first events (local: 8, regional: 4, local and regional: 2). There were no differences between the two groups with respect to age, use of trastzumab, use of hormone therapy, pathological tumor size, number of dissected axillary nodes, percentage of hormone receptor positive tumors, or HER2 positive tumors.

The 5-years rate of LRR for the PMRT group and the non-PMRT group were 12.8% and 27.0% respectively. (p = 0.144) In the patients with positive lymph nodes after neoadjuvant chemotherapy, the PMRT group had significantly lower LRR risk than the non-PMRT group (5-yaers rate: 11.9% vs 37.5%, p = 0.039). But in the patients with negative lymph node, there were no significant difference between the PMRT group and the non-PMRT group. For hormone receptor positive and HER2 negative subtype, a significantly improved LRR risk found after PMRT (5-yaers rate: 5.9% vs 26.1%, p = 0.048). No significant difference in HER2 positive subtype and triple negative subtype were observed between two groups. In the patients who did not achieve breast pCR, the PMRT group had significantly lower LRR risk than the non-PMRT group (5-yaers rate: 9.0% vs 30.6%, p = 0.037). The 5-years rate of lymphedema was no significant difference between the two groups (p = 0.787).

Conclusion

After neoadjuvant chemotherapy and mastectomy, PMRT was found to benefit local control for the patients with positive lymph nodes, the patients with hormone receptor positive and HER2 negative cancer, and the patients who did not achieve breast pCR.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-02.

Abstract P3-06-16: The difference of molecular subtypes and prognosis after surgery for breast cancer patients with each blood types

(Introduction) ABO blood type has been associated with various malignancies, including pancreatic and stomach cancer. However the correlation between blood type and hormone receptor (ER/PR), HER2/neu, patient outcomes remains largely unexplored in patients with breast cancer.

(Methods)This study involved retrospective chart review of patients diagnosed with primary breast cancer stages I-III at Aichi Cancer Hospital between January 2004 and December 2011. Among 1944 breast cancer patients, the relationships between ABO blood type and clinicopathological findings, outcomes were analyzed. Descriptive statistics and c2 analysis were utilized for data summary and comparisons.

(Results) Of 1944 patients, 723 (37%), 577 (29%), 446 (23%), 198 (11%) were blood type A, O, B, AB respectively. This distribution is similar to that reported previously for general Japanese population. 327 (16.8%) patients were ductal carcinoma in situ and 1617 (83.2%) were invasive cancer, and there were no significant differences in this distribution based on each blood types. Among 1617 invasive breast cancer patients, we did not observe significant associations between blood type and pathological T stage or pathological N stage. However, patients with blood type O had lower rate of Luminal type (68.2%) compared blood type A, B, AB (73.5%, 75.2% and 76.0%, respectively (P = 0.03). The blood type O had higher rate of Tripe Negative type (13.7%) compared blood type A, B, AB (10.6%, 9.9% and 8.4%, respectively (P = 0.04). No other statistically significant differences in baseline characteristics among the four blood type groups were noted. No significant differences were observed in type of treatment (endcrine therapy, chemotherapy and anti-HER2 therapy) in each breast cancer subtypes among four blood type groups. Compared to women with blood type A, there was no significant difference in disease free survival among the for blood type O [hazard ratio (HR) 1.754; 95% confidence interval (CI) 0.735-2.731], blood type B (HR 0.978; 95% CI 0.724-1.542.), blood type AB (HR 1.235; 95% CI 0.694-2.864). For patients with blood type O, this difference did not reach statistical significance, although a trend toward worse prognosis of the patients with blood type O status was seen.

(Conclusion) The blood type O had lower rate of Luminal type and higher rate of Tripe Negative type compared other blood types. No significant differences were observed in disease-free survival according to ABO blood types.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-16.

Abstract P1-02-02: Receptor discordance in breast cancer recurrence: Is re-biopsy a necessity?

Background: Decision making on systematic treatment of patients with metastatic breast cancer is based on features like estrogen receptor (ER), progesterone receptor (PgR), and HER2 status assessed on the primary tumor. Recent prospective studies have investigated discordance in receptor status between the primary and metastatic tumor. We evaluated the discordance of receptor status between the primary and metastatic tumor and assessed the impact of re-biopsy on patient management.

Methods: In breast cancer patients who underwent surgical resection of primary tumor and re-biopsy of metastatic tumor at Aichi Cancer Center hospital, we examined the discordance of ER status, PgR status, and HER2 status between the primary and metastatic tumor. For sampling of metastases, core needle biopsy (CNB), trans-bronchial lung biopsy (TBLB), or surgical resection was performed. And fine-needle aspiration biopsy was not used.

The ER and PgR status were assessed using Allreds scoring system by IHC. These statuses were categorized as positive when the total score was more than two. HER2 expression status was tested by IHC and FISH. HER2 3+ by IHC, or 2+ and FISH positive were judged as HER2 positive.

Results: 48 patients underwent re-biopsy from 2003 to 2012. Twenty-eight were loco-regional (local: 25, Supraclavicular: 2, Axilla: 1) and 21 were distant (Lung: 14, Liver: 6, Bone: 1). Discordance in ER, PgR, or HER2 between the primary and metastatic tumor were 6.2% (3/48), 16.7% (8/48), and 4.2% (2/48), respectively. One patient had discordance on re-biopsy with initial triple negative primary tumor (1/5, 20%). 11/48 patients (22.9%) changed the molecular subtype (Group A), and 37/48 patients (77.1%) did not change (Group B). Time to recurrence (TTR) was significantly longer in Group A than Group B (82.3 months vs 51.2 months, p = 0.04). No significant difference in re-biopsy techniques (CNB and TBLB vs surgical resection), metastatic lesions (loco-regional vs distant), and adjuvant therapy were observed between Group A and Group B.

Conclusions: Our results show the low level of discordance for ER and HER2 between the primary and metastatic tumor. But re-biopsy should be considered in the patients with long TTR, since it is likely to impact treatment choice. Further study is needed to determine the value of re-biopsy.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-02-02.

Abstract P3-12-06: Clinicopathological Analysis of Breast Cancer Patients with Brain Metastases

Background: Recent advances in chemotherapy have enabled to control the progression of metastases from breast cancer except for the brain, highlighting the symptoms associated with brain metastases. In addition, improvement in our understanding of breast cancer biology changed the treatment strategy, possibly leading to improved outcomes in patients with breast cancer and brain metastases.

Object: The aim of this study was to investigate the correlation between biology of primary tumors and prognosis of patients with breast cancer metastasis to the brain.

Patients and method: Among 3,171 patients with primary breast cancer undergoing surgery at out hospital from 2003 to 2010, 35 patients (1.1%) who developed brain metastases, excluding stage IV at the initial diagnosis. We reviewed 35 patients for a correlation between survival and clinicopathological variables, including stage, hormonal sensitivity, HER2 expression status, the number of brain metastases, and treatment for brain metastases.

Results: The mean age of 35 patients was 52.1 years (range 22–68) and the median follow-up period was 41.0 months. The subtypes of primary tumors included triple-negative (TN) in 14 patients (40%), luminal in 11 patients (31.4%), luminal HER2-positive (luminal HER2) in 2 patients (5.7%), and HER2-positive (HER2) in 2 patients (5.7%). The duration from surgery to recurrence (disease-free survival, DFS, months) was 14.7 in TN, 26.5 in luminal, 29.8 in luminal HER2, and 31.0 in HER2. The duration from the first recurrence to the detection of brain metastases (months) was 7.2 in TN, 14.4 in luminal, 15.8 in luminal HER2, and 4.0 in HER2. The mean survival time after the diagnosis of brain metastases was 8.6 months (range, 0–40) with a survival time of ³ 1 year in 8/35 patients (23%) and that of < 1 year in 21/35 patients (60%). Both DFS and the duration from the first recurrence to the diagnosis of brain metastases were shorter in TN compared with other subtypes. In HER2 subtype, DFS was long but, once recurrence was detected, the duration to the development of brain metastases was short. In multivariate analysis of clinicopathological variables (age, DFS, ER, HG, HER2, the number of brain metastases (solitary versus multiple), the site of initial metastasis (brain versus other organs), and the presence or absence of chemotherapy after brain metastases, revealed solitary brain metastasis (p = 0.002) and the initial metastatic site of brain (p = 0.003) to be independent factors predicting survival.

Prospective evaluation of corrected QT intervals and arrhythmias after exposure to epirubicin, cyclophosphamide, and 5-fluorouracil in women with breast cancer

BACKGROUND

Corrected QT (QTc) interval prolongation can induce fatal arrhythmias such as torsade de pointes.

PATIENTS AND METHODS

To assess the characteristics of QTc intervals and arrhythmias in women with early breast cancer who received FEC100 adjuvant chemotherapy, electrocardiograms (ECGs) were recorded before and after each chemotherapy. Associations between QTc interval prolongation and single nucleotide polymorphisms (SNPs) of potassium channel genes were also investigated.

RESULTS

A total of 131 ECG records were obtained in 34 patients who received 153 cycles of FEC100. QTc intervals could be measured in 127 records. There was a significant trend toward QTc interval prolongation after each treatment, persisting through four cycles of chemotherapy (P < 0.001). Median QTc interval prolongations were 13, 11, 18, and 14 ms in the first through fourth cycles of chemotherapy, respectively. QTc intervals differed significantly between cycles 1 and 4 before treatment as well as after treatment (P < 0.05). A single supraventricular premature contraction was noted in 3 (2.3%) of the 131 cycles in 2 (5.9%) of the 34 patients. There was no significant association between QTc interval prolongation and SNPs of potassium channel genes.

CONCLUSION

This prospective study confirmed that FEC100 is associated with significant QTc interval prolongation in women with early breast cancer.

P4-09-25: Impact of Body Mass Index (BMI) for Clinical Outcomes in Japanese Breast Cancer Patients

Background: Obesity is risk factor of breast cancer incidence in postmenopausal women including Japanese population. Currently, many clinical trials data were shown that obesity may be one of prognostic factors after primary treatment in postmenopausal breast cancer patients. However, the proportion of obesity is large different between Asain and Western populations in all breast cancer patients. There is a little paper about relationship between body mass index (BMI) and prognosis after surgery in Asian breast cancer population.

Methods: We conducted retrospective analysis about BMI and outcome after primary treatment in Japanese breast cancer patients. We reviewed the clinical data (height, weight, BMI, ER status, HER status, and outcome) based on our medical reports in our single institution. This research object is 1,100 patients with primary breast cancer who operated between Jan 2003 and Jan 2006 in our institution. Median follow up was 59 months (1-97). All patients are categorized into four groups according to BMI. The range of BMI is less than 18.5 kg/m2, from 18.5 to 24.9 kg/m2, 25 to 29.9 kg/m2, more than 30 kg/m2 in underweight, normal, overweight and obesity groups, respectively. Patient's characteristics are well balanced excluding age and menopausal status. Nobody is obesity in young women (less than 35 years old). The correlation BMI with disease free survival (DFS) and overall survival (OS) were statistically analyzed by using the Cox hazard model.

Results: 785 (71.3%), 88 (8%), 192 (17.5%), 35 (3.2%) patients were categorized into normal, underweight, overweight obesisty groups, respectively. Breast cancer recurrences including local and distant metastases were occurred in 126 patients (11.5%).66 (6%) patients died due to breast cancer recurrence (54 patients) and other disease (8 patients). The multivariate hazard ratio (HR) in obesity groups was tend to be high compared with normal groups in disease free survival and overall survival. HR for OS was 4.30 (95%CI, 1.79−10.3) in obesity group. However, there are no statistical significant differences among four groups. Especially, HR for DFS and OS was 2.90 (95% CI 1.15−7.30 p=0.024) and 7.05(95%CI 2.38−20.8 P&lt;0.001) in obesity group compared with normal group in ER positive patients, respectively. However, there are no statistical significant difference for DFS and OS among four groups in ER negative patients.

Conclusions: The proportion of obesity is very lower in Japanese population (3.2%) than Western population (about 25–30%). However, obesity might be risk factor for DFS and OS in Japanese breast cancer patients with ER positive similar with Western countries. The different proportion of BMI may be influenced the different overall survival rate in lymph node negative breast cancer patients between Japan and Western countries. This study is a first report of the association between obesity and clinical outcomes in Japanese breast cancer patients. However, a number of patients were limited and this study is retrospective analyses including heterogeneous subtypes in single institution. A large scale cohort study should be conducted based on the clinical trial in Japanese population.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-09-25.

P5-11-01: The Accuracy of Preoperative Ultrasonography Guided Vacuum-Assisted Breast Biopsy in Determining Histological Type, ER Status, PgR Status, HER2 Status and Ki67 Level in Invasive Breast Cancer

Background

Recently, ultrasonography guided vacuum-assisted breast biopsy (US-guided VABB) has been widely used as alternative to surgical open biopsy. Enough breast tissue samples obtained by US-guided VABB are important because of increasing neoadjuvant treatment. Although the information obtained from US-guided VABB may be the only information available for determining the candidates for neoadjuvant treatment, only few studies evaluated the concordance of histological type, estrogen receptor (ER) status, progesterone receptor (PgR) status, human epidermal growth factor-2 (HER2) status, and Ki67 level between US-guided VABB and surgical specimen. The aim of this study was to evaluate the accuracy of preoperative US-guided VABB.

Materials and Methods: In 439 breast cancer patients without neoadjuvant treatment who underwent US-guided VABB and surgical resection from April 2004 and March 2011 at Aichi Cancer Center hospital, we examined the concordance of Histological type, ER status, PgR status, HER2 status, and Ki67 level between US-guided VABB and surgical specimen. All the US-guided VABB were performed using 11-gauge Mammotome® or 10-gauge VACORA®. The ER and PgR status were assessed using Allreds scoring system by IHC. These statuseswere categorized as positive when the total score was more than two. HER2 expression status was tested by IHC and FISH. HER2 3+ by IHC, or 2+ and FISH positive were judged as HER2 positive. In this study, the Ki67 cut-off level for positivity was defined at 20% (Penault-Llorca et al, JCO 2009).

The agreement on histological type, ER status, PgR status, HER2 status, and Ki67 level were tested using the absolute concordance rate and the kappa statistic values.

Results: The concordance rate of histological types between US-guided VABB and surgical specimens was 93.4% (410 of 439 cases) with a Kappa statistic value of 0.82. In 115 cases diagnosed as DCIS by US-guided VABB, 28 cases (24.3%) were subsequently diagnosed as invasive cancer by surgical specimens. However, among these cases, 78.6% (22/28) were T1mic and T1a. And one case (0.3%, 1/324) diagnosed as invasive cancer by US-guided VABB changed DCIS by surgical specimens. The concordance rate of ER, PgR, and HER2 status were 96.6% (112/116), 89.5% (102/116), and 97.4%(113/116), respectively (kappa statistic value of 0.99, 0.76, and 0.90). In HER2 status, the concordance rate between US-guided VABB and surgical specimens was better than between core needle biopsy and surgical specimens (the concordance rate: 88%, kappa statistic value: 0.65, Usami et al, Jpn J Clin Oncol 2007).

The agreement of Ki67 level was 85.7% (24/28) with a Kappa statistic value of 0.71.

Conclusions: The judgment of histological type, ER status, and HER2 status by preoperative US-guided VABB can be used with confidence due to determine the treatment strategies according to molecular subtype.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-01.

Clinical Experiment of Mutant Herpes Simplex Virus HF10 Therapy for Cancer

We reviewed our clinical trial using mutant herpes simplex virus "HF10". We have evaluated the safety and effect of HF10 against recurrent breast cancer since 2003 and also applied HF10 to non-resectable pancreatic cancer since 2005. An oncolytic herpes simplex virus type 1, mutant HF10, has been isolated and evaluated for anti-tumor efficacy in syngeneic immunocompetent mouse models. From long time before clinical trial, we have found that the mutant virus can have remarkable potential to effectively treat cancer in experimental studies using animals, and that all of the surviving mice acquire resistance to rechallenge of the tumor cells. A number of studies have shown that HF10 is effective and safe for use in localized or peritoneally disseminated malignant tumors of non-neuronal origin in animals. Pilot studies using HF10 have been initiated in patients with metastatic breast cancer. For each patient, 0.5 ml HF10 diluents at various doses were injected into test nodule, and 0.5 ml sterile saline was injected into a second nodule. All patients were monitored for local and systemic adverse effects, and the nodules were excised 14 days after viral injection for histopathological studies. All patients tolerated the clinical trial well. While no adverse effects occurred, there was cancer cell death and 30-100% regression histopathologically in recurrent breast cancer. As mentioned above, intratumoral injection of mutant herpes simplex virus HF10 for recurrent metastatic breast cancer was safe and effective. Also a trial for non-resectable pancreatic cancer being carried out on the basis of the above result has proved to be innocuous and has been in progress to assess the clinical benefit and enhance the potentiality of HF10 against cancer.

Changes in the weights of the accessory sex organs in male CD/IGS rats (Rattus norvegicus) after castration

This study was designed to detect time-course changes in the weights of accessory sex organs after castration. Crj:CD(SD) IGS rats (Rattus norvegicus) were castrated at age of 6-weeks and sacrificed within 14 days of the procedure. The ventral prostate, vesicular gland, bulbospongiosus/levator ani muscle, glans penis and bulbourethral glands were then weighed. The ventral prostate and vesicular gland had significantly decreased in weight 8 and 6 days after castration, respectively. The other organs did not decrease in weight significantly between time periods though there was an overall decrease in weight.

Endothelin-1 promotes vascular structural remodeling during the progression of heart failure prevention of vascular remodeling using a specific endothelin-converting enzyme inhibitor

To evaluate the effects of endothelin (ET)-converting enzyme (ECE) inhibitor on vascular remodeling in dogs with congestive heart failure (CHF), we chronically administered an ECE inhibitor, FR901533 (FR, iv. 0.3mg/kg/hr, n=6), to dogs with CHF induced by rapid ventricular pacing. Vehicle CHF dogs were given saline (n=7). In the vehicle CHF group after 3 weeks of pacing, the ET system was activated in the plasma and vasculature (3 and 5 times higher than normal, respectively). Inward remodeling occurred in the femoral artery; medial thickness (MT, 225+/-5 vs 193+/-4 microm, P<0.05) and deposition of collagen (DC, 22+/-2 vs 17+/-1%, P<0.01) significantly increased, while lumen diameter (LD, 1173+/-39 vs 1481+/-44 microm, P<0.05) decreased in the femoral artery with CHF compared with the normal femoral artery. There were significant correlations between the number of ET-1 positive cells and MT, DC, LD and systemic vascular resistance. FR significantly suppressed the changes in these vascular parameters compared with the changes in the vehicle CHF group despite the lack of an effect on blood pressure, and moreover FR caused decreases in ET-1 levels in both the plasma and femoral artery (reduced to 43% and 54%, respectively, of the levels in the vehicle CHF group, P<0.05). In conclusion, ET-1 plays a critical role in the structural deterioration of the vasculature during the progression of CHF, and ECE inhibitors can prevent the development of vascular remodeling.

Preputial separation and glans penis changes in normal growing Crj: CD (SD) IGS rats

This study was designed to detect preputial separation and glans penis changes in normal growing SD rats. We examined the changes until 53 days after birth. The glans penis surface changed from a protruding os penis structure to a W shape, and from a W shape to a flattened surface with age. The protruding os penis structure changed gradually to the W shape from postnatal day (PND) 30, and all rats had the W shape by PND 35. The flattened surface was observed from PND 39, and all rats had this structure by PND 44. In all rats, the day of complete preputial separation exactly corresponded to the day of appearance of the flattened surface.

Strain sensitivity differences in the Hershberger assay

The Hershberger assay is a test method for detecting androgenic or antiandrogenic properties based on alterations in the weights of accessory sex organs in castrate male animals. We performed this study to examine strain sensitivity differences in the Hershberger assay. Flutamide (FLU) at a dose of 3.2 mg/kg was administered to castrated F344, SD, or Wistar rats, in addition to testosterone propionate (TP) administered at a dose of 0.4 mg/kg. Although FLU significantly attenuated the TP-induced increase in glans penis weight in SD and Wistar rats, this attenuation was not observed in F344 rats. Statistical analysis showed differences among the strains in all sex accessory organ weights. The interaction in the ventral prostate, seminal vesicle, and glans penis weights was significant between SD and F344 rats, and between Wistar and F344 rats, but not between SD and Wistar rats. F344 rats were less suitable than SD or Wistar rats for detecting FLU-induced changes.

Relationship between tumor necrosis factor-alpha production and oxidative stress in the failing hearts of patients with dilated cardiomyopathy

OBJECTIVES

This study evaluated oxidative stress in the failing ventricle in patients with dilated cardiomyopathy (DCM).

BACKGROUND

Oxidative stress appears to increase in the failing myocardium and may contribute to ventricular dysfunction in patients with DCM. Tumor necrosis factor-alpha (TNF-alpha), which is expressed in the failing heart, may stimulate oxidative stress.

METHODS

We measured plasma oxidized low density lipoprotein (oxLDL) by sandwich enzyme-linked immunosorbent assay using specific antibodies against oxLDL in the aortic root (AO) and the coronary sinus (CS) in control subjects (n = 8) and in 22 patients with DCM and mild congestive heart failure. We also measured the plasma levels of TNF-alpha and angiotensin II.

RESULTS

There was no difference in oxLDL between the AO and CS in control subjects. In contrast, plasma oxLDL was significantly higher in the CS than the AO in patients with DCM, suggesting that the transcardiac gradient ofoxLDL reflects oxidative stress in the failing heart in these patients. Plasma TNF-alpha levels were significantly higher in the CS than the AO with a significant positive correlation of the transcardiac gradient of TNF-alpha and the transcardiac gradient of oxLDL. Moreover, a significant negative correlation existed between the transcardiac gradient of oxLDL and left ventricular ejection fraction. The transcardiac gradient of plasma oxLDL was significantly lower in 6 patients who received carvedilol than in 16 patients who did not receive carvedilol.

CONCLUSIONS

These findings indicate that the transcardiac gradient of oxLDL may be a marker of oxidative stress in the heart and that left ventricular dysfunction may be partly due to the oxidative stress in patients with DCM. In addition, TNF-alpha may stimulate oxidative stress in the failing heart in patients with DCM.

Effect of spironolactone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure

OBJECTIVES

We sought to evaluate the effects of spironolactone on neurohumoral factors and left ventricular remodeling in patients with congestive heart failure (CHF).

BACKGROUND

Aldosterone (ALD) promotes collagen synthesis and structural remodeling of the heart. Spironolactone, an ALD receptor antagonist, is reported to reduce mortality in patients with CHF, but its influence on left ventricular remodeling has not been clarified.

METHODS

Thirty-seven patients with mild-to-moderate nonischemic CHF were randomly divided into two groups that received treatment with spironolactone (n = 20) or placebo (n = 17). We measured left ventricular volume and mass before treatment and after four months of treatment. We also measured the plasma levels of neurohumoral factors, such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), as well as plasma procollagen type III aminoterminal peptide (PIIINP), a marker of myocardial fibrosis.

RESULTS

Left ventricular volume and mass were significantly decreased and ejection fraction was significantly increased in the spironolactone group, while there were no changes in the placebo group. Plasma levels of ANP, BNP and PIIINP were significantly decreased after spironolactone treatment, but were unchanged in the placebo group. There was a significant positive correlation between the changes of PIIINP and changes of the left ventricular volume index (r = 0.45, p = 0.045) as well as the left ventricular mass index (r = 0.65, p = 0.0019) with spironolactone treatment.

CONCLUSIONS

These findings indicate that four months of treatment with spironolactone improved the left ventricular volume and mass, as well as decreased plasma level of BNP, a biochemical marker of prognosis and/or ventricular hypertrophy, suggesting that endogenous aldosterone has an important role in the process of left ventricular remodeling in nonischemic patients with CHF.

Effects of olive, corn, sesame or peanut oil on the body weights and reproductive organ weights of immature male and female rats

Olive, corn, sesame or peanut oil which have been used as vehicles in the immature rat uterotrophic assay or Hershberger assay, for detection of endocrine disrupting effects of environmental chemicals, was administered to ten immature female rats by subcutaneous injection from postnatal day (PND) 21 for 3 or 7 days, and each oil was also administered to ten male rats from PND 21 for 7 and 10 days. The body weights, and the weights of sex and sex accessory organs in female and male rats were measured. There were no significant differences in body weights of female rats between each oil group and the control group, while the body weight of male rats in the group given peanut or olive oil was significantly increased from 8 or 9 days after administration. There were no changes in the sex and sex accessory organ weights of female or male rats related to the endocrine disrupters. The results of the body weights and organ weights demonstrate that each oil is a suitable vehicle for the immature rat uterotrophic assay. However, each oil is suggested to be unsuitable for the Hershberger assay, because the analysis of changes of sex accessory organ weights in this assay might be confused by the increased body weights.

Effects of age and weaning on the immature rat uterotrophic assay using ethynylestradiol

The purpose of this study was to evaluate the most appropriate rat age for the start of administration, and the effect of weaning, in the immature rat uterotrophic assay using ethynylestradiol (EE). Animals weaned on postnatal day (PND) 20 were administered subcutaneously EE at doses of 0.06-6 micrograms/kg/day for 3 days beginning on PND 21, 23 or 25. EE at the same doses was also administered to rats weaned on PND 17 or 20 from PND 21 for 3 days. Although uterine weight was significantly increased in the rats given 0.6-6 micrograms/kg EE in both of the studies, the percentage increase relative to the control in each group given EE from PND 21 and weaned on PND 20 was higher than in those groups given EE from PND 23 or 25, and the group weaned on PND 17.

Immature rat uterotrophic assay of bisphenol A

We used the immature rat uterotrophic assay to determine the estrogenicity of bisphenol A (BPA). We administered BPA (in sesame oil) to rats subcutaneously (sc; 0, 8, 40, and 160 mg/kg/day) or orally (0, 40, 160, and 800 mg/kg/day) for 3 days beginning on postnatal day (PND) 18; rats were sacrificed 24 hr after the last administration. Uterine wet, blotted, and relative weights increased in all groups given BPA sc. After oral administration, uterine relative weight increased in 160 and 800 mg/kg BPA groups, and wet and blotted weights increased in the 800 mg/kg BPA group. Plasma concentrations of BPA at 1 hr after the last administration were detected in all groups given BPA sc and in groups given 160 and 800 mg/kg BPA orally, with a dose-response effect. The study was then reproduced under the same conditions. After sc injections, uterine wet and blotted weights increased in the 40 and 160 mg/kg BPA groups, and relative weight increased in all groups given BPA sc. By contrast, uterine wet, blotted, and relative weights increased only in the 160 and 800 mg/kg oral BPA groups. Also, to examine time-course changes in uterine weight, we administered BPA (in sesame oil) sc from PND 18 to PND 20 for 3 days at doses of 0, 8, 40, and 160 mg/kg/day; uterine weights were then measured at 6, 12, 18, and 24 hr after the last administration. Uterine wet, blotted, and relative weights increased in all BPA groups at 6 and 24 hr and in 40 and 160 mg/kg BPA groups at 12 hr. By contrast, at 18 hr, uterine wet, blotted, and relative blotted weights increased in all BPA groups and relative wet weight increased in 40 and 160 mg/kg BPA groups. The percentage increases in uterine wet and relative weights of 40 and 160 mg/kg BPA groups at 6 hr were higher than those at 24 hr relative to the controls, but the coefficient of variation in these weights in the group given 8 mg/kg BPA at 24 hr was smaller than that at 6 hr. These findings demonstrate BPA-induced uterotrophy in the immature uterotrophic assay in rats administered 8 mg/kg/day sc and in rats given 160 mg/kg/day orally, and suggest that the autopsy at 24 hr after the last administration is suitable.

Significant roles of endothelin-A- and -B-receptors in renal function in congestive heart failure

Endothelin-1 (ET-1) not only causes potent vasoconstriction but also leads to fluid retention, both actions mediated by ET(A)- and/or ET(B)-receptors. Selective ET(A)- and combined ET(A)/ET(B)-receptor antagonists improve hemodynamics in heart failure; however, it is also important to evaluate the effects of these antagonists on urine output in heart failure. We administered an acute dose of either the selective ET(A)-receptor antagonist FR139317 (FR, n=5, 1 and 3 mg/kg) or the mixed ET(A)/ET(B)-receptor antagonist TAK-044 (TAK, n = 5, 1 and 3 mg/kg) to dogs with heart failure induced by rapid ventricular pacing. Renal hemodynamic and tubular functions were subsequently investigated. FR increased urinary excretion in association with increased renal plasma flow (RPF) and glomerular filtration rate (GFR) with no significant changes in the fractional reabsorption of water distally (FRWD). In contrast, despite increased GFR, TAK did not alter urine volume or RPF with significantly increased FRWD. The increase of GFR and RPF induced by FR was significantly larger than that of TAK. These findings indicate that ET(B)-receptor activation may result in diuresis by renal vasodilatation and reduction of water reabsorption in the distal tubules and collecting ducts. Acute ET(A)-receptor antagonism may therefore be more beneficial to diuresis than dual ET(A)/ET(B)-receptor inhibition in heart failure.

Combination of a teratoma and embryonal carcinoma of the testis in SD IGS rats: a report of two cases

Testicular tumors of germ cell origin are extremely rare in rats. We encountered 2 cases of teratoma and embryonal carcinoma in the testes of 8- and 10-week-old Sprague-Dawley IGS rats. A unilateral tumor mass with bilateral testicular atrophy was observed macroscopically in both cases. Microscopic examination revealed that the tumor mass had characteristic features of a teratoma and was composed of several types of differentiated cells and tissues at various stages of maturation. Embryonal carcinoma tissue, composed of undifferentiated cells with an embryonic and anaplastic appearance, was observed within the tumor mass. In addition, foci of intratubular teratomas and embryonal carcinomas were observed in the testis on the side without any obvious mass. No obvious germ cells were observed in the seminiferous tubules in the remnant nontumorous area. Furthermore, intratubular transition of cells was observed from the embryonal carcinoma tissue to the squamous epithelium. This finding indicates that an embryonal carcinoma differentiates toward a teratoma even at a very early stage of development of the germ cell tumor.