Abstract P2-11-01: Safety and efficacy of sacituzumab govitecan (anti-Trop-2-SN-38 antibody-drug conjugate) as ≥3rd-line therapeutic option for treatment-refractory HER2-negative metastatic breast cancer (HER2Neg mBC)

Background: Sacituzumab govitecan is an antibody-drug conjugate consisting of SN-38, the active metabolite of irinotecan, conjugated to a humanized mAb targeting Trop-2 (trophoblastic antigen-2), which is highly expressed in many epithelial cancers. A phase I/II basket trial (NCT01631552) investigated its activity in patients (pts) with advanced epithelial cancers. Herein, we summarize pooled safety and efficacy findings in 162 pts with HER2-negative metastatic breast cancer (mBC) accrued between 7/2013 and 6/2017 who received at least 2 prior therapies for metastatic disease and were treated with sacituzumab govitecan at the 10 mg/kg dose level.

Methods: Patients with triple-negative (N=108) and patients with hormone-receptor positive (N=54) mBC received 10 mg/kg sacituzumab govitecan on days 1 & 8 of a 21-day cycle continued until progression or unacceptable toxicity. All pts had measurable disease by CT or MRI. Efficacy was assessed locally by RECIST 1.1 including overall response rate (ORR) and Kaplan-Meier estimates of duration of response (DOR), progression-free survival (PFS) and overall survival (OS). Adverse events (AE) were evaluated according to CTCAE v4.0

Results: The patient cohort (161 female /1 male; median age 55 yrs, range 31-80) received a median of 4 prior therapies for metastatic disease (range 2-17), with prior chemotherapy agents in the metastatic setting including taxane (68%), capecitabine (60%), platinum (59%), gemcitabine (44%), eribulin (41%), and anthracycline (38%). 77 pts have died, with 57 in long-term follow-up and 28 still on treatment at data cutoff. The median number of administered sacituzumab govitecan doses was 14 (range 1-88). Treatment was generally well tolerated. 29% of pts had dose reductions, 3% discontinued treatment due to drug-related AEs, and there were no treatment-related deaths. Based on currently available AE data, grade ≥ 3 toxicity included neutropenia (43%), anemia (9.5%), diarrhea (7.0%) and febrile neutropenia (6.3%). For the TNBC subgroup, with a median follow-up of 9.3 months, the ORR was 33% (3 CRs + 33 PRs /108) with a median DOR of 8.3 months (95% CI: 4.8 – 11.6). For the ER+ subgroup, with a median follow-up of 10.0 months, the ORR was 31% (17 PRs/54) with a median DOR of 7.4 months (95% CI: 4.4 – 18.3). The combined HER2Neg ORR was 33% (3 CRs+50 PRs/162), with a median DOR of 8.3 months (95% CI: 4.9 - 10.8), PFS of 5.6 months (95% CI: 5.1 – 6.9) and OS of 13.0 months (95% CI: 11.5 - 15.0). The ORR was comparable for pts ≤ 50 yrs. old [32.2% (19/59)] vs. > 50 yrs old [33.0% (34/103)] and little different for pts with 2 prior therapies [35.4% (17/48)] vs. >2 prior therapies [31.6% (36/114)].

Conclusions: Monotherapy with sacituzumab govitecan was well tolerated with a manageable safety profile, and achieved a 30+% objective response rate among heavily pre-treated patients with HER2-negative metastatic breast cancer regardless of ER status.

Citation Format: Kalinsky K, Isakoff SJ, Tolaney SM, Juric D, Mayer IA, Vahdat LT, Diamond JR, O'Shaughnessy J, Moroose RL, Santin AD, Shah NC, Abramson V, Goldenberg DM, Sharkey RM, Washkowitz SA, Wegener WA, Iannone R, Bardia A. Safety and efficacy of sacituzumab govitecan (anti-Trop-2-SN-38 antibody-drug conjugate) as ≥3rd-line therapeutic option for treatment-refractory HER2-negative metastatic breast cancer (HER2Neg mBC) [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 P2-11-01.

A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice

Introduction The aim of this study was to explore the impact of increasing proportions of high risk referrals on surgical margin outcomes of a surgeon's learning curve in robotic prostatectomy. Methods All patients in this study underwent robot assisted radical prostatectomy (RARP) performed by three different consultant urological surgeons. Data collected included preoperative clinical stage, Gleason score and prostate specific antigen levels, which were used to risk stratify patients according to National Institute for Health and Care Excellence criteria. Oncological clearance was assessed by overall and stage specific positive margin status. Comparisons were made between each surgeon for the first and second 50 consecutive cases. Results For the three surgeons, there was a progressive increase in the proportion of high risk cases referred accompanied by a corresponding decline in low risk disease (p<0.001). Postoperative pathology also showed an upward trend in pT3 cases across the three eras. There was no statistical difference in overall positive margin rates between the surgeons. The overall rates were 12%, 20% and 23% for the first 50 cases, and 32%, 36% and 21% for the second 50 cases for the three surgeons respectively. Conclusions Our series demonstrates an upward trend in the risk profile of men referred for robotic prostatectomy over a nine-year period. Despite this, there was minimal impact on pathological and surgical outcomes among our surgeons, who were at the initial stages of their RARP learning curve. Our results suggest that there is no requirement for an active case selection bias against patients with high risk disease for surgeons newly embarking on their RARP learning experience.

Abstract P1-12-01: Withdrawn

This abstract was withdrawn by the authors.

Identification of pathologically insignificant prostate cancer is not accurate in unscreened men

Background:

Identification of men harbouring insignificant prostate cancer (PC) is important in selecting patients for active surveillance. Tools have been developed in PSA-screened populations to identify such men based on clinical and biopsy parameters.

Methods:

Prospectively collected case series of 848 patients was treated with radical prostatectomy between July 2007 and October 2011 at an English tertiary care centre. Tumour volume was assessed by pathological examination. For each tool, receiver operator characteristics were calculated for predicting insignificant disease by three different criteria and the area under each curve compared. Comparison of accuracy in screened and unscreened populations was performed.

Results:

Of 848 patients, 415 had Gleason 3+3 disease on biopsy. Of these, 32.0% had extra-prostatic extension and 50.2% were upgraded. One had positive lymph nodes. Two hundred and six (24% of cohort) were D'Amico low risk. Of these, 143 had more than two biopsy cores involved. None of the tools evaluated has adequate discriminative power in predicting insignificant tumour burden. Accuracy is low in PSA-screened and -unscreened populations.

Conclusions:

In our unscreened population, tools designed to identify insignificant PC are inaccurate. Detection of a wider size range of prostate tumours in the unscreened may contribute to relative inaccuracy.

Comparative evaluation of microleakage of silorane-based composite and nanohybrid composite with or without polyethylene fiber inserts in class II restorations: an in vitro study

AIM

To evaluate microleakage between nanocomposite and silorane composite in class II restorations with or without a polyethylene fiber insert.

METHODOLOGY

Standardized class II cavities were prepared on extracted molars and randomly divided into 4 groups (n=20 each): group 1, Ceram X mono; group 2, Ceram X mono + Ribbond; group 3, Filtek P90; and Group 4, Filtek P90 + Ribbond. All specimens were subjected to a thermocycling regime, immersed in 2% methylene blue dye for 24 hours, sectioned longitudinally, and examined under a stereomicroscope to assess dye penetration on a six-point scale. The score data were subjected to statistical analysis whereby Kruskal-Wallis analysis of variance was used for multiple group comparisons and the Mann-Whitney test for groupwise comparisons at a significance level of p≤0.05.

RESULTS

A statistically significant decrease in microleakage was found when Ribbond fiber was used with nanoceramic and silorane composite. A highly significant decrease in microleakage scores was found in silorane composite when compared to nanoceramic composite.

CONCLUSION

Use of polyethylene fiber and silorane composite reduces microleakage in class II composite restorations with gingival margins below the cemento-enamel junction.

PONI and its association with oxidative stress in type I and type II diabetes mellitus

OBJECTIVE

Paraoxonase (PON) is an antioxidant enzyme linked with cardiovascular disease (CVD), diabetes as it prevents LDL oxidation. The relation of PON with the other established risk factor of diabetic complications has not been looked into.

RESEARCH DESIGN AND METHODS

370 subjects were included in the study. Dividing into four group, i.e. group I included type II DM (n=220), group II was age matched control (n=100), group III were type I DM (n=25) and group IV (n=25) were age matched control group. The protocol of the study was approved by the ethical committee of the institute. SOD, GSH, PON (paraoxonase and arylesterase activity), GHb, and MDA were estimated.

RESULTS

A highly significant decrease in paraoxonase and arylesterase activity was seen in the type II DM (p<0.0001) while in type I DM both the activity was not significant (p>0.05). Paraoxonase and arylesterase activity of PONI showed a negative significant correlated with MDA (r=-0.51, p<0.0001 and r=-0.23, p<0.001) in type II DM but was not correlated in type I DM. The GHb and MDA levels were significantly increased (p<0.0001) while the levels of SOD and GSH have been decreased in type I and type II DM.

CONCLUSION

PONI is definitely associated with development of the complications of diabetes. This may be due to the role of it as an antioxidant. As it also show a negative correlation with MDA like the other antioxidants studied.

Robotic-assisted laparoscopic prostatectomy

Prostate cancer remains a significant health problem worldwide and is the second highest cause of cancer-related death in men. While there is uncertainty over which men will benefit from radical treatment, considerable efforts are being made to reduce treatment related side-effects and in optimising outcomes. This article reviews the development and introduction of robotic-assisted laparoscopic radical prostatectomy (RALP), the results to date, and the possible future directions of RALP.

Impacts of a participatory approach to assess sustainable sewage treatment technologies for urban fringe of Surat city in India

This paper describes the assessment of the sustainability of a number of different sewage treatment technologies by means of a multi-criteria, participatory method for a scattered settlement of urban fringe of Surat. The special efforts have been made for the broad participation to achieve stronger democracy, better quality of the end product, and a more effective process. The mere participation of technocrats and bureaucrats certainly lead to the greater efficiency in working methods. However, the ultimate goal of sustainable developments of such technologies could not be reached in absence of democratic participation and social learning. Keeping this important aspect in view for assessment of sustainability, the detailed study was conducted in the presence of policy makers and stakeholders, academicians, technical experts, finance managers and NGO, to find out sustainability criteria and indicators for three different sewage treatment technologies: (A) Conventional Activated Sludge Process (B) Extended Aeration System, and (C) Upflow Anaerobic Sludge Blanket (UASB) Reactor followed by Aerated Lagoon and Polishing Pond. Technologies were compared according to four criteria subdivided into twenty operational indicators. Criteria and indicators were evaluated as in a weighted-scale matrix. In India, sustainability criteria used in this type of comparisons are often restricted to a limited set of environmental impacts and financial costs but in this study additional criteria were evaluated including economic, social, and technical aspects. Based on the values assigned by the panel, the Sustainability Index (SI) was calculated for each technology. According to the SI and a predefined scale, sustainability was medium for options A and B, whereas high for option C. The purpose of this study is to provide a basis for the selection of a particular technology based on a rational and democratic assessment of its contribution to sustainability in the local and global context.

Critical configuration analysis of four methods for measuring polymerization shrinkage strain of composites

OBJECTIVES

To compare four methods for measuring polymerization shrinkage strain of composites and to develop a rational basis for comparing data from different methods and laboratories.

METHODS

Dilatometry, modified bonded disk, strain gage, and a new linear transducer method were used to measure polymerization shrinkage strain of a model composite under similar irradiation conditions. The resin consisted of an untinted resin (50:50 BISGMA/TEGDMA, 0.7% CQ, 0.35% DMAEM, 0.05% BHT) filled with 5% fumed silica and 67 wt% untreated hybrid filler. Specimens (n = 10) were exposed for 60 s at 600 mW/cm2 and then monitored for 300 s. Specimen volumes were 8 mm3 for the strain gage method, 25 mm3 for the linear transducer and dilatometer methods and 43 mm3 for the bonded disk method. The degree of constraint applied to the specimens by each method was calculated and compared. Shrinkage strain values at 60 and 300 s were tested for significance at p = 0.05 using one-way ANOVA and Tukey's test.

RESULTS

Shrinkage strain magnitudes at 60 and 300 s for the four methods were significantly different (p < 0.01) The modified bonded disk method measured the highest shrinkage value and exhibited the highest degree of specimen constraint. There was a 5 s delay after light activation before strain was detected by the strain gage.

SIGNIFICANCE

Specimen constraint differed in all four methods and was linearly correlated with shrinkage strain magnitude when the degree of constraint was less than 42%.

Research capacity building in general practice. The new Australian scene

BACKGROUND

Primary care research needs strengthening. The Commonwealth Government Department of Health and Aged Care has recently funded the university departments of general practice and rural health to build research capacity in primary care.

OBJECTIVE

To explore issues surrounding building primary care research capacity, as well as looking at barriers to research capacity building and ways of overcoming them.

DISCUSSION

New funding provides many opportunities for increasing research capacity in primary health care areas. Different institutions will select those methods that are best suited to their skills and the requirements of their area.

The acute effects of continuous and conditional neuromodulation on the bladder in spinal cord injury

STUDY DESIGN

Laboratory investigation using serial slow-fill cystometrograms.

OBJECTIVES

To examine the acute effects of different modes of dorsal penile nerve stimulation on detrusor hyperreflexia, bladder capacity and bladder compliance in spinal cord injury (SCI).

SETTING

Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.

METHODS

Fourteen SCI patients were examined. Microtip transducer catheters enabled continuous measurement of anal sphincter, urethral sphincter and intravesical pressures. Control cystometrograms were followed by stimulation of the dorsal penile nerve at 15 Hz, 200 micros pulse width and amplitude equal to twice that which produced a pudendo-anal reflex. Stimulation was either continuous or in bursts of one minute triggered by a rise in detrusor pressure of 10 cm water (conditional). Further control cystometrograms were then performed to examine the residual effects of stimulation.

RESULTS

Bladder capacity increased significantly during three initial control fills. Continuous stimulation (n=6) significantly increased bladder capacity by a mean of 110% (+/-Standard Deviation 85%) or 173 ml (+/-146 ml), and bladder compliance by a mean of 53% (+/-31%). Conditional stimulation in a different group of patients (n=6) significantly increased bladder capacity, by 144% (+/-127%) or 230 ml (+/-143 ml). In the conditional neuromodulation experiments, the gap between suppressed contractions fell reliably as bladder volume increased, and the time from start of stimulation to peak of intravesical pressure and 50% decline in intravesical pressure rise was 2.8 s (+/-0.9 s) and 7.6 s (+/-1.0s) respectively. The two methods of stimulation were compared in six patients; in four out of six conditional neuromodulation resulted in a higher mean bladder capacity than continuous, but the difference was not significant.

CONCLUSIONS

Both conditional and continuous stimulation significantly increase bladder capacity. The conditional mode is probably at least as effective as the continuous, suggesting that it could be used in an implanted device for bladder suppression.

Magnetic resonance imaging (MRI) of Saccharum officinarum L. (sugarcane) during its growth for sucrose content

Magnetic Resonance Imaging (MRI) was employed to monitor changes in image intensities in stems of sugarcane which reflect on the increase in sucrose concentration. Contrast in images originates in the increase of sucrose concentration in the aqueous phase of the predominant parenchyma cells and physiological changes. In matured stems mixed MR intensity patterns were observed in transverse planes. We associate this due to the reflection of vascular bundles in ground parenchyma cells which constitute 80% sucrose storage.

Rosai-Dorman disease causing cervical myelopathy

STUDY DESIGN

A case report of a rare disease entity and review of the literature.

OBJECTIVES

To illustrate the occurrence of an unusual disease affecting the spine and spinal canal.

SUMMARY OF BACKGROUND DATA

Rosai-Dorman disease is considered an idiopathic benign lymphoproliferative disease that typically occurs in the earlier decades of life. The usual manifestation is painless massive cervical lymphadenopathy, although involvement of many extra nodal sites is common. This case illustrates Rosai-Dorman disease occurring in an elderly man with myelopathy and mass lesions of the cervical, thoracic, and lumbar spinal canal without typical lymphadenopathy.-

METHODS

Case report illustrating clinical presentation as well as radiographic and pathologic findings, including comparisons to cases previously reported.

RESULTS

Surgical decompression with incomplete resection of the lesion was performed, providing diagnosis and treatment guidance. The patient experienced significant neurologic improvement of myelopathy.

CONCLUSIONS

Recognizing clinical and laboratory features of this disease may permit earlier diagnosis and limit or avoid surgical intervention in some cases.

Use of Memokath temporary urethral stent in treatment of detrusor-sphincter dyssynergia

In spinal-injured patients, detrusor-sphincter dyssynergia (DSD) can lead to high intravesical pressures, upper tract dilation, and recurrent infections. The standard treatment for DSD is sphincterotomy and, more recently, permanent sphincter stenting. Many spinal-injury patients would prefer a reversible treatment because of concern about fertility or because they are awaiting a "miracle cure." There is also concern over the theoretical long-term risk of squamous carcinoma after permanent stenting. In view of this, the Memokath, a thermosensitive temporary stent, has been undergoing trials at our center to determine which patients could benefit. Fourteen Memokath stents have been inserted in spinal-injured patients with DSD at our center, and they have been followed up for as long as 2 years. Stents were placed under cystoscopic guidance as a day case procedure. The stents were inserted either through the sphincter alone (short [4-cm] stents; 3 patients) or through the sphincter and bladder neck (long [5-7-cm] stents; 11 patients). There were no complications during surgery in either placement or removal of these stents. There was a significant (p < 0.001) reduction in the residual urine volume after stenting. Preoperative hydronephrosis and attacks of autonomic dysreflexia noted in some patients also resolved after stenting. Short stents that bridge the external urethral sphincter were ineffective in emptying the neuropathic bladder. Therefore, we advise that only long stents that lie across both the bladder neck and the external sphincter be used. Because of its easily reversible nature, the Memokath should be adopted for use in patients who are unsure about their preferred option of bladder management and those involved in a fertility program.

Hitherto unreported medicinal uss of plants of lucknow district

The medicinal uses of thirteen plants from Lucknow District are reported in this paper.

In vitro Propagation of Valeriana wallichii

A tissue culture procedure has been developed for the rapid multiplication of VALERIANA WALLICHII D C. through shoot tip and axillary bud explants. MS medium containing Kn or BAP (5.0 mg/l (-1)) in combination with IAA (1.0 mg/l (-1)) induced an optimal growth of shoots within 6-8 days from both apical and axillary bud explants. The roots developed on the same medium within 2-3 weeks. Hardening of IN VITRO grown plantlets in pots under glass-house conditions was dependent upon the temperature and humidity. A cold-temperate climate favoured early establishment. Following the given procedure, a large number of plants have been established under field conditions at two locations. The method has implications in the early introduction of an elite population as well as its improvement.

Volatile Constituents of Artemisia nilagirica

The essential oil of ARTEMISIA NILAGIRICA was analysed by capillary gas chromatography, IR, (1)H-NMR, and GC-MS. The main constituents of the oil are camphor, beta-eudesmol, 1,8-cineole, borneol, artemisia alcohol, camphene, alpha-gurjunene, P-cymene, terpinene-4-ol and alpha-pinene.

Herbal folk medicines in Northern India

The herbal folk medicine in North India is commonly made available through the herbalists, elderly persons, sadhus (hermits), ojhas (village physicians practising witchcraft) and the traditional street vendors whether in the alpine region near the snows or in the arid region near the deserts. The Northern part of India constitutes four main broad regions: the Montane region; the sub-Montane region; the Northern plains; and the arid region. The very important herbal folk medicines which have been in vogue from ancient times in these regions, are discussed.

A comparative study of a few tests of dynamic lung function

A variety of tests like FEV0-76, FEV1, PFR, MEFR is in use for assessment of ventilatory function of the lungs. Each of them has some marginal advantage over the other. It is, therefore, necessary to find out their relative merits and choose the one which can provide the maximum information in a reasonably short time. In this project, a norm of all the above tests for the people of Gujarat of age group 18-20 years has been found, the relative merit of the tests has been discussed and the velocity of air flow at 0.3 sec of expiration has been suggested as the single measurement which may conveniently replace all the other above.