Use of Real-World Evidence in a Virtual Bridging Analysis for a Human Epidermal Growth Factor Receptor 2-Targeted Antibody-Drug Conjugate in Gastric Cancer

This study bridged pharmacokinetic, efficacy, and safety clinical trial data from Japan to a Western population using real-world evidence (RWE) to investigate the antibody-drug conjugate trastuzumab deruxtecan (T-DXd) in the treatment of human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer. Using population pharmacokinetic and exposure-response (efficacy/safety) models, exposure-efficacy data from 117 patients and exposure-safety data from 158 patients in Japan who received T-DXd 6.4 mg/kg as second-line or later treatment were bridged to RWE including covariate information from 25 Western patients with HER2-positive gastric cancer who received second-line or later T-DXd treatment. Pharmacokinetic simulations indicated that intact T-DXd and released drug (DXd) steady-state exposures were comparable between Western patients and patients from Japan; the Western/Japan ratio of exposure medians ranged from 0.82 (T-DXd steady-state minimum concentration) to 1.18 (DXd steady-state maximum concentration). Exposure-efficacy simulations estimated a confirmed objective response rate of 28.6% (90% confidence interval, 20.8-38.4) in real-world Western patients versus 40.1% (90% confidence interval, 33.5-47.0) in patients from Japan, possibly because of checkpoint inhibitor use in 4% versus 30% of patients, respectively. Western patients had a higher estimated rate of serious adverse events than patients from Japan (42.2% vs 34.6%); however, the rate of interstitial lung disease was lower (less than 10%) in Western patients. Overall, T-DXd was predicted to have meaningful clinical activity and a manageable safety profile in Western patients with HER2-positive gastric cancer. Using RWE, bridging analysis supported US approval of T-DXd 6.4 mg/kg in advanced gastric cancer before a clinical trial was completed in Western patients.

Model-based meta-analysis of non-small cell lung cancer with standard of care PD-1 inhibitors and chemotherapy for early development decision making

Single-arm cohorts/trials are often used in early phase oncology programs to support preliminary clinical activity assessments for investigational products, administered alone or in combination with standard of care (SOC) agents. Benchmarking clinical activity of those combinations against other treatments, including SOC, requires indirect comparisons against external trials, which presents challenges including cross-study differences in trial populations/other factors. To facilitate such nonrandomized comparisons, we developed a comprehensive model-based meta-analysis (MBMA) framework to quantitatively adjust for factors related to efficacy in metastatic non-small cell lung cancer (mNSCLC). Data were derived from 15 published studies assessing key programmed cell death protein-1 (PD-1) inhibitors pembrolizumab (n = 8) and nivolumab (n = 7), representing current SOC in mNSCLC. In the first stage, a mixed-effects logistic regression model for overall response rate (ORR) was developed accounting for effects of various population covariates on ORR. The ORR model results indicated an odds ratio (OR) of 1.02 for squamous versus non-squamous histology and OR of 1.20 for PD-ligand 1 tumor proportion score (TPS) per every 10% increase of TPS level. Next, a nonparametric mixed-effects model for overall survival (OS) was developed with ORR/other clinical covariates as input. Subsequently, MBMA simulations of relevant hypothetical scenarios involving single-arm trial design predicted OS hazard ratios as a function of ORR with matched patient characteristics. Findings from this MBMA and derived parameter estimates can be generally applied by the reader as a framework for interpreting efficacy data from early phase trials to support ORR-based go/no-go decisions and futility rules, illustrated through examples in this report.

PK/PD modeling to characterize placebo and treatment effect of omalizumab for chronic spontaneous urticaria

The pharmacokinetic (PK) characteristics of omalizumab and its pharmacodynamic (PD) effect in patients has yet to be fully characterized in chronic spontaneous urticaria, which could elucidate its pathogenesis and treatment response. This study has two objectives; (1) characterize the population PK of omalizumab and its PD effect on IgE, and (2) develop a drug effect model of omalizumab in urticaria (via change in weekly itch severity score). The target-mediated population of PK/PD model incorporating omalizumab-IgE binding and turnover adequately described PK and PD of omalizumab. The effect compartment model and linear drug effect and additive placebo response adequately described placebo and treatment effects of omalizumab. Several baseline covariates were identified for PK/PD and drug effect models. The developed model has the potential to aid in understanding variability in PK/PD as well as response to omalizumab treatment.

Significance of mitral L wave to predict late recurrence of atrial fibrillation after radiofrequency catheter ablation

Background

Mitral L wave, prominent mid-diastolic filling wave in echocardiographic examinations, is associated with severe left ventricular diastolic dysfunction, and that has been reported to predict recurrent atrial fibrillation (AF) after cardioversion. However, association between mitral L wave and the outcome of AF after radiofrequency catheter ablation (RFCA) has not been established.

Objective

The aim of this study is to evaluate the predictive value of mitral L wave on AF recurrence after RFCA.

Methods

250 patients including 164 paroxysmal AF (65.6%) and 86 non-paroxysmal AF (34.4%) who received RFCA in single center from January 2015 to December 2016 were enrolled consecutively. Echocardiographic examinations before RFCA were recorded, and the mitral L wave was defined as a distinct mid-diastolic flow velocity with a peak velocity ≥20 cm/s following the E wave. Systematic follow-up was conducted after RFCA. Univariate and multivariate analyses were carried out to determine the factors predicting late recurrence of AF (LRAF) which means AF recurrence after 3 months. Enrolled patients were divided into groups with the L wave (L-group; n=57) or without the L wave (NL-group; n=193) based on the findings of echocardiographic examinations.

Results

During a follow-up of 35.0±17.6 months, the ratio of LRAF in the L-group was significantly higher than that in the NL-group (32 (56.1%) vs. 41 (21.2%), Hazard ratio [HR]: 3.55, 95% confidence interval [CI]: 2.33 - 5.42, p<0.001). Among the clinical factors, presence of mitral L wave, BNP value, non-paroxysmal AF and moderate-severe mitral regurgitation were related to LRAF. A multivariate analysis using a Cox proportional hazard model found that presence of mitral L wave (HR: 2.67, 95% CI: 1.30 - 5.48, p=0.007) was significantly associated with LRAF.

Conclusion

This study revealed that mitral L wave predicts late recurrence of AF after RFCA.

Funding Acknowledgement

Type of funding sources: None.

Exposure-Response Relationships in Patients With HER2-Positive Metastatic Breast Cancer and Other Solid Tumors Treated With Trastuzumab Deruxtecan

Trastuzumab deruxtecan (T-DXd) is a HER2-targeting antibody-drug conjugate composed of a novel enzyme-cleavable linker and membrane-permeable topoisomerase I inhibitor payload. T-DXd has been approved for HER2-positive metastatic breast cancer and for HER2-positive metastatic gastric cancer. The approval in breast cancer was based on results from the DESTINY-Breast01 (U201; NCT03248492) and J101 (NCT02564900) trials. Here, we present dose justification for the approved 5.4 mg/kg every-3-weeks (Q3W) dose based on exposure-efficacy evaluated in patients with HER2-positive breast cancer (N = 337) from these 2 trials. Exposure-safety was assessed in patients with all tumor types (N = 639, n = 512 with breast cancer) across 5 trials, including J101 and DESTINY-Breast01. T-DXd doses ranged from 0.8-8.0 mg/kg Q3W; most patients received 5.4 (n = 312) or 6.4 mg/kg (n = 291). For each end point, multivariate logistic or Cox regression analysis was performed using various exposure metrics of T-DXd and released drug. A statistically significant association was observed between intact T-DXd area under the concentration-time curve (AUC) and confirmed objective response rate (ORR; P = 0.028). No significant exposure-response relationships were observed between intact T-DXd or released drug and duration of response or progression-free survival; however, follow-up was limited. All evaluated safety end points demonstrated a significant (P < 0.05) relationship with either intact T-DXd or released drug, with higher adverse event (AE) rates projected at higher exposures. Dose-response projections suggested an increase in ORR (67.5% vs. 62.9%) and toxicity (e.g., grade ≥ 3 all-cause treatment-emergent AEs: 61% vs. 54%) with T-DXd 6.4 vs. 5.4 mg/kg. Results demonstrate the benefit-risk profile at different doses and guide clinicians in the use of the 5.4-mg/kg Q3W dose in patients with HER2-positive metastatic breast cancer.

Selinexor population pharmacokinetic and exposure-response analyses to support dose optimization in patients with diffuse large B-cell lymphoma

PURPOSE

Characterize the population PK and exposure-response (ER) relationships of selinexor in patients with diffuse large B-cell lymphoma (DLBCL) (efficacy endpoints) or other non-Hodgkin's lymphoma (NHL) patients (safety endpoints) to determine the optimal dose in patients with DLBCL.

METHODS

This work included patients from seven clinical studies, with 800 patients for PK, 175 patients for efficacy and 322 patients for safety analyses. Logistic regression models and Cox-regression models were used for binary and time-to-event endpoints, respectively. Model-based simulations were performed to justify dose based on balance between efficacy and safety outcome.

RESULTS

Selinexor pharmacokinetics were well-described by a two-compartment model with body weight as a significant covariate on clearance and central volume of distribution and gender on clearance. Overall response rate (ORR) in patients with DLBCL increased with day 1 C_max and decreased in patients with higher baseline tumor size (p < 0.05). Significant exposure-safety relationships (p < 0.05) in NHL patients were identified for the frequency of the following safety endpoints: dose modifications, decreased appetite Grade ≥ 3 (Gr3+), fatigue Gr2+, vision blurred Gr1+, and vomiting Gr2+. Similar exposure-safety relationships were found for time-to-onset of the adverse events.

CONCLUSIONS

Simulations of the safety and efficacy ER models suggested that, compared to a starting dose of 60 mg twice weekly (BIW), a 40 mg BIW regimen resulted in an absolute decrease in AE probabilities between 1.9 and 5.3%, with a clinically significant absolute efficacy decrease of 4.7% in ORR. The modeling results support that 60 mg BIW is the optimal dose in patients with DLBCL.

Population pharmacokinetic and exposure-response analyses of ivosidenib in patients with IDH1-mutant advanced hematologic malignancies

Ivosidenib is a once daily (q.d.), orally available, potent mutant isocitrate dehydrogenase 1 (mIDH1) inhibitor approved for treatment of patients with relapsed or refractory (R/R) acute myeloid leukemia (AML) and intensive chemotherapy ineligible AML with a susceptible IDH1 mutation. Population pharmacokinetics (PKs; N = 253), exposure‐response (efficacy [n = 201] and safety [n = 253]), and concentration‐corrected electrocardiogram QT interval (QTc; n = 171) analyses were performed using phase I data (100 mg twice daily and 300–1200 mg q.d.). Ivosidenib disposition was well‐described by a two‐compartment PK model with first‐order absorption and elimination. Between‐subject variability was moderate for PK parameters. Intrinsic factors did not affect ivosidenib PKs. Moderate/strong CYP3A4 inhibitors increased the area under the plasma ivosidenib concentration‐time curve at steady state (AUC_ss) by 60%. Efficacy responders and nonresponders had similar ivosidenib exposures. Based on AUC_ss, there was no apparent relationship between ivosidenib exposure and efficacy or adverse events. The plasma ivosidenib concentration‐QT analysis showed a mean change in QTc using Fridericia’s method (ΔQTcF) of 17.2 msec at the approved 500 mg q.d. dose. Because of the direct association between ivosidenib exposure and QTcF, patients should have their electrocardiograms and electrolytes monitored, and comedications that increase ivosidenib exposure or prolong the QT interval should be avoided. These model‐based analyses quantitatively provide a framework to describe the relationship among ivosidenib dose, exposure, and clinical end points. With precautions for QTc prolongation, the exposure‐response analyses support the 500 mg q.d. dose in patients with AML with a susceptible IDH1 mutation.

Electrocardiographic evaluation of depolarization and repolarization abnormalities in breast cancer patients with HER2-inhibitor related cardiac dysfunction

Background

The arrhythmic substrates of the myocardium such as depolarization and repolarization abnormalities are thought to reflect cardiac dysfunction prior to the morphologic left ventricular dysfunction. Activation time (AT), recovery time (RT) and T wave peek-end interval dispersion (Tpe-dispersion) are useful indicators of the arrhythmic substrate. We examined the appearance of depolarization and repolarization abnormalities in patients with cancer therapeutics-related cardiac dysfunction (CTRCD) using AT, RT and Tpe-dispersion.

Methods

We conducted a standardized case-control study of CTRCD with 40 patients who developed breast cancer and treated with trastuzumab (13 cases and 27 controls). We assessed the relation between electrocardiographic indexes, including AT, RT and corrected Tpe-dispersion, and CTRCD. QT intervals were measured by Fridericia method, and QT observer 3 software were used for the measurement of all electrocardiographic indexes.

Results

LVEF in case and control group were 45.7±8% and 69.2±6%, respectively. AT in aVR lead was significantly higher in case group compared with control (28.8±7ms vs 22.8±5ms, P=0.02). corrected Tpe-dispersion tended to be higher in case group than that of control group (43.2±19ms vs 31.9±10ms, P=0.06). QT dispersion and RT dispersion were not different between case and control group.

Conclusions

Our study demonstrated that AT in aVR may predict cardiac dysfunction in breast cancer patients with HER2-inhibitor related cardiac dysfunction. More detailed studies using other modalities which can detect depolarization and repolarization abnormalities, including ventricular late potentials and T wave alternans, are needed.

Funding Acknowledgement

Type of funding source: None

Population Pharmacokinetics of Trastuzumab Deruxtecan in Patients With HER2-Positive Breast Cancer and Other Solid Tumors

Trastuzumab deruxtecan (DS‐8201) is a human epidermal growth factor receptor 2 (HER2)–targeting antibody–drug conjugate with a novel enzyme‐cleavable linker, a topoisomerase I inhibitor payload, and a drug‐to‐antibody ratio of ≈ 8. We have characterized the population pharmacokinetics (PK) of trastuzumab deruxtecan and released drug (topoisomerase I inhibitor) in patients with HER2‐positive breast cancer or other solid tumor malignancies. This analysis includes pooled data from five clinical studies with 639 patients. Trastuzumab deruxtecan doses ranged from 0.8 to 8.0 mg/kg every 3 weeks. Serum concentrations of trastuzumab deruxtecan and released drug were analyzed using a sequential two‐step approach, with the nonlinear mixed‐effects modeling methods. Covariate assessment was based upon stepwise forward‐addition and backward‐elimination process, followed by both univariate and multivariate analysis quantifying their impact on steady‐state exposure of trastuzumab deruxtecan and released drug. A two‐compartment model with linear elimination best described PK profiles of intact trastuzumab deruxtecan, while a one‐compartment model with time‐varying release‐rate constant and linear elimination described released‐drug PK profiles. Statistically significant covariates (country, tumor size, sex, formulation, age, body weight, albumin, total bilirubin, and aspartate aminotransferase) resulted in < 20% change in steady‐state area under the concentration‐time curve of trastuzumab deruxtecan and released drug, except for increased body weight (95th percentile, 86 kg) and decreased albumin (5th percentile, 31 g/L). Analysis of patients stratified by country, race, renal function, and hepatic function found no clinically meaningful differences in steady‐state exposure of intact trastuzumab deruxtecan or released drug. Overall, results suggest that no dose adjustment based on tested covariates or in specific patient populations is warranted.

Preliminary clinical pharmacokinetics and dose-response to support a phase II dose selection for CX-2009: A masked probody drug conjugate to CD166

3599

Background: PROBODY therapeutics are antibody prodrugs with cleavable peptide masks designed to reduce off-tumor, on-target toxicities. The mask blocks binding in the periphery and is removed by tumor-associated proteases resulting in intratumoral binding. CX-2009 is a PROBODY drug conjugate directed against CD166/ALCAM, which is a target overexpressed in carcinomas but not suitable for traditional ADC targeting because it is expressed in normal epithelium. CX-2009 is conjugated to DM4, a potent microtubule inhibitor. Here we report preliminary clinical pharmacokinetic (PK) and exploratory dose-response (DR) analyses for CX-2009 from the ongoing phase 1/2 PROCLAIM-CX-2009 study (NCT03149549). Methods: Human PK and anti-drug antibody (ADA) data were obtained at selected times post-dose following IV 0.25–10 mpk CX-2009 Q3W and of 6 mpk Q2W. Covariates were selected for population PK (POPPK) based on multivariate screening at P< 0.01. Preliminary exploratory DR analyses were conducted for selected endpoints including adverse events of special interest and response data (CR, PR, SD, and PD). Results: Preliminary CX-2009 PK data from 92 subjects were available as of October 2019. Median free DM4 levels circulated at ≤0.3% of Total CX-2009 (masked + activated CX-2009) levels across the 1–10 mpk dose levels. A two-compartment POPPK model with linear elimination was fit to the Intact (masked form) CX-2009 data. The preliminary CX-2009 POPPK model estimates for Intact CX-2009 clearance (CL), volume of distribution, and half-life were 0.47 L/day, 4.51 L, and 7.14 days, respectively, with 91% of CX-2009 circulating as Intact CX-2009. ADA was not a statistically significant covariate on Intact CX-2009 CL. Evidence of clinical activity was observed at doses of 4 mpk Q3W or higher. DR analysis suggested that the frequency of grade ≥3 ocular toxicity events increased significantly at dose equivalents ≥8 mpk Q3W. POPPK simulations suggested that the targeted 90 nM trough concentration (based on nonclinical data) would be contained within the 90% prediction interval of predicted Intact CX-2009 levels following CX-2009 7 mpk. Conclusions: Preliminary CX-2009 PK data following CX-2009 0.25-10 mpk suggest that CX-2009 circulates predominantly as Intact CX-2009, and that Intact CX-2009 PK is not strongly influenced by target-mediated drug disposition or ADA. Preliminary DR and POPPK simulations support further evaluation of 7 mpk CX-2009 Q3W in selected cohort expansions. Clinical trial information: NCT03149549 .

P93 The usefulness of dual cardiac autonomic nervous modulation assessment for prediction of mortality in patients with relatively preserved left ventricular ejection fraction

Background

Recent guidelines have stated that reduced left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. Although reduced LVEF identifies patients at an increased risk of cardiac arrest, sudden cardiac deaths (SCDs) occur considerably more often in patients with relatively preserved LVEF. Current guidelines on SCDs risk stratification do not adequately cover this general population pool. Heart rate variability (HRV) and heart rate turbulence (HRT) are non-invasive electrocardiography (ECG)-based techniques capable of providing relevant information on the cardiac autonomic nervous modulation. Although a large body of evidence about autonomic nervous modulation markers has been reported, the usefulness of HRV and HRT parameters for risk stratification in such patients with relatively preserved LVEF has not yet been elucidated.

Purpose

This study aimed to evaluate HRV and HRT parameters for predicting cardiac mortality in patients with structural heart disease (SHD), including ischemic heart disease, dilated cardiomyopathy and valvular heart disease, who have mid-range left ventricular dysfunction (LVD).

Methods

We prospectively enrolled 229 patients (187 men, age 63 ± 13 years) with SHD who have mid-range LVD (LVEF &gt; 40%). HRV and HRT parameters based on 24-hour ambulatory ECG recordings (Fukuda Denshi Co., Ltd., Tokyo, Japan) were evaluated as follows; SDNN, triangular index, high and low frequency HRV, turbulence onset and slope. The primary endpoint was all-cause mortality. Univariate and multivariate Cox regression analysis were used to assess the association between these cardiac autonomic nervous modulation and mortality.

Results

During a mean follow-up of 21 ± 11 months, all-cause mortality was seen in 11 (4.8%) patients. Univariate Cox regression analysis showed that reduced SDNN (&lt;50ms), reduced triangular index (&lt;20ms) and HRT category 2 were significantly associated with the primary endpoint (P &lt; 0.05). When HRT category 2 combined with reduced SDNN, Multivariate Cox regression analysis revealed that this combination more strongly associates with the primary endpoint (hazard ratio =7.91, 95%CI, 1.82-34.2; P = 0.006).

Conclusion

Dual cardiac autonomic nervous modulation assessment which combined HRT and HRV could be a superior technique to predict mortality in patients with relatively preserved LVEF.

Population pharmacokinetics, exposure-safety, and immunogenicity of atezolizumab in pediatric and young adult patients with cancer

BACKGROUND

The iMATRIX-atezolizumab study was a phase I/II, multicenter, open-label study designed to assess the safety and pharmacokinetics of atezolizumab in pediatric and young adult patients. We describe the pharmacokinetics (PK), exposure-safety, and immunogenicity of atezolizumab in pediatric and young adults with metastatic solid tumors or hematologic malignancies enrolled in this study.

METHODS

Patients aged < 18 years (n = 69) received a weight-adjusted dose of atezolizumab (15 mg/kg every 3 weeks [q3w]; maximum 1200 mg); those aged ≥ 18 years (n = 18) received a flat dose (1200 mg q3w). A prior two-compartment intravenous infusion input adult population-PK (popPK) model of atezolizumab was used as a basis to model pediatric data.

RESULTS

A total of 431 atezolizumab serum concentrations from 87 relapse-refractory pediatric and young adult patients enrolled in the iMATRIX-atezolizumab study were used for the popPK analysis. The dataset comprised predominantly patients aged < 18 years, including two infants aged < 2 years, with a wide body weight and age range. The clearance and volume of distribution estimates of atezolizumab were 0.217 L/day and 3.01 L, respectively. Atezolizumab geometric mean trough exposures were ~ 20% lower in pediatric patients versus young adults; this was not clinically meaningful as both groups achieved the target concentration (6 μg/mL). Safety was similar between pediatric and young adult patients with no exposure-safety relationship observed. Limited responses (4/87) precluded an exposure-response assessment on outcomes. A comparable rate (13% vs 11%) of atezolizumab anti-drug antibodies was seen in pediatric and young adult patients.

CONCLUSIONS

These findings demonstrate a similar exposure-safety profile of atezolizumab in pediatric and young adult patients, supportive of weight-based dosing in pediatric patients.

TRIAL REGISTRATION

NCT02541604.

P3754Comparison of the transdermal bisoprolol patch with the oral bisoprolol fumarate administration as a therapeutic agent for idiopathic frequent premature ventricular contractions

Background

The transdermal bisoprolol patch (TB) was designed to maintain a sustained concentration of bisoprolol in plasma by higher trough concentration than the oral bisoporolol fumarate administration (OB). It is unclear whether the TB is as effective in treating idiopathic premature ventricular contractions (PVCs) as the OB.

Purpose

We compared the efficacy between the TB and OB in treating idiopathic PVCs while considering their duration of action.

Methods

Among 198 patients with a PVC count of ≥3,000 beats/24 hours, 84 patients were divided into groups treated with TB 4mg (n=50) or OB 2.5mg (n=34). The PVCs were divided into positive heart rate (HR)-dependent PVCs (P-PVCs) and non-positive HR-dependent PVCs (NP-PVCs) based on the relationship between the hourly PVCs density and hourly mean HR. To evaluate the efficacy, PVC counts by 24-hour Holter electrocardiograms were measured at baseline and at 1 month after the initiation of the therapy.

Results

There were no significant between-group differences for the mean HR, PVC count, or type of PVCs. Both the TB (from 16,692±9,737 to 10,442±10,711 beats/24 hours, P<0.001) and OB (from 19,633±16,298 to 9,235±12,124 beats/24 hours, P<0.001) significantly decreased the total PVC count after the initiation of therapy, and a comparison between the two drugs showed no significant difference (P=0.46). In the P-PVC group, both the TB and OB significantly decreased the total PVC count (P<0.001, P=0.022 respectively), PVC count during the day-time (P<0.001, P=0.030 respectively), and PVC count during the night-time (P=0.0038, P=0.022 respectively). In contrast, in the NP-PVC group, neither the TB nor OB made any significantly change in the total PVC count (P=0.079, P=0.10 respectively), PVC count during the day-time (P=0.35, P=0.12 respectively), or PVC count during the night-time (P=0.11, P=0.12 respectively). The TB exhibited a significant reduction during each time period regarding the changes within 24-hours in the P-PVC count from baseline, while the OB did not significantly reduce the P-PVC count from baseline during each time period between 0 and 5 o'clock.

Conclusions

Compared with the OB, the TB could be used with the same efficacy for reducing the PVC count. The TB could be a more useful therapeutic agent for idiopathic P-PVCs during a 24-hour period than the OB.

P6559Long-term follow-up and outcomes of patients with discontinuation of oral anticoagulant therapy after successful ablation procedures for atrial fibrillation

Background

Oral anticoagulant therapy (OAT) is effective for preventing strokes in atrial fibrillation (AF) patients. Currently, there is controversy regarding the discontinuation of OATs in patients with ablation procedures to eliminate AF.

Aim

We investigated the incidence of major bleeding and ischemic strokes/systemic embolisms in low-risk patients that discontinued OATs after successful AF ablation procedures.

Methods

Of 330 consecutive patients that underwent AF ablation procedures and were prescribed one of the direct oral anticoagulants or warfarin, 207 AF patients (158 men, mean age 61±11 years) who discontinued OATs three months after the procedure were enrolled. The average CHADS2 and HAS-BLED scores were 1.0±0.9 and 1.2±1.0, respectively, which meant that most patients had a low risk for strokes.

Results

During follow-up, 31 patients (15%) had recurrences of AF. Those patients underwent a re-ablation procedure and then re-discontinued their OATs three months after the session. During a 60±13 months follow-up, major bleeding was observed in five patients (2.4%) and was associated with a higher HAS-BLED score (2.2±0.4 vs. 1.1±1.0, P=0.027). In contrast, none of the patients experienced ischemic strokes/systemic embolisms.

Conclusions

This prospective study demonstrated that in patients with successful ablation procedures and low risk scores for AF management, OATs could be discontinued three months after the procedure. Unnecessary continuation of OATs may increase the incidence of major bleeding during the follow-up.

Exposure-Response-Based Product Profile-Driven Clinical Utility Index for Ipatasertib Dose Selection in Prostate Cancer

The aims of this work were to characterize ipatasertib exposure–response (E‐R) relationships in a phase II study and to quantitatively assess benefit‐risk using a clinical utility index approach to support ipatasertib phase III dose selection in patients with metastatic castration‐resistant prostate cancer. Logistic regression and Cox proportional‐hazards models characterized E‐R relationships for safety and efficacy endpoints, respectively. Exposure metrics with and without considering dose interruptions/reductions (modifications) were tested in the E‐R models. Despite a steeper E‐R relationship when accounting for dose modifications, similar dose‐response projections were generated. The clinical utility index analysis assessed important attributes, weights, and clinically meaningful cutoff/tradeoff values based on predefined minimal, target, and optimistic product profiles. Ipatasertib 400 mg daily, showing the highest probability of achieving the minimal product profiles and better benefit‐risk balance than other doses (200–500 mg daily), was selected for further development in metastatic castration‐resistant prostate cancer.

Development of a Subcutaneous Fixed-Dose Combination of Pertuzumab and Trastuzumab: Results From the Phase Ib Dose-Finding Study

Adding pertuzumab to trastuzumab (both monoclonal antibodies targeting human epidermal growth factor receptor 2 [HER2]) has proven survival benefits when combined with chemotherapy for patients with HER2-positive breast cancer. The combination of pertuzumab and trastuzumab together in 1 vial for subcutaneous (SC) administration is being developed as a ready-to-use formulation to reduce the treatment burden on patients while improving healthcare efficiency. An open-label, 2-part, phase Ib dose-finding study (NCT02738970) was undertaken in healthy male volunteers (part 1) and female patients with HER2-postive early breast cancer who had completed standard (neo)adjuvant treatment (part 2). This study aimed to identify an SC pertuzumab dose given with recombinant human hyaluronidase that results in comparable exposure to that of the intravenous (IV) pertuzumab dose, based on pertuzumab serum trough concentration and area under the serum concentration-time curve. Pharmacokinetics (PK), safety, and tolerability of a single dose of SC pertuzumab given alone or in a fixed-dose combination (comixed or coformulated) with trastuzumab were also assessed. A maintenance dose of 600 mg for SC pertuzumab resulted in an equivalent exposure to that of IV pertuzumab, and no new safety signals were identified for SC pertuzumab or trastuzumab. A loading dose of 1200 mg for SC pertuzumab was selected based on approximate dose proportionality. The PK and safety results support further development of a fixed-dose coformulation combination of pertuzumab and trastuzumab for SC administration, which will be investigated in an upcoming phase III trial in patients with HER2-positive early breast cancer.

Evidence for prevalent Z = 6 magic number in neutron-rich carbon isotopes

The nuclear shell structure, which originates in the nearly independent motion of nucleons in an average potential, provides an important guide for our understanding of nuclear structure and the underlying nuclear forces. Its most remarkable fingerprint is the existence of the so-called magic numbers of protons and neutrons associated with extra stability. Although the introduction of a phenomenological spin-orbit (SO) coupling force in 1949 helped in explaining the magic numbers, its origins are still open questions. Here, we present experimental evidence for the smallest SO-originated magic number (subshell closure) at the proton number six in 13-20C obtained from systematic analysis of point-proton distribution radii, electromagnetic transition rates and atomic masses of light nuclei. Performing ab initio calculations on 14,15C, we show that the observed proton distribution radii and subshell closure can be explained by the state-of-the-art nuclear theory with chiral nucleon-nucleon and three-nucleon forces, which are rooted in the quantum chromodynamics.

Abstract P5-20-07: A phase Ib dose-finding study of subcutaneous pertuzumab in combination with subcutaneous trastuzumab in healthy male volunteers and female patients with early breast cancer

Background:

A fixed-dose combination (FDC) of subcutaneous (SC) pertuzumab (F. Hoffmann-La Roche Ltd, Basel, Switzerland) + SC trastuzumab (F. Hoffmann-La Roche Ltd) is being developed to reduce the treatment burden on patients while improving treatment facility efficiency. This phase Ib dose-finding study (NCT02738970) aimed to identify the SC pertuzumab dose that is comparable to the intravenous (IV) dose, based on serum trough concentrations (Ctrough) and area under the concentration–time curve (AUC) when administered with or without SC trastuzumab.

Methods:

This two-part study consisted of SC pertuzumab dose determination in healthy male volunteers (HMVs) (Part 1) and a subsequent SC pertuzumab dose confirmation in patients with early breast cancer (EBC) (Part 2). Part 1 of the study was comprised of 48 HMVs who received various SC pertuzumab doses (400–1200 mg) or the standard IV dose (420 mg), administered alone or co-mixed with SC trastuzumab 600 mg. Non-compartmental and statistical methods were used to test the pharmacokinetic (PK) interaction between SC pertuzumab and SC trastuzumab when administered with recombinant human hyaluronidase, a permeation enhancer. Two population PK (popPK) models were built to estimate PK parameters and PK variability. Model 1 used IV/SC PK data from Part 1 of the current study only. Model 2 used Part 1 SC PK data and PK parameters from the published IV pertuzumab popPK model (Garg A, et al. Cancer Chemother Pharmacol 2014; 74: 819–829). Each popPK model was used to simulate 400 phase III clinical trials. Per simulated trial, the geometric mean ratio (GMR) of Cycle 8 Ctrough at steady state and AUC at steady state for SC/IV were calculated. The percentage of trials with the 5th percentile confidence interval of the GMR above 0.8 was tabulated.

Results:

In Part 1 of the study, there was no impact on pertuzumab or trastuzumab PK from co-mixing SC trastuzumab with SC pertuzumab. The absolute bioavailability of SC pertuzumab in HMVs was approximately 70–80%, with a median time to reach maximum concentrations of 4–5 days. Clinical trial simulations indicated that an SC pertuzumab dose of 600 mg will achieve the target Ctrough and AUC SC/IV GMRs &gt; 99% of the time. Results were consistent between the models. Safety data supported the selection of an SC pertuzumab maintenance dose of 600 mg. The 600 mg SC pertuzumab dose determined in HMVs was confirmed in Part 2 of the study in patients with EBC.

Conclusions:

These data support the development of an SC pertuzumab + SC trastuzumab FDC product.

Citation Format: Kirschbrown WP, Wynne C, Kagedal M, Wada R, Li H, Nijem I, Badovinac Crnjevic T, Heeson S, Eng-Wong J, Garg A. A phase Ib dose-finding study of subcutaneous pertuzumab in combination with subcutaneous trastuzumab in healthy male volunteers and female patients with early 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 P5-20-07.

Wash or wipe? A comparative study of skin physiological changes between water washing and wiping after skin cleaning

BACKGROUND/PURPOSE

Presently, skin-cleaning agents that claim to be removed by water or wiping alone are commercially available and have been used for the purpose of bed baths. However, there is a lack of knowledge on how water washing and wiping differently affect skin physiological functions or ceramide content. The aim of this study was to compare the effects of water washing and wiping on skin physiological functions and ceramide content.

METHODS

Three kinds of the cleaning agents with different removal techniques (ie, water washing and wiping) were used in this study. Skin physiological functions (ie, transepidermal water loss, skin hydration, and skin pH) and skin ceramide content were measured before and after seven consecutive days of the application of each cleaning agent.

RESULTS

No significant differences in skin physiological functions or ceramide content were observed between water washing and wiping.

CONCLUSION

Cleaning agents that claim to be removed by water washing or wiping do not affect skin physiological functions or ceramide content by either removal method.

Mechanistic pharmacokinetic/pharmacodynamic modeling of in vivo tumor uptake, catabolism, and tumor response of trastuzumab maytansinoid conjugates

PURPOSE

Trastuzumab emtansine (T-DM1), an antibody-drug conjugate (ADC) comprised of trastuzumab linked to the antimitotic agent DM1, has shown promising results in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. Investigations of the mechanisms of the action of ADCs, including T-DM1, have been primarily descriptive or semiquantitative. However, quantitative pharmacokinetic/pharmacodynamic (PK/PD) analysis may provide insights into their complex behavior. The analyses described herein applied PK/PD modeling to nonclinical studies of maytansinoid conjugates.

METHODS

The maytansinoid conjugates T-DM1 and T-SPP-DM1, with thioether and disulfide linkers, respectively, were tested in mouse efficacy, PK, and tumor uptake studies. (3)[H]DM1-bearing ADCs were used to facilitate the quantitation of the ADCs in plasma, as well as ADC and ADC catabolites in tumors. Three mechanistic PK/PD models were used to characterize plasma ADC, tumor ADC, and tumor catabolite concentrations. Tumor catabolite concentrations were used to fit tumor response. Model parameters were estimated using R software and nonlinear least squares regression.

RESULTS

Plasma ADC-associated DM1 concentrations of T-DM1 decreased more slowly than those of T-SPP-DM1, likely due to slower DM1 release. A comparison of the mechanistic models found that the best model allowed catabolism and catabolite exit rates to differ between ADCs, that T-DM1 exhibited both faster tumor catabolism and catabolite exit rate from tumors than T-SPP-DM1; findings inconsistent with expected behavior based on the physicochemical nature of the respective catabolites. Tumor catabolite concentrations adequately described tumor response with both ADCs showing similar potency.

CONCLUSION

Mechanistic PK/PD studies described herein provided results that confirmed and challenged current hypotheses, and suggested new areas of investigation.

HCl yield and chemical kinetics study of the reaction of Cl atoms with CH3I at the 298K temperature using the infra-red tunable diode laser absorption spectroscopy

Pulsed ArF excimer laser (193 nm)-CW infrared (IR) tunable diode laser Herriott type absorption spectroscopic technique has been made for the detection of product hydrochloric acid HCl. Absorption spectroscopic technique is used in the reaction chlorine atoms with methyl iodide (Cl+CH3I) to the study of kinetics on reaction Cl+CH3I and the yield of (HCl). The reaction of Cl+CH3I has been studied with the support of the reaction Cl+C4H10 (100% HCl) at temperature 298 K. In the reaction Cl+CH3I, the total pressure of He between 20 and 125 Torr at the constant concentration of [CH3I] 7.0×10(14) molecule cm(-3). In the present work, we estimated adduct formation is very important in the reaction Cl+CH3I and reversible processes as well and CH3I molecule photo-dissociated in the methyl [CH3] radical. The secondary chemistry has been studied as CH3+CH3ICl = product, and CH3I+CH3ICl = product2. The system has been modeled theoretically for secondary chemistry in the present work. The calculated and experimentally HCl yield nearly 65% at the concentration 1.00×10(14) molecule cm(-3) of [CH3I] and 24% at the concentration 4.0×10(15) molecule cm(-3) of [CH3I], at constant concentration 4.85×10(12) molecule cm(-3) of [CH3], and at 7.3×10(12) molecule cm(-3) of [Cl]. The pressure dependent also studied product of HCl at the constant [CH3], [Cl] and [CH3I]. The experimental results are also very good matching with the modelling work at the reaction CH3+CH3ICl = product (k = (2.75±0.35)×10(-10) s(-1)) and CH3I+CH3ICl = product2 (k = 1.90±0.15)×10(-12) s(-1). The rate coefficients of the reaction CH3+CH3ICl and CH3I+CH3ICl has been made in the present work. The experimental results has been studied by two method (1) phase locked and (2) burst mode.

Development of a Predictive Pharmacokinetic Model for a Novel Cyclooxygenase-2 Inhibitor

A predictive population pharmacokinetic model was developed for a novel cyclooxygenase-2 (COX-2) inhibitor CS-706, using data from 130 subjects in 3 phase 1 trials after single or multiple doses of CS-706 (2- to 800-mg doses daily, up to 14 days) and validated using sparse data from a separate study. A 2-compartment model described the data. Typical apparent clearance (CL/F) was 47.2 L/h and was reduced by 43% at doses greater than 200 mg. Apparent clearance was decreased by 38% in female subjects and by 64% and 15%, respectively, in poor/intermediate CYP 2D6 and poor CYP 2C9 metabolizers. Typical apparent volume of the central compartment was 166 L and increased with body weight. Bioavailability increased by 42% after nighttime doses and decreased saturably with increasing dose (50% reduction at 221 mg). Predicted exposures in Japanese subjects were reduced relative to whites because of a lower frequency of poor metabolizers. The model may aid in optimizing the design of future studies and predicting exposures in other subpopulations.

Predictive Population Pharmacokinetic/Pharmacodynamic Model for a Novel COX-2 Inhibitor

The objectives of these analyses were to (1) develop a population pharmacokinetic/pharmacodynamic model for a novel COX-2 inhibitor (CS-706) using data from primarily Caucasian subjects, (2) predict responses in subpopulations of interest (including Japanese subjects), and (3) correlate pharmacodynamic parameters to safety outcomes. The model was developed using data from 130 healthy adults following single or multiple doses of CS-706. Serial plasma concentrations of CS-706 and ex vivo whole-blood cyclooxygenase-1 (COX-1) and COX-2 activity were determined up to 72 hours postdose. An E(max) model described relationships between CS-706 plasma concentrations and COX-1 and COX-2 inhibition. CS-706 potency (EC(50)) was 397 ng/mL for COX-1 and 20 ng/mL for COX-2. None of the tested covariates influenced the pharmacodynamics of CS-706. Japanese subjects are expected to show a slightly reduced response to CS-706, consistent with lower exposure following the same dose given to Caucasian subjects. Predictive pharmacokinetic/pharmacodynamic modeling for COX-1 and COX-2 inhibition indicates a 20-fold potency ratio that is expected to be similar in Japanese and Caucasians. There was good correlation between COX-1 inhibition and the incidence of 7-day gastroduodenal mucosal injury. A dose of less than 25 mg bid could be adequate to inhibit COX-2 activity with a low risk of gastrointestinal mucosal injury.

Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes

Taxes and subsidies are increasingly being considered as potential policy instruments to incentivize consumers to improve their food and beverage consumption patterns and related health outcomes. This study provided a systematic review of recent U.S. studies on the price elasticity of demand for sugar-sweetened beverages (SSBs), fast food, and fruits and vegetables, as well as the direct associations of prices/taxes with body weight outcomes. Based on the recent literature, the price elasticity of demand for SSBs, fast food, fruits and vegetables was estimated to be -1.21, -0.52, -0.49 and -0.48, respectively. The studies that linked soda taxes to weight outcomes showed minimal impacts on weight; however, they were based on existing state-level sales taxes that were relatively low. Higher fast-food prices were associated with lower weight outcomes particularly among adolescents, suggesting that raising prices would potentially impact weight outcomes. Lower fruit and vegetable prices were generally found to be associated with lower body weight outcomes among both low-income children and adults, suggesting that subsidies that would reduce the cost of fruits and vegetables for lower-socioeconomic populations may be effective in reducing obesity. Pricing instruments should continue to be considered and evaluated as potential policy instruments to address public health risks.

Detection of unruptured ovarian pregnancy subsequently successfully treated by conservative laparoscopic surgery: a case report and review of the literature

Early detection of ovarian pregnancy (OP) is essential for successful laparoscopic conservative surgery. However, early preoperative ultrasonography-based diagnosis is often difficult when fetal cardiac activity or the yolk sac is absent. The authors report a case of OP diagnosed at eight weeks gestational age in a natural pregnancy. The patient presented with amenorrhea and transient vaginal bleeding, and slight tenderness in the right ovary was noted during vaginal ultrasonography. Furthermore, ultrasonography showed a gestational sac (GS) without fetal cardiac activity or yolk sac, consistent with OP, and an adjacent compressible lutein cyst. The uterus, fallopian tubes, and left ovary were normal, and no cul-de-sac blood or ascites were found. Laparoscopy showed a two-cm mass partially covering the right ovary, which contained an unruptured GS. Subsequently, the mass was removed, and OP was histologically confirmed.

Laboratory tests of low density astrophysical nuclear equations of state

Clustering in low density nuclear matter has been investigated using the NIMROD multidetector at Texas A&M University. Thermal coalescence modes were employed to extract densities, ρ, and temperatures, T, for evolving systems formed in collisions of 47A MeV (40)Ar+(112)Sn, (124)Sn and (64)Zn+(112)Sn, (124)Sn. The yields of d, t, (3)He, and (4)He have been determined at ρ=0.002 to 0.03 nucleons/fm(3) and T=5 to 11 MeV. The experimentally derived equilibrium constants for α particle production are compared with those predicted by a number of astrophysical equations of state. The data provide important new constraints on the model calculations.

Experimental determination of in-medium cluster binding energies and Mott points in nuclear matter

In-medium binding energies and Mott points for d, t, 3He and α clusters in low-density nuclear matter have been determined at specific combinations of temperature and density in low-density nuclear matter produced in collisions of 47A MeV 40Ar and 64Zn projectiles with 112Sn and 124Sn target nuclei. The experimentally derived values of the in-medium modified binding energies are in good agreement with recent theoretical predictions based upon the implementation of Pauli blocking effects in a quantum statistical approach.

Symmetry energy of dilute warm nuclear matter

The symmetry energy of nuclear matter is a fundamental ingredient in the investigation of exotic nuclei, heavy-ion collisions, and astrophysical phenomena. New data from heavy-ion collisions can be used to extract the free symmetry energy and the internal symmetry energy at subsaturation densities and temperatures below 10 MeV. Conventional theoretical calculations of the symmetry energy based on mean-field approaches fail to give the correct low-temperature, low-density limit that is governed by correlations, in particular, by the appearance of bound states. A recently developed quantum-statistical approach that takes the formation of clusters into account predicts symmetry energies that are in very good agreement with the experimental data. A consistent description of the symmetry energy is given that joins the correct low-density limit with quasiparticle approaches valid near the saturation density.

Neoadjuvant transarterial chemoembolization (TACE) using cisplatin with the combination of dose-dense intravenous administration of paclitaxel for the locally advanced cervical adenocarcinoma

e16518

Background: Adenocarcinoma (including adenosquamous carcinoma) of the uterine cervix has a tendency to early lymph node metastasis and is resistant to radiation therapy, thus results in poor prognosis compared with squamous cell carcinoma. Neoadjuvant chemotherapy (NAC) followed by radical hysterectomy (RH) for bulky cervical adenocarcinoma seems to be an alternative therapy to primary radiation. Methods: P2 at the single institution. Eligible criteria were as follows: Histologically diagnosed cervical adeno or adenosquamous carcinoma with FIGO stage IB2-IVA, Age < or equal to 75, PS 0–2, given informed consent. The NAC regimen consisted of paclitaxel (60mg/m2, iv, D1, D8, D15) and cisplatin (70 mg/m2, trans-uterine arterial infusion followed by embolization using the gelform, D2) repeated every 3 weeks for 2–3 cycles, followed by RH. Primary endpoints were clinical and pathological responses, and secondary endpoints were toxicities, relapse free survival (RFS) and overall survival (OS). Results: Enrolled patients: 22 (1998–2006), Age: median 51 (33–75), FIGO stage: IB2 (9), IIA-IIB (8), IIIB (3), IVA (2), adeno/adenosquamous: 16/6. Toxicities during NAC (CTCAE ver.3) were as follows: G3/G4 neutropenia 18% (4/22), G3/G4 anemia 14% (3/22), G3/G4 thrombocytopenia 0%, G2/G3 sensory neuropathy 0 %, G3/G4 creatinine elevation 0%, G2 alopecia 100%. Clinical response rate (RR: CR+PR) of the patients with stage IB2-IIB was 100%. 16 of 17 received RH, and no residual malignant cells were found pathologically (pCR) in 3. RR of the patients with stage IIIb-IVa was 80%, three patients completed RH with either modified anterior or posterior exenteration, and pCR was found in one patient. The rate of radiation therapy following either NAC or surgery among enrolled patients were 18% (3/17) with stage IB2-IIB and 40% (2/5) with IIIB-IVA. 5 year RFS/OS were 69%/68% with stage IB2-IIb and 60%/60% with stage IIIb-IVa. All 15 alive patients had RH. One patient with stage IVa had urostomy, and other 14 patients have no trouble in urination function. Conclusions: TACE with cisplatin and dose dense paclitaxel in the neoadjuvant setting is feasible and effective for cervical adenocarcinoma.

[Table: see text]

Validation of genotyping of gastrointestinal stromal tumor in Japan

e21502

Background: Most gastrointestinal stromal tumors (GIST) have activating mutations in the KIT or PDGFRA gene. Genotyping of GIST is important in Dx and Tx of GIST. Methods of genotyping using genomic DNA extracted from paraffin-embedded specimens are diverse and not standardized. We did validation study of genotyping using special reference to sequencing data obtained from cDNA from fresh GIST samples. Methods: Three DNA extraction methods (QIAamp, DEXPAT, or original) and four PCR methods (Ex Taq, AmpliTaq condition-1, AmpliTaq condition-2, or QIAGEN Tag) were compared using 20 paraffin-embedded specimens with special reference to sequencing data obtained from cDNA from corresponding 20 fresh GIST samples. After DNA extraction, KIT exon 9, 11, 13 and 17, and PDGFRA exon 12 and 18 were amplified by each PCR method using specific primers and directly sequenced. Results: In evaluation of PCR method, the protocol with Ex Taq showed 100% amplication of DNA and sequence agreement, the protocol with QIAGEN Tag 99%, and the protocol with AmpliTaq condition-2 86% agreement, and the protocol with AmpliTaq condition-1 showed much less amplication and higher disagreement. For the DNA extraction, the protocol with QIAamp showed best DNA extraction and its DNA sequence data were consistent with reference sequence in 98%, DNA sequence obtained using DEXPAT showed 33% consistency, and 89% of DNA sequence data obtained from an original method was agreed with reference data. Some modifications improved DNA amplication but inconsistent sequence data also increased probably due to miss-PCR. Conclusions: Each DNA extraction method had different quantity of DNA and four PCR methods showed different quality. Using this validation study, a standard genotyping method in Japan was established.

No significant financial relationships to disclose.

Quantum nature of a nuclear phase transition

At finite temperatures and low densities, nuclei may undergo a phase change similar to a classical liquid-gas phase transition. Temperature is the control parameter while density and pressure are the conjugate variables. In the nucleus the difference between the proton and neutron concentrations acts as an additional order parameter, for which the symmetry potential is the conjugate variable. We present experimental results which reveal the N/Z dependence of the phase transition and discuss possible implications of these observations in terms of the Landau free energy description of critical phenomena.

Single-transverse-spin asymmetries of identified charged hadrons in polarized pp collisions at sqrt[s]=62.4 GeV

The first measurements of xF-dependent single-spin asymmetries of identified charged hadrons, pi+/-, K+/-, and protons, from transversely polarized proton-proton collisions at 62.4 GeV at RHIC are presented. Large asymmetries are seen in the pion and kaon channels. The asymmetries in inclusive pi+ production, AN(pi+), increase with xF from 0 to approximately 0.25 and AN(pi-) decrease from 0 to approximately -0.4. Observed asymmetries for K- unexpectedly show positive values similar to those for K+, increasing with xF, whereas proton asymmetries are consistent with zero over the measured kinematic range. Comparisons of the data with predictions of QCD-based models are presented.

Production of mesons and baryons at high rapidity and high p(T) in proton-proton collisions at square root[s] = 200 GeV

We present particle spectra for charged hadrons pi(+/-), K(+/-), p, and p[over] from pp collisions at square root[s] = 200 GeV measured for the first time at forward rapidities (2.95 and 3.3). The kinematics of these measurements are skewed in a way that probes the small momentum fraction in one of the protons and large fractions in the other. Large proton to pion ratios are observed at values of transverse momentum that extend up to 4 GeV/c, where protons have momenta up to 35 GeV. Next-to-leading order perturbative QCD calculations describe the production of pions and kaons well at these rapidities, but fail to account for the large proton yields and small p[over]/p ratios.

Differential susceptibility of equine and mouse brain microvascular endothelial cells to equine herpesvirus 1 infection

Equine herpesvirus 1 (EHV-1) shows endotheliotropism in the central nervous system (CNS) of infected horses. However, infection of endothelial cells has not been observed in the CNS of infected mice. To explore the basis for this difference in endotheliotropism, we compared the susceptibility of equine brain microvascular endothelial cells (EBMECs) and mouse brain microvascular endothelial cells (MBMECs) to EHV-1 infection. The kinetics of viral growth in EBMECs was typical of a fully productive infection whereas viral infection in MBMECs seemed to be nonproductive. Immunofluorescence microscopy using anti-EHV-1 polyclonal antibody demonstrated viral antigen in infected EBMECs, but not infected MBMECs. EHV-1 immediate early (IE), early (ICP0), and late (gB, gD and gK) transcripts were expressed in infected EBMECs. However, none of these genes was detected in infected MBMECs by reverse transcription-polymerase chain reaction. Electron microscopic examination at the stage of viral entry showed that viral particles were present within uncoated vesicles in the cytoplasm of EBMECs, but absent from those of MBMECs. These results suggest that viral entry is an important determinant of the susceptibility of EBMECs and MBMECs to EHV-1 infection.

Deposition of intraosseous fat in a degenerating simple bone cyst

A simple bone cyst in the proximal humerus of an 18-year-old man was treated by percutaneous ablation with alcohol irrigation. Subsequent involution of the cyst was associated with fatty replacement within the intraosseous defect. A possible relationship between involuting bone cyst and apparent intraosseous lipoma is discussed.