Omalizumab versus Mepolizumab as add-on therapy in asthma patients not well controlled on at least an inhaled corticosteroid: A network meta-analysis

OBJECTIVE

The purpose of this study is to examine the comparative efficacy of Omalizumab (OMA) and Mepolizumab (Mepo) in the treatment of severe asthma by performing a network meta-analysis.

METHOD

Data Sources: A systematic review of the literature was performed through four databases from their inception to February 2016.

STUDY SELECTIONS

Randomized control trials and cohort studies were considered if they addressed the individual efficacy of OMA and Mepo in the treatment of asthma that was not well controlled on inhaled corticosteroids (ICSs) with or without other agents.

RESULTS

OMA was significantly better than Mepo in improving the Asthma Quality of Life Questionnaire with a mean difference of 0.38 and a confidence interval of (0.21-0.55), p < 0.0001, without reaching the minimal clinically important difference of 0.5. No significant difference was seen in Asthma Control Questionnaire, forced expiratory volume in second 1 (FEV1), and Peak Expiratory Flow Rate (PEFR) improvement from baseline. Both medications were successful in reducing the calculated annualized rates of asthma exacerbations (AEs) vs placebo by approximately 50%. The heterogeneity score for the different comparisons were elevated except for the PEFR.

CONCLUSION

When compared indirectly via a network meta-analysis, the efficacy of OMA and Mepo was similar in the treatment of asthma that was not well controlled on at least high-dose ICS. The high heterogeneity observed and the different selection criteria for the use of the two drugs do not permit us to make any definitive recommendations for the preferential use of OMA vs Mepo in the patient populations studied. However, the current data do not suggest any major differences in efficacy.

Efficacy of 4 Irrigation Protocols in Killing Bacteria Colonized in Dentinal Tubules Examined by a Novel Confocal Laser Scanning Microscope Analysis

INTRODUCTION

The aim of this study was to determine the efficiency of 4 irrigation systems in eliminating bacteria in root canals, particularly in dentinal tubules.

METHODS

Roots of human teeth were prepared to 25/04, autoclaved, and inoculated with Enterococcus faecalis for 3 weeks. Canals were then disinfected by (1) standard needle irrigation, (2) sonically agitating with EndoActivator, (3) XP Endo finisher, or (4) erbium:yttrium aluminum garnet laser (PIPS) (15 roots/group). The bacterial reduction in the canal was determined by MTT assays. For measuring live versus dead bacteria in the dentinal tubules (4 teeth/group), teeth were split open and stained with LIVE/DEAD BackLight. Coronal, middle, and apical thirds of the canal dentin were scanned by using a confocal laser scanning microscope (CLSM) to determine the ratio of dead/total bacteria in the dentinal tubules at various depths.

RESULTS

All 4 irrigation protocols significantly eliminated bacteria in the canal, ranging from 89.6% to 98.2% reduction (P < .001). XP Endo had the greatest bacterial reduction compared with other 3 techniques (P < .05). CLSM analysis showed that XP Endo had the highest level of dead bacteria in the coronal, middle, and apical segments at 50-μm depth. On the other hand, PIPS had the greatest bacterial killing efficiency at the 150-μm depth in all 3 root segments.

CONCLUSIONS

XP Endo appears to be more efficient than other 3 techniques in disinfecting the main canal space and up to 50 μm deep into the dentinal tubules. PIPS appears to be most effective in killing the bacteria deep in the dentinal tubules.

Does Suture Technique Affect Re-Rupture in Arthroscopic Rotator Cuff Repair? A Meta-analysis

PURPOSE

To evaluate the effects of suture configuration, repair method, and tear size on rotator cuff (RC) repair healing.

METHODS

We conducted a literature search of articles that examined surgical treatment of RC tears published between January 2003 and September 2014. For single-row (SR) repairs, we calculated rerupture rates for simple, mattress, and modified Mason-Allen sutures while stratifying by tear size. All double-row repairs-those using 2 rows of suture anchors (DA) and those using a suture bridge (SB)--were performed using mattress sutures, and we compared rerupture rates by repair method while stratifying by tear size. A random-effects model with pooled estimates for between-study variance was used to estimate the overall rerupture proportion and corresponding 95% confidence interval for each group. Statistical significance was defined as P < .05.

RESULTS

A total of 682 RC repairs from 13 studies were included. For SR repairs of tears measuring less than 3 cm, there was no significant difference in rerupture rates for modified Mason-Allen sutures versus simple sutures (P = .18). For SR repairs of tears measuring 3 cm or more, there was no significant difference in rerupture rates for mattress sutures versus simple sutures (P = .23). The rates of rerupture did not differ between SB and DA repairs for tears measuring less than 3 cm (P = .29) and 3 cm or more (P = .50).

CONCLUSIONS

For SR repairs, there were no significant differences in rerupture rates between suture techniques for any repair method or tear size. All DA and SB repairs were secured with mattress sutures, and there were no differences in the rates of rerupture between these methods for either size category. These findings suggest that suture technique may not affect rerupture rates after RC repair.

LEVEL OF EVIDENCE

Level IV, systematic review of Level I through IV studies.

Computed Tomography Scans as an Objective Measure of Disease Severity in Chronic Rhinosinusitis

Objectives:

A truly objective method of measuring disease severity in CRS does not exist. We evaluated computed tomography (CT) scans of chronic rhinosinusitis (CRS) patients using a novel 3-D computerized method and compared them to a 2-D objective computerized analysis of a single coronal slice through the osteomeatal complex (OMC), and subjective methods including Lund-Mackay and Zinreich’s modification of Lund-Mackay.

Methods:

Forty-six adults with symptoms and endoscopy confirmation of CRS underwent CT examination and received a triamcinolone injection, followed by CT scan 4-5 weeks later. Analyze software determined the 3-D total volume of inflammatory mucosal thickening in all sinuses. The triamcinolone injection served as a tool to determine each method’s sensitivity to a treatment intervention.

Results:

The Lin’s concordance class correlation (CCC) of the OMC method revealed the best correlation to the 3-D volumetric computerized values (0.915), followed by the Zinreich (0.904) and Lund-Mackay methods (0.824). Post-treatment results demonstrated that both the OMC (0.824) and Zinreich’s (0.778) methods had strong agreement with the 3-D volumetric methods and were very sensitive to change, whereas the Lund-Mackay (0.545) only had moderate agreement.

Conclusions:

Computerized CT analysis provides the most comprehensive, objective, and reproducible method of measuring disease severity and is very sensitive to change induced by treatment intervention. A 2-D coronal image through the OMC provides a valid, user-friendly method of assessing CRS and is representative of CRS severity in all sinuses. Zinreich’s subjective method correlated well overall, but Lund-Mackay lagged behind in disease representation and sensitivity to change.

Management of comorbidities in diabetics with renal cell carcinoma: past utilization and current outcomes

OBJECTIVES

This study evaluated whether particular diabetes mellitus (DM), hyperlipidemia, or hypertension pharmacotherapy was associated with improved renal cell carcinoma (RCC) outcomes in diabetics with emergent RCC.

METHODS

All DM cases newly diagnosed with RCC at Roswell Park Cancer Institute (January 01, 2003-December 31, 2010) were included (n = 95). Baseline demographic information, clinical history, and cancer outcomes were documented after chart review. Fisher's test was used for the analysis of categorical outcomes across different treatment groups. Univariate and multivariate analyses for the comparisons of the overall survival and progression-free survival across treatment groups were assessed using Kaplan-Meier log-rank test and Cox proportional hazards models.

RESULTS

We found that DM pharmacotherapy users, which may represent a more advanced disease as compared to those controlled by diet alone, displayed significantly greater mortality (P = .01). Additionally, we found that cholesterol-lowering pharmacotherapy use was associated with decreased RCC mortality (hazard ratio = 0.54, P = .06). Individuals receiving combined hypertension regimens had a lower chance to present with baseline metastasis; however, hypertension pharmacotherapy use added no survival benefit.

CONCLUSION

Reinforcing guidelines compliance for hyperlipidemia management in patients with DM may provide a considerable cancer benefit if diagnosed with RCC. Studies evaluating the need for cholesterol-lowering pharmacotherapy in guidelines-noncompliant DM cases upon RCC diagnosis are currently needed.

Mouse mammary gland is refractory to the effects of ethanol after natural lactation

Ethanol is a dietary factor that dose-dependently increases breast cancer risk in women. We previously have shown that ethanol increases mammary epithelial density through increased branching after dietary exposure during puberty in CD2/F1 mice. To extend these studies to parous mice in a breast cancer model, we used a transgenic mouse model of human parity-associated breast cancer, the FVB-MMTV-Her2/Neu mouse, which overexpresses wildtype EGFR2, resulting in constitutive activation of growth signaling in the mammary epithelium. Here we describe the short-term effects of ethanol feeding on progression through involution. Mice were fed diets supplemented with 0%, 0.5%, 1%, or 2% ethanol for 4, 9, or 14 d starting on day 21 of lactation (that is, at the start of natural postlactational involution). Unlike peripubertal mice exposed to ethanol, postlactational dams showed no changes in body weight; liver, spleen, and kidney weights; and pathology. Ethanol exposure had no effect on mammary gland lobular density and adipocyte size throughout involution. Likewise, the infiltration of inflammatory cells and serum oxidized lipid species were unchanged by diet, suggesting that ethanol feeding had no effect on local inflammation (leukocyte infiltration) or systemic inflammation (oxidized lipids). In conclusion, ethanol exposure of parous dams had no effect on mammary gland structure or the regression of the lactating mammary gland to a resting state. The period of involution that follows natural lactation appears to be refractory to developmental effects of ethanol on mammary epithelium.

Risk of colorectal adenomas in women with prior breast cancer

BACKGROUND AND AIMS

Longer life expectancy in patients with prior breast cancer may increase their risk of developing other primary cancers, including colorectal cancer (CRC). Whether the risk of developing CRC in this patient population is higher in comparison to those with no prior cancer remains unclear. The purpose of this study was to compare the prevalence of colorectal adenomas and any CRC in breast cancer survivors with those who have no history of prior cancer and assess any difference with use of antiestrogen therapy.

METHODS

We compared the prevalence of colorectal cancer and adenomas in breast cancer survivors with that of a group of matched controls. Eligible survivors were ≤85 years of age; had initially been diagnosed with stage 0, I, II, or III breast cancer; had completed all cancer treatments with the exception of adjuvant antiestrogen therapy; and had no evidence of recurrence on follow-up. We used the screening colonoscopy database at our institution to identify age-, sex-, and race-matched controls with no history of cancer.

RESULTS

We identified 302 study-eligible breast cancer survivors and 302 matched controls. No colorectal cancers were found in either group. Forty-one breast cancer survivors and 30 controls had tubular adenomas; four survivors and three controls had villous adenoma; and eight survivors and ten controls had advanced adenoma. Multivariate regression analysis revealed that adjuvant antiestrogen therapy was not significantly associated with an increased risk of advanced adenoma.

CONCLUSIONS

The prevalence of colorectal adenomas in breast cancer survivors and controls was similar. Breast cancer survivors, including those receiving adjuvant antiestrogen therapies may follow the colorectal screening guidelines used for average-risk population.

KRAS status and clinical outcome in metastatic colorectal cancer patients treated with first-line FOLFOX chemotherapy

BACKGROUND

Two previous first-line studies showed an improved trend in response rate (RR) and progression free survival (PFS) in metastatic colorectal cancer (CRC) patients with KRAS mutation. Others have reported a worsened outlook for metastatic CRC patients with KRAS mutation and a higher likelihood of metastatic disease to the lungs. In this study, we aimed to address the impact of KRAS on the pattern of metastatic disease at presentation and on RR and PFS with first-line 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy.

METHODS

Patients with CRC who underwent KRAS testing using DxS assay at Roswell Park Cancer Institute (RPCI) were identified. Patients with metastatic CRC treated with first-line FOLFOX +/- bevacizumab were assessed for response and survival using RECIST 1.1 guidelines. A two-sided Fisher's exact test was used to determine the statistical significance.

RESULTS

181 patients with metastatic CRC and KRAS testing were identified. 83/181 patients were treated with FOLFOX (+/- bevacizumab) in the first-line setting at RPCI and were evaluable as per study guidelines. KRAS mutation (MT) occurred in 40.31% cases. There was no difference in organ-metastases distribution, RR (56.60% in KRAS wild-type (WT) and 50% in KRAS mutant) or PFS (9.3 months KRAS WT and 8.7 months in KRAS MT) based on KRAS status.

CONCLUSION

In this single institute study, our findings do not support any predictive role for KRAS-MT in terms of response to FOLFOX first-line chemotherapy, or in terms of sites of metastatic disease at mCRC presentation.

Folate exacerbates the effects of ethanol on peripubertal mouse mammary gland development

Alcohol consumption is linked with increased breast cancer risk in women, even at low levels of ingestion. The proposed mechanisms whereby ethanol exerts its effects include decreased folate levels resulting in diminished DNA synthesis and repair, and/or acetaldehyde-generated DNA damage. Based on these proposed mechanisms, we hypothesized that ethanol would have increased deleterious effects during periods of rapid mammary gland epithelial proliferation, such as peripuberty, and that folate deficiency alone might mimic and/or exacerbate the effects of ethanol. To test this hypothesis, weight-matched 28-35 day old CD2F1 female mice were pair-fed liquid diets ±3.2% ethanol, ±0.1% folate for 4 weeks. Folate status was confirmed by assay of liver and kidney tissues. In folate deficient mice, no significant ethanol-induced changes to the mammary gland were observed. Folate replete mice fed ethanol had an increased number of ducts per section, due to an increased number of terminal short branches. Serum estrogen levels were increased by ethanol, but only in folate replete mice. These results demonstrate that folate deficiency alone does not mimic the effects of ethanol, and that folate deficiency in the presence of ethanol blocks proliferative effects of ethanol on the mammary ductal tree.

Abstract 5460: Effects of ethanol exposure during involution on mouse mammary gland

Mammary gland involution represents a discrete developmental time point when the breast may be particularly susceptible to risk factors associated with mammary carcinogenesis. One dietary carcinogen which has been shown to affect breast cancer risk in women is ethanol; as little as one drink per day can increase breast cancer risk by 10%. The purpose of the current study was to determine if ethanol exposure during involution affects mammary tumor development or progression in the FVB-MMTV-Her2/Neu transgenic mouse. Dams were fed isocaloric liquid diets containing 0, 0.5, 1 or 2% ethanol from day 1 of involution (weaning at day 21 of lactation) until day 4, 9 or 14 post-weaning. Short-term effects of ethanol on the progression of involution were assessed. No significant difference in mouse weight, or organ weights (spleen, liver or kidney), was seen between groups. Lobular regression (decrease in ducts per lobule) occurred similarly in all dietary groups, in parallel with an increase in average adipocyte size. No difference in leukocyte infiltration was seen between dietary groups. Proteomic analysis and tumor studies are ongoing.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5460. doi:1538-7445.AM2012-5460

Effect of 25-hydroxyvitamin D status on serological response to influenza vaccine in prostate cancer patients

BACKGROUND

Epidemiologic data suggest that there is an association between vitamin D deficiency and influenza infection. We conducted a prospective influenza vaccination study to determine the influence of vitamin D status on serological response to influenza vaccine in prostate cancer (CaP) patients.

METHODS

During the 2006-2007 influenza season, CaP patients treated at Roswell Park Cancer Institute were offered vaccination with the trivalent influenza vaccine (Fluzone®, 2006-2007) and sera collected for hemagglutination inhibition (HI) assay titers before and 3 months after vaccination. Response to vaccination was defined as ≥1:40 titer ratio or a fourfold increase in titer at 3 months, against any of the three strains. Serum 25-hydroxyvitamin D (25-D₃) levels were measured using DiaSorin ¹²⁵I radioimmunoassay kits.

RESULTS

Thirty-five patients with CaP participated in the study. Median baseline 25-D₃ level was 44.88 ng/ml (range: 9.16-71.98 ng/ml) Serological response against any of the three strains was noted in 80%. There was a significant effect of baseline 25-D3 level when tested as a continuous variable in relation to serological response (P = 0.0446). All patients in the upper quartile of 25-D3 level responded by mounting a serological response (P = 0.0344). None of the other baseline variables (age, race, chemotherapy status, or white cell count) had an effect on serological response.

CONCLUSIONS

In this study in CaP patients, a replete vitamin D status was associated with more frequent serological response to influenza vaccine.

Hypoxia-inducible factor-1α protein expression is associated with poor survival in normal karyotype adult acute myeloid leukemia

We examined the predictive impact of HIF-1α protein expression on clinical outcome of 84 normal karyotype acute myeloid leukemia (NK-AML) patients (median age 66.5 years) at our institute. Thirty percent of NK-AML cells expressed cytoplasmic HIF-1α. In univariate analysis, low HIF-1α (≤ 5%, n = 66) was associated with improved event-free survival (p = 0.0453, HR = 0.22). Multivariate analysis incorporating age, complete remission, FLT3-ITD mutation, and marrow blast percentage demonstrated that HIF-1α was independently associated with poorer overall and event-free survival. HIF-1α expression correlated with VEGF-C but not VEGF-A, marrow angiogenesis, FLT3 ITD or NPM1 mutations. These results support HIF-1α as an outcome marker for NK-AML.

Does circular stapled esophagogastric anastomotic size affect the incidence of postoperative strictures?

BACKGROUND

Postoperative anastomotic strictures produce significant morbidity after esophagectomy. Previous reports have described a variable association between the diameter of the circular end-to-end anastomosis (EEA) stapler commonly used in esophagogastric anastomoses and the incidence of stricture formation. Stapler technology has improved. We investigated an association between stapler diameter and the incidence of postoperative anastomotic strictures in a contemporary series. This has renewed importance given the limited diameter of trans-oral staplers that are being increasingly used.

METHODS

Retrospective chart review revealed that of 194 patients undergoing an esophagectomy over a 10-y period (10/1998-8/2008) at our institution, an EEA stapler was used in 91. EEA size information and follow-up were available in 89 patients. Patients were divided into two groups based on EEA size: 'small' = 23-25 mm (n = 24) and 'large' = 28-33 mm (n = 65). Patients with strictures were identified based on symptoms of dysphagia requiring an esophageal dilation procedure. Patients with postoperative leaks were excluded when analyzing for the association of stricture with EEA size, as postoperative leaks are known to be associated with stricture. Wilcoxon and Fisher's exact tests were used for statistical analysis; a 5% α error was accepted.

RESULTS

Fifteen (16.8%) of 89 patients developed a stricture postoperatively. The anastomotic leak rate was 3.3%. There was no statistically significant association between EEA size group and stricture formation (P = 0.7506).

CONCLUSIONS

No association was found between the size of the EEA stapler used and stricture formation. EEA size should be determined at surgery by the native esophageal diameter.

Phase 2 trial of weekly intravenous 1,25 dihydroxy cholecalciferol (calcitriol) in combination with dexamethasone for castration-resistant prostate cancer

BACKGROUND

Preclinical data indicate that there is substantial antitumor activity and synergy between calcitriol and dexamethasone. On the basis of these data, the authors conducted a phase 2 trial of intravenous (iv) calcitriol at a dose of 74 microg weekly (based on a recent phase 1 trial) and dexamethasone in patients with castration-resistant prostate cancer (CRPC).

METHODS

A 2-stage Kepner-Chang design was used. Oral dexamethasone at a dose of 4 mg was given weekly on Days 1 and 2, and iv calcitriol (74 microg over 1 hour) was administered weekly on Day 2 from 4 to 8 hours after the dexamethasone dose in patients with CRPC. Laboratory data were monitored weekly, and renal sonograms, computed tomography scans, and bone scans were obtained every 3 months. Disease response was assessed by using the Response Evaluation Criteria in Solid Tumors (RECIST) and standard criteria for prostate-specific antigen (PSA) response. The calcitriol dose was delineated by from the authors' recent phase 1 trial.

RESULTS

Of 18 evaluable patients, 15 patients were Caucasian (83%). No patients had a complete or partial response by either RECIST or PSA response criteria. Fourteen patients had progressive disease, 2 patients refused to continue treatment (after 64 days and 266 days), and 2 patients remain on the trial (for 306 days and 412 days).The median time to disease progression was 106 days (95% confidence interval, 80-182 days). Fourteen episodes of grade 3 or 4 toxicity were noted in 7 patients (hyperglycemia, hypocalemia, chest pain, dyspnea, hypercalcemia, hypophosphatemia, cardiac arrhythmia, and pain). Only 1 episode of grade 3/ 4 toxicity was related definitely to calcitriol (hypercalcemia). No treatment-related deaths were noted.

CONCLUSIONS

High-dose, iv calcitriol at a dose of 74 microg weekly in combination with dexamethasone was well tolerated but failed to produce a clinical or PSA response in men with CRPC.

Analysis of second primary lung cancers in the SEER database

BACKGROUND

We sought to examine the outcomes of second primary lung cancers in the large population-based Surveillance Epidemiology and End Results (SEER) database. We also sought to study the outcomes of synchronous second non-small-cell lung cancers (NSCLCs), classified as stage IVA (M1A) according to the seventh edition of the TNM staging for lung cancer.

METHODS

Data of patients with at least two primary lung cancers were obtained. All available variables potentially associated with the incidence of a second primary lung cancer were examined. The overall survival of patients with synchronous NSCLC was compared with those with metachronous and stage IV NSCLC.

RESULTS

A small proportion (1.5%) of patients with lung cancer developed a second primary. A second primary is associated with younger age, female gender, earlier stage, and white race. The median survival of patients with metachronous NSCLCs (n = 3352) was worse than those with synchronous NSCLCs (n = 1858) (median survival 22 mo versus 29 mo, respectively; P < 0.01). After adjusting for age, race, gender, stage, and histology of both primaries, this difference in survival between patients with synchronous and metachronous second primary lung cancers was not statistically significant, but was better than those with stage IV NSCLC (n = 127,654; median survival 4 mo).

CONCLUSIONS

The incidence of second primary lung cancer is lower than that previously reported. Factors associated with good prognosis predict a second primary. Synchronous NSCLCs have an outcome better than a stage IV (M1a) designation. These patients should receive appropriate stage-specific multi-modality therapy suitable for the independent stage of each cancer without considering them unresectable.

High-dose octreotide acetate for management of gastroenteropancreatic neuroendocrine tumors

BACKGROUND

Long-acting sandostatin (S-LAR; octreotide acetate) is well tolerated and effective for symptom control and possibly disease control in gastroenteropancreatic neuroendocrine tumors (GEP-NETs). We undertook a retrospective analysis to study the efficacy and tolerability of higher doses (more than 20-30 mg/month) of S-LAR in GEP-NETs.

PATIENTS AND METHODS

With IRB approval, charts of all patients with GEP-NET who received S-LAR between June 2002 to September 2007 at Roswell Park Cancer Institute were reviewed and their data analyzed.

RESULTS

Fifty-four patients with GEP-NET received S-LAR; thirty required dose escalation. Patients received a median of 5 doses of S-LAR at conventional dose followed by up-titration of the dose for symptom control (20) and radiological progression (17). Median high dose of S-LAR was 40 mg (range: 40-90 mg) with a median of 8.5 high doses received. No treatment related toxicities were seen. The estimated 1-year survival for patients on conventional dose alone was 0.77 (95% CI of 0.50 to 0.91) and those on high-dose was 0.88 (95% CI of 0.68 to 0.96) (p=0.4777) while median time to any other intervention was 2.9 months versus 17.7 months (p=0.12).

CONCLUSION

Dose escalation of S-LAR is well tolerated and may provide longer disease control.

Primary adenocarcinoma of the anus: a 22-year SEER population database analysis

e15072

Background: Most anal canal cancers consist of squamous cell carcinoma (SCCA). Adenocarcinoma (AdenoCa) is rare and accounts for approximately 10% of anal cancers. A search of the SEER database (1973 to 2005) was carried out to evaluate the pattern of radiation (RT) and surgical treatment. Impact of the treatment on overall survival (OS) was evaluated. Methods: The search of the SEER database revealed 1,008 pts who had pathologically confirmed anal cancers with either SCCA or AdenoCa. All pts had single diagnosis of anal cancer with localized disease without nodal involvement. Excluded were pts with unknown use of surgery or radiation. Kaplan-Meier estimates and Cox-Mantel model were used to calculate and compare survival rates. Results: Median age of all pts was 57 years (range 29 to 99). For the SCCA group, median age was 57 years (range 29 to 99), which was younger than the AdenoCa group with median age of 74 years (range 37 to 92). Among the 1,008 pts, 954 had SCCA (94.6%), and 54 had AdenoCa (5.4%). Within the SCCA group, 14 (1.5%) had abdominoperineal resection (APR) in combination with external beam RT, and 795 (83.3%) had RT only with non-APR local surgical treatment inclusive of excision. Remaining 145 SCCA pts (15.2%) had non-APR local surgical treatment only without RT or had no treatment. Within the AdenoCa group, 10 (18.5%) had APR in combination with external beam RT, and 21 (38.9%) had RT only with non-APR local surgical treatment inclusive of excision. Remaining 23 AdenoCa pts (42.6%) had non-APR local surgical treatment only without RT. None of the adenoCa pt had no treatment. OS at 10 years was superior for pts with SCCA vs. AdenoCa (64.9% vs. 25.8%, p<0.05). Among the SCCA subset, there was no signficant difference in the 10-yr OS between the APR versus the RT pts (71% vs. 65%, p=0.78). On the other hand, among the AdenoCa subset, pts who had APR had better 10-yr OS than RT pts (53.8% vs. 0%, p=0.03) Conclusions: For localized anal SCCA, RT yielded equivalent overall survival as compared to APR. On the other hand, pts with localized anal adenoCa appeared to do worse when APR was omitted. RT only without APR might not be sufficient treatment in these patients. This database lacks information on use of chemotherapy and local disease control. Omission of APR in pts with anal canal adenoCa should be cautiously weighed.

No significant financial relationships to disclose.

Effect of 25 hydroxy vitamin D status on serological response to influenza vaccine in cancer patients

e20575

Background: Increasing epidemiologic data suggest association of vitamin D deficiency with influenza epidemic. Vitamin D acts as an immune modulator and stimulates the expression of protective anti-microbial peptides. We conducted a prospective influenza vaccination study to determine the influence of vitamin D status on serological response to flu vaccine in cancer patients. Methods: Cancer patients at Roswell Park Cancer Institute were offered trivalent (H1N1, H3N2, B/Malaysia) Flu vaccine (Fluzone, 2006–7) and sera collected for hemagglutination inhibition (HI) assay titers. Response to vaccination was defined as ≥ 1:40 titer ratio or a 4 fold increase in HI titer at 3 months post vaccination, against any of the 3 strains. Chi-square tests were performed to compare serological response between the groups with lowest and highest quartiles of baseline 25 (OH) vitamin D (D) level. Logistic regression model was used using other covariates such as age, gender, cancer type, and chemotherapy (CT) as controls. Results: 85 patients with colorectal, 35 with prostate, 1 with anal and 1 with gastric adenocarcinoma participated in the study. Median age was 62 years (range: 24–87 years), 85 (70%) were males. Overall serological response was 59%. Median baseline D level was 42.9 ng/mL (range: 4.0–92.8 ng/mL); lowest and highest quartiles were 26.9 and 53.4 ng/mL. There was no association between serological response and baseline D level (p=0.42) or the lowest and highest quartiles of D level (p=0.6). The odds of response did not vary by sex (p=0.95). CRC patients (OR-0.051; 95% CI-0.013 to 0.209; p<0.0001) were less likely to respond. Few patients (n=20; 16%) were D deficient (<20ng/mL), 43 had D < 32ng/mL .70 patients (54.7%) were on vitamin D supplements. Among those in whom the dose of supplement was known (46),the median daily vitamin D supplement dose was 2000 IU (800–9000 IU).There was no association between serological response and dose (p=0.09). There was no difference in the response rates among patients on D supplement 44/70 (62.9%) versus those not on any D supplement 28/52 (53.8%)(p=0.32). Conclusions: Vitamin D status, in a population in which vitamin D supplementation was commonly used, did not affect serological response to influenza vaccine.

No significant financial relationships to disclose.

Expression of breast cancer resistance protein (BCRP) in esophageal cancers (EC)

e13529

Background: EC patients face a dismal outcome despite tri-modality management strategy. Median survival remains 15–18 months despite platinum, fluropyrimidine & irinotecan based therapy. BCRP is an ATP-dependent efflux protein associated with chemotherapy (CT) (e.g. irinotecan) resistance. Role of BCRP expression in EC and normal esophageal cells is not known. We examined the expression of this protein and correlate it with survival (OS) in patients receiving irinotecan-based CT. Methods: With IRB approval, 40 cases of EC diagnosed between 2004 and 2008 were stained for BCRP expression by IHC & scored by the pathologist blinded to clinical data. Baseline demographics, therapy given & OS data were collected and correlated with BCRP expression. BCRP score (membrane or cytoplasm) >/= 30 was considered positive (calculated by multiplying BCRP intensity and % staining). Fisher's exact test used to determine association between BCRP expression & demographics. Cox proportional hazards model used for association of BCRP & OS. Results: Baseline patient and tumor characteristics: Gender: M 35, F 5; Histology: 37 Adenoca & 3 SCC; Stage 1-III 27, Stage IV 10, unknown 3; CT: cisplatin+irinotecan (n=16), oxaliplatin+fluoropyrimidine (n=8), other (n=16); IHC: 30 of 40 cancers (75%) expressed BCRP [strong (n=28) & intermediate (n=3); membranous (n=17), cytoplasmic (n=27) & both (n=14)]. Down-regulation of BCRP expression in tumor compared to normal cells seen in 40% of patients. Median OS was 19 months with no difference in OS between BCRP positive and negative patients (p=0.13). Estimated hazard ratio (HR) of death for BCRP positive patients was 2.29 (95% CI 0.79 - 6.64).There was no association between BCRP expression and stage, age, gender or histology. For patients who received cisplatin and irinotecan as first line CT there was no difference in OS (p=0.39) of BCRP negative versus positive patients. Conclusions: BCRP expression is seen in a majority of EC & normal esophageal mucosa. Response rates to irinotecan based therapies are seen in 30–40 % of EC, whether the 40% with low tumor BCRP constitute a majority of the responders needs to be prospectively validated in a larger dataset & should include markers that predict response to 5-FU & platinum based CT to allow individualizing therapy for this cancer.

No significant financial relationships to disclose.

Adjuvant FOLFOX chemotherapy and splenomegaly in patients with stages II-III colorectal cancer

BACKGROUND

The impact of adjuvant chemotherapy on hepatic function and portal hypertension in patients with stages II-III colon cancer has not been previously described. We conducted a retrospective study to assess the effects of adjuvant FOLFOX chemotherapy on the splenic index (SI) as a surrogate marker for portal hypertension.

METHODS

Stage II-III colorectal cancer patients treated with adjuvant FOLFOX or fluorouracil/leucovorin (5-FU/LV) at Roswell Park Cancer Institute between 2002 and 2006 were identified. Computerizedt omography (CT) scans obtained prior to and at completion of chemotherapy, and every 6 months thereafter were reviewed. Splenic size was evaluated using the SI (SI = length x width x height of the spleen).

RESULTS

40 patients were identified in the FOLFOX group and 23 in the 5-FU/LV group. After 6 months of adjuvant chemotherapy, the mean increase in SI was 45.7 and 16.3% in the FOLFOX and 5-FU/LV groups, respectively (p = 0.0069). SI increased by >100% in 6 patients (15%) in the FOLFOX group versus none in the 5-FU/LV group (p = 0.16). The mean SI at completion of adjuvant chemotherapy was significantly higher in the FOLFOX group than in the 5-FU/LV group (p = 0.007). The mean SI decreased steadily over a period of 2 years after discontinuation of FOLFOX, suggesting potential reversibility of oxaliplatin-induced hepatic injury in this setting.

CONCLUSIONS

Adjuvant FOLFOX significantly increases the SI in patients with resected colorectal cancer in comparison to adjuvant 5-FU/LV. The increase in SI may be a marker of oxaliplatin-induced hepatic injury and should be investigated further in prospective longitudinal studies of oxaliplatin-based adjuvant chemotherapy.

Multiple primary tumors in men with breast cancer diagnoses: a SEER database review

BACKGROUND

Male breast cancer (MBC) comprises 1% of all breast cancers and less than 1% of cancer cases in men. After a diagnosis of MBC, men are at risk of developing a second primary cancer, particularly a second primary breast cancer. The objective of this study is to analyze the characteristics of the population of men diagnosed with a second malignancy, specifically a second MBC.

METHODS

Using the Surveillance, Epidemiology, and End Results (SEER) database, 4,873 male patients diagnosed with invasive or in situ breast cancer from 1973 to 2004 were identified and data from patients who developed a second MBC were reviewed. Additional non-breast primary cancer diagnoses were also recorded.

RESULTS

A review of 4,966 records corresponding to 4,873 patients revealed 4,462 invasive and 504 in situ breast cancer events. Of the 4,873 patients, 93 (1.9%) were identified with a second MBC. Among the 4,873 patients with MBC, 1,001 (21%) have other non-breast primary cancer diagnoses recorded in the SEER registry.

CONCLUSIONS

Although MBC is uncommon, these patients are at risk of a contralateral breast cancer and second primary non-breast cancers. Our findings support that men with breast cancer would benefit from continued long-term surveillance for breast cancer and appropriate screening for non-breast cancers.

A phase II study of first-line biweekly capecitabine and bevacizumab in elderly patients with metastatic colorectal cancer

PURPOSE

This phase II study was conducted to determine the efficacy and safety of capecitabine and bevacizumab in untreated elderly metastatic colorectal cancer patients.

METHODS

Patients received 1500 mg/m(2)/dose of capecitabine twice daily x 7 days and bevacizumab at 5mg/kg on day 1, in 2 week-cycles.

RESULTS

The study was closed early, due to poor accrual, after a total of 16 patients enrolled. Four patients had an objective response and 11 patients had stable disease. The median time to progression and overall survival were 9.5 and 21.2 months, respectively. The most common grade >or= 3 toxicities included diarrhea (13%) and hand and foot syndrome (25%). Three patients had an arterial thrombotic event and one patient developed a bowel perforation.

CONCLUSIONS

In this underpowered phase II study in elderly patients with metastatic colorectal cancer, capecitabine plus bevacizumab was associated with considerable clinical activity but at an increased risk of hand and foot syndrome and arterial thrombotic events.

Qualitative radiology assessment of tumor response: does it measure up?

Our purpose was to assess whether a simpler qualitative evaluation of tumor response by computed tomography is as reproducible and predictive of clinical outcome as the Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) methods. This study was a two-reader retrospective evaluation in which qualitative assessment resulted in agreement in 21 of 23 patients with metastatic colorectal carcinoma (91.3%, kappa=0.78; 95% CI, 0.51-1.00). Hepatic metastases were classified as increased, decreased, or unchanged, compared with agreement in 20 of 23 patients (87.0%) for RECIST (kappa=0.62; 95% CI, 0.23-1.00) and WHO (kappa=0.67; 95% CI, 0.34-1.00) methods. Patients were placed into partial response, stable disease, and disease progression categories. Time to progression of disease was better predicted qualitatively than by RECIST or WHO. Our pilot data suggest that our qualitative scoring system is more reproducible and predictive of patient clinical outcome than the RECIST and WHO methods.

Mucinous cystadenocarcinoma (mca) of the appendix: Role of adjuvant therapy

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Introduction: MCA is the most common (non-carcinoid) appendiceal cancer. Adjuvant 5-fluorouracil (5-FU) based systemic chemotherapy (ASC) is often considered for MCA cases after surgery, extrapolating data from colon cancer. Patients (pts) with peritoneal disease are considered for regional perfusional therapy. However, the role of adjuvant therapy in this setting has not yet been established. Methods: Retrospective analysis of cases with the diagnosis of MCA. Pts treated with curative intent and subsequent adjuvant therapy [ASC or Intraperitoneal Hyperthermic Chemotherapy (IPHC)] were included. Pts who received surgery alone were compared to those who received surgery in combination with adjuvant therapy. Estimation of the survival distribution of each group was performed using the Kaplan-Meier method. Statistical assessment of observed differences in the survival distributions was per the log-rank test. Analyses were also performed adjusting for age and sex using the stratified log rank test. A 0.05 nominal significance level was used in all testing. Results: A total of 34 consecutive pts were treated between 8/1973 and 4/2005 for MCA. Pt characteristics were: 15 males (44%), median age 50 yrs (range 27–79), 33 (97%) Caucasian, 30 (88%) had peritoneal metastasis at diagnosis. All patients underwent surgical resection; 26 (76%) underwent >1 of the following procedures. Surgeries were: right hemicolectomy (n=20, 58%), appendectomy (n=16, 47%), total abdominal hysterectomy (n=9, 26%), ileocolectomy (n=4, 11%) or debulking (n=12, 35%). Eight pts (23%) underwent IHPC with 5-FU (n=5), Mitomycin (n=2) or Yttrium90 (n=1). Thirteen patients (38%) underwent ASC: 5-FU based (n=12) or Paclitaxel/ Carboplatin (n=1). Pts who underwent surgery alone had a median survival of 40 months. Pts who had surgery and also received ASC or IPHC had a median survival of 53 months. There was no statistical difference in the overall survival between the groups after adjusting for age, sex and stage differences (p=0.1). Conclusions: MCA is an aggressive tumor; optimally treated with radical surgery even at an advanced stage. Larger studies are required to determine the value of ASC or IPHC in this setting.

No significant financial relationships to disclose.