A Lung Cancer Mouse Model Database

Lung cancer, the leading cause of cancer mortality, exhibits diverse histological subtypes and genetic complexities. Numerous preclinical models have been developed to study lung cancer, but data from these models are disparate, siloed, and difficult to compare in a centralized fashion. Here we established the Lung Cancer Mouse Model Database (LCMMDB), an extensive repository of 1,354 samples from 77 transcriptomic datasets. Meticulous curation and collaboration with data depositors have produced a robust and comprehensive database, enhancing the fidelity of the genetic landscape it depicts. The LCMMDB aligns 859 tumors from genetically engineered mouse models (GEMMs) with human lung cancer mutations, enabling comparative analysis and revealing a pressing need to broaden the diversity of genetic aberrations modeled in GEMMs. Accompanying this resource, we developed a web application that offers researchers intuitive tools for in-depth gene expression analysis and fostering potential collaborations. With standardized reprocessing of gene expression data, the LCMMDB serves as a powerful platform for cross-study comparison and lays the groundwork for future research, aiming to bridge the gap between mouse models and human lung cancer for improved translational relevance.

Genetically engineered mouse model of pleomorphic liposarcoma: Immunophenotyping and histologic characterization

INTRODUCTION

Pleomorphic liposarcoma is a rare and aggressive subset of soft-tissue sarcomas with a high mortality burden. Local treatment largely consists of radiation therapy and wide surgical resection, but options for systemic therapy in the setting of metastatic disease are limited and largely ineffective, prompting exploration of novel therapeutic strategies and experimental models. As with other cancers, sarcoma cell lines and patient-derived xenograft models have been developed and used to characterize these tumors and identify therapeutic targets, but these models have inherent limitations. The establishment of genetically engineered mouse models represents a more realistic framework for reproducing clinically relevant conditions for studying pleomorphic liposarcoma.

METHODS

Trp53fl/fl/Rb1fl/fl/Ptenfl/fl (RPP) mice were used to reliably generate an immunocompetent model of mouse pleomorphic liposarcoma through Cre-mediated conditional silencing of the Trp53, Rb1, and Pten tumor suppressor genes. Evaluation of tumor-infiltrating lymphocytes was assessed with immunostaining for CD4, CD8, and PD-L1, and flow cytometry with analysis of CD45, CD3, CD4, CD8, CD19, F4/80, CD11b, and NKp46 sub-populations.

RESULTS

Mice reliably produced noticeable soft-tissue tumors in approximately 6 weeks with rapid tumor growth between 100 and 150 days of life, after which mice reached euthanasia criteria. Histologic features were consistent with pleomorphic liposarcoma, including widespread pleomorphic lipoblasts. Immunoprofiling and assessment of tumor-infiltrating lymphocytes was consistent with other soft-tissue sarcomas.

CONCLUSION

Genetically engineered RPP mice reliably produced soft-tissue tumors consistent with pleomorphic liposarcoma, which immunological findings similar to other soft-tissue sarcomas. This model may demonstrate utility in testing treatments for this rare disease, including immunomodulatory therapies.

Gemcitabine and Cisplatin Versus Methotrexate, Vinblastine, Doxorubicin, and Cisplatin in Advanced or Metastatic Bladder Cancer: Results of a Large, Randomized, Multinational, Multicenter, Phase III Study

PURPOSE

Gemcitabine plus cisplatin (GC) and methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) were compared in patients with locally advanced or metastatic transitional-cell carcinoma (TCC) of the urothelium.

PATIENTS AND METHODS

Patients with stage IV TCC and no prior systemic chemotherapy were randomized to GC (gemcitabine 1,000 mg/m2 days 1, 8, and 15; cisplatin 70 mg/m2 day 2) or standard MVAC every 28 days for a maximum of six cycles.

RESULTS

Four hundred five patients were randomized (GC, n = 203; MVAC, n = 202). The groups were well-balanced with respect to prognostic factors. Overall survival was similar on both arms (hazards ratio [HR], 1.04; 95% confidence interval [CI], 0.82 to 1.32; P = .75), as were time to progressive disease (HR, 1.05; 95% CI, 0.85 to 1.30), time to treatment failure (HR, 0.89; 95% CI, 0.72 to 1.10), and response rate (GC, 49%; MVAC, 46%). More GC patients completed six cycles of therapy, with fewer dose adjustments. The toxic death rate was 1% on the GC arm and 3% on the MVAC arm. More GC than MVAC patients had grade 3/4 anemia (27% v 18%, respectively) and thrombocytopenia (57% v 21%, respectively). On both arms, the RBC transfusion rate was 13 of 100 cycles and grade 3/4 hemorrhage or hematuria was 2%; the platelet transfusion rate was four patients per 100 cycles and two patients per 100 cycles on GC and MVAC, respectively. More MVAC patients, compared with GC patients, had grade 3/4 neutropenia (82% v 71%, respectively), neutropenic fever (14% v 2%, respectively), neutropenic sepsis (12% v 1%, respectively), and grade 3/4 mucositis (22% v 1%, respectively) and alopecia (55% v 11%, respectively). Quality of life was maintained during treatment on both arms; however, more patients on GC fared better regarding weight, performance status, and fatigue.

CONCLUSION

GC provides a similar survival advantage to MVAC with a better safety profile and tolerability. This better-risk benefit ratio should change the standard of care for patients with locally advanced and metastatic TCC from MVAC to GC.

Abstract 5901: Germline tissue sequencing in patients with solid tumors uncovers clonal hematopoiesis variants

The peripheral blood (PB) is broadly used as a source of germline tissue for next generation sequencing in both clinical and research settings. Incidental or secondary findings are often uncovered at the time of germline sequencing. Current guidelines focus on secondary findings as they relate to inherited cancer predisposition. However, sequencing done on the PB has the potential of uncovering cancer-associated somatic variants. Somatic variants in genes associated with hematologic malignancies could indicate the presence of clonal hematopoiesis, clonal cytopenias or in rare instances an undiagnosed hematologic malignancy. In this abstract, we describe leukemia-associated somatic variants identified through whole exome sequencing (WES) in the PB of genomic research participants. A total of 24 patients with clonal hematopoiesis were identified from our institutional cohort of the ORIEN avatar study of 807 patients with solid tumors. Pathogenic and likely pathogenic variants were selected from protein coding sequences and splice sites of 64 genes involved in hematologic malignancies. Matched tumor and PB samples allowed for inclusion of variants found exclusively in the PB sample. Chart reviews were performed, and blood indices were collected for patients with clonal hematopoiesis variants. The median age of patients in this cohort was 73 years old (range 42-82) and 54% (n=13) were still living at the time of chart review. There were 27 variants distributed amongst 24 patients with 8% (n=2) of patients having 2 or more variants identified. The median reported variant allele frequencies (VAF) was 0.447. Most variants were missense (n=14) followed by stop gain (n=5), frameshift (n=3), splice site (n=3), stop lost (n=1), and inframe insertion (n=1). TP53 and DNMT3A (n=4) variants were identified most frequently followed by JAK2, KRAS, MYD88 (n=3), and PTEN (n=2). The rest of the genes accounted for one variant each, including TET2 and IDH2. Complete blood count (CBC) values were recorded for WBC, Hgb, MCV, RDW, platelets, and ANC, 79% (n=19) of patients had abnormal CBCs. No patients in this cohort were seen by a hematologist. Our results indicate that approximately 3% of patients identified in a research based solid tumor cohort had clonal hematopoiesis. Most of these patients had abnormalities in their hematologic parameters and would likely benefit from referral to hematology. Our data demonstrate the importance of considering somatic variation when the PB is used as germline tissue in research settings. Clonal hematopoiesis has significant clinical consequences ranging from risk of blood cancers to cardiovascular disease. We argue for the need to establish accepted frameworks for identification and evaluation of clonal hematopoiesis in participants of genomics research. Further analysis of associations between incidence of CHIP, cancer type, and prior treatment are underway

Citation Format: Jennie Vagher, Aaron Atkinson, Mikaela Larson, David Nix, Andrew Post, Courtney Scaife, Jonathan Tward, Cindy Matsen, Jason P. Hunt, Marcus Monroe, Mia Hashibe, Deborah M. Stephens, Nicola J. Camp, Wallace L. Akerley, Trudy Oliver, Douglas Grossman, Sheri L. Holmen, Howard Colman, Randy Jensen, Kevin B. Jones, Afaf E. Osman. Germline tissue sequencing in patients with solid tumors uncovers clonal hematopoiesis variants [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5901.

Abstract 2939: Activation of NRF2 signaling accelerates development of small cell lung cancer in mice

Activating mutations in NRF2 frequently occur in human lung cancers, especially the E79Q mutation. However, how the activating mutation contributes to lung tumor development is not well understood. We used a new genetically engineered mouse model (GEMM), LSL-Nrf2E79Q/+ with Cre-inducible expression of this mutation within the endogenous Nrf2 locus, to understand its contribution to lung tumor development. We compared tumor development in p53fl/fl;p16fl/fl;LSL-Nrf2+/+ (WT) versus p53fl/fl;p16fl/fl;Nrf2E79Q/+ (Het) mice after intranasal instillation of Adenoviral Cre. While we did not observe a significant difference in lung adenocarcinoma (LUAC) between the Het and WT mice, the Het mice showed significantly higher frequencies of bronchial neuroendocrine tumors that resembled small cell lung carcinomas (SCLC) compared to WT. Additionally, the latency of SCLC lesions was lower in Het mice compared to WT. Surprisingly, LUACs in both groups were negative for NRF2 by IHC labeling despite recombination of the mutant Nrf2 allele. While all lesions in the WT and Het mice displayed positive ASCL1 and CGRp (NE markers) IHC labeling, only the SCLCs in Het mice expressed NRF2. This is the first study showing activation of Nrf2E79Q mutation drives development of small cell lung carcinomas. Interestingly, our data also suggest that the E79Q NRF2 activating mutation may inhibit the progression of LUAD.

Citation Format: Samera Hamad, Stephanie Montgomery, Brittany Bowman, Ryan Murphy, Scott Randell, Trudy Oliver, D. Neil Hayes, M. Ben Major, Bernard Weissman. Activation of NRF2 signaling accelerates development of small cell lung cancer in mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2939.

Abstract B72: Lineage specifiers SOX2 and NKX2-1 inversely regulate tumor cell fate and neutrophil recruitment in lung cancer

The major types of non-small cell lung cancer, squamous cell carcinoma and adenocarcinoma, have distinct tumor immune microenvironments. Understanding the mechanisms underlying these differences is of particular importance given the success and current limitations of immunotherapy. We developed multiple mouse models of lung cancer to demonstrate that NKX2-1 potently suppresses SOX2-driven squamous tumorigenesis by repressing adeno-to-squamous transdifferentiation. Furthermore, SOX2 recruits, whereas NKX2-1 suppresses, tumor-associated neutrophils (TANs) at least partly through inverse regulation of the chemoattractant CXCL5/6. Single-cell RNA sequencing revealed that TANs exhibit tumor-promoting features and distinct gene expression profiles compared to blood neutrophils. Finally, TANs cooperate with squamous-associated genetic alterations to promote squamous tumors. These data reveal how transcription factors with key functions in normal development dictate not only cancer cell identity but also distinct tumor immune microenvironments.

Citation Format: Gurkan Mollaoglu, Alex Jones, Sarah Wait, Anandaroop Mukhopadhyay, Sangmin Jeong, Rahul Arya, Soledad Camolotto, Timothy Mosbruger, Chris Stubben, Christopher Conley, Arjun Bhutkar, Jeffery Vahrenkamp, Kristofer Berrett, Melissa Cessna, Thomas Lane, Benjamin Witt, Mohamed Salama, Jason Gertz, Kevin Jones, Eric Snyder, Trudy Oliver. Lineage specifiers SOX2 and NKX2-1 inversely regulate tumor cell fate and neutrophil recruitment in lung cancer [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr B72.

The volume of liver irradiated during modern free-breathing breast radiotherapy: Implications for theory and practice

INTRODUCTION

Incidental liver irradiation during breast radiotherapy can increase the risk of second primary malignancy and induce adverse inflammatory states. This study establishes the volume of liver irradiated during free-breathing breast radiotherapy. Novel associations between liver dose-volume data and systemic interleukin-6 soluble receptor and blood counts are evaluated.

METHODS

The volume of liver within the 10%, 50% and 90% isodose was determined for 100 women with stage 0 to II breast carcinoma undergoing 40Gy in 15 fractions over three weeks tangential irradiation. Blood counts and interleukin 6 soluble receptor concentration were recorded before, during and four weeks after radiotherapy. Dose-volume data for right-sided treatments was associated with longitudinal measures at bivariate and multivariable levels.

RESULTS

A maximum of 226cm³ (19%), 92 cm³ (8%) and 62 cm³ (5%) of the liver was irradiated within the 10%, 50% and 90% isodose. Liver irradiation was almost exclusively a feature of the 52 right-sided treatments and was strongly correlated with breast volume (ρ = 0.7, p < 0.0001). Liver V10% was significantly associated with interleukin-6 soluble receptor concentration four weeks post-radiotherapy (beta = 0.38, p = 0.01) after controlling for theoretical confounding variables.

CONCLUSION

Up to 8% of the liver is irradiated within the primary beam during local right-sided breast radiotherapy. Select use of a deep inspiration breath hold technique would reduce this volume, and minimise the risk of radiation-induced malignancy and acute systemic elevation of inflammatory interleukin 6 soluble receptor.

Deep vein thrombosis, an unreported first manifestation of polyglandular autoimmune syndrome type III

A 71-year-old woman with severe right lower leg pain, edema and erythema was presented to the Emergency Department and was found to have an extensive deep vein thrombosis (DVT) confirmed by ultrasound. She underwent an extensive evaluation due to her prior history of malignancy and new hypercoagulable state, but no evidence of recurrent disease was detected. Further investigation revealed pernicious anemia (PA), confirmed by the presence of a macrocytic anemia (MCV=115.8fL/red cell, Hgb=9.0g/dL), decreased serum B12 levels (56pg/mL), with resultant increased methylmalonic acid (5303nmol/L) and hyperhomocysteinemia (131μmol/L), the presumed etiology of the DVT. The patient also suffered from autoimmune thyroid disease (AITD), and both antithyroglobulin and anti-intrinsic factor antibodies were detected. She responded briskly to anticoagulation with heparin and coumadin and treatment of PA with intramuscular vitamin B12 injections. Our case suggests that a DVT secondary to hyperhomocystenemia may represent the first sign of polyglandular autoimmune syndrome III-B (PAS III-B), defined as the coexistent autoimmune conditions AITD and PA. It is important to recognize this clinical entity, as patients may not only require acute treatment with vitamin B12 supplementation and prolonged anticoagulation, as in this patient, but may also harbor other autoimmune diseases.

LEARNING POINTS

A DVT can be the first physical manifestation of a polyglandular autoimmune syndrome.Hyperhomocysteinemia secondary to pernicious anemia should be considered as an etiology of an unprovoked DVT in a euthyroid patient with autoimmune thyroid disease.Patients with DVT secondary to hyperhomocysteinemia should undergo screening for the presence of co-existent autoimmune diseases in addition to treatment with B12 supplementation and anticoagulation to prevent recurrent thromboembolism.

Abstract 1612: Investigating NF-κB pathway as a novel therapeutic target in preclinical lung cancer mouse models

Lung cancer represents the most frequent cancer type and the leading cause of cancer death (1.3 million worldwide). Non-small cell lung cancer (NSCLC) accounts for 80% of all lung cancer cases. NSCLC development is associated with frequent mutations in well-defined oncogenes and tumor suppressor genes such as Kras (30%) and p53 (50-70%). We recently demonstrated that hyper-activated NF-kB pathway in NSCLC is required for the initiation and maintenance of lung cancer, indicating this pathway as a promising therapeutic target. In this study, we tested therapeutic delivery of proteasome inhibitor Bortezomib (Velcade) to inhibit NF-κB pathway in NSCLC mouse models. In mouse lung cancer cell lines harboring KrasG12D and p53 loss (KP cells), Bortezomib efficiently reduced nuclear p65, repressed NF-kB target genes such as Bcl2 and rapidly induced apoptosis. The cell lines with high NF-kB activity are especially sensitive to Bortezomib. Using autochothonous mouse models and microCT imaging, we showed that Bortezomib treatment at a well-tolerated dose leads to lung tumor regression in mice and prolonged survival. Our results demonstrated using preclinical mouse models to study cancer treatment response and supported NF-kB pathway as an effective therapeutic target in lung cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1612. doi:10.1158/1538-7445.AM2011-1612

Optimal chemotherapy treatment for women with recurrent ovarian cancer

Question

What is the optimal chemotherapy treatment for women with recurrent ovarian cancer who have previously received platinum-based chemotherapy?

Perspectives

Currently, standard primary therapy for advanced disease involves a combination of maximal cytoreductive surgery and chemotherapy with carboplatin plus paclitaxel or with carboplatin alone. Despite initial high response rates, a large proportion of patients relapse, resulting in a therapeutic challenge. Because these patients are not curable, the goal of therapy becomes improvement in both quality and length of life. The search has therefore been to find active agents for women with recurrent disease following platinum-based chemotherapy.

Outcomes

Outcomes of interest included any combination of tumour response rate, progression-free survival, overall survival, adverse events, and quality of life.

Methodology

The medline, embase, and Cochrane Library databases were systematically searched for primary articles and practice guidelines. The resulting evidence informed the development of clinical practice recommendations. The systematic review and recommendations were approved by the Report Approval Panel of the Program in Evidence-Based Care, and by the Gynecology Cancer Disease Site Group (dsg). The practice guideline was externally reviewed by a sample of practitioners from Ontario, Canada.

Results

Thirteen randomized trials compared various chemotherapy regimens for patients with recurrent ovarian cancer.

In five of the thirteen trials in which 100% of patients were considered sensitive to platinum-containing chemotherapy, further platinum-based combination chemotherapy significantly improved response rates (two trials), progression-free survival (four trials), and overall survival (three trials) when compared with single-agent chemotherapy involving carboplatin or paclitaxel. Only two of these randomized trials compared the same chemotherapy regimens: carboplatin alone versus the combination of carboplatin and paclitaxel. Both trials were consistent in reporting improved survival outcomes with the combination of carboplatin and paclitaxel. In one trial, the combination of carboplatin and gemcitabine resulted in significantly higher response rates and improved progression-free survival when compared with carboplatin alone. Median survival with carboplatin alone ranged from 17 months to 24 months in four trials.

In eight of the thirteen trials in which 35%–100% of patients had platinum-refractory or -resistant disease, one trial reported a statistically significant 2-month improvement in overall survival with liposomal doxorubicin as compared with topotecan (15 months vs. 13 months, p = 0.038; hazard ratio: 1.23; 95% confidence interval: 1.01 to 1.50). In that trial, because of the limited clinical benefit and the unusual finding that a survival difference emerged only after a year of treatment with no corresponding improvement in the rate of response or of progression-free survival, the authors concluded that further confirmation by results from randomized trials were needed to establish the superiority of one agent over another in their trial. In one trial, topotecan was superior to treosulphan in patient progression-free survival by a span of approximately 2 months (5.4 months vs. 3.0 months, p < 0.001).

Toxicity was reported in all of the randomized trials, and although data on adverse events varied by treatment regimen, the observed adverse events correlated with known toxicity profiles. As expected, combination chemotherapy was associated with higher rates of adverse events.

Practice Guideline

A phase II study investigating the re-induction of endocrine sensitivity following chemotherapy in androgen-independent prostate cancer

When chemotherapy is used in androgen-independent prostate cancer (AIPC), androgen deprivation is continued despite its failure. In this study, we investigated whether it was possible to re-induce hormone sensitivity in previously castrate patients by stopping endocrine therapy during chemotherapy. A phase II prospective study investigated the effects of reintroduction of endocrine therapy after oral chemotherapy in 56 patients with AIPC, which was given without concurrent androgen deprivation. After chemotherapy, patients were given maximum androgen blockade until failure when treatment was switched to diethylstilbestrol and dexamethasone. Patients had already received these endocrine treatments in the same sequence before chemotherapy. All patients were castrate at the start of chemotherapy. Forty-three subsequently restarted endocrine therapy after the completion of chemotherapy. The median overall survival for these 43 patients from the time of restarting endocrine therapy was 7.7 months (95% confidence interval (CI): 3.7–10.9 months). Sixteen (37%) patients had a 50% PSA response to treatment, which was associated with improved overall survival (14.0 months vs 3.7 months P=0.003). Eight out of 12 patients who did not respond to diethylstilbestrol before chemotherapy did so post chemotherapy. Re-induction of hormone sensitivity can occur after chemotherapy in AIPC.

Chemotherapy for recurrent, metastatic, or persistent cervical cancer: a systematic review

To determine the front-line chemotherapeutic options for women with recurrent, metastatic, or persistent cervical cancer. The Medline, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing chemotherapy regimens for patients with recurrent, metastatic, or persistent cervical cancer. Studies were included if response rate, survival, toxicity, or quality of life data were reported. Fifteen RCTs were identified. The proportion of patients with prior chemoradiotherapy ranged from 0% to 57%. Four of the 15 RCTs detected significant improvements in overall response with combination cisplatin-based chemotherapy when compared with single-agent cisplatin. One of the 15 RCTs reported a significant median survival advantage with topotecan and cisplatin when compared with single-agent cisplatin (9.4 vs 6.5 months,P= 0.017); 57% of patients in this trial had previous chemoradiotherapy. Significant increases in grade 3 and 4 adverse events, especially severe hematologic toxicities, were detected among patients treated with that combination of chemotherapy. Thus, we conclude that cisplatin and topotecan should be discussed as a reasonable treatment option for appropriate patients who may wish to maximize the response and survival benefits associated with combination chemotherapy. Patients should understand that prior chemoradiotherapy with cisplatin may moderate the benefits observed, and that the relative benefits in response and survival outcomes come at the expense of increased toxicity. The improvement in median survival of 2.9 months represents a novel survival benefit in this difficult-to-treat patient population. Further randomized trials are needed to inform the role of single-agent or combination chemotherapy regimens, particularly in patients with prior chemoradiotherapy.

The long term side effects of adjuvant carboplatin for stage 1 seminoma

5089

Background: Radiotherapy is associated with an increase of second cancer and cardiovascular disease. Because of difficulties in detecting recurrence on surveillance which can occur out to 10 years, this unit has developed Carboplatin as the treatment for these patients and this abstract summarises late events in these 3 cohorts. Methods: Radiation therapy consisted of para-aortic and pelvis treatment (3,000 cGy). This occurred between 1960 and 1978. Surveillance began in 1980 and Carboplatin studies in 1984 with 2 courses of 450 mg/m2 being standard until 1987 when 1 course AUC × 7 was introduced and with increased confidence became standard. Results: Seventy-eight patients were treated with radiotherapy (median follow up 17 years). Overall mortally was 24% at 20 years compared with expected 10%. Death from germ cell cancer was 4.0%, deaths from 2nd non-germ cell cancer were 13%, and deaths from other causes was 7.0%. For surveillance (n=110, median follow up 9.8 years) there were 1.7% deaths, with no germ cell or non-germ cell cancer related deaths., and 1.7% deaths due to non cancer. Carboplatin (n=186, median follow up 9.5 years 97>10 yrs, and 38 >15 yrs) was associated with 98% survival at 10 years with 0 deaths due to GCC (3% relapse all before 3 years) 1% due to second non-GCC cancer and 1% to other causes. Conclusion: The numbers of cases are too small to be absolutely confident of these figures. However, this data suggests there are no late relapses and no excess of cancer or cardiovascular deaths in the single agent carboplatin cohort.

No significant financial relationships to disclose.

Phase II screening study of an LHRH analog, dexamethasone and somatostatin analog versus LHRH analogue with dexamethasone in HRPC

15579

Background: As far as prostatic cancer is concerned, we know that somatuline (SMS) blocks GH, PRL, tissular growth factors (TGF) and that it has a direct antiproliferative cellular growth effect. The simultaneous administration of depot forms of SMS and LHRH analogues induced the greatest decrease in tumor growth. Methods: A randomised Phase II trial was carried out in M0 (PSA ≥ 20 ng/ml) and M1 patients with hormone refractory prostate cancer to simultaneously screen decapeptyl and dexamethasone, both with and without SMS (120 mg every 4 weeks), with respect to the PSA response rate, time to PSA progression, duration of survival and toxicity. Results: 72 patients with a median PSA of 77 ng/ml were randomised by 3 centers, 35 to decapeptyl, dexamethasone, both with and without SMS (DDS) and 37 to decapeptyl and dexamethasone (DD). 18 of 33 (54%) patients on DDS and 13 of 32 on DD (43%) had a PSA response (a decrease of at least 50% as compared to baseline). The median time to PSA was 5.5 months in the SMS group and 1.9 months in the group without SMS. At 6 months, 45.7% were PSA progression free in the SMS group versus 35.1% in the goup without SMS. The median time to PSA progression in PSA responders was 10.6 months in the SMS group and 13.9 months in the group without SMS. At 6 months, 73.7% of the PSA responders were progression free in the SMS group versus 81.3% in the group without SMS. 45 patients died (62.5%), 22 (62.9%) in the SMS group and 23 (62.2%) in the group without SMS. 15 and 19 of the deaths respectively were due to prostate cancer. The median duration of survival is 1.65 years in the SMS group and 1.48 years in the group without SMS. At 6 months, 85.7% were alive in the SMS group vs 78.1% in the group without SMS. At 12 months, 77.1% were alive in the SMS group vs 69.4% in the group without SMS. Conclusions: There is no evidence that SMS may have increased the incidence of side effects. The PSA response rate was slightly higher in the SMS group, 54% vs 43% and the median time to PSA progression in all patients appears to have been slightly longer in the SMS group. Fewer objective progressions were also observed in the SMS arm, 4 vs 12. These results suggest that SMS may add to the activity of decapeptyl and dexamethasone and thus have a role in the treatment of hormone refractory prostate cancer.

No significant financial relationships to disclose.

A phase II study using a topoisomerase I-based approach in patients with multiply relapsed germ-cell tumours

BACKGROUND

The outcome of patients with germ-cell tumours (GCTs), who relapse more than once or relapse with a mediastinal primary is poor. We have shown that topoisomerase 1 may be an attractive target in relapsed GCT. We investigated the role of irinotecan, paclitaxel and oxaliplatin (IPO) followed by topotecan-based high-dose therapy in responding patients, in this patient population.

PATIENTS AND METHODS

Twenty-eight patients with multiply relapsed gonadal and mediastinal GCT were recruited to this phase 2 study. All patients received IPO chemotherapy and 12 (43%) went on to receive high-dose therapy. The outcome of these patients was assessed using the Kaplan-Meier method with a median progression-free follow-up of 1 year.

RESULTS

Twenty patients (71%) responded to the therapy including five complete remissions (18%), 13 (46%) marker-negative partial responses and two (7%) marker-positive partial responses. Nine (32%) patients continue to be progression free, and the median survival for the whole group currently measures 17 months. Out of 12 individuals who received subsequent high-dose therapy consolidation, seven (58%) remain progression free. The commonest grade III/IV toxicity was infection (68%) and there were no IPO-related toxic deaths; there was one death from high-dose therapy.

CONCLUSION

Topoisomerase I-based IPO chemotherapy that lacks etoposide is very active in multiply relapsed GCT. This data merit further investigation.

Intraperitoneal chemotherapy for patients with advanced ovarian cancer: a review of the evidence and standards for the delivery of care

OBJECTIVES

To evaluate the role of intraperitoneal (IP) chemotherapy as part of primary treatment in patients with advanced ovarian cancer and to develop standards of care within the context of current clinical practice.

METHODS

A multidisciplinary expert panel, convened to develop standards on the use of IP chemotherapy, searched the MEDLINE, EMBASE, and Cochrane Library databases up to December 2006 for randomized trials or published standards on the efficacy and/or delivery of IP chemotherapy.

RESULTS

Eight randomized trials comparing IP chemotherapy versus intravenous (IV) chemotherapy were identified. Three trials reported statistically significant improvements in median survival of 8.0, 11.0, and 15.9 months with cisplatin-based IP chemotherapy. In one trial, the 15.9-month improvement in median overall survival (RR=0.75, 95% CI=0.58-0.97) represented a 25% reduction in the risk of death with IP chemotherapy. Severe adverse events and catheter-related complications were often dose limiting with IP chemotherapy. Using a consensus-based approach with a nationally representative panel, multidisciplinary care standards were developed to review medical and surgical criteria, the practice setting, volume requirements, and the institutional criteria required to safely deliver IP chemotherapy.

CONCLUSION

The survival benefits with cisplatin-based IP chemotherapy may represent a significant improvement in the outlook for select patients with advanced ovarian cancer. The delivery of IP chemotherapy is more challenging than the IV route; however, severe adverse events and catheter-related complications may be offset through research defining the optimum treatment regimen, and the standardization of care. System-wide standards for the delivery of IP chemotherapy in Canada for patients with optimally debulked stage III ovarian cancer are offered.