Abstract P2-23-18: Analysis of Serum Galectin Profiles by Breast Cancer Subtypes and Patient Characteristics

Background: Galectins are sugar binding proteins that play a role in adhesion, apoptosis, immune regulation, and many other cellular processes. There are three different classes of galectins, and they are all found intracellularly and secreted in serum. Galectins have an established relationship with breast cancer, and galectin-3 has been repeatedly associated with cancer cell survival and tumor progression. Most research regarding breast cancer and galectins has used immunohistochemistry (IHC) as a method for identifying galectin expression in breast cancer tissue samples. However, little research has identified a relationship between serum galectin concentrations and breast cancer subtypes. Breast cancer is characterized both by histological and molecular subtype, and this identification often directs treatment decisions. The current method for identifying breast cancer subtypes is through invasive biopsy and the subsequent use of IHC. This project characterized serum galectin concentrations in breast cancer patients to determine if they changed based on different histological and molecular subtypes, cancer stage, and other patient characteristics. Our goal was to evaluate a potential noninvasive means of breast cancer subtype identification and to identify potential therapeutic targets.

Methods: One-hundred breast cancer patient serum samples were studied using Enzyme-linked Immunosorbent Assays (ELISAs) to determine concentrations of galectins -1, -3, -7, and -9. Results were compared using many patient characteristics, including breast cancer subtype, stage, and patient history (smoking status and treatment). Statistical Analysis was performed using ANOVA, Student’s t-test, and the Wilcoxon Method.

Results: The concentrations of galectins -1, -3, and -9 in breast cancer patients were all significantly higher than those of healthy controls (Table 1), which is consistent with previous studies. The concentration of galectin-3 was significantly higher in invasive lobular carcinoma samples (N, 6; mean, 13.04 ng/mL) compared to invasive ductal carcinoma samples (N, 80; mean, 9.93 ng/mL; p-value, 0.0428). Galectin-3 concentrations were significantly lower in samples from breast cancer patients who received chemotherapy (N, 9; mean, 9.22 ng/mL) versus those who did not (N, 7; mean, 14.60 ng/mL; p-value, 0.0228). Concentrations of galectin-1 were found to increase by stage (p-value, 0.0031), with significant differences between samples from patients with stage I breast cancer (N, 45; mean, 19.02 ng/mL) and both stage II (N, 40; mean, 24.15 ng/mL; p-value, 0.0127) and stage III (N, 12; mean, 28.37 ng/mL; p-value, 0.0026) disease.

Conclusions: Our findings suggest a potential use for serum galectin-3 concentrations as a non-invasive means for breast cancer histological subtype differentiation and more refined diagnosis. In addition, our results suggest a possible use of galectin-1 concentrations for more accurate cancer staging. Further research could explore the relationship of serum galectin concentrations and other breast cancer subtypes. Future studies could also analyze how galectin concentrations change with patient treatment status and determine the potential of galectins as specific targets for breast cancer treatment.

Table 1: Galectin Concentrations in Breast Cancer vs Healthy Controls

Citation Format: Jonah Shealy, Alex Kesic, Avery Funkhouser, Julie Martin, W. Larry Gluck, w. Jeffery Edenfield, Anna Blenda. Analysis of Serum Galectin Profiles by Breast Cancer Subtypes and Patient Characteristics [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-23-18.

Efficacy of therapeutic plasma exchange in the treatment of penn class 3 and 4 cytokine release syndrome complicating COVID-19

Objectives

Cytokine release syndrome (CRS) is a potentially severe complication of COVID-19 most commonly resulting in respiratory failure. This ten-patient study was designed to determine the efficacy of therapeutic plasma exchange (TPE) in improving oxygenation and in reducing the cytokine load in a critically ill subset of patients.

Methods

Five single volume plasma exchanges over eight days within a 14-day study period. In mechanically ventilated patients, oxygenation was measured via the PaO2/FiO2 (P/F) ratio and the oxygenation index (OI) daily for 14 days. Supplemental oxygen requirements were tracked daily for non-ventilated patients.

Results

Non-ventilated patients were liberated from supplemental oxygen after TPE. The response was rapid with an 87% average reduction in oxygenation requirements following and average time to return to room air of 5.25 days. All mechanically ventilated patients demonstrated improvement in oxygenation with a 78% average improvement in the P/F ratio and a 43% improvement in OI. C-reactive protein (CRP) and serum levels of IL-6, IL-8, IL-10, TNFα, IFNγ and GM-CSF, were measured daily with immediate post TPE levels drawn on days 1, 2, 4, 6 and 8. All patients demonstrated significant reductions in CRP, IL-6, IL-10 and TNFα.

Conclusions

In the majority of patients with Penn class 3 and 4 CRS complicating COVID-19, TPE demonstrated a prompt improvement in oxygenation and reduction in cytokine load without compromising patient safety. As this pilot study was envisioned to be hypothesis generating, expanded trials using TPE alone and in conjunction with novel pharmacologic agents are warranted.

Registration

ClinicalTrials.gov NCT04374149.

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Plasmapheresis can effectively reduce injurious cytokines that complicate COVID-19.

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Plasmapheresis can produce clinically meaningful improvement in oxygenation.

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Plasmapheresis can be safely used as a treatment for COVID-19 cytokine storm.

Phase 1 study of the MDM2 inhibitor AMG 232 in patients with advanced P53 wild-type solid tumors or multiple myeloma

Background This open-label, first-in-human, phase 1 study evaluated AMG 232, an oral selective MDM2 inhibitor in patients with TP53 wild-type (P53WT), advanced solid tumors or multiple myeloma (MM). Methods In the dose escalation (n = 39), patients with P53WT refractory solid tumors enrolled to receive once-daily AMG 232 (15, 30, 60, 120, 240, 480, and 960 mg) for seven days every 3 weeks (Q3W). In the dose expansion (n = 68), patients with MDM2-amplified (well-differentiated and de-differentiated liposarcomas [WDLPS and DDLPS], glioblastoma multiforme [GBM], or other solid tumors [OST]), MDM2-overexpressing ER+ breast cancer (BC), or MM received AMG 232 at the maximum tolerated dose (MTD). Safety, pharmacokinetics, pharmacodynamics, and efficacy were assessed. Results AMG 232 had acceptable safety up to up to 240 mg. Three patients had dose-limiting toxicities of thrombocytopenia (n = 2) and neutropenia (n = 1). Due to these and other delayed cytopenias, AMG 232 240 mg Q3W was determined as the highest tolerable dose assessed in the dose expansion. Adverse events were typically mild/moderate and included diarrhea, nausea, vomiting, fatigue, decreased appetite, and anemia. AMG 232 plasma concentrations increased dose proportionally. Increases in serum macrophage inhibitor cytokine-1 from baseline were generally dose dependent, indicating p53 pathway activation. Per local review, there were no responses. Stable disease (durability in months) was observed in patients with WDLPS (3.9), OST (3.3), DDLPS (2.0), GBM (1.8), and BC (1.4–2.0). Conclusions In patients with P53WT advanced solid tumors or MM, AMG 232 showed acceptable safety and dose-proportional pharmacokinetics, and stable disease was observed.

Prolonged response of widely metastatic HER2-positive colon cancer to trastuzumab therapy

Emerging evidence suggests a small subset of late-stage colon cancer driven by HER2, a biomarker routinely evaluated in select breast and gastric cancers, may respond to HER2-targeted therapy. Herein, we describe a 49-year-old male with widely metastatic colon cancer originating in the sigmoid colon. After failing standard therapy, a biopsy specimen of the tumor was evaluated for novel biomarkers using molecular profiling. After identification of ERBB2 (HER2) amplification using in situ hybridization, the patient subsequently received a trial of trastuzumab monotherapy and experienced a dramatic and durable response. This report builds on our understanding of using precision oncology to improve survival in metastatic colon cancer.

RX-5902: A phosphorylated p68 targeting agent to treat subjects with advanced solid tumors

TPS778

Background: Phosphorylated p68 may play a vital role in cell proliferation and tumor/cancer progression. RX-5902 is a novel compound that targets phosphorylated p68 RNA helicase (also known as DDX5), a member of the DEAD box family of RNA helicases. As a single agent, RX-5902 inhibits tumor growth and enhances survival in a variety of xenograft tumor models (e.g., pancreatic, renal, ovarian, melanoma). Methods: This Phase 1, open-label, multicenter study evaluates the efficacy and safety of RX-5902 in subjects with solid tumors. RX-5902 is administered orally 1, 3 or 5 times per week for 3 weeks with 1 week of rest in each 4 week cycle. Dose escalation starts with an accelerated design treating 1 subject per dose followed by a standard 3 + 3 design using a modified Fibonacci sequence after the occurrence of a single Grade 2 or greater adverse event that is considered at related to RX-5902. The primary endpoint is the overall safety profile characterized by the type, frequency, severity, timing of onset, duration and relationship to study therapy of any adverse events, or abnormalities of laboratory tests or electrocardiograms as well as the description of any dose limiting toxicities that occur during Cycle 1, serious adverse events, or adverse events leading to discontinuation of study treatment. Secondary endpoints include pharmacokinetic parameters (e.g., time to maximum observed concentration [Tmax], maximum observed plasma concentration [Cmax], trough concentration [Ctrough], area under the concentration-time curve [AUC]) and Indices of anti-tumor activity (e.g., overall response rate, time to response, duration of response, and progression-free survival during treatment. Exploratory endpoints are biochemical levels of drug targets in blood and tumor samples. Eligible subjects must have confirmed histologic or cytologic evidence of metastatic or locally advanced solid neoplasm that has failed to respond to standard therapy, progressed despite standard therapy or for which standard therapy does not exist. There is no limit on the number of prior treatment regimens. Clinical trial information: NCT02003092.

Abstract CT233: A phase I study evaluating continuous and intermittent AZD2014 in combination with fulvestrant in patients with ER+ advanced metastatic breast cancer

Background: Preclinical and clinical (BOLERO 2) data suggest that pts with ER+ breast cancer become less sensitive to hormonal therapy over time with greater dependency on the mTOR pathway. AZD2014 is a selective dual mTORC1 and mTORC2 inhibitor that may offer additional benefit vs mTORC1 inhibitors through suppression of AKT via mTORC2. Preclinical data demonstrate that continuous or intermittent dosing schedules are equally effective in a model of ER+ breast cancer and the latter may achieve improved tolerability in pts. This Ph I trial assesses the safety, tolerability, PK, PD and preliminary efficacy of AZD2014 administered both continuously and intermittently in combination with fulvestrant (F); data are unvalidated and subject to change.

Methods: Adult pts with ER+ metastatic breast cancer were treated with continuous or intermittent AZD2014 in combination with F 500mg intramuscularly on day 1 of each 28 day cycle.

Results: In the continuous schedules, 43 pts have been treated in 4 cohorts: 50mg BD = 13; 35mg BD = 6; 100mg QD = 10; and 75mg QD = 14. In the intermittent schedules 23 pts have been treated on D1 and 2 (2 days out of 7) per week in 2 cohorts: 170mg BD = 8; 125mg BD = 15. DLTs on the continuous schedule included rash/stomatitis (1 pt) and hyperglycemia (1 pt) at 50mg BD; fatigue (1 pt) and stomatitis (1 pt) at 100mg QD; and rash (1 pt) at 75mg QD. There were no DLTs at 170mg or 125mg BD (D1&2) on the intermittent schedule. Treatment-related toxicities (any grade) in 66 pts include: nausea (58%), fatigue (52%), diarrhea (46%), stomatitis (41%), vomiting (32%), decreased appetite (30%), maculo-papular rash (26%), and hyperglycemia (15%). PK data show that AZD2014 is rapidly absorbed (median tmax 1-1.75h). The mean single dose terminal elimination t1/2 was 3.3-5.6h and increased following multiple and/or high dosing. There was no evidence that co-administration of F had a clinically relevant impact on AZD2014 exposure. Inhibition of both mTORC1 and 2 was observed in both surrogate and tumor tissue. In the 49 pts with measureable disease, 9 confirmed (duration 1.8-22 months) and 3 unconfirmed PRs were observed. Overall, CBR (CR+PR+SD >24 weeks) was 29/66.

Conclusion: Continuous and intermittent dosing of AZD2014 in combination with F is tolerable with clinical benefit observed in 44% of all pts with clinical activity observed with both schedules. Toxicities observed with the continuous dosing schedule are broadly consistent with AEs observed in other trials with mTOR inhibitors. Notably, the intermittent schedule had a different AE profile with a lower incidence of rash. AZD2014 inhibited both mTORC1 and mTORC2 in surrogate and tumor tissue and the PK data were broadly consistent with previous findings for AZD2014 single agent. A randomized phase II trial of the combination comparing both the continuous and intermittent dosing schedules is ongoing.

Citation Format: Manish Patel, Erika Hamilton, Patricia M. LoRusso, W. Larry Gluck, Suzanne F. Jones, Muaiad Kittaneh, Sabina Cosulich, Elizabeth A. Harrington, Stephen Green, Wendy Burke, Donald K. Strickland, Elisabeth Oelmann, Howard A. Burris. A phase I study evaluating continuous and intermittent AZD2014 in combination with fulvestrant in patients with ER+ advanced metastatic breast cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr CT233. doi:10.1158/1538-7445.AM2015-CT233

Phase II trial of piroxantrone in gastric carcinoma. A Southwest Oncology Group study

Twenty-one evaluable patients with advanced gastric adenocarcinoma were treated with piroxantrone at a dose of 150 mg/m2 intravenously every 21 days. One objective response was seen for an overall response rate of 5% (95% confidence interval 0-24%). Toxicities of grade > or = 3 were primarily hematologic and seen in 13/21 patients. Piroxantrone has minimal activity against gastric adenocarcinoma and no further investigation of this agent on this schedule in this disease is recommended.

Thyroid and parathyroid cancer

The epidemiology, etiology, pathology, and management of thyroid and parathyroid carcinoma are discussed. Emphasis is placed on the clinical differences in the management and treatment of the various histologic subtypes of thyroid cancer. The biologic and prognostic differences among the various histologic types of thyroid cancer and their relationship to age are stressed.

Thyroid and parathyroid cancer

The epidemiology, etiology, pathology, and management of thyroid and parathyroid carcinoma are discussed. Emphasis is placed on the clinical differences in the management and treatment of the various histologic subtypes of thyroid cancer. The biologic and prognostic differences among the various histologic types of thyroid cancer and their relationship to age are stressed.

1 alpha,25 Dihydroxyvitamin D3 and mononuclear phagocytes: enhancement of mouse macrophage and human monocyte hydrogen peroxide production without alteration of tumor cytolysis

1 alpha,25 dihydroxyvitamin D3 (1,25 D3) is known to interact with hematopoietic cells. The purpose of this study was to determine the effect of 1,25 D3 on hydrogen peroxide (H2O2) production and tumor cell killing by mouse peritoneal macrophages and human blood monocytes. Enhanced monocyte and macrophages phorbol myristate acetate (PMA)-stimulated H2O2 production was observed at concentrations of 0.13 to 130 nM 1,25 D3 and and was maximal at 1.3 nM. At concentrations of 100 U/ml, gamma interferon (IFN-gamma) alone had a similar effect but, in combination with 1,25 D3, there was no cooperative effect. At concentrations ranging from 0.13 to 130 nM, 1,25 D3 failed to augment tumor cell lysis by macrophages from peptone-injected normal or bacillus Calmette-Guerin (BCG)-infected mice, or by blood monocytes from normal humans. Our results indicate that 1,25 D3 can activate the monocyte and macrophage for H2O2 secretion without concomitant activation for tumor cell killing.

Acute myeloblastic leukemia in paroxysmal nocturnal hemoglobinuria. Evidence of evolution from the abnormal paroxysmal nocturnal hemoglobinuria clone

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hematopoietic stem cell disorder in which the blood cells demonstrate aberrant interactions with serum complement. In part, this is due to the absence of the complement regulatory protein, decay accelerating factor (DAF). A small number of patients with PNH have gone on to develop acute nonlymphocytic leukemia, which is thought to arise from the injured marrow as a second hematopoietic disorder. We have studied a patient with PNH who developed acute myeloblastic leukemia (AML); the blasts from this patient were found to lack DAF as measured by polyclonal antibody binding and fluorescence flow cytometry as well as by immunoblotting. The blasts from 11 other patients with AML bound anti-DAF antibody in amounts similar to normal mononuclear cells from healthy donors. Cells of the human leukemia cell lines HL-60, K562, U937, and HEL also bound anti-DAF antibody. In addition to DAF deficiency, blasts from the PNH patient had undetectable alkaline phosphatase activity, in contrast to human leukemia cell lines. These data suggest that the leukemic cells of the PNH patient arose out of the PNH clone and that AML in the setting of PNH is not a separate disorder.

Isolated anterior chamber relapse in acute monoblastic leukemia

A case of acute monoblastic leukemia relapsing in the anterior chamber of the eye is described. Despite rigorous evaluation, no systemic or central nervous system involvement was detected. All previously reported cases of anterior chamber infiltrates in AML have had coexistent systemic or central nervous system disease.

Acute lymphoblastic leukemia of Burkitt's type (L3 ALL) with 8;22 and 14;18 translocations and absent surface immunoglobulins

A 57-year-old woman presented with L3 acute lymphoblastic leukemia demonstrating typical Burkitt's type morphology. Cytogenetic analysis revealed one of the variant translocations seen in Burkitt's lymphoma [t(8;22)] and a 14;18 translocation. Surface marker data at presentation and at autopsy demonstrated several B-cell markers, but absent surface immunoglobulins. The case presented here reveals a possible cytogenetic link between Burkitt's lymphoma and follicular center-cell lymphoma, and illustrates a variant surface marker profile for Burkitt's lymphoma.

Radiologic manifestations of small-bowel toxicity due to floxuridine therapy

Floxuridine (5-FUDR) is an antipyrimidine used in the treatment of metastatic colorectal carcinoma. Bowel toxicity, manifested predominantly by diarrhea and abdominal pain, is one of the main complications of 5-FUDR therapy. Six patients who had received 5-FUDR infusion either by hepatic arterial or systemic intravenous routes subsequently developed severe diarrhea and were evaluated by small-bowel series. Radiographic changes were largely confined to the ileum. In four of six patients, the entire ileum or its more distal part was markedly narrowed. In the other two patients, changes consisted of thickening or effacement of the mucosal folds in the distal ileum. The symptoms of all six patients resolved after discontinuation of 5-FUDR therapy. This was accompanied by improvement in the radiographic appearance of the ileum in three patients who underwent a subsequent small-bowel series. The finding of reversible ileal changes, particularly extensive or segmental narrowing, seems to be a characteristic radiographic feature of bowel toxicity due to infusional 5-FUDR delivered by either the intraarterial or the systemic route.

A reversible enteropathy complicating continuous hepatic artery infusion chemotherapy with 5-fluoro-2-deoxyuridine

This article describes two patients with hepatic metastases from colorectal cancer in whom a reversible enteropathy developed during the administration of hepatic artery infusion chemotherapy with 5-fluoro-2-deoxyuridine (5-FUdR) via an Infusaid Series 400 pump (Infusaid Corp., Sharon, MA). Both patients had severe diarrhea and signs that suggested small bowel obstruction. Barium studies revealed a distinctive radiologic appearance of severe narrowing of the ileum associated with complete loss of normal mucosal patterns. Results of an extensive evaluation for an infectious or toxin-related enterocolitis were negative. Perfusion studies confirmed the appropriate position of the catheters and revealed no extrahepatic perfusion. Systemic shunting of the 5-FUdR through the liver or tumor bed is postulated as the primary event, with the small bowel manifesting the major toxicity.