Sorafenib and pegylated interferon-α2b in advanced metastatic melanoma: a multicenter phase II DeCOG trial

BACKGROUND

The combination of sorafenib, a multikinase inhibitor, and pegylated interferon-α2b (Peg-IFN-α2b) could potentially lead to an improved antitumoral response. Previously, combinations of interferon and sorafenib have been used in renal cell cancer.

PATIENTS AND METHODS

Patients with stage IV metastatic melanoma and no previous systemic therapies apart from adjuvant immunotherapy received Peg-IFN-α2b 3 μg/kg once per week, and sorafenib 400-mg b.i.d. for a minimum of 8 weeks. The primary study end point was disease control rate (DCR).

RESULTS

Between February 2008 and February 2009, 55 patients were enrolled with a median age of 64 years (20-85). At 8 weeks, 2 patients (3.6%) had a partial response (PR) and 14 patients a stable disease (25.5%), for a DCR of 29.1% in the intention-to-treat (ITT) population. The median progression-free survival in the ITT population was 2.47 months (95% confidence interval 1.22-3.72 months). The toxicity of sorafenib and Peg-IFN-α2b combination was characterized by mainly hematological side-effects, including one treatment-related bleeding complication with a fatal outcome. Other grade 3/4 toxic effects were fatigue and flu-like symptoms.

CONCLUSION

The combination of sorafenib and Peg-IFN-α2b showed modest clinical activity and some serious side-effects including fatal bleeding complications.

Prevention of non-melanoma skin cancer in organ transplant patients by regular use of a sunscreen: a 24 months, prospective, case-control study

BACKGROUND

Skin cancers represent a major challenge within the ever growing group of long time surviving organ transplant recipients (OTR) world wide. Especially UV-induced non-melanoma skin cancers (NMSC) like invasive squamous cell carcinomas (SCC) and actinic keratoses (AK), and basal cell carcinoma (BCC), outnumber every other form of cancer in organ transplant recipients. Despite encouraging reports of protective effects of broad-spectrum sunscreens in immunocompetent patients, evidence for the prevention of NMSC in immunocompromised patients is still missing.

OBJECTIVES

To assess preventive effects of regular sun-screen use on AK, SCC and BCC in chronically immunocompromised organ transplant recipients.

METHODS

Hundred and twenty matched (age, sex, skin type, graft, transplant duration, previous post-transplant skin malignancies) organ transplant recipients (40 heart, 40 kidney, 40 liver grafted) were recruited for this prospective, single-center study. Both groups received equally written and oral information on sun protection measures. Sixty patients were provided with a free broad spectrum study-sunscreen (SPF>50, high-UVA absorption) for daily application of 2 mg cm(-2) to the head, neck, forearms, and hands.

RESULTS

All 120 patients completed the 24 months study. Within this 24 month study interval 42 of the 120 patients developed 82 new AK (-102 sunscreen group vs. +82 control; P<0.01), 8 new invasive SCC (0 vs. 8; P<0.01) and 11 BCC (2 vs. 9; ns). In spite of equal numbers of AK at baseline, a marked difference in favor of the intent-to-treat sunscreen group was recorded after 24 months (89 vs. 273; P<0.01, mean difference 3.07 [1.76-4.36]) and the lesion count was significantly lower as compared to the initial visit (89 vs. 191; P<0.01, mean difference 1.7 [0.68-2.72]). With an average of 5.6 applications per week throughout the 24 months the study sunscreen was generally well tolerated. Serum 25-hydroxy vitamin D levels as marker for vitamin D status were decreased in all patients without adequate substitution and 25(OH)D was found to be lower in the sunscreen-group as compared to the control group (mean value 53 ng mL(-1) vs. 60 ng mL(-1)).

INTERPRETATION

Regular use of sunscreens, as part of a consequent UV-protection strategy, may prevent the development of further AK and invasive SCC and, to a lesser degree, BCC in immune-compromised organ transplant recipients.

Influence of the menstrual cycle on aminolevulinic acid induced protoporphyrin IX fluorescence in the endometrium: In vivo study

BACKGROUND AND OBJECTIVES

In vitro studies indicated that compared to postmenopausal women, premenopausal women had increased aminolevulinic acid induced protoporphyrin IX (ALA-induced PpIX) fluorescence expression in the endometrium. The aim of this study was to evaluate menstrual cycle dependency of ALA-induced PpIX fluorescence in the endometrium in vivo.

STUDY DESIGN/PATIENTS AND METHODS

Thirteen patients were included for in vivo spectrofluorometric measurements of ALA-induced PpIX in the endometrium and 51 patients for fluorescence hysteroscopy. Two milliliter of a 2% 5-ALA-solution at pH = 4.0 (ASAT AG/Zug, Switzerland) was topically administrated just before spectrofluorometry and 4 hours before hysteroscopy. Spectrofluorometry: Optical fiber based. Fluorescence hysteroscopy: STORZ-D-Light system (Storz, Tuttlingen, Germany). Histological classification of curettage and bioptic endometrial tissue stained with hematoxylin and eosin (H&E).

RESULTS

Hysteroscopic and in vivo spectrofluorometric measurements showed an increase of ALA-induced PpIX fluorescence in the secretory and hyperplastic endometrium compared to proliferative and atrophic endometrium.

CONCLUSIONS

The accuracy of fluorescence hysteroscopy and the success of the photodynamic endometrial ablation using ALA-induced PpIX may depend on the hormonal influence of the menstrual cycle. The mechanisms responsible for the increased ALA-induced PpIX fluorescence in the secretory versus proliferative phase of the menstrual cycle deserve further studies.

Fluorescence hysteroscopy using 5-aminolevulinic: a descriptive study

BACKGROUND AND OBJECTIVES

To assess the feasibility of fluorescence hysteroscopy following topical ALA application and to describe the optical appearance of normal and neoplastic endometrium.

STUDY DESIGN/MATERIALS AND METHODS

Fifty-four patients scheduled for routine hysteroscopy and D&C were assigned to the study group using topically applied ALA. Two milliliters of a 2% 5-ALA-solution at pH = 4.0 (ASAT AG/Zug, Switzerland) was administrated into the uterine cavity 4 hours before fluorescence hysteroscopy, using a STORZ-D-Light (Tuttlingen, Germany) system. Hysteroscopic findings were compared to the histological diagnosis of hematoxylin & eosin (H&E) stained sections. In the study group, 60 histological specimens were taken (47 materials of curettage and 13 targeted biopsies). The percentage of fluorescence positive patients was calculated.

RESULTS

The rate of fluorescent endometrial samples was low in atrophic endometrium 1/16 (6.2%). Endometrial carcinoma were diagnosed in two patients. Both cases exhibited selective and intense PpIX-mediated red fluorescence. Fluorescence hysteroscopy could not differentiate between hyperplastic areas with or without atypia. Minimal uterine cramps or discomfort following ALA instillation were complained by 30 (56%) patients, no pain was indicated by 24 patients (44%).

CONCLUSIONS

Fluorescence hysteroscopy following intrauterine application of ALA is feasible. Cancerous, hyperplastic, and secretory endometrial tissue showed high red fluorescence.

Method for collecting semen from the ostrich (Struthio camelus) and some of its quantitative and qualitative characteristics

1. Four methods of semen collecting that involved interruption of mating in two breeding ostrich pairs were tested: an artificial vagina was tested without promising results; the funnel method, in which a funnel was placed under the phallus of the tested male immediately after mating allowing semen drips to be collected; the vacuum method, using a turkey semen collector, inserted into the seminal canal; and the tube method, conducted by placing a test tube inside the seminal canal, allowing semen to enter by gravity. 2. For the funnel, vacuum and tube methods, respectively, average semen volume was 0.1 +/- 0.02, 1.12 +/- 0.22, and 0.58 +/- 0.13 ml, sperm concentration was 0.66 +/- 0.14, 2.35 +/- 0.26, and 2.13 +/- 0.27 x 10(9) cells/ml, and percentage of abnormal cells was 5.82 +/- 1.79%, 4.68 +/- 1.19%, and 7.09 +/- 1.72%. 3. Semen characteristics varied throughout the reproductive season reaching peak concentration in June-July. 4. The vacuum method proved to be the most efficient and was a low stress, restraint-free method for collecting ostrich semen.

Photodynamic endometrial ablation: morphological study

BACKGROUND AND OBJECTIVES

Endometriumablation provides an alternative treatment modality to hysterectomy for dysfunctional uterine bleeding (DUB). Its feasibility was demonstrated in animal studies. The purpose of this study was the evaluation of histological changes following photodynamic endometrial ablation in patients.

STUDY DESIGN/MATERIALS AND METHODS

5-Aminolevulinic acid (ALA) was topically applied in three premenopausal and one postmenopausal patient 4-6 hours before laser-illumination. ALA-concentration: 100-400 g/ml, NaOH-titration (pH 5.5). Volume applied, 1.5-2.0 ml; intrauterine balloon-lightdiffuser; wavelength, 635 nm; lightdose, 160 J/cm(2). Hysterectomy was performed 3-152 days after photodynamic ablation. Histological examination was carried out on endometrium sections stained with hematoxylin and eosin (H&E).

RESULTS

Necrosis including the full thickness of the endometrium was found 3 days after photodynamic endometrial ablation. Specimens collected after 35 and 152 days did not exhibit fibrosis or adhesions. Foci of preserved endometrium were detected in all patients.

CONCLUSIONS

Photodynamic endometrial ablation is selective and does not cause endometrial fibrosis or adhesions.

Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid

BACKGROUND AND OBJECTIVES

To determine the feasibility of photodynamic therapy (PDT) of vulvar and vaginal condyloma and intraepithelial neoplasia (VIN, VAIN) and to compare PDT results with conventional treatments.

STUDY DESIGN/MATERIALS AND METHODS

Thirty-eight patients with vulvar or vaginal intraepithelial neoplasia (VIN) grade II/III (n = 22) or condyloma (n = 16) had 10% 5-aminolevulinic acid (ALA)-gel applied topically. After 2-4 hours, 80-125 J/cm(2) laser light at a wavelength of 635 nm was applied. PDT was compared to conventional treatments for condyloma (CO(2) laser evaporation) and for VIN III (laser evaporation, surgical excision).

RESULTS

The complete clearance rate for condyloma treated by PDT was 66% and the rate for IN was 57% (as determined by biopsy). Of the neoplasia patients, none with hyperkeratotic VIN (n = 4) responded, and only one of four with increased pigmentation cleared. No scarring occurred, and postoperative discomfort lasted 4.9 +/- 3.4 days. Reduced disease-free survival (DFS) was associated with multifocal VIN (P = 0.02, OR 2.17, 95% CI 1.15-4.08), but DFS did not vary with treatment mode.

CONCLUSIONS

Although PDT is not equally efficacious for all subgroups, PDT for condyloma and intraepithelial neoplasia appears to be as effective as conventional treatments, but with shorter healing time and excellent cosmetic results.

Photodynamic therapy of locoregional breast cancer recurrences using a chlorin-type photosensitizer

Chest wall recurrences are a frequent problem in patients treated by mastectomy for breast cancer. Surgery and ionizing radiation are established treatment modalities in these cases. Photodynamic therapy (PDT) provides an alternative treatment modality using a photosensitizer and laser light to induce selective tumor necrosis. PDT was performed as compassionate use in 7 patients aged 57.6 years (+/-12.6 SD). A total of 89 metastatic skin nodes were treated in 11 PDT sessions. As photosensitizer meta-tetra(hydroxyphenyl)chlorin (m-THPC) was applied intravenously. Patients (n = 3) photosensitized with a drug dose of 0.10 mg/kg bodyweight were irradiated 48 hr after drug application at a lightdose of 5 J/cm(2). Patients (n = 4) were illuminated by an optical dose of 10 J/cm(2) 96 hr after photosensitization with 0.15 mg/kg. Laser light at a wavelength of 652 nm was generated by a diode laser and applied by a front lens light diffuser using a fluence rate of 20--25 mW/cm(2). PDT using m-THPC resulted in complete response in all patients. Response to treatment did not differ when using the 2 different drugdose protocols. Healing time depended mainly on the size of the illumination field but not on the lightdose. Pain score usually raised 1 day after PDT and lasted at higher levels for about 10 days. Healing time usually ranged between 8--10 weeks. Photodynamic technique offers a minimal-invasive, outpatient treatment modality for recurrent breast cancer on the chest wall with few side effects, high patient's satisfaction and with possible repetitive application.

Two diastereomers of 9-(2,6-dichlorophenyl)-4a-hydroxy-3,3,6,6-tetramethyl-1,2,3,4,4a,5,6,7,8,9a-decahydroxanthene-1,8-dione in the same crystal

The reaction of dimedone with 2,6-dichlorobenzaldehyde leads to the title compound, C(23)H(26)Cl(2)O(4). In principle, the reaction could yield eight different stereoisomers. We have found four of them in the same crystal as two enantiomeric pairs of diastereomers, which means that the asymmetric unit is built up of two different diastereomers. Two of the three chiral centres display the same configuration, while the third is different in the two molecules in the asymmetric unit. The packing of the molecules is stabilized by hydrogen bonds between the hydroxy group and the carbonyl group attached to the cyclohexene ring, forming chains in which the different diastereomers alternate.

Packing considerations of bis-dimedone derivatives

We have determined the crystal structures of 2,2'-(4-fluorophenyl)methylenebis(3-hydroxy-5,5-dimethyl-2-cyclohexen-1-one), C(23)H(27)FO(4), (I), 2,2'-(4-chlorophenyl)methylenebis(3-hydroxy-5,5-dimethyl-2-cyclohexen-1-one), C(23)H(27)ClO(4), (II), 2,2'-(4-hydroxyphenyl)methylenebis(3-hydroxy-5,5-dimethyl-2-cyclohexen-1-one), C(23)H(28)O(5), (III), 2,2'-(4-methylphenyl)methylenebis(3-hydroxy-5,5-dimethyl-2-cyclohexen-1-one), C(24)H(30)O(4), (IV), 2,2'-(4-methoxyphenyl)methylenebis(3-hydroxy-5,5-dimethyl-2-cyclohexen-1-one), C(24)H(30)O(5), (V), and 2,2'-(4-N,N'-dimethylaminophenyl)methylenebis(3-hydroxy-5,5-dimethyl-2-cyclohexen-1-one), C(25)H(33)NO(4), (VI). Structures (III) to (VI) of these bis-dimedone derivatives show nearly the same packing pattern irrespective of the different substituent in the para position of the aromatic ring. However, (II) does not fit into this scheme, although the Cl atom is a substituent not too different from the others. The different packing of the fluoro compound, (I), can be explained by the fact that it crystallizes with two molecules in the asymmetric unit, which show a different conformation of the dimedone ring. On the other hand, (I) shows a similar packing pattern to bis(2-hydroxy-4,4-dimethyl-6-oxo-1-cyclohexenyl)phenylmethane, a compound containing an aromatic ring without any substituent and with Z' = 2.

Diels-alder adducts of maleic anhydride and dienes: new compounds by crystallization

We have determined the crystal structures of bicyclo[2.2. 1]hept-2-ene-endo-cis-5,6-dicarboxylic anhydride, C(9)H(8)O(3), (I), 1,2,3,4,7,7-hexachlorobicyclo[2.2.1]hept-2-ene-endo-cis-5, 6-dicarboxylic anhydride diethyl ether solvate, C(9)H(2)Cl(6)O(3).0. 16C(4)H(10)O, (II), bicyclo[2.2.1]hept-2-ene-endo-cis-5, 6-dicarboxylic acid, C(9)H(10)O(4), (III), 1,2,3,4,7, 7-hexachlorobicyclo[2.2.1]hept-2-ene-endo-cis-5,6-dicarboxylic acid, C(9)H(4)Cl(6)O(4), (IVa) and (IVb), and ethyl 1,2,3,4,7, 7-hexachloro-6-carboxybicyclo[2.2. 1]hept-2-ene-endo-cis-5-carboxylate monohydrate, C(11)H(8)Cl(6)O(4). H(2)O, (V). Compounds (I) and (II) were prepared by a standard Diels-Alder reaction from maleic anhydride and cyclopentadiene or hexachlorocyclopentadiene, respectively. The crystal-growing processes of these compounds led to surprising results: rapid recrystallization of (I) from diethyl ether and (II) from petroleum ether gave crystals of these compounds, however, crystallization by slow evaporation techniques using common solvents yielded new compounds in which the five-membered heterocycle has been cleaved.

4-Phenylbutan-2-one semicarbazone

The title compound, C(11)H(15)N(3)O, crystallizes with two molecules in the asymmetric unit, which are held together by an extended network of hydrogen bonds. It is remarkable that only five of the six theoretically possible hydrogen bonds are formed.

Effects of felodipine ER, a dihydropyridine calcium antagonist, on blood pressure and serum lipids

In an open trial, the antihypertensive efficacy of felodipine and its effects on lipid metabolism were investigated in 117 Nordic patients with mild to moderate essential hypertension and hyperlipidaemia. In the intent-to-treat analysis (n = 106) a significant (p < 0.01) drop in the mean systolic and diastolic blood pressure values was observed between baseline and 24 weeks' treatment from 157/100 mmHg to 145/92 (supine) and from 155/103 to 145/96 mmHg (erect). No relevant differences were seen in the pulse rate. Median total cholesterol and triglycerides remained unchanged, whereas HDL-cholesterol increased significantly from 1.30 mmol/l to 1.33 mmol/l (p < 0.02); LDL- and VLDL-cholesterol, apolipoprotein A1 and apolipoprotein B remained unchanged during the 24-week treatment period. In the per protocol analysis (n = 76), blood pressure values changed significantly from 158/100 mmHg to 144/91 mmHg (supine) and from 157/104 mmHg to 143/95 mmHg (erect) (p < 0.01 for both). HDL-cholesterol increased significantly (p = 0.03), whereas LDL- and VLDL-cholesterol, total cholesterol and triglycerides, as well as the apolipoproteins, remained unchanged during the trial. Felodipine thus proved to possess positive effects on lipid parameters in hypertensive patients.

Specific internalization of basal membrane domains containing the integrin alpha 6 beta 4 in dispase-detached cultured human keratinocytes

The integrin alpha 6 beta 4 is polarized towards the basal side of basal keratinocytes and helps anchor these cells to the basement membrane components. We have found that cultured human epidermal keratinocytes, when detached from their culture substratum, as for grafting, using the enzyme dispase, rapidly internalize the basal membrane domains containing the integrin alpha 6 beta 4, while integrins of the very late antigen subtype remain on the cell surface. Detachment and incubation at 4 degrees C prevent this internalization, as well as the contraction of the detached sheet area. Subsequent incubation at 37 degrees C initializes this contraction and allows the basal integrin alpha 6 beta 4 to be internalized. We took advantage of this blockage to label upon detachment using immunogold techniques, the alpha 6 subunit present on the basal cell surface; then we studied its internalization with the electron microscope. This internalization pathway differs from classical receptor-mediated endocytosis, and intermediate filaments might possibly play a role in this process. Interestingly, 1 h after their internalization from the basal membrane, a third of the gold particles labeling the alpha 6 subunit was found between lateral membranes of basal cells, strongly suggesting that the integrin alpha 6 beta 4 can be partly recycled to the cell surface in these conditions.

Basal cell adhesion to a culture substratum controls the polarized spatial organization of human epidermal keratinocytes into proliferating basal and terminally differentiating suprabasal populations

The contribution of adhesion to an extracellular matrix in the polarized spatial organization of keratinocytes was studied in dispase-detached cultures stored as floating sheets. Proliferating and terminally differentiating cell populations were, therefore, localized on tissue sections by their DNA-synthesizing ability and involucrin immunostaining, respectively. A progressive reorganization was induced from superposed proliferating and differentiating layers into clusters exhibiting differentiating cells on the outside. Measurements of proliferation and terminal differentiation in detached cultures revealed the progressive disappearance of proliferating cells, followed by an increase in involucrin-positive cells. Attempts to block the spatial reorganization by the addition of components of the extracellular matrix remained unsuccessful. These results suggest that basal anchorage is responsible for the superposition of proliferating and differentiating cells in keratinocyte cultures. They afford new arguments for the induction of terminal differentiation in non-adhesive keratinocytes which exhibit a concomitant modification of cell shape.

Utilization of human cultured epidermal keratinocytes: irreversibility of the inhibition of proliferation induced in stored detached cultures

In order to look for the best conditions required for the utilization of cultured epithelium in the treatment of burn wounds, some experiments have been performed studying the storage of dispase-detached cultures. The viability of keratinocytes and, after trypsin dissociation of the cultures, the adhesion and proliferative potential of living keratinocytes were measured. Our laboratory investigations suggest that the storage period of detached cultures has to be kept as short as possible to preserve the keratinocytes' growth potential.