The efficacy of sacituzumab govitecan and trastuzumab deruxtecan on stable and active brain metastases in metastatic breast cancer patients-a multicenter real-world analysis

BACKGROUND

Fifteen to thirty percent of all patients with metastatic breast cancer (MBC) develop brain metastases (BCBMs). Recently, the antibody-drug conjugates (ADCs) sacituzumab govitecan (SG) and trastuzumab deruxtecan (T-DXd) have shown to be highly effective in the treatment of MBC. However, there are only limited data whether these macromolecules are also effective in patients with BCBMs. We therefore aimed to examine the efficacy of SG and T-DXd in patients with stable and active BCBMs in a multicenter real-world analysis.

PATIENTS AND METHODS

Female patients with stable or active BCBMs who were treated with either SG or T-DXd at three breast centers in Germany before 30 June 2023 were included. As per local clinical praxis, chemotherapy efficacy was evaluated by whole-body computed tomography and cranial magnetic resonance imaging at baseline and at least every 3 months according to local standards. Growth dynamics of BCBMs were assessed by board-certified neuroradiologists.

RESULTS

Of 26 patients, with a median of 2.5 prior therapy lines in the metastatic setting (range 2-15), 12 (43%) and 16 (57%) patients received SG and T-DXd, respectively. Out of the 12 patients who received SG, 2 (17%) were subsequently treated with T-DXd. Five out of 12 (42%) and 5 out of 16 (31%) patients treated with SG and T-DXd, respectively, had active BCBMs at treatment initiation. The intracranial disease control rate was 42% [95% confidence interval (CI) 13% to 71%] for patients treated with SG and 88% (95% CI 72% to 100%) for patients treated with T-DXd. After a median follow-up of 12.7 months, median intracranial progression-free survival was 2.7 months (95% CI 1.6-10.5 months) for SG and 11.2 months (95% CI 7.5-23.7 months) for T-DXd.

CONCLUSIONS

SG and T-DXd showed promising clinical activity in both stable and active BCBMs. Further prospective clinical studies designed to investigate the efficacy of modern ADCs on active and stable BCBMs are urgently needed.

Migration of iodine-129 and iodine-127 in soils

To draw the balance of anthropogenic 129I input into European soils, the concentrations of 129I and 127I in seven soils from Lower Saxony were analyzed down to a depth of 250 cm. In comparison with pre-nuclear soils and Ukrainian soils, we detected a significant anthropogenic input of 129I. Considering the different time periods for the input of 129I and 127I it was possible to assess the dynamics of sorption processes which dominate migration and accumulation. Anthropogenic 129I was successfully used as a tracer for a clarification of the migration processes of trace elements in soils.

Piezo1 and BKCa channels in human atrial fibroblasts: interplay and remodelling in atrial fibrillation

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science, Research and Arts Baden-Württemberg (MWK-BW Sonderlinie Medizin)

Atrial Fibrillation (AF) is an arrhythmia of increasing prevalence. One of the important indicators for AF is sustained atrial dilatation, highlighting the importance of mechanical overload in the pathophysiology of AF. The mechanisms by which atrial cells, including fibroblasts, sense and react to such changing mechanical forces, are not fully elucidated. Here, we characterise stretch-activated ion channels (SAC) in human atrial fibroblasts and changes in their expression and activity associated with AF.

Using primary cultures of human atrial fibroblasts, isolated from patients in sinus rhythm or with sustained AF, we combine electrophysiological, molecular and pharmacological tools to identify SAC. Two electrophysiological SAC-signatures were detected, indicative of cation-nonselective and potassium-selective channels. Using siRNA-mediated knockdown, we identified the nonselective SAC as Piezo1. Biophysical properties of the potassium-selective channel and its pharmacology indicated presence of ‘big potassium channels’, BKCa. In cells from AF patients, Piezo1 activity and mRNA expression levels were higher than in cells from sinus rhythm patients, while BKCa activity (but not expression) was downregulated. Both Piezo1-knockdown and removal of extracellular calcium from the patch pipette resulted in a significant reduction of stretch-induced BKCa current. No co-immunoprecipitation of Piezo1 and BKCa was detected.

Human atrial fibroblasts express functional Piezo1 and BKCa channels. While Piezo1 is directly stretch-activated, the increase in BKCa activity during mechanical stimulation appears to be mainly secondary to calcium influx via SAC such as Piezo1. During sustained AF, Piezo1 is increased, while BKCa activity is reduced, highlighting differential regulation of both channels. Our data show the presence and activity of Piezo1 and BKCa in human atrial fibroblasts and suggest an interplay between the two in the absence of direct physical interactions.

Retrospective dosimetry of Iodine-131 exposures using Iodine-129 and Caesium-137 inventories in soils--A critical evaluation of the consequences of the Chernobyl accident in parts of Northern Ukraine

The radiation exposure of thyroid glands due to (131)I as a consequence of the Chernobyl accident was investigated retrospectively based on (129)I and (137)Cs inventories in soils in Northern Ukraine. To this end, soil samples from 60 settlements were investigated for (129)I, (127)I, and (137)Cs by AMS, ICP-MS and gamma-spectrometry, respectively. Sampling was performed between 2004 und 2007. In those parts of Northern Ukraine investigated here the (129)I and (137)Cs inventories are well correlated, the variability of the individual (129)I/(137)Cs ratios being, however, high. Both the (129)I and (137)Cs inventories in the individual 5 samples for each settlement allowed estimating the uncertainties of the inventories due to the variability of the radionuclide deposition and consequently of the retrospective dosimetry. Thyroid equivalent doses were calculated from the (129)I and the (137)Cs inventories using aggregated dose coefficients for 5-year old and 10-year-old children as well as for adults. The highest thyroid equivalent doses (calculated from (129)I inventories) were calculated for Wladimirowka with 30 Gy for 5-years-old children and 7 Gy for adults. In 35 settlements of contamination zone II the geometric mean of the thyroid equivalent doses was 2.0 Gy for 5-years-old children with a geometric standard deviation (GSD) of 3.0. For adults the geometric mean was 0.47 Gy also with a GSD of 3.0. In more than 25 settlements of contamination zone III the geometric means were 0.82 Gy for 5-years old children with a GSD of 1.8 and 0.21 Gy for adults (GSD 1.8). For 45 settlements, the results of the retrospective dosimetry could be compared with thyroid equivalent doses calculated using time-integrated (131)I activities of thyroids which were measured in 1986. Thus, a critical evaluation of the results was possible which demonstrated the general feasibility of the method, but also the associated uncertainties and limitations.

Iodine-129, iodine-127 and caesium-137 in the environment: soils from Germany and Chile

Soil profiles from Bavaria in southern Germany and from Chile were analysed for (129)I by accelerator mass spectrometry (AMS), for (127)I by inductively coupled plasma mass spectrometry (ICP-MS), and for (137)Cs by gamma-spectrometry. The mean deposition density of (137)Cs in soils from Bavaria was (41×1.5(±1)) kBq m(-2) (geometric mean and geometric standard deviation), originating mostly from the Chernobyl fall-out. The deposition density of (129)I in these soils was (109×1.5(±1)) mBq m(-2). The dominant sources of (129)I in Bavaria are, however, the reprocessing plants La Hague and Sellafield and not the Chernobyl fall-out. The (129)I/(127)I isotopic ratios of the Bavarian soils were between 10(-7) and 10(-10), i.e. 10(2)-10(5) times higher than the ratios observed for the samples from Chile. The (129)I integral deposition densities in Chile, Easter Island and Antarctica were between 0.3 mBq m(-2) and 2 mBq m(-2). In these soils, the observed (129)I/(127)I ratios were about 10(-12). The soils from Chile allow the determination of the (129)I fall-out from the atmospheric nuclear weapons explosions undisturbed from contaminations due to releases from reprocessing plants. An upper limit of the integral (129)I deposition density of the atmospheric nuclear weapons explosions on the Southern Hemisphere (27°S) is about 1 mBq m(-2). Finally, the dependence of the migration behaviour of (137)Cs, (127)I and of (129)I on the soil properties is discussed. It turns out that there is a distinctly different behaviour of (127)I, (129)I, and (137)Cs in the soils exhibiting different sorption mechanisms for old and recent iodine as well as for (137)Cs.

Iodine-129 and iodine-127 in European seawaters and in precipitation from Northern Germany

In order to obtain a comprehensive survey on the consequences of the marine (129)I discharges from the European reprocessing plants La Hague and Sellafield, the distribution of (129)I and (127)I in surface waters of the North Sea, the English Channel, the Irish Sea, and the Northeast Atlantic was studied using accelerator mass spectrometry for (129)I and ICP-MS for (127)I. Samples of seawater were taken in the German Bight in May, September, and November 2005 and in the entire North Sea and the English Channel in August 2005. Further samples were obtained from the Irish Sea in June and August 2006 and from Arctic waters between Spitsbergen and Southern Norway in September 2005. (129)I is a conservative tracer in seawater. The concentrations of (127)I are relatively constant with exceptions of coastal areas with high biological activity and of areas influenced by influx from rivers and the Baltic Sea. The variability of the (129)I/(127)I isotopic ratios is exclusively determined by admixture of (129)I released from the reprocessing facilities Sellafield and La Hague to the seawater. The (129)I/(127)I ratios were between 4 × 10(-9)and 3 × 10(-6): at least 3 orders of magnitude higher than the natural equilibrium isotopic ratio 1.5 × 10(-12). (129)I/(127)I ratios of a few times 10(-10) were only found in seawater from the Indian Ocean and from the Pacific at Hawaii. Comparison of the results obtained for seawater with those of a measurement of airborne iodine species and with iodine isotopes in precipitation in Northern Germany demonstrates the transfer of (129)I and (127)I from the sea into the atmosphere and the dominating role of the marine discharges for the atmospheric fallout of (129)I in Western Europe. The results are discussed with the goal to estimate the relevance of the marine discharges for the contamination of the continental areas.

Accumulation of (137)Cs in Brazilian soils and its transfer to plants under different climatic conditions

The spatial distribution and behaviour of the global fallout (137)Cs in the tropical, subtropical and equatorial soil-plant systems were investigated at several upland sites in Brazil selected according to their climate characteristics, and to the agricultural importance. To determine the (137)Cs deposition density, undisturbed soil profiles were taken from 23 environments situated between the latitudes of 02 degrees N and 30 degrees S. Sampling sites located along to the equator exhibited (137)Cs deposition densities with an average value of 219Bqm(-2). Extremely low deposition densities of 1.3Bqm(-2) were found in the Amazon region. In contrast, the southern part of Brazil, located between latitudes of 20 degrees S and 34 degrees S, exhibited considerably higher deposition densities ranging from 140Bqm(-2) to 1620Bqm(-2). To examine the (137)Cs soil-to-plant transfer in the Brazilian agricultural products, 29 mainly tropical plant species, and corresponding soil samples were collected at 43 sampling locations in nine federal states of Brazil. Values of the (137)Cs concentration factor plant/soil exhibited a large range from 0.020 (beans) to 6.2 (cassava). Samples of some plant species originated from different collecting areas showed different concentration factors. The (137)Cs content of some plants collected was not measurable due to a very low (137)Cs concentration level found in the upper layers of the incremental soils. Globally, the soil-to-plant transfer of (137)Cs can be described by a logarithmic normal distribution with a geometric mean of 0.3 and a geometric standard deviation of 3.9.

Iodine-129 in soils from Northern Ukraine and the retrospective dosimetry of the iodine-131 exposure after the Chernobyl accident

Forty-eight soil profiles down to a depth of 40 cm were taken in Russia and Ukraine in 1995 and 1997, respectively, in order to investigate the feasibility of retrospective dosimetry of the 131I exposure after the Chernobyl accident via the long-lived 129I. The sampling sites covered areas almost not affected by fallout from the Chernobyl accident such as Moscow/Russia and the Zhitomir district in Ukraine as well as the highly contaminated Korosten and Narodici districts in Ukraine. 129I was analyzed by radiochemical neutron activation analysis (RNAA) and accelerator mass spectrometry (AMS). 127I was measured for some profiles by RNAA or ion chromatography (IC). The results for 127I demonstrated large differences in the capabilities of the soils to store iodine over long time spans. The depth profiles of 129I and of 137Cs showed large differences in the migration behavior between the two nuclides but also for each nuclide among the different sampling sites. Though it cannot be quantified how much 129I and 137Cs was lost out of the soil columns into deeper depths, the inventories in the columns were taken as proxies for the total inventories. For 129I, these inventories were at least three orders of magnitude higher than a pre-nuclear value of 0.084+/-0.017 mBq m(-2) derived from a soil profile taken in 1939 in Lutovinovo/Russia. From the samples from Moscow and Zhitomir, a pre-Chernobyl 129I inventory of (44+/-24) mBq m(-2) was determined, limiting the feasibility of 129I retrospective dosimetry to areas where the 129I inventories exceed 100 mBq m(-2). Higher average 129I inventories in the Korosten and Narodici districts of 130 and 848 mBq m(-2), respectively, allowed determination of the 129I fallout due to the Chernobyl accident. Based on the total 129I inventories and on literature data for the atomic ratio of 129I/131I=13.6+/-2.8 for the Chernobyl emissions and on aggregated dose coefficients for 131I, the thyroid exposure due to 131I after the Chernobyl accident was estimated for the inhabitants of four villages in the Korosten and of three villages in the Narodici districts. The limitations and uncertainties of the 129I retrospective dosimetry are discussed.

Evaluation of radioactive exposure from 137Cs in contaminated areas of Northern Ukraine

The paper gives averages of 137Cs deposition densities in soils from three areas in Northern Ukraine measured 12 to 15 y following the Chernobyl accident: in an area near Narodici (75 km west of the Chernobyl nuclear power plant in the so-called zone II) heavily contaminated by the Chernobyl fall-out and in areas around Korosten and Zhitomir showing contamination levels to be much lower. The three areas exhibited very different 137Cs deposition densities of 2.2 MBq m(-2), 400 kBq m(-2), and 5 kBq m(-2), respectively. During a 1-y observation, measurements of the 137Cs transfer in the food chain to humans and 137Cs whole body contents dependent on the 137Cs daily intake were carried out under realistic conditions of the rural inhabitants who lived in settlements within zone II. Detailed investigations of components of the daily diet showed that the high 137Cs contamination levels found in soils of zone II do not affect in any way low 137Cs concentrations of all important agricultural products harvested and consumed by villagers. With regard to consumption habits of the population of zone II, mushrooms and wild berries were found to contribute more than 95% of the 137Cs daily intake to the 137Cs whole body content of about 12 kBq (with maximum values up to 760 kBq) measured in a group of inhabitants of zone II during a period from July 1998 to July 1999. The median of the annual dose of these inhabitants from external and internal exposures was 1.2 mSv y(-1) with a geometric standard deviation of 2.6. Excluding extreme habits, the geometric mean of the total exposure was 1.0 mSv y(-1) with a geometric standard deviation of 1.3.

The significance of intrathecal opioid therapy for the treatment of neuropathic cancer pain conditions

The effectiveness of intrathecal opioid therapy when applied to different pain mechanisms, in particular neuropathic and nociceptive pain conditions, was studied retrospectively in 43 patients suffering from cancer pain. On the basis of clinical and radiological data, the pain mechanisms were categorized as nociceptive (n = 23) and neuropathic (n = 20). The average duration of treatment of nociceptive pain was 5 months, of neuropathic pain only 2.5 months. The initial median reduction of pain with intrathecal opioid therapy was 77.8% for nociceptive and 61.1% for neuropathic pain. Long-term results with patients suffering nociceptive pain showed a continuing good median pain reduction of 66.7%. Patients suffering from neuropathic pain showed poor long-term results (11.1% median pain reduction). Neuropathic pain in the extremities reacted least to the application of intrathecal opioids. Optimal results were obtained for nociceptive pain in the trunk area of the body.

On the analysis of iodine-129 and iodine-127 in environmental materials by accelerator mass spectrometry and ion chromatography

Based on a review of literature about the abundances of 129I (T1/2 = 15.7 Ma) in the environment we show that there is a severe lack of knowledge, in particular about natural, pre-nuclear levels. Among the two analytical techniques which are sensitive enough to investigate 129I in environmental materials, namely radiochemical neutron activation analysis (RNAA) and accelerator mass spectrometry (AMS), only AMS is capable of covering the natural, pre-nuclear levels. Since such AMS measurements require chemical separation of iodine from the matrix, a wide variety of separation schemes are necessary for environmental analyses. We report here on such schemes for the analysis of soils, plants and soft tissue. They are applied exemplarily to analyses of soils from the vicinity of Chernobyl. For chemical separations prior to analysis, contamination control and blank analyses are essential. Here, we discuss quality control procedures in detail, both for RNAA and AMS. In the case of AMS we use ion-chromatography (IC) for the determination of stable iodine. The IC analysis is included in the separation schemes for environmental materials. First AMS-analyses of terrestrial biospheric materials demonstrate that natural environmental levels of 129I are lower than previously deduced from investigations using RNAA, but higher than expected from model calculations. AMS is capable of providing the missing knowledge about the radioecology of 129I.

Biospheric 129I concentrations in the pre-nuclear and nuclear age

In order to detect characteristic regional differences or temporal changes of 129I concentrations in the biosphere, thyroids from humans, grazing livestock, and herbivorous wildlife species (reindeer and roedeer) were collected in various areas of the world which are not affected by reprocessing plants. For reasons of comparison, all samples were analyzed for their 129I:127I atom ratios. Human and bovine thyroids taken from the 10th region in Southern Chile (39 degrees-41 degrees South) indicated values of the 129I:127I atom ratio between 1.1 x 10(-9) and 2.0 x 10(-9) and between 1.2 x 10(-10) and 9 x 10(-9), respectively. They showed no significant increase in the concentration of biospheric 129I in comparison with that established in the pre-nuclear age. Atom ratios found in human thyroids collected in Lower Saxony (Federal Republic of Germany), which is a region not directly affected by reprocessing plants, exhibited 129I:127I values between 8 x 10(-9) and 6 x 10(-8) from February 1988 to September 1990. Thyroid glands of reindeer and roedeer as well as heather, moss, and lichen were taken from the Vilhelmina, Heby, and Gävle communes in Sweden and analyzed for 129I and 127I. All three communes were found to be seriously contaminated by fallout from the Chernobyl accident. Highest 129I:127I atom ratios between 3.5 x 10(-7) and 1 x 10(-6) were found in the Gävle commune (approximately 150 km northwest of Stockholm) where the highest 137Cs ground deposition (70-80 kBq m-2) was measured. Two soil samples taken from Krasnaya Gora and Mirny locations in Russia (approximately 200 km northeast of Chernobyl) exhibited ratios of about 1 x 10(-6). These locations showed a 137Cs ground deposition of 370 and 1,300 kBq m-2, respectively.

Axes: focus of taxonomy II

A number of persistent issues in the nursing diagnosis community have challenged the ability of one nursing diagnosis taxonomy to account for nursing's practice. The North American Nursing Diagnosis Association (NANDA) Taxonomy Committee, charged with the preparation of one taxonomy for all, has struggled with some of these issues and has initiated development of axes. The issues, figuratively speaking, become the axes. The axes are intended to describe the dimensions of the human condition. This article, third in a series of four, describes the process and development of the proposed axes.

Development of definitions for taxonomy II

In the process of placing diagnoses into Taxonomy I, certain inconsistencies became apparent. Inadequate definition of both diagnoses and human response patterns, lack of defining characteristics, and inconsistency in the levels of abstraction within the taxonomic hierarchy made the task of assigning a diagnosis to a taxonomic pattern difficult. Ambiguity in the definitions of the nine patterns resulted in ambiguity in the basic foundation, which affected the entire structure. The Taxonomy Committee, before evaluating the current structure, had to make the following decisions regarding the current human response patterns: (1) Should the nine human response patterns be retained for further taxonomic work? and (2) If they are retained, what should be the first step in examining Taxonomy I-Revised? This second article in a series of four will familiarize the readers with the process and decisions by which Taxonomy II of the North American Nursing Diagnosis Association (NANDA) is evolving through the work of the Taxonomy Committee. This article also will identify the specific problems encountered in the development of Taxonomy I and Taxonomy I-Revised, and describe the steps establishing the validity of the process of formation of the nine human response patterns.

[Medical, social, economic value of the rational use of non-invasive studies for diagnosing phlebitis. Experience of the Regional Hospital Center of Nimes from 1984 to 1988]

Continuous wave Doppler, and B-Mode ultrasound allow the diagnosis of deep venous thrombosis with a 96% sensitivity, and a 98% specificity versus venography (1). Therefore, these methods can be extensively used for the detection of deep venous thrombosis, following a new diagnostic algorithm: X ray venography is used only for the assessment of topographic extent of iliac and caval thrombosis, and when non invasive methods give equivocal results. As a result, the number of X ray venographies significantly decreased since 1984 (7) in Nîmes University Hospital. About 75% of patients with a deep venous thrombosis (diagnosed by non invasive methods) were treated without necessity of X ray venography.