A phase III study of belagenpumatucel-L, an allogeneic tumour cell vaccine, as maintenance therapy for non-small cell lung cancer

BACKGROUND

Treatment options after first-line chemotherapy are limited in non-small cell lung cancer (NSCLC). Belagenpumatucel-L is a therapeutic vaccine comprised of 4 transforming growth factor (TGF)-β2-antisense gene-modified, irradiated, allogeneic NSCLC cell lines that may be useful for maintenance after initial treatment.

METHODS

Stage III/IV NSCLC patients who did not progress after platinum-based chemotherapy were randomised 1:1 to receive maintenance belagenpumatucel-L or placebo. Patients were eligible for randomisation between one and four months from the end of induction chemotherapy. The primary endpoint was overall survival.

RESULTS

This phase III trial enrolled 270 patients in the belagenpumatucel-L arm and 262 in the control arm. Belagenpumatucel-L was well tolerated with no serious safety concerns. There was no difference in survival between the arms (median survival 20.3 versus 17.8months with belagenpumatucel-L versus placebo, respectively; hazard ratio (HR) 0.94, p=0.594). There were also no differences in progression-free survival (4.3months versus 4.0 for belagenpumatucel-L vs placebo, respectively; HR 0.99, p=0.947). A prespecified Cox regression analysis demonstrated that the time elapsed between randomisation and the end of induction chemotherapy had a significant impact on survival (p=0.002) and that prior radiation was a positive prognostic factor (median survival 28.4months with belagenpumatucel-L versus 16.0months with placebo; HR 0.61, p=0.032).

CONCLUSIONS

Although the overall trial did not meet its survival endpoint, improved survival for belagenpumatucel-L is suggested in patients who were randomised within 12weeks of completion of chemotherapy and in those who had received prior radiation. Further studies of belagenpumatucel-L in NSCLC are warranted.

Alterations of carbohydrate and lipoprotein metabolism in childhood obesity--impact of insulin resistance and acanthosis nigricans

AIM

To study the prevalence of alterations of glucose and lipoprotein metabolism and the impact of acanthosis nigricans (AN) in childhood obesity.

PATIENTS AND METHODS

113 obese children, 57 with simple obesity (SO) and 58 with obesity and AN (OAN). Oral glucose tolerance test was performed, serum glucose, insulin and lipoprotein parameters were determined, and insulin resistance/sensitivity indices were calculated.

RESULTS

Insulin resistance, basal and reactive hyperinsulinemia, impaired glucose tolerance (IGT) and dyslipidemia were found to be frequent conditions in children with OS as well as OAN. Reactive insulinemia was more pronounced in OAN than in SO, and insulin resistance was more frequent when AN was more prominent. Triglycerides were higher and HDL-C was lower, and atherogenic dyslipidemia was more frequent in OAN compared to SO.

CONCLUSION

Children with obesity form a risk population. AN is a factor which can be used in metabolic risk factor clustering estimation in childhood obesity.

A phase II study of DJ-927 administered orally once every three weeks as second line therapy to subjects with locally advanced or metastatic non small cell lung cancer (NSCLC) after failure of platinum-based non-taxane regimen

17006

Background: For the treatment of NSCLC (1st and 2nd line) effective oral formulations of drugs are currently investigated. DJ-927 is a semi-synthetic novel taxane with in vitro activity against NSCLC cells lines. Phase I studies show active plasma concentrations after oral administration with hematologic dose-limiting toxicity (DLT). This multi-centre phase II study was conducted to evaluate the safety and efficacy of the DJ-927 in patients (pts) with recurrent NSCLC. Methods: Pts with locally advanced or metastatic NSCLC who have received one prior platinum (non-taxane) containing treatment regimen, performance status 0 -2, and adequate organ function were enrolled. Pts received an initial DJ-927 dose of 27 mg/m2 on day 1 of cycle 1, orally, every 3-weeks. If < 2 DLTs occurred at this dose, the next cohort of 6 pts would start at a dose of 35 mg/m2, every 3 weeks, and all subsequent pts would be treated at that dose level. The primary endpoint was to assess the response rate. Pts were also assessed for time to disease progression (TTP), survival and safety. Results: 36 pts were enrolled, male/female 27/9; median age of 57 years (range 33–75); ECOG 0/1/2 7/21/8; stage IIIB/IV 12/24. Histology included adenocarcinoma 5; squamous cell 16; large cell 3; undifferentiated 3; other 7; unknown 2. Thirty-four pts received DJ-927; the median number of cycles was 2 (range 1–8). The optimal dosing level was confirmed at 27 mg/m2 as no dose escalation was performed based on toxicity data from parallel studies. Response in evaluable pts (completed Course 1) included CR 1, PR 1, SD 15, PD 8; for an overall response rate of 7 % and a disease control rate (CR, PR and SD) of 61%. Toxicity, ≥ grade 3, in evaluable pts (n = 32) included neutropenia (15), anaemia (6), thrombocytopenia (2), fatigue (2), nausea (2), anorexia (2), pneumonitis (1). Conclusions: In a 3-weekly setting, an oral dose 27 mg/m2 of DJ-927 shows limited efficacy in 2nd line therapy for NSCLC with neutropenia, gastrointestinal toxicity and fatigue as major side effects.

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Toxicity of a pendimethalin containing herbicide formulation and three heavy metals in chicken embryos

The toxic effects of a widely used herbicide (Stomp 330 containing 33% pendimethalin as active ingredient) applied alone or in combination with three heavy elements (copper sulphate, cadmium sulphate and lead acetate) modelling the heavy metal load of the environment were studied on chicken embryos with injection treatment. The treatment was done on day 0 of incubation. Solutions and emulsions of different concentrations were made from the test materials and injected in 0.1 ml volume into the air space of eggs. The macroscopical evaluations were done on day 19 of the incubation. Summarizing the findings, it can be established that the individual administration of the 33% pendimethalin containing herbicide formulation was less toxic compared to the control group than the simultaneous administration of the pesticide and heavy elements. As compared with each other the results from the combined administrations of the 33% pendimethalin containing herbicide formulation and heavy elements the simultaneous administration of cadmium and the herbicide caused the highest embryomortality while the incidence of developmental anomalies were the highest in the interaction study of the copper and the pesticide.

Teratogenicity testing of a 2,4-D containing herbicide formulation and three heavy metals in chicken embryos

The toxic effects of a widely used herbicide (Dikamin D containing 72% 2,4-D-amine Na as active ingredient) applied alone or in combination with three heavy elements (copper sulphate, cadmium sulphate and lead acetate) modelling the heavy metal load of the environment were studied on chicken embryos with injection treatment. The treatment was done on day 0 of incubation. Solutions and emulsions of different concentrations were made from the test materials and injected in 0.1 ml volume into the air space of eggs. The macroscopical evaluations were done on day 19 of the incubation. Summarizing the findings, it can be established that the individual administration of the 72% 2,4-D containing herbicide formulation was less toxic compared to the control group than the simultaneous administration of the pesticide and heavy elements. As compared with each other the results from the combined administrations of the 72% 2,4-D containing herbicide formulation and heavy elements the simultaneous administration of cadmium and the herbicide caused the highest embryomortality while the incidence of developmental anomalies were the highest in the interaction study of the copper and the pesticide.

Early embryogenesis study on a dimethoate containing formulation and Cd-sulphate in chicken embryos

The toxic effects of a widely used organophosphate insecticide (BI 58 EC containing 38% dimethoate as active ingredient) applied alone or in combination with cadmium sulphate modelling the heavy metal load of the environment were studied on chicken embryos in the early phase of development. Solutions and emulsions of different concentrations were made from the test materials and injected in 0.1 ml volume into the air space of eggs on the first day (day 0) of incubation. Subsequently, on days 2 and 3 of incubation permanent preparations were made from the embryos in order to study the early developmental stage. Embryos fixed on slides and stained with osmium tetroxide solution were studied under light microscope. Summarising the findings, it can be established that the embryotoxicity increased after the simultaneous administration of Cd-sulphate and 38% dimethoate containing insecticide formulation compared to the control or the individually treated groups.

Teratogenicity study of some pesticides in chicken embryos

The use of pesticides involves the risk of poisoning on wild animals. Teratological tests carried out on avian embryos provide useful data for environmental protection and facilitate the development of environment-friendly chemical plant protection techniques. A 30% dimethoate containing insecticide formulation (BI 58 EC) and a 20% benfluralin containing herbicide formulation (Flubalex) and a 960 g/l S-metolachlor containing herbicide formulation (Dual Gold 960 EC) were studied in chicken embryos after single administration by immersion and injection technique. Treatment was done on day 0 of incubation. Applied concentration of pesticides were 0.1% (dimethoate) and 2.05% (S-metolachlor) and 0.375% (benfluralin) corresponding to that used in plant protection practice. Test materials were injected into the air chamber in a volume of 0.1 ml/egg, or eggs were treated by the immersion technique for 30 min. at 37 degrees C. Evaluation was done on day 19 of incubation. Injection treatment: the administration of S-metolachlor and benfluralin did not result a significant decrease in the average body weight of embryos. At the same time the body weight of embryos significantly decreased because of single administration of dimethoate. The embryomortality increased markedly after the administration of test materials (S-metolachlor, benfluralin, dimethoate). Immersion treatment: the administration of S-metolachlor and benfluralin and dimethoate did not result a significant decrease in the average body weight of embryos. The rate of embryomortality was low after the administration of S-metolachlor, benfluralin and dimethoate. After the immersion and the injection treatment the incidences of developmental anomalies were sporadic. In summary it can be established that the injection treatment was more toxic than immersion technique of the test materials in our study.

Toxicity of a dichlorvos containing insecticide formulation and an atrazine containing herbicide formulation in chicken embryos after individual administration

A 50% dichlorvos containing insecticide formulation (Unifosz 50 EC) and a 50% atrazine containing herbicide formulation (Hungazin PK 50 WP) were studied in chicken embryos after administration as single compounds. Applied concentrations of dichlorvos were 0.1% (corresponding to the plant protection practice), 0.05%, 0.02%, 0.01%. Applied concentrations of atrazine were 0.66% (corresponding to the plant protection practice), 0.33%, 0.132%, 0.066%. The test materials were injected directly into the air-chamber of eggs on day 0 of the hatching period and evaulation was carried out on day 19 of incubation. The chicken embryos were examined for the following: rate of embryo mortality, body mass, type of developmental anomalies. After the single administrations of dichlorvos containing insecticide formulation and atrazine containing herbicide formulation on day 0 of incubation, the average body weight of chicken embryos significantly did not decrease as compared to the control. After the individual administrations of pesticides the incidence of developmental anomalies was sporadic. The embryonic mortality markedly increased at the highest concentrations of pesticides. The rate of embrio mortality were 61% (dichlorvos insecticide containing formulation) and 52% (atrazine containing herbicide formulation). In summary, the 50% dichlorvos containing insecide formulation (Unifosz 50 EC) and the 50% atrazine containing herbicide formulation (Hungazin PK 50 WP) were toxic to the developing chicken embryos at the highest concentration in our study. The toxic effect was expressed in the high rate of embrio mortality.

Subclinical pulmonary involvement assessed by bronchoalveolar lavage in patients with early undifferentiated connective tissue disease

OBJECTIVE

To assess the presence of neutrophil and lymphocyte fibrosing alveolitis by bronchoalveolar lavage in patients with early undifferentiated connective tissue disease (EUCTD) and systemic sclerosis (SSc).

METHOD

Bronchoalveolar lavage (BAL) was performed in 13 patients with EUCTD who exhibited signs of lung involvement by non-invasive methods including lung function tests and high resolution computed tomography. The mean age of cases was 48.1 +/- 6.6, and the mean disease duration was 1.8 +/- 0.8 years. Differential cell counts of BAL were evaluated. Eleven patients with systemic sclerosis and 5 healthy control subjects were also investigated.

RESULTS

Eleven of the 13 EUCTD and 10 of the 11 SSc patients showed an elevated total cell number (above the median cell/ml of control + 2 SD) in the BAL fluid. In patients with EUCTD, the lymphocyte count was elevated in 6, and the polymorphonuclear neutrophil count in 2 patients. One of the patients with EUCTD had simultaneously elevated lymphocyte and neutrophil granulocyte counts. In the SSc group, 6 patients had an elevated lymphocyte and 6 an increased neutrophil count. Three of these cases had both increased neutrophil and elevated lymphocyte counts, simultaneously.

CONCLUSION

Subclinical, predominantly lymphocyte alveolitis can be present in patients with EUCTD. Patients with SSc tend to exhibit neutrophil alveolitis.

Predictive value of MRI in lung cancer

Pathologic results of 543 lymph nodes removed during 164 radical surgery for lung cancer is compared with the expected findings based on preoperative MRI imaging. Specificity of T2 weighted MRI images were 95.5% for individual lymph nodes and 88.1% for TNM staging, respectively. Sensitivity was found to be 89.4% for lymph nodes and 94.6% for TNM staging of the patient. The accuracy of the MRI imaging was 84.7%. Properly chose MRI imaging and interpretation sounds to be no inferior to more invasive methods as collar mediastinoscopy, Chamberlain procedure or VATS exploration.

[Helicobacter pylori infection in diabetic patients]

The purpose of our research was to prove the occurrence of Helicobacter pylori infection in diabetic patients. Out of the 100 patients who were treated at the diabetological clinic, the antibody of Helicobacter pylori could be shown in 57 patients. Through histological tests carried out in the course of upper panendoscopia of the patients having positive results of serological test, Helicobacter pylori infection could be actually proved in 39 cases. On the basis of the evaluated material of diabetic patients, the occurrence of Helicobacter pylori infection was not higher than that in of the average population. No connection has been found between the frequency of the infection, and type of diabetes or its duration. The eradicational treatment was successful with 85% of the patients.

Calcifying liver metastases in a case of primary lung cancer

A 50-year-old man presented with primary lung cancer with bone lesions and calcifying liver nodi. Two months after stopping chemotherapy, he died. Autopsy revealed multiple organ metastases. Histologically, the calcified nodi in the liver proved to be affected by tumor metastasis.

[The role of computerized tomography in the staging of lung cancer]

Staging of lung cancer place significant role in the prognosis and treatment of the disease. Beside bronchoscopy, CT one of the important method for the tumor staging. 135 CT examinations with diagnosis of suspected lung cancer were evaluated and radiologic diagnosis was compared with the cyto-histological and surgical results. In 112 cases both CT and histological diagnosis were performed: both method revealed malignant tumors in 108 cases. Five lesions were regarded as tumour by CT but histological result proved aspergilloma, or specific processes. Abnormal lymph nodes were recognised at 98 tumours patients. There was a good correlation-regarding the number, size measurement-between CT and surgery. Histological diagnosis proved that all of the lymph nodes larger, then 2 cm of diameter contained metastic cells. In the 1-2 cm size almost all of the lymph nodes were metastatic. In addition tumour cells were found in some lymph nodes smaller, than 1 cm, too. This gives warning sign: smaller lymph nodes need more attention than we assumed. CT prove to be confident method for the evaluation, measurement and localisation of the tumours and lymph nodes in the chest.

[Thoracic actinomycosis]

The authors describe in their case study the history of a 51 year old man, at whom they verified without thoracotomy thoracal actinomycosis. They achieved recovery giving permanently high doses of Penicillin. In connection with this rare case the authors review pathogenesis, the symptomatology, the diagnosis and the therapy of actinomycosis. The authors have found only one case in the Hungarian literature, which was recognized without thoracotomy and was cured by antibiotic therapy within a short period of time.

High lipoprotein(a) levels with predominance of high molecular weight apo(a) isoforms in patients with pulmonary embolism

Lipoprotein(a) (Lp(a)) may interact with the cellular components and protein co-factors of fibrinolysis. To evaluate the effect of Lp(a) in thromboembolic diseases of the venous system, we measured serum levels and the isoform distribution of apo(a) in 25 patients with pulmonary embolism (18 men, 7 women, aged 21-77 years). The control group was adjusted for sex and age (P = 0.189). Serum Lp(a) concentration was significantly higher in the study group (median: 9.3 vs. 4.3 mg dL-1). As the distribution of high and low molecular weight subtypes of apo(a) did not show any differences (P = 0.127) between the two groups, the elevated Lp(a) levels in patients with pulmonary embolism could not be attributed to the investigated kringle-4 polymorphism of the apo(a) gene and therefore other genetic or non-genetic implications are indicated.

Plasma lipoprotein (a) concentration and phenotypes in diabetes mellitus

Patients with Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes mellitus are at increased risk of developing atherosclerotic vascular diseases. A variety of lipoprotein abnormalities have been described as being associated with this increased risk. In this study, apo(a) isoform frequencies and lipoprotein(a) [Lp(a)] concentrations were determined in Type 1 and Type 2 diabetic patients in order to investigate a possible contribution of Lp(a) to the increased risk for atherosclerosis in diabetes. No significant differences in plasma Lp(a) concentrations were found in two ethnically different populations (Austrians from the province of Tyrol and Hungarians from Budapest) in either type of diabetes when compared to respective control groups (91 Type 1 and 112 Type 2 diabetic patients vs 202 control subjects in the Hungarian study and 44 Type 1 diabetic and 44 Type 2 diabetic vs 125 control subjects in the Austrian study). There were also no significant apo(a) isoform frequency differences between both patient groups and control subjects in the two study groups. These data, obtained from two large ethnically different populations, provide no evidence of a contribution of Lp(a) to the increased risk for atherosclerosis in diabetes.

[Doege-Potter syndrome. Fibrous mesothelioma of multicentric localization, causing hypoglycemia]

The authors present a case of a 73 year old female patient. She had a left side pleural mesothelioma and had been operated thrice. At the third operation an abdominal propagation joined to the thoracic mesothelioma. Starting from this third surgery severe hypoglycemic episodes illustrated the clinical pictures. The electronmicroscopy of the resected tumor mass documented the presence of neurosecretory granules. This strongly suggests that tumor mass produced a substance which could have been responsible for the hypoglycemic episodes. Due to the fact the insulin levels measured during severe hypoglycemias were always on a low level, we suppose that an insulin like material (IGF--II) was responsible for the above mentioned symptoms. The authors briefly review the literature.

[Herpes zoster infection with acute urinary retention]

The history of a young female patient is presented. She developed urine retention of sudden onset as a complication of herpes zoster infection manifested in the sacral dermatomes. Symptomatic and antiviral treatments were introduced with full recovery of bladder function. The correct diagnosis of this rare and benign complication of herpes zoster infection can help to avoid unnecessary and invasive examinations.

The effect of oxidative stress on inbred mice of different ages

The effect of oxidative stress applied for 2 months was compared in adult (14-month-old) and aged (27-month-old) female BALB/c mice. The stress was administered in two ways. One group of animals received a high dose of H2O2 (0.5% H2O2 in drinking water) the other one was given a low dose of H2O2 (0.4 ml of 0.5% H2O2 by esophageal cannula every alternate day). After a 2-month treatment the activity of superoxide dismutase (SOD), catalase and lipid peroxidation capacity were measured in liver homogenates of mice. The activity of catalase and capacity of lipid peroxidation gradually decreased as a function of age while the SOD activity did not reduce even in older mice. The aged-mice could tolerate a high dose of H2O2 mainly by increasing SOD activity. As a result of intake of low dose of H2O2 in old animals SOD activity was decreased and lipid peroxidation capacity was getting higher suggesting that in this life period the liver tissue is very sensitive to chronic, oxidative stress effects of low dose.

[Study of two psychosomatic disorders of the gastrointestinal system (ulcer, colitis) using the Frustration Test]

By means of the frustration test (PFT) authors studied two psychosomatic diseases (ulcer and colitis) of the gastrointestinal tract. According to pertinent literature and pertinent literature and personal experiences the test will be helpful in revealing elaboration modalities of stress which are of decisive importance in the pathogenesis of the diseases. The study has been carried out on altogether 281 persons divided into following groups: psychosomatic patients in the "organic" and the "functional" stage, neurotics, and sine morbo controls, respectively. Statistical analysis and the paired t-test was used for the evaluation of results. It has been established that the particular psychosomatic type of reaction, the PFT-profile corresponding the "acting in", having been assessed by authors did exist. Nevertheless it permits no differentiation between patients in the "organic" and "functional" stage, as well as the neurotics with psychosomatic complaints, respectively. Some specific signs have been found however being characteristic for psychosomatic patients in the "organic" stage. According to authors disturbances of personality development lead in both, the neurotic and, they psychosomatic patients to disorders of adaptation, the ego integration, and inadequacy of mechanisms of stress elaboration. PFT is suitable to clear severity of the psychic anomaly.