A phase I study of talazoparib (BMN 673) combined with carboplatin and paclitaxel in patients with advanced solid tumors (NCI9782)

Background

Inhibitors of poly(ADP‐ribose) polymerase (PARP) proteins potentiate antitumor activity of platinum chemotherapy. This study sought to determine the safety and tolerability of PARP inhibitor talazoparib with carboplatin and paclitaxel.

Methods

We conducted a phase I study of talazoparib with carboplatin AUC5‐6 and paclitaxel 80 mg/m² days 1, 8, 15 of 21‐day cycles in patients with advanced solid tumors. Patients enrolled using a 3 + 3 design in two cohorts with talazoparib for 7 (schedule A) or 3 days (schedule B). After induction with 4–6 cycles of triplet therapy, patients received one of three maintenance options: (a) continuation of triplet (b) carboplatin/talazoparib, or (c) talazoparib monotherapy.

Results

Forty‐three patients were treated. The MTD for both schedules was talazoparib 250mcg daily. The main toxicity was myelosuppression including grade 3/4 hematologic treatment‐related adverse events (TRAEs). Dose modification occurred in 87% and 100% of patients for schedules A and B, respectively. Discontinuation due to TRAEs was 13% in schedule A and 10% in B. Ten out of 22 evaluable patients in schedule A and 5/16 patients in schedule B had a complete or partial response. Twelve out of 43 patients received ≥6 cycles of talazoparib after induction, with a 13‐month median duration of maintenance.

Conclusion

We have established the recommended phase II dose of Talazoparib at 250mcg on a 3‐ or 7‐day schedule with carboplatin AUC6 and paclitaxel 80 mg/m² on days 1, 8, 15 of 21‐day cycles. This regimen is associated with significant myelosuppression, and in addition to maximizing supportive care, modification of the chemotherapy component would be a consideration for further development of this combination with the schedules investigated in this study.

Depletion of CCN1/CYR61 reduces triple-negative/basal-like breast cancer aggressiveness

Triple-negative/basal-like breast cancer (BC) is characterized by aggressive biological features, which allow relapse and metastatic spread to occur more frequently than in hormone receptor-positive (luminal) subtypes. The molecular complexity of triple-negative/basal-like BC poses major challenges for the implementation of targeted therapies, and chemotherapy remains the standard approach at all stages. The matricellular protein cysteine-rich angiogenic inducer 61 (CCN1/CYR61) is associated with aggressive metastatic phenotypes and poor prognosis in BC, but it is unclear whether anti-CCN1 approaches can be successfully applied in triple-negative/basal-like BC. Herein, we first characterized the prevalence of CNN1 expression in matched samples of primary tumors and metastatic relapse in a series of patients with BC. We then investigated the biological effect of CCN1 depletion on tumorigenic traits in vitro and in vivo using archetypal TNBC cell lines. Immunohistochemical analyses of tissue microarrays revealed a significant increase of the highest CCN1 score in recurrent tissues of triple-negative/basal-like BC tumors. Stable silencing of CCN1 in triple-negative/basal-like BC cells promoted a marked reduction in the expression of the CCN1 integrin receptor αvβ3, inhibited anchorage-dependent cell growth, reduced clonogenicity, and impaired migration capacity. In an orthotopic model of triple-negative/basal-like BC, silencing of CCN1 notably reduced tumor burden, which was accompanied by decreased microvessel density and concurrent induction of the luminal epithelial marker E-cadherin. Thus, CNN1/CYR61-targeting strategies might have therapeutic value in suppressing the biological aggressiveness of triple-negative/basal-like BC.

Problem Solving Training for Veterans with Complex Comorbidities: Treatment Delivery Adaptations during COVID-19

OBJECTIVES

To summarize adaptations due to COVID-19 for VA Problem Solving Training (PST) for clinicians serving medically complex patients and to compare patient mental health outcomes in the year before (2019) and during COVID-19 (2020).

METHODS

Clinicians attended a multi-day workshop and up to 6 months of small-group consultation for two training cases. In 2019 and 2020, 122 Veteran patients completed baseline and posttreatment measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7 item), and negative problem-solving beliefs (Negative Problem Orientation Questionnaire). Qualitative data were collected on clinician's pandemic-related treatment implementation challenges.

RESULTS

Program adaptations during COVID-19 addressed challenges due to delivering treatment by telephone, video, or in person; Veteran patient recruitment barriers; and privacy issues for telephone and video. Veterans in both pre-pandemic and COVID-19 cohorts had significant improvements in depression, anxiety, and negative problem-solving beliefs, with no significant differences in the amount of improvement between the two cohorts.

CONCLUSIONS

Flexibilities afforded to clinicians delivering the PST training program during the pandemic addressed key obstacles and barriers to recruitment, and implementation did not diminish the effectiveness of the intervention.

CLINICAL IMPLICATIONS

Findings support continued implementation of the PST training program with added flexibility to treatment delivery beyond the pandemic.

Large seasonal fluctuations in whole-tree carbohydrate reserves: is storage more dynamic in boreal ecosystems?

BACKGROUND AND AIMS

Carbon reserves are a critical source of energy and substrates that allow trees to cope with periods of minimal carbon gain and/or high carbon demands, conditions which are prevalent in high-latitude forests. However, we have a poor understanding of carbon reserve dynamics at the whole-tree level in mature boreal trees. We therefore sought to quantify the seasonal changes in whole-tree and organ-level carbon reserve pools in mature boreal Betula papyrifera.

METHODS

Non-structural carbohydrate (NSC; soluble sugars and starch) tissue concentrations were measured at key phenological stages throughout a calendar year in the roots, stem (inner bark and xylem), branches and leaves, and scaled up to estimate changes in organ and whole-tree NSC pool sizes. Fine root and stem growth were also measured to compare the timing of growth processes with changes in NSC pools.

KEY RESULTS

The whole-tree NSC pool increased from its spring minimum to its maximum at bud set, producing an average seasonal fluctuation of 0.96 kg per tree. This fluctuation represents a 72 % change in the whole-tree NSC pool, which greatly exceeds the relative change reported for more temperate conspecifics. At the organ level, branches accounted for roughly 48-60 % of the whole-tree NSC pool throughout the year, and their seasonal fluctuation was four to eight times greater than that observed in the stemwood, coarse roots and inner bark.

CONCLUSIONS

Branches in boreal B. papyrifera were the largest and most dynamic storage pool, suggesting that storage changes at the branch level largely drive whole-tree storage dynamics in these trees. The greater whole-tree seasonal NSC fluctuation in boreal vs. temperate B. papyrifera may result from (1) higher soluble sugar concentration requirements in branches for frost protection, and/or (2) a larger reliance on reserves to fuel new leaf and shoot growth in the spring.

Squamous Metaplasia in Colonic Tubulovillous Adenoma: A Three Case Series and review of literature

Introduction/Objective

Although squamous metaplasia of colonic tubulovillous adenoma is a rare phenomenon, colorectal polyps can show focal squamous metaplasia. While the exact cause in unknown, it has been suggested that mechanical irritation, torsion and chronic inflammation may predispose to squamous metaplasia within large colonic polyps.

Methods/Case Report

We observed this finding in two men and one woman with colorectal polyps who underwent endoscopic mucosal resection in a three-week timeframe. In two cases the polyps were rectal, while in the third case, it was located in the descending colon. Polyp size ranged from 1-5 cm and were semi-pedunculated. Histologically, all three lesions were tubulovillous adenomas with focal high-grade dysplasia and multiple foci of squamous metaplasia characterized by cells with benign-appearing nuclei, eosinophilic cytoplasm, and solid growth pattern. Some metaplastic foci approached the muscularis mucosae, mimicking adenocarcinoma at low power magnification. Interestingly, these metaplastic foci were reactive against p16 immunohistochemical stain.

Results (if a Case Study enter NA)

NA

Conclusion

We present these three cases to add to the few previously reported. Pathologists should be aware of this finding to avoid the overdiagnosis of invasive carcinoma in the setting of nested and pseudo invasive squamous morules, especially in polyps with high grade dysplasia. In addition, squamous metaplasia could be a precursor lesion for colorectal squamous cell carcinoma.

Presentation of a diagnostically challenging case of chronic eosinophilic leukemia with marrow dysplasia and ringed sideroblasts

Chronic eosinophilic leukemia, not otherwise specified can be challenging to differentiate from hypereosinophilic syndrome and myelodysplastic syndromes with elevated eosinophilia. We present a diagnostically challenging case of chronic eosinophilic leukemia, not otherwise specified that initially seemed like a myelodysplastic syndrome but progressed to eosinophilic tissue infiltration and overt eosinophilic dyspoiesis. In addition, we discuss the morphologic and molecular findings that can overlap among these entities that made the diagnosis difficult in the case presented.

Epidermoid Cyst in Male Patient Mimicking a Suspicious Breast Mass and Consequences of Biopsy

Male patients presenting to the mammography department for workup of breast disease is an overall rare event compared to females. Gynecomastia is statistically the most common breast condition afflicting male patients, with ductal carcinoma an uncommon secondary diagnostic consideration. Secondary benign breast conditions or mimickers of breast disease in men are even rarer than primary carcinoma and can pose a significant challenge in breast imaging workups. We present a challenging workup of a superficial epidermoid cyst (EC) in a male patient with significant subcutaneous growth and indeterminate imaging characteristics, mimicking a breast neoplasm. Furthermore, we present undesirable consequences of performing a biopsy of an EC including rupture and abscess formation.

A case report of paraneoplastic syndrome in β-hCG-secreting duodenal adenocarcinoma

Human chorionic gonadotropin (hCG) is a glycoprotein hormone that is used in clinical practice to detect pregnancy and serves as a sensitive marker for trophoblastic tumors. Other organs besides placental trophoblasts naturally express the hormone at low levels, which can be elevated in nontrophoblastic malignancies. Some studies have suggested that elevated β-hCG levels in nontrophoblastic tumors are a sign of aggressive disease and strongly associated with poor prognosis. We describe a case of a 50-year-old post-menopausal woman with metastatic duodenal adenocarcinoma who presented with a negative pregnancy test that later changed to positive. Biopsy of the primary duodenal mass showed positive immunohistochemical expression of β-hCG. The patient was also found to have multiple brain metastases, which is uncommon in gastrointestinal cancer. This is a rare case of paraneoplastic syndrome in a β-hCG-secreting duodenal adenocarcinoma.

Supply, distribution and characteristics of international medical graduates in family medicine in the United States: a cross-sectional study

Background

To describe the supply, distribution, and characteristics of international medical graduates (IMGs) in family medicine who provide patient care in the U.S.

Methods

A cross-sectional study design, using descriptive statistics on combined data from the Educational Commission for Foreign Medical Graduates and the American Medical Association, including medical school attended, country of medical school, and citizenship when entering medical school.

Results

In total, 118,817 physicians in family medicine were identified, with IMGs representing 23.8% (n = 28,227) of the U.S. patient care workforce. Of all 9579 residents in family medicine, 36.0% (n = 3452) are IMGS. In total, 35.9% of IMGs attended medical school in the Caribbean (n = 10,136); 19.9% in South-Central Asia (n = 5607) and 9.1% in South-Eastern Asia (n = 2565). The most common countries of medical school training were Dominica, Mexico, and Sint Maarten. Of all IMGs in family medicine who attended medical school in the Caribbean, 74.5% were U.S. citizens. In total, 40.5% of all IMGs in family medicine held U.S. citizenship at entry to medical school. IMGs comprise almost 40% of the family medicine workforce in Florida, New Jersey and New York.

Conclusions

IMGs play an important role in the U.S. family medicine workforce. Many IMGs are U.S. citizens who studied abroad and then returned to the U.S. for graduate training. Given the shortage of family physicians, and the large number of IMGs in graduate training programs, IMGs will continue to play a role in the U.S. physician workforce for some time to come. Many factors, including the supply of residency training positions, could eventually restrict the number of IMGs entering the U.S., including those contributing to family practice.

A Recurrence of Bilateral Diffuse Sclerosing Lobular Hyperplasia of Breast: A Case Report

Mammary sclerosing lobular hyperplasia is an uncommon benign fibroproliferative lesion of adolescent and young women, often of African American heritage with an incidence of ~3%. Patients generally complain of a palpable, painless, or slightly tender and well-defined lump in breast. Very rarely, this lesion may be bilateral and diffuse. The definitive diagnosis of sclerosing lobular hyperplasia requires histopathologic evaluation. Here, we describe a case of diffuse sclerosing lobular hyperplasia in a 29-year-old African American woman that required bilateral mastectomy and recurred bilaterally requiring second resections. This appears to be the first report of this phenomenon.

Abstract B19: Breast cancer patient-derived xenografts: The University of Illinois at Chicago Cancer Center experience

Introduction: The purpose of this study was to create the first ever breast cancer patient-derived xenograft (PDX) model at the University of Illinois at Chicago (UIC) Cancer Center available to all breast cancer investigators. The intention is to provide opportunities to perform preclinical trials of lead cancer drugs as well as to conduct racial disparity studies.

Methods: All patient tissues were collected from informed, consented patients with an IRB approved protocol (#14-1078) and with compliance of HIPAA law. None of the patients received neoadjuvant chemotherapy. Within 30 minutes of surgical excision, each tumor specimen was bilaterally implanted into the 2nd thoracic mammary fat pad of two NOD/SCID/IL2γ-receptor null (NSG) mice. Additional tissue was placed in RNAlater for gene expression analysis in successful engraftments. Transplantation sites were monitored daily for one week and measured weekly with calipers using the formula l x w2/2. Formalin-fixed and paraffin embedded sections (5 μm) were stained with hematoxylin and eosin (H&E) for histological examination. Immunohistochemical (IHC) staining was performed with ERα (SP1), CD20 (L26), and keratin cocktail (AE1/3) antibodies (Ventana).

Results: Between April and August 2015, a total of eleven primary breast cancer PDXs were engrafted from eight African-American, two Caucasian and one patient of unknown race. The subtypes represented in these primary engraftments included one triple-negative breast cancer (TNBC), eight estrogen receptor alpha positive (ERα+) and two HER2 positive (HER2+) PDXs. Five primary PDXs engrafted successfully and were passaged to second generation mice including one TNBC and four ERα+ PDXs. After 12 weeks of primary engraftment, UIC-PDX#6 (ERα+) PDX grew at a much faster rate than any of the other PDXs and was passaged twice. Following the second passage, tumor tissue was processed for histological examination when it was discovered the PDX was not a tumor of epithelial origin, but was in fact a tumor of B-cell origin. This finding is in agreement with the recent report by Bondarenko et. al. (Neoplasia, 2015) that B-cell lymphomas frequently occur in PDXs engrafted into NSG mice. At the time of this writing, the remaining TNBC and ERα+ PDXs are growing at a slower pace in the second passage NSG mice and two additional primary PDXs are growing and nearing secondary passage.

Conclusions: A breast cancer PDX effort was initiated at UIC from a racially diverse patient population. Despite engraftment of a B-cell tumor in one PDX, four promising stable breast cancer PDXs are currently being maintained. We have plans to test and validate novel endocrine therapies as well as other promising strategies to treat breast cancer.

Citation Format: Huiping Zhao, Thao Pham, Rajyasree Emmadi, Elizabeth Wiley, Michael Warso, Alejandra Perez-Tamayo, George Salti, Kent Hoskins, Debra A. Tonetti. Breast cancer patient-derived xenografts: The University of Illinois at Chicago Cancer Center experience. [abstract]. In: Proceedings of the AACR Special Conference: Patient-Derived Cancer Models: Present and Future Applications from Basic Science to the Clinic; Feb 11-14, 2016; New Orleans, LA. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(16_Suppl):Abstract nr B19.

DNA methylation and hormone receptor status in breast cancer

Background

We examined whether differences in tumor DNA methylation were associated with more aggressive hormone receptor-negative breast cancer in an ethnically diverse group of patients in the Breast Cancer Care in Chicago (BCCC) study and using data from The Cancer Genome Atlas (TCGA).

Results

DNA was extracted from formalin-fixed, paraffin-embedded samples on 75 patients (21 White, 31 African-American, and 23 Hispanic) (training dataset) enrolled in the BCCC. Hormone receptor status was defined as negative if tumors were negative for both estrogen and progesterone (ER/PR) receptors (N = 22/75). DNA methylation was analyzed at 1505 CpG sites within 807 gene promoters using the Illumina GoldenGate assay. Differential DNA methylation as a predictor of hormone receptor status was tested while controlling for false discovery rate and assigned to the gene closest to the respective CpG site. Next, those genes that predicted ER/PR status were validated using TCGA data with respect to DNA methylation (validation dataset), and correlations between CpG methylation and gene expression were examined. In the training dataset, 5.7 % of promoter mean methylation values (46/807) were associated with receptor status at P < 0.05; for 88 % of these (38/46), hypermethylation was associated with receptor-positive disease. Hypermethylation for FZD9, MME, BCAP31, HDAC9, PAX6, SCGB3A1, PDGFRA, IGFBP3, and PTGS2 genes most strongly predicted receptor-positive disease. Twenty-one of 24 predictor genes from the training dataset were confirmed in the validation dataset. The level of DNA methylation at 19 out 22 genes, for which gene expression data were available, was associated with gene activity.

Conclusions

Higher levels of promoter methylation strongly correlate with hormone receptor positive status of breast tumors. For most of the genes identified in our training dataset as ER/PR receptor status predictors, DNA methylation correlated with stable gene expression level. The predictors performed well when evaluated on independent set of samples, with different racioethnic distribution, thus providing evidence that this set of DNA methylation biomarkers will likely generalize to prospective patient samples.

Electronic supplementary material

The online version of this article (doi:10.1186/s13148-016-0184-7) contains supplementary material, which is available to authorized users.

Correlative Analysis of miRNA Expression and Oncotype Dx Recurrence Score in Estrogen Receptor Positive Breast Carcinomas

Altered expression of miRNAs has been observed in many types of cancer, including breast cancer, and shown to contribute to cancer growth, aggressiveness, and response to therapies. In this pilot study, we investigated the possible correlation of miRNAs with risk of recurrence of estrogen receptor positive, lymph node-negative mammary carcinomas as determined by the Oncotype DX® Breast Cancer assay. To accomplish this, we extracted RNA from a collection of breast carcinomas that had previously been analyzed by Oncotype DX®. Multiple Let-7 family members were negatively correlated with the recurrence score (RS), which is consistent with their tumor suppressor properties. Additional miRNAs were found to positively correlate with RS, including miR-377-5p, miR-633b, miR-548t and miR-3648. Pathway analysis of putative and validated targets suggests that these miRNAs may have a diverse range of functions that may contribute to tumor recurrence. Taken together, these findings provide evidence that a miRNA expression signature can be developed to aid existing methods to determine the risk of recurrence for women with estrogen receptor positive breast cancers treated with endocrine therapy.

Abstract B51: Exploring the role of reproductive factors and DNA methylation in ethnic disparities in breast cancer tumor aggressiveness

Purpose: Non-Hispanic (nH) Black and Hispanic (or minority) breast cancer patients tend to be diagnosed with more aggressive forms of breast cancer compared to their nH White counterparts. Prior research as well as analyses from the current study has identified hormonal and reproductive factors associated with breast cancer aggressiveness subtypes. We explored the potential role of hormonal and reproductive factors, and the potential contribution of DNA methylation, in explaining the racial/ethnic disparity in tumor aggressiveness in a population based study of breast cancer disparities.

Methods: The breast Cancer Care in Chicago (BCCC) study included 989 recently diagnosed nH White, nH Black and Hispanic patients with first primary breast cancer. Analyses include a subset of 286 patients with available tumor immunohistochemistry (IHC) data on estrogen and progesterone receptor (ER/PR), HER2, p53 and Ki67 status. A tumor aggressiveness score (TAS) with a high internal reliability coefficient (Chronbach's alpha=0.76) was created from tumor grade and IHC data on ER, PR, HER2, p53 and Ki67. Values were standardized to have a mean of 0 and standard deviation of 1, then summed together and re-standardized to create the score. Pyrosequencing assays for DNA methylation were conducted on a set of DNA sequences identified based on prior literature, ENCODE data for DNA methylation, and transcription for normal vs. cancer cell lines from the UCSC genome browser. Of the 286 patients with tumor aggressiveness data, 214 had available methylation data for BRCA1, GSTM2, EGFR, RASSF1, Sat2 and TFF1 genes. Multivariable linear regression models were estimated with standardized aggressiveness score as the dependent variable and using nested models to conduct likelihood ratio tests for both forward (type 1) and backwards (type 3) analyses. A method of rescaled-coefficients was then used to estimate an average controlled direct effect representing the ethnic disparity in breast cancer tumor aggressiveness and the extent to which the disparity might be explained by patient reproductive factors and tumor DNA methylation. Because stage at diagnosis is downstream of, and strongly influenced by, tumor aggressiveness, it was excluded from our analyses.

Results: Factors significantly associated with having a higher TAS (p&lt; 0.05) included: nH black or Hispanic race/ethnicity; younger age at first birth; nulliparity; positive family history (FH) of breast cancer, longer use of oral contraceptives; higher pathologic stage; and higher mean BRCA1, GSTM2 and TFF2 methylation levels. In multivariable modeling, variables retained for further analysis included: FH, nulliparity, and methylation of BRCA1, GSTM2, TFF1 and Sat2. In forwards (type 1) analysis of nested models, both nulliparity (p= 0.034) and DNA methylation variables (p&lt; 0.001) were retained. In backwards (type 3) analyses, DNA methylation variables (p&lt; 0.001) but not nulliparity (p= 0.261) were retained. As independent domains, DNA methylation variables explained 46% of the ethnic disparity in TAS (p= 0.054), whereas nulliparity explained 38% (p= 0.058), and family history did not explain any of the disparity. Further, the combination of DNA methylation variables and nulliparity together explained 63% of the disparity (p= 0.033).

Conclusions: Our findings suggest that DNA methylation of specific genes may influence breast cancer tumor aggressiveness and may help to explain the preponderance of aggressive subtypes diagnosed in ethnic minority women. DNA methylation may represent a promising avenue for biomarker development for early detection for biologically aggressive tumor types in vulnerable populations. These findings require replication and validation in other studies.

Citation Format: Keith A. Dookeran, Abeer M. Mahmoud, Matthew Poulin, Liying Yan, Melanie Ehrlich, Jacob K. Kresovich, Virgilia Macias, Andre Kajdacsy-Balla, Elizabeth Wiley, Garth H. Rauscher. Exploring the role of reproductive factors and DNA methylation in ethnic disparities in breast cancer tumor aggressiveness. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B51.

Risk of Colorectal and Other Cancers in Patients With Serrated Polyposis

Patients with serrated polyposis develop multiple colorectal hyperplastic and/or serrated sessile adenomas/polyps. We investigated the risk of colorectal and other cancers by analyzing data from 64 patients with serrated polyposis (mean age at diagnosis, 54 y; 41% men; 92% white) listed in the Johns Hopkins Polyposis Registry. Medical, endoscopic, and histopathology reports were evaluated. Six patients (9.4%) had a history of colorectal cancer, diagnosed at a mean age of 56 years; 6 additional patients (9.4%) had at least 1 advanced colorectal adenoma. Extracolonic cancers were found in 16% of the study population. The standard incidence ratio for colorectal cancer in patients with serrated polyposis was 18.72 (95% confidence interval, 6.87-40.74) and for extracolonic cancer was 31.20 (95% confidence interval, 14.96-57.37), compared with the Surveillance, Epidemiology, and End Results population. Patients with serrated polyposis therefore have a high risk for colorectal cancer and require vigilant colorectal surveillance, starting at the time of diagnosis of serrated polyposis. The risk of extracolonic cancer also appears to be increased, but this requires further evaluation.

Primary peritoneal angiosarcoma: a case report

Peritoneal angiosarcoma is an extremely rare sarcoma (0.01287% incidence per 100,000) with an aggressive clinical course and a poor prognosis. We herein report a case of a young man with diagnosis of angiosarcoma whose tumor adhering to the inferior wall of his bladder and omentum was initially thought to be rhabdomyosarcoma. His disease state progressively worsened, despite initiation of different types of chemotherapies. Blood was tested for cytokine and soluble receptor levels. Unexpectedly and never previously reported, very high levels of interleukin-6 (IL-6), osteopontin, and prolactin were found. Surprisingly, angiogenic cytokines levels were low. The patient died 5 months after initial presentation. In the present report, we discuss the difficulties in diagnosing this rare sarcoma and possible therapeutic targets, including the IL-6 pathway that may provide more effective ways in controlling this cancer in its metastatic stage.

Abstract 1846: Cyr61 a therapeutic target for breast carcinomas

Background: Cyr61, also known as CCN1, is a survival and pro-angiogenic factor overexpressed in invasive breast tumors that promotes tumorigenicity. We investigated whether Cyr61 plays important roles in breast cancer and evaluated its potential role as a chemotherapeutical target. Methods: We analyzed Cyr61 expression in a tissue microarray from breast cancer patients consisting of primary breast carcinomas and recurrences. Cyr61 was silenced in the metastatic MDA-MB-231 cells using a Cyr61-specific short hairpin RNA (Cyr61-shRNA). The effect of Cyr61 silencing on anchorage dependent- and independent growth, migration and invasiveness was characterized in vitro. The mechanism by which Cyr61 mediates the proliferation effects was investigated. The effect of Cyr61 in tumor growth was investigated in a subcutaneous orthotopic tumor xenograft model and the histological and immunohistochemical analysis ware performed. All statistical tests were two-sided. Results: Cyr61 is highly expressed in about 47% of the metastatic breast cancer patients analyzed. The expression is higher in the recurrences than in the primary tumors. Silencing Cyr61 inhibits cell proliferation, prevents anchorage-dependent and -independent growth, and suppresses the invasive potential of the cells by inhibiting migration in vitro. We also found that silencing Cyr61 decreases the expression of its own receptor αvβ3, and decreases its signaling activities. Remarkably, the in vivo studies showed that after silencing Cyr61 the tumor burden is significantly decreased and there is poor vascularized compared to control tumors. Conclusions: Our findings provide the proof of concept that Cyr61 is a key promoter of breast cancer tumorigenicity. It should be considered as a potential target for developing therapies to breast cancers patients that overexpress Cyr61.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1846. doi:1538-7445.AM2012-1846

Marjolin ulcer: an overlooked entity

Marjolin ulcer is a well-defined, but uncommon malignant ulcer that occurs in chronic wounds and cutaneous scars. Jean-Nicolas Marjolin was credited with describing this phenomenon in 1828. This entity is frequently overlooked and therefore inadequately treated leading to a poor prognosis. The malignant transformation of an ulcer is most commonly associated with burn scars, but has been reported in many other types of chronic, non healing wounds such as traumatic wounds, venous stasis and chronic pressure ulcers, fistulas, lacerations and leprosy ulcers. Development of malignancy tends to be slow with an average time of approximately 25 years. Various theories concerning pathogenesis of Marjolin ulcer have been proposed. Well-differentiated squamous cell carcinoma (SCC) is the most common histological type of Marjolin ulcer. Biopsy with histopathologic interpretation remains the gold standard for the diagnosis, with radical surgical excision being the treatment of choice. A high index of suspicion should be held by any health care provider when evaluating a chronic, non healing wound. This is a case report of a Marjolin ulcer arising on the left buttock of a patient with a long-standing history of a traumatic wound.

When more is less: the fitness consequences of predators attacking more unpalatable prey when more are presented

In 1879, Fritz Müller hypothesized that mimetic resemblance in which defended prey display the same warning signal would share the costs of predator education. Although Müller argued that predators would need to ingest a fixed number of prey with a given visual signal when learning to avoid unpalatable prey, this assumption lacks empirical support. We report an experiment which shows that, as the number of unpalatable prey presented to them increased, avian predators attacked higher numbers of those prey. We calculated that, when predators increase attacks, the fitness costs incurred by unpalatable prey can be substantial. This suggests that the survival benefits of mimicry could be lower than Müller proposed. An important finding is, however, that these costs decline in importance as the total number of available prey increases.

Increased Expression of Inflammatory Genes in Pregnancy-Associated Breast Cancers

Introduction: Epidemiological studies have shown that women of all ages experience a transient increase in the risk of developing breast cancer following pregnancy. Furthermore, breast cancers detected soon after a completed pregnancy (pregnancy-associated breast cancers, or PABCs) have a worse prognosis than those detected at more distant intervals (Schedin 2006). We previously found evidence for increased expression of inflammatory genes in the human breast following pregnancy. (Asztalos et al. 2008). In this study we analyzed the same gene set in human breast cancer tissue, to investigate the role of inflammation in pregnancy associated breast cancers.Patients and Methods: Women ≤ 45 years of age with breast cancer were eligible for the study, and were categorized as either nulliparous, recently pregnant or distantly pregnant. Thirteen nulliparous, 14 recently pregnant (&lt;2 years since pregnancy) and 15 distantly pregnant (5-10 years) patients were identified. Tumor regions were isolated from formalin-fixed paraffin embedded tissues using Laser Capture Microdissection, followed by RNA extraction and cDNA synthesis. Genes of interest were preamplified linearly, followed by real time PCR. We chose 59 genes involved in the processes of inflammation, ECM remodeling and angiogenesis. A small number of breast cancer prognostic genes were also included. Gene expression between groups was compared using either t-test, ANOVA or unsupervised hierarchical clustering.Results: When recent and distant PABCs were combined and compared to the nulliparous group, we observed a number of significantly differentially regulated genes, such as CXCL1, THBS1, ELN, IL11 and MMP3. Upregulation of CXCL1 in the post-pregnant samples is interesting since CXCL1 is an important inflammatory chemokine, with implications in cancer. THBS1, a natural inhibitor of neovascularization and tumorigenesis, was downregulated in the post-pregnancy group. In this early analysis, we did not observe a difference in gene expression between recent and distant pregnancies, possibly due to the limited number of samples. However, immunoglobulin A showed a trend towards upregulation in the recent pregnancy group, suggesting an enhanced state of immune activity in the cancers occurring in the recently pregnant breast. When concerted gene expression was compared by non-supervised hierarchical clustering, we found that PABCs (both recent and distant) had more frequent associations with inflammation associated gene-expression patterns than those of nulliparous patients.Conclusions: This is the first study to address the hypothesis suggesting the role of post-pregnancy events, such as inflammation, ECM remodeling and angiogenesis in the etiology and aggressiveness of PABCs by looking at a set of human breast cancers with known pregnancy history. We show that the cancers of patients detected post-pregnancy are more frequently associated with an inflammation-associated gene expression pattern, than those of nulliparous women. The exact role of inflammation in the aggressiveness of PABCs remains to be further elucidated.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5158.

Predicting nursing facility transition candidates using AID: a case study

PURPOSE

Although the nursing facility transition literature is growing, little research has analyzed the characteristics of individuals so assisted or compared participants to those who remain institutionalized. This article describes an analytic method that researchers can apply to address these knowledge gaps, using the Arkansas Passages nursing facility transition program as a case study.

DESIGN AND METHODS

This study employed Arkansas Minimum Data Set 2.0 data for 111 transitioned individuals, a derivation sample of 1,000 other residents, and a validation sample of all residents from the transitioned individuals' nursing facilities. Tree classification techniques identified distinct groups of transitioned and nontransitioned residents.

RESULTS

Nearly two thirds of transitionees were part of a group comprising only 1.5% of all Arkansas nursing facility residents. Five characteristics identified this group: age, day of stay (i.e., current day of stay at the time of the assessment), having hemiplegia/paraplegia, cognitive impairment level, and classification into one of eight Resource Utilization Groups (RUG-III) case-mix groups associated with the least nursing staff time. Another group containing 92% of the transitionees comprised 22% of all residents. Two characteristics identified this group: being younger than age 65 or being in the eight low-resource RUG-III groups.

IMPLICATIONS

Given that the majority of individuals assisted by this pilot represent a small and unusual nursing facility subpopulation, policy makers may wish to exercise caution in utilizing these data to forecast future transition populations, costs, or outcomes. Replicating this analysis using additional states' data could increase understanding about the characteristics of those assisted across transition programs and could help construct a more robust definition of what constitutes a transition success.

Paracrine-stimulated gene expression profile favors estradiol production in breast tumors

Paracrine interactions between adipose fibroblasts and malignant epithelial cells are essential for structural and hormonal support of breast tumors. Factors derived from malignant epithelial cells inhibit adipogenic differentiation of fibroblasts and upregulate expression of aromatase, which stimulates estrogen synthesis and creates a localized, growth-stimulatory environment. Here, we characterized the gene expression profile of breast adipose fibroblasts in an in vitro model of malignancy to identify other paracrine interactions that support tumor growth. Primary breast adipose fibroblasts from cancer-free women were treated with conditioned media from malignant breast epithelial cells or normal breast epithelial cells, and differences in gene expression were identified by microarray. A total of 79 differentially regulated genes encoding cytokines, enzymes, angiogenic factors, cytoskeletal proteins, extra-cellular matrix remodeling proteins, signal transduction proteins and cell surface receptors were identified, and 6 of these were verified by real-time PCR. Among these, the expression of aldo-keto reductase family 1, member C3 (AKR1C3) was upregulated. AKR1C3 has multiple enzymatic properties, including conversion of estrone to estradiol and androstenedione to testosterone. Immunoreactive AKR1C3 was detected in epithelial and stromal components of benign lesions and ductal carcinomas in situ, and in 59.8% of epithelial and 69.6% of stromal cells in invasive breast carcinomas. AKR1C3 expression was significantly higher in myoepithelial cells surrounding the neoplastic epithelium of ductal carcinoma in situ compared with those surrounding benign epithelial lesions. Importantly, AKR1C3 and aromatase mRNA levels correlated positively in 61 malignant breast tumors (R=0.3967, p=0.00156). Malignant epithelial cell-conditioned medium significantly increased formation of testosterone and estradiol from androstenedione in breast adipose fibroblasts. In conclusion, malignant epithelial cell-derived factors significantly upregulate the enzymes AKR1C3 and aromatase that catalyze a series of complementary reactions to convert the circulating precursor androstenedione to biologically active estradiol in vitro in the stromal fibroblasts, and in vivo, in stromal component of breast tumors.

AlphaB-crystallin is a novel oncoprotein that predicts poor clinical outcome in breast cancer

Recent gene profiling studies have identified a new breast cancer subtype, the basal-like group, which expresses genes characteristic of basal epithelial cells and is associated with poor clinical outcomes. However, the genes responsible for the aggressive behavior observed in this group are largely unknown. Here we report that the small heat shock protein alpha-basic-crystallin (alphaB-crystallin) was commonly expressed in basal-like tumors and predicted poor survival in breast cancer patients independently of other prognostic markers. We also demonstrate that overexpression of alphaB-crystallin transformed immortalized human mammary epithelial cells (MECs). In 3D basement membrane culture, alphaB-crystallin overexpression induced luminal filling and other neoplastic-like changes in mammary acini, while silencing alphaB-crystallin by RNA interference inhibited these abnormalities. alphaB-Crystallin overexpression also induced EGF- and anchorage-independent growth, increased cell migration and invasion, and constitutively activated the MAPK kinase/ERK (MEK/ERK) pathway. Moreover, the transformed phenotype conferred by alphaB-crystallin was suppressed by MEK inhibitors. In addition, immortalized human MECs overexpressing alphaB-crystallin formed invasive mammary carcinomas in nude mice that recapitulated aspects of human basal-like breast tumors. Collectively, our results indicate that alphaB-crystallin is a novel oncoprotein expressed in basal-like breast carcinomas that independently predicts shorter survival. Our data also implicate the MEK/ERK pathway as a potential therapeutic target for these tumors.

Effects of pulsation frequency and endothelial integrity on enhanced arterial transmural filtration produced by pulsatile pressure

The role of the endothelium in regulating transmural fluid filtration into the artery wall under pulsatile pressure and the effects of changes in pulsatile frequency on filtration have received little attention. Previous experiments (Alberding JP, Baldwin AL, Barton JK, and Wiley E. Am J Physiol Heart Circ Physiol 286: H1827-H1835, 2004) demonstrated significantly increased filtration after initial onset of pulsatile pressure compared with that predicted by using parameters measured under steady pressure. To determine the role of the endothelium in this phenomenon, the following experiments were performed on five New Zealand White rabbits (anesthetized with 30 mg/kg pentobarbital sodium). One of each pair of carotid arteries was deendothelialized, and filtration measurements under steady and pulsatile pressure were compared with those made in intact vessels (Alberding JP, Baldwin AL, Barton JK, and Wiley E. Am J Physiol Heart Circ Physiol 286: H1827-H1835, 2004). To determine the effect of increasing pulsatile frequency on arterial filtration, transmural filtration was measured by using pulsatile pressure frequencies of 1 Hz, followed by 2 Hz, in another set of intact arteries (6 arteries and 3 animals). For deendothelialized vessels, the initial increase in filtration after onset of pulsatility was similar to that observed in intact vessels, but the subsequent reduction in filtration was less abrupt. When pulsatile frequency was increased from 1 to 2 Hz in intact arteries, an initial increase in filtration was observed, similar to that obtained after onset of pulsatile pressure subsequent to a steady pressure. The observed responses of arteries to pulsatile pressure, with and without endothelium, or undergoing a frequency change, suggest a dynamic role for the endothelium in regulating transvascular transport in vivo.

Prediction of breast cancer size by ultrasound, mammography and core biopsy

Neoadjuvant chemotherapy and non-surgical tumor ablation rely upon imaging studies to determine tumor size. In this study the accuracy of ultrasound (US) mammography and core biopsy in determining tumor size was examined in 202 patients with Stages I and II breast cancer. The most accurate single modality for determining tumor size was mammography with a correlation coefficient of 0.66, followed by US (r = 0.48) and core biopsy (r = 0.28). Size measurements were less accurate in lobular than ductal cancers. The combination of the three modalities understaged 25% of the tumors > 1cm in size, and overstaged 10% of those < 1cm. The inability to accurately determine tumor size has important implications for the use of non-surgical ablation.

Onset of pulsatile pressure causes transiently increased filtration through artery wall

Convective fluid motion through artery walls aids in the transvascular transport of macromolecules. Although many measurements of convective filtration have been reported, they were all obtained under constant transmural pressure. However, arterial pressure in vivo is pulsatile. Therefore, experiments were designed to compare filtration under steady and pulsatile pressure conditions. Rabbit carotid arteries were cannulated and excised from male New Zealand White rabbits anesthetized with pentobarbitol sodium (30 mg/kg iv administered). Hydraulic conductance was measured in cannulated excised rabbit carotid arteries at steady pressure. Next, pulsatile pressure trains were applied within the same vessels, and, simultaneously, arterial distension was monitored using Optical coherence tomography (OCT). For each pulse train, the volume of fluid lost through filtration was measured (subtracting volume change due to residual distension) and compared with that predicted from steady pressure measurements. At 60- and 80-mmHg baseline pressures, the experimental filtration volumes were significantly increased compared with those predicted for steady pressure ( P < 0.05). OCT demonstrated that the excess fluid volume loss was significantly greater than the volume that would be lost through residual distension ( P < 0.05). After 30 s, the magnitude of the excess of fluid loss was reduced. These results suggest that sudden onset of pulsatile pressure may cause changes in arterial interstitial hydration.

Adrenal lesions with heterogeneous suppression on chemical shift imaging: Clinical implications

PURPOSE

To investigate the frequency and significance of adrenal lesions that demonstrate heterogeneous suppression on chemical shift magnetic resonance imaging (MRI).

MATERIALS AND METHODS

A retrospective search of adrenal lesions identified on MR from November 1997-July 2001 was performed. The adrenal lesions were classified as having suppression typical for an adenoma, nonsuppression, or atypical heterogeneous suppression. Lesions with heterogeneous suppression were further reviewed. Follow-up for the heterogeneous lesions consisted of imaging studies or pathology from surgical excision.

RESULTS

Adrenal lesions were identified in 242 patients. Heterogeneously suppressing lesions were seen in 34 (14%) patients. Several different patterns of heterogeneous suppression were identified. Imaging or pathologic follow-up was available for 18 of the heterogeneously suppressing lesions (one patient had both). Fifteen patients with follow-up imaging showed stability of the lesion over a significant interval, suggesting a benign lesion. Pathology was available for four patients revealing two patients with adenomas and two patients with nodular hyperplasia. Thus, all 18 patients with heterogeneous suppression had a benign lesion.

CONCLUSION

Adrenal lesions that have a heterogeneous pattern of suppression on out-of-phase chemical shift MR images are a common finding. Our small series suggest that these lesions are probably benign.

Assessment of utility of ductal lavage and ductoscopy in breast cancer-a retrospective analysis of mastectomy specimens

Early detection of breast lesions continues to be an important goal in the management of breast cancer. At present, mammographic imaging in addition to physical examination is the main screening method for the detection of cancer. Fiberoptic ductoscopy and duct lavage are being recently used to evaluate patients at risk for breast cancer. Both techniques examine the nipple and central duct area to identify intraductal lesions. In this study, we examined the frequency of involvement of these structures in mastectomy specimens as a surrogate marker to estimate the utility of these methods in breast cancer patients. The presence and type of involvement of the nipple and central duct area was retrospectively evaluated in 801 mastectomy specimens from a 4-year period that had been performed for infiltrating or in situ carcinoma. Atypical proliferation or cells, when seen in the ducts of this region, was considered as evidence of nipple involvement, even if definite evidence of malignancy was lacking. The review of 801 mastectomies showed nipple and central duct involvement in 179 (22%) cases. Among the 665 cases of infiltrating carcinoma, 17% did not have an intraductal component. The relative rarity of nipple and central duct in mastectomy specimens and the lack of an in situ component in many cases raise questions about the utility of fiberoptic ductoscopy and duct lavage as methods for screening of breast cancer. Additionally, as these methods examine only 1-2 ducts of the 15-20 ducts that open at the nipple, they might fail to detect focal abnormalities.