CBT program to reduce recidivism risk for road crashes among adolescents and young adults: Results of a randomized controlled study and prospects

Road crashes are the first cause of mortality for young adults aged 18-25 years and the human factor contributes to 90-95% of events. The present study was carried out to determine the efficacity of the ECARR2 recurrence prevention program among adolescents and young adults at high risk of having a new traffic crash in the following months. A total of 288 participants having had a traffic crash that required going to the emergency room, at high risk of accident recurrence (ECARR≥5) were randomly allocated to either the intervention group (n = 144) or the control group (n = 144).

Results

revealed that the risk of recurrence was highest during the first 6 months (66% of recurrences). In per-protocol analysis population, at 6 months after inclusion, the accident recurrence rate was 14.2% ± 3.3% in the intervention group, and 23.5% ± 4.0% in the control group. The intervention had an effect per se, independently of the other predictors (p = 0.020). This effect was mediated by the three interaction variables: BDI, Impulsive Behavior Scale lack of perseverance, and Orientation to Happiness engagement. It was therefore through these dimensions that the intervention had an effect. In conclusion, the ECARR score predicts the risk of recurrence, risk which is the highest during the first 6 months. Finally, results confirm the predictive validity of the ECARR scale. The ECARR score had an effect on the risk of recurrence regardless of group (p = 0.045) and was predictive of recurrence (p = 0.045).A brief psychological intervention such as ECARR2 program, offered to young people ar hight risk of having a new crash, just after the crash, seems to halve the risk of recurrence at 6 months. Future research should improve the brief psychological intervention and its access via a mobile application or few hours in high school or in a driving school given.

Road accidents in young adults with ADHD: Which factors can explain the occurrence of injuries in drivers with ADHD and how to prevent it?

Some 1.35 million people die and more than 50 million are injured or disabled from road accidents annually across the globe. Driving is a complex task with multiple complex cognitive functions, including perception, motor coordination, and executive function. Thus, driving can be a significant challenge for patients suffering from attention-deficit hyperactivity disorder (ADHD), a common neurodevelopmental disorder with cognitive symptoms such as inattention, impulsivity, and executive dysfunction. Undoubtedly, risk of car accidents is higher in people with ADHD. The aim of this article is to explore factors that could explain the occurrence of road accidents in patients with ADHD and to highlight prevention points. Indeed, reduction of risky driving is an important priority for public health.

Description of Various Factors Contributing to Traffic Accidents in Youth and Measures Proposed to Alleviate Recurrence

Traffic accidents are the leading cause of hospitalization in adolescence, with the 18-24-year-old age group accounting for 23% of deaths by traffic accidents. Recurrence rate is also high. One in four teenagers will have a relapse within the year following the first accident. Cognitive impairments known in adolescence could cause risky behaviors, defined as repetitive engagement in dangerous situations such as road accidents. Two categories of factors seem to be associated with traffic accidents: (1) factors specific to the traffic environment and (2) "human" factors, which seem to be the most influential. Moreover, the establishment of a stronger relation to high speed driving increases traffic accident risks and can also be intensified by sensation seeking. Other factors such as substance use (alcohol, drugs, and "binge drinking") are also identified as risk factors. Furthermore, cell phone use while driving and attention deficit disorder with or without hyperactivity also seem to be important risk factors for car accidents. The family environment strongly influences a young person's driving behavior. Some interventional driving strategies and preventive measures have reduced the risk of traffic accidents among young people, such as the graduated driver licensing program and advertising campaigns. So far, few therapeutic approaches have been implemented. Reason why, we decided to set up an innovative strategy consisting of a therapeutic postaccident group intervention, entitled the ECARR2 protocol, to prevent recurrence among adolescents and young adults identified at risk, taking into account the multiple risk factors.

Abstract OT3-1-10: ASTER 70s (UNICANCER phase III trial): Is personalized adjuvant treatment for women over 70 with luminal breast cancer the way to go?

Background

The question of the additional benefit of adjuvant chemotherapy (CT) compared to hormonal therapy alone (HT) for women >70 with ER+ / HER2- breast cancer (BC) and aggressive characteristics is still unsolved. This trial compares the impact of both strategies on overall survival (OS).

Trial design

Following surgery, ∼2,000 patients will have a Genomic Grade (GG) centrally performed on FFPE specimens. Those with a high or equivocal GG will be randomized HT alone vs HT+CT. Patients with low GG will be followed as an observational cohort. The study, on-going in France since April 2012, has been recently activated in Belgium.

Eligibility criteria

Any ER+ HER2- BC after complete surgery, M0, any pT or pN. Normal organ functions. No specific BC treatment before surgery. Contralateral BC, invasive BC after ductal carcinoma in situ and isolated local invasive relapse when adjuvant systemic treatment is considered are all eligible. Multifocal or bilateral are eligible according to focus with worst GG. The G8 screening tool is used as stratification criteria for randomization.

Specific aims

OS (all deaths) is the primary endpoint. Secondary objectives include competing events, cost-effectiveness and Q-TWiST analysis, geriatric dimension, acceptability/willingness and health-related quality of life including specific ELD15. The Lee's 4-year mortality score is calculated. Translational research will focus on prognostic biomarkers and pharmacogenetic, investigating also the impact of treatments on putative ageing biomarkers as CRAMP, stathmin, EF-1α and chitinase and telomeres length.

Statistical methods

Sample size based on 4-year OS (87.5 vs 80%), bilateral test, α = 0.05, β = 0.20 and HR = 0.60.

In total, 129 events are expected, requiring 340 patients/arm. Considering those lost to follow-up, ∼700 patients in total should be included (5 extra patients/year).

Present accrual and target accrual

As of May 2013, 43 centres have included 406 Patients aged 70-88.

Only 14 GG evaluations were not performed for the following reasons: Patients consent withdrawal (n = 3), tumour block not available for the GG test (n = 5), CT not a treatment option anymore (patients or investigator's decision) (n = 2) or tumour status (ER+/HER2-) not confirmed by central review (n = 4). 8 GG evaluations are on-going.

Of 384 cases with GG report, 160 (42%), 151 (39%) and 65 (17%) were respectively GG-1 (low risk), GG-3 (high risk) and GG-EQ (equivocal); 8 (2%) tests failed for technical reasons. The proportion of high GG in the study (53%) is similar to those observed in previous studies in general BC populations (40% to 60%).

Of 216 GG-3/-EQ cases, 4 were not randomized because of distant metastases detected during extensive work-up (n = 3) and Patient refusal of CT treatment before randomization (n = 1). Five randomizations are on-going.

GG determination was obtained in 384 leading to randomization in 207, totalizing so far 30% of the projected recruitment for the primary objective. This confirms the feasibility of such multicentre strategic program with an innovative prognostic signature in the elderly BC population.

Contact information

c-orsini@unicancer.fr.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT3-1-10.

Abstract OT3-3-04: ALOPREV: first cooling scalp trial for prevention of persisting alopecia after docetaxel for early breast cancer patients

During SABCS 2009, Western France Observatory of Cancer has presented “ALOPERS” results from more than one hundred patients with persisting alopecia or suboptimal hair regrowth after chemotherapy for early breast cancer. Docetaxel 75–100 mg/msq was concerned for majority of patients. 43% of patients experienced alopecia more than 24 months after their last chemotherapy infusion. Optimal information of patients about alopecia and persisting alopecia appears to be mandatory before treatment: 47% of patients undergo a psychological shock during hair loss. Morevover, BCIRG 001 study (TAC versus FAC) led to the conclusion that docetaxel 75 mg/msq is responsible for persisting alopecia for 3% of patients. So, by extrapolating, in France, each year, docetaxel could induce a persisting alopecia in 300 patients. To confirm this figure, “ERALOP” study is in progress to evaluate precisely the incidence of persisting alopecia after docetaxel in early breast cancer patients and then theses data will be communicated to ANSM. It must be noticed that 8% of patients refused to be treated because of the risk of persistant alopecia (Trueb et al, 2010). That's why it is a worldwide public health problem, with personal and societal implications.

As alopecia is universal after FEC100 regimen, the cooling scalp has been supposed to be very effective during docetaxel 1 hour infusion and to allow a better hair regrowth but with a high risk in term of tolerance. Since 2012, a prospective clinical trial “ALOPREV” has begun in Western France to evaluate tolerance of cooling scalp, after 3–4 courses of FEC100 regimen and during 3–4 courses of docetaxel 100 mg/msq, for patients treated for early breast cancer. So, ALOPREV is designed as a safety trial. First, cooling scalp major toxicities (headache, neck pain, discomfort associated with cold, sinusitis) are evaluated during each docetaxel course by the patient. Then, auto-questionnary about hair loss and regrowth, nails disorders and others toxicities due to docetaxel and questionnary about quality of life (EORTC QLQ-C30 and BR-23 scales) is completed by the patients before, during and after treatment. Patients will be followed-up 12 months and final toxicities will be reported by physicians. According to our daily practice, it will demonstrate that 60% of patients could tolerate two consecutive cooling scalps during docetaxel infusion, and with statistical considerations (alpha-beta risks and 10% of ineligibility). So 160 patients must be included during inclusion period (18 months). 10 public or private care centers have been opened (45 investigators). This trial implicates particularly nurses teams and all patients will sign an informed consent before FEC100 courses. ALOPREV started two months ago and 25 patients are already enrolled.

In conclusion, cooling scalp is known to be safe, manageable and partially effective before hair loss. ALOPREV will evaluate safety and efficacy to avoid persisting alopecia after hair loss.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr OT3-3-04.

Plasma and tissue proteomic prognostic factors of response in primary breast cancer patients receiving neoadjuvant chemotherapy

A pathological complete response (pCR) after neoadjuvant chemotherapy is observed in approximately 20% of breast cancer patients. A proteomic analysis was performed on plasma and tumor tissue before treatment to evaluate its potential impact on the prediction of response. One hundred and forty-nine breast cancer patients eligible for neoadjuvant chemotherapy were included in the study between February 2004 and January 2009 at three centers. The proteomic analysis was performed using SELDI Technology (ProteinChip CM10 pH4, IMAC-Cu and H50). Three acquisition protocols were used according to the mass range. Plasma and tumor proteomic signatures were generated using generalized ROC criteria and cross-validation. Twenty-eight (18.8%) patients out of 149 experienced a pCR according to Sataloff criteria. In the cytosol analysis, respectively 4, 2 and 8 proteins had significantly different levels of expression in the responders and non-responders using IMAC-Cu, H50 and CM10 pH4. Among the 8 proteins of interest on CM10 pH4, 2 (C1 and C7) were selected and were validated in 95.0 and 85.6% of the models. In the plasma analysis, respectively 12, 6 and 2 proteins had different levels of expression using the same proteinchips. Among the 12 plasma proteins of interest on IMAC-Cu, 2 (P1 and P7) were selected and were validated in 94.8 and 97.6% of the models. A combined proteomic signature was generated, which remained statistically significant when adjusted for hormone receptor status and Ki-67. Our results show that proteomic analysis can differentiate complete pathological responders in breast cancer patients after neoadjuvant chemotherapy.

Identifying the primary site using gene expression profiling in patients with carcinoma of an unknown primary (CUP): a feasibility study from the GEFCAPI

e22168

Background: CUP are an heterogeneous family of neoplasms with a dismal prognosis, with empiric chemotherapy as the recommended treatment. The aim of this study was to evaluate the feasibility of a 500-mRNA microarray to identify the tissue of origin in patients with CUP. Methods: Diagnostic biopsy formalin-fixed, paraffin-embedded (FFPE) specimens from 22 patients with CUP were prospectively collected. Gene expression profiling was performed using oligonucleotide microarray that contains 495 genes selected as highly differentially expressed between 49 tumor types (CupPrint). Results: The assay was successfully performed on specimens from 18 of the 22 patients (82%). It could not be performed because of a low RNA preservation in the remaining 4 cases. The median age was 57 years (range: 29–70 years). The median delay from tissue shipping to receipt of CupPrint result was 11 days (range: 1–26 days). The most common tissues of origin identified were lung cancer (22%) and colorectal cancer (17%). Of note, a primary cancer which would not be adequately treated by an empiric chemotherapy regimen currently recommended in CUP (like cisplatin-gemcitabine or carboplatin-paclitaxel) was identified in about half patients: kidney cancer (1), hepatocarcinoma (1), colorectal cancer (3), head and neck cancer (2) and cholangiocarcinoma (1). Conclusions: Gene expression profiling of FFPE biopsy specimens from patients with CUP is feasible in a reasonable delay, making it feasible in clinical practice. A phase III randomized trial is planned to compare therapy based on gene expression-suspected primary cancer versus empiric chemotherapy.

No significant financial relationships to disclose.

Prognostic value of the expression of tumor necrosis factor-alpha (TNFa) and its receptors in head and neck cancer (HNC) patients: A pilot study

e17029

Background: TNFa was initially described as an inductor of apoptosis in cancer cells. In vitro data showed that TNFa can also activate anti-apoptotic signaling in cancer cells. We analyzed the prognostic value of the expression of TNFa and its receptors TNFR1 and TNFR2 in HNC patients. Methods: Twenty-four patients treated for HNC were retrospectively analyzed for TNFa, TNFR1, and TNFR2 expression by real-time PCR (RT-PCR). Tissue samples were collected at the time of initial diagnosis. Total RNA was reverse-transcribed with TaqMan quantitative RT-PCR (Applied Biosystems). Results were recorded as average threshold cycle, and relative expression was determined using Normalized Expressions method. Expression of TNFa, TNFR1, and TNFR2 was related to survival after 3 years of follow-up. Results: In the 24 patients, expression of TNFa (mean value 7.8, median 2.4, range 0.02–62.3), TNFR1 (mean value 58, median 49, range 0.02–246.9) and TNFR2 (mean value 4.8, median 3.3, range 0.8–18.9) demonstrated a great variability between patients. After a 3-year follow-up, 14 patients were alive without evolution of cancer (group A) and 10 were dead because of cancer evolution (group D). In group D, median level of TNFa was 8.8 whereas it was 1.1 in group A (p = 0.02). Median level of TNFR1 was 71.8 in group D and 28.5 in group A (p = 0.01). In contrast, median level of TNFR2 was 3.3 for both groups. Patients with high level of TNFa or TNFR1 expression had a worse survival (p = 0.01 and p = 0.009, respectively). There was also a strong correlation between high expression of TNFa and of TNFR1 (p = 0.0007). Conclusions: In this small series, TNFa and TNFR1 expression seem to have significant prognostic value to predict survival of HNC patients. This result needs to be confirmed in larger series and compared with usual prognostic factor. It suggests that TNFa expression could have a dual effect in HNC and that TNFR1 expression may play a role in this process.

No significant financial relationships to disclose.

Prognostic value of serum level of HER-2 extracellular domain (ECD) at diagnosis of HER-2 overexpressed primary breast cancer (BC)

e11508

Background: Serum level of HER2 ECD is an adverse prognostic factor in HER2 over-expressed metastatic BC. We analyzed the prognostic value of serum level of HER2 ECD at the diagnostic of HER2 over-expressed primary BC. Methods: Patients with HER2 over-expressed primary BC treated with adjuvant trastuzumab in 2005 and 2006 were retrospectively analyzed. Serum level of HER2 ECD was assessed on frozen sera collected for CA15–3 measurement before initial treatment. Serum level of HER2 ECD was measured with an Elisa commercial kit (Oncogene Science, Cambridge, MA). The cut-off was 15μg/l as recommended. Results: Pre-treatment serum was available for 65 patients treated for non metastatic HER2 over-expressed BC. Seven patients (11%) had initially an elevated serum level of HER2 ECD (mean 25μg/l, range 15.1–38.9). After an average follow-up of 30 months, 4 patients (57%) out of the 7 with initially elevated serum level of HER2 ECD had a metastatic relapse of BC. In contrast, only 3 patients (5%) out of 58 with initially low serum level of HER2 ECD experienced relapse (p=0.004). Median of serum level of HER2 ECD was 17μg/l in patients who experienced relapse during follow-up whereas it was 8.4μg/l in patients who remained relapse-free (p=0.03). Univariate analysis showed that only elevated serum level of HER2 ECD and absence of hormone receptors expression were linked with metastatic relapse (p=0.0004 and p=0.02, respectively). Multivariate analysis showed that elevated serum level of HER2 ECD and absence of hormone receptors expression were linked with metastatic relapse (p=0.02 and p=0.04, respectively). Survival curves showed also that elevated serum level of HER2 ECD was related with a worse disease-free survival (p=0.0004). Conclusions: In this small series, elevated serum level of HER2 ECD was an adverse prognostic factor for HER2 over- expressed non metastatic primary BC. It was also a predictive factor for early failure of adjuvant treatment with trastuzumab.

No significant financial relationships to disclose.

[Pneumocystis pneumonia in two breast cancer patients treated with docetaxel: an unusual adverse event of chemotherapy]

We report two cases of pneumocystis pneumonia in patients receiving chemotherapy for breast cancer. These case series emphasize the frailty of the patients as the causative role for occurrence of this uncommon complication of chemotherapy in breast cancer. We remind the importance of screening for unusual adverse events in frail patients receiving chemotherapy.

P53 functional assay in yeast: evaluation in 1856 patients in a large prospective clinical trial (EORTC 10994/BIG 00-01)

Abstract #1067

Background:Although mutations in the p53 gene can occur in 20-30% of sporadic breast cancer, and are associated with other poor prognostic factors, there is no clear evidence as to whether p53 status should influence therapy. Immunohistochemistry has been demonstrated to be an inferior method compared with sequencing, but the optimal technique to assess the functional p53 status is not known. The yeast test is a functional assay which tests the transcriptional competence of p53, and detects biologically important mutations. Here we present the results of p53 evaluation using this method in a prospective study.
 Material and methods: EORTC 10994/BIG 00-01 trial is a randomized trial comparing the neoadjuvant use of an anthracycline-based regimen with a taxane-containing regimen in patients with large operable or locally advanced breast cancers. Fresh frozen tumour biopsies were mandatory before starting chemotherapy. Frozen sections were examined centrally and the p53 test was done if the invasive tumour cell content was above 20%. RNA extract was used to assess p53 status: p53 wild type tumours were defined as tumours whose cDNA transfected in yeast gave less than 20% red colonies (background); p53 mutated tumours gave 20% or more red colonies.
 Results: The trial accrual was completed in November 2006 after inclusion of 1856 patients. There was no frozen sample available in 70 patients. In 276 patients the % of tumour cells was <20. The p53 test failed in 62 patients, generally because the quality or quantity of RNA was too low for RT-PCR. P53 was successfully assessed in 1458 patients: 661 (45%) tumours are p53 mutated and 797 (55%) are p53 wt. p53 mutated and wild type tumours were grade III in 40% (265/661) and 19% (153/797), respectively, and estrogen receptor negative in 41% (270/661) and 14.5% (116/797), respectively. We did not see any correlation between p53 status and tumour size or nodal status at diagnosis. HER2 status data are being collected.
 Conclusion: P53 status has been successfully evaluated using a yeast assay in 78.5% (1458/1856) of cases in the context of a multicenter trial. In indirect comparisons the frequency of patients with functionally altered p53 status is higher than with sequenced based methods. Our results confirm an association between p53 mutation and high grade or estrogen receptor negative status, but not with age, tumour size or clinical nodal status. More data regarding the quality and quantity of RNA collected will be presented at the meeting.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1067.

Intravenous Delivery of Anti-RhoA Small Interfering RNA Loaded in Nanoparticles of Chitosan in Mice: Safety and Efficacy in Xenografted Aggressive Breast Cancer

Overexpression of RhoA in cancer indicates a poor prognosis, because of increased tumor cell proliferation and invasion and tumor angiogenesis. We showed previously that anti-RhoA small interfering RNA (siRNA) inhibited aggressive breast cancer more effectively than conventional blockers of Rho-mediated signaling pathways. This study reports the efficacy and lack of toxicity of intravenously administered encapsulated anti-RhoA siRNA in chitosan-coated polyisohexylcyanoacrylate (PIHCA) nanoparticles in xenografted aggressive breast cancers (MDA-MB-231). The siRNA was administered every 3 days at a dose of 150 or 1500 microg/kg body weight in nude mice. This treatment inhibited the growth of tumors by 90% in the 150-microg group and by even more in the 1500-microg group. Necrotic areas were observed in tumors from animals treated with anti-RhoA siRNA at 1500 microg/kg, resulting from angiogenesis inhibition. In addition, this therapy was found to be devoid of toxic effects, as evidenced by similarities between control and treated animals for the following parameters: body weight gain; biochemical markers of hepatic, renal, and pancreatic function; and macroscopic appearance of organs after 30 days of treatment. Because of its efficacy and the absence of toxicity, it is suggested that this strategy of anti-RhoA siRNA holds significant promise for the treatment of aggressive cancers.

Celecoxib (Ce) + exemestane (Ex) versus placebo + Ex in post-menopausal (PM) metastatic breast cancer (MBC) patients (pts): A double-blind phase III GINECO study

565

Background: in vitro and in vivo studies suggest that COX-2 inhibitors have proper antitumor effect and could enhance the activity of aromatase inhibitors (AI). Methods: PM first-line MBC pts without previous adjuvant AI were randomized to receive per os until progression either A: Ce (400 mg bid) + Ex (25mg/d) or B: placebo (1 tablet bid) + Ex (25mg/d). PFS was the main end-point. The trial was prematurely stopped (Dec 2004) with 157/342 pts enrolled (A: 74, B: 83 pts) after occurrence of Ce cardio-vascular toxicity in other trials. Results: patient (median age, A:61, B:63 yrs) characteristics were well balanced between A and B (%) : ER and/or PR positive (93, 94), HER2 positive (4, 5), adjuvant chemotherapy (45, 53) or tamoxifen (57, 61), ECOG PS 0–1 (90, 90), visceral (63, 53) or bone involvement (35, 41). Tolerance: compared to placebo (B), pts treated with Ce (A) experienced less gr 2–3 CTCAE: pain (A:52, B:63%), arthralgias (19, 28), asthenia (20, 30), Gr 1–3 insomnia (32, 47), but more hypersentivity reactions (7,0) and oedema (8, 2). Gastro-intestinal toxicity was not increased in A. One episode of paroxystic arythmia occurred in the Ce arm, without complication in a patient with known cardiopathy. Overall response rate was significantly higher in A (35 vs 20%, p=.034). Median PFS in intent-to-treat analysis was similar in A (9.8 months) and B (9.8), but tend to be superior in A (A:12.2, B:9,8, p=.09) in pts who were included at least 3 months before early trial stopping. In addition, PFS was significantly longer in pts treated with Ce +Ex (A: 8.4 months, B: 4.7, p=.019) in the subgroup of pts who developed MBC under Tam or within 12 months after Tam stopping (A: 26, B: 29 pts). Conclusion: The combination of celecoxib and exemestane is promising and should be further explored in MBC with adequate cardiac monitoring.

No significant financial relationships to disclose.

Cooperation between monocytes and breast cancer cells promotes factors involved in cancer aggressiveness

In breast cancers, clinical symptoms of inflammation localised around the tumour at the time of diagnosis have been considered to have poor prognosis significance. In this study, the biological mechanisms responsible for the deleterious action of monocytes in cancer were investigated. The incubation of the breast-cancer-derived MDA-MB231 cells with monocytes resulted in an increase in factors involved in cell invasion (i.e. both cancer cells and monocytes-associated urokinase and Tissue Factor, and PAI-1 and MMP-9 secretion). Moreover, the functions of monocytes were also modified. Incubation of monocytes with MDA-MB231 cancer cells resulted in a downregulation in the secretion of the antiproliferative cytokine Oncostatin M, while the apoptotic factor TNF alpha was dramatically increased. However, MDA-MB231 cancer cells have been shown to be resistant towards the apoptotic action of TNF alpha. These findings demonstrate that incubation of MDA-MB231 cancer cells with monocytes induced a crosstalk, which resulted in an increased expression of factors involved in cancer cell invasiveness and in a modification of monocytes function against cancer cells, while inflammatory effects were increased.

Outbreak of Clostridium difficile-related diarrhoea in an adult oncology unit: risk factors and microbiological characteristics

We describe the risk factors and microbiological findings of an outbreak of Clostridium difficile (CD)-related diarrhoea in the Medical Oncology Department of the Curie Institute. Screening for CD in stools was performed on 59 patients with diarrhoea and 146 patients without diarrhoea. Toxin secretion, serotyping (enzyme-linked immunosorbant assay) and genotyping (AP-polymerase chain reaction) were performed on 39 CD strains from 32 patients. The risk factors for toxigenic CD-positive diarrhoea were also investigated. Twenty-seven (46%) patients with diarrhoea and 12 (8%) patients without diarrhoea were CD-positive (P<0.001). Patients with diarrhoea were older (P=0.03). Chemotherapy was a risk factor for toxigenic CD-related diarrhoea (P=0.02) and antibiotic treatment was a risk factor only in those patients who were also receiving chemotherapy. Serotyping and genotyping showed that several strains were involved in this outbreak, with only two instances of patient-to-patient transmission, involving four and two patients.

Apigenin--strong cytostatic and anti-angiogenic action in vitro contrasted by lack of efficacy in vivo

The cancer chemopreventive agent apigenin also has strong cytostatic and anti-angiogenic effects in vitro. We now investigated its efficacy against experimental Lewis lung carcinomas (LLC), C-6 gliomas and DHDK 12 colonic cancers in vivo. Tumour bearing mice received 50 mg/kg/day apigenin in three different galenical formulations during 12 days in 8-hourly intervals. Only weak effects of apigenin on the size and the number of new tumour blood vessels of both established and newly transplanted tumours were recorded although the intratumoural necrosis was elevated (45 +/- 15% vs. 20 +/- 7% (control), p < 0.05%). These results contrast sharply with the high in vitro sensitivity of LLC, C-6, DHDK 12 and endothelial cells to apigenin where complete growth suppression occurs at concentrations beyond 30 g/ml. Possible causes are discussed.

Influence of the delay of adjuvant postoperative radiation therapy on relapse and survival in oropharyngeal and hypopharyngeal cancers

PURPOSE

To determine whether the delay between surgery and the beginning of radiation therapy influences survival or the risk of local-regional relapse in oropharyngeal or hypopharyngeal squamous cell carcinomas.

METHODS AND MATERIALS

From 2052 patients referred to the Henri Becquerel Center for the radiation therapy of an oropharyngeal or hypopharyngeal cancer between January 1, 1981 and December 31, 1992, 420 were included in a retrospective study. Exclusion criteria were another cancer, metastasis, incomplete resection, lack of homolateral lymph node resection, or previous chemotherapy. Radiation therapy delivered 45 to 75 Gy on initial location and lymph node. Follow-up was performed until December 31, 1997. A Cox proportional hazard regression analysis was used to evaluate the prognostic factors.

RESULTS

The delay between surgery and radiation therapy was not found to be a significant prognostic factor for survival or risk of local-regional relapse. The only parameters found to influence local-regional and survival control were margins' pathologic state (respectively p < 0.0001 and p = 0.015) and T (p < 0.0001) and N (respectively p < 0.0001 and p = 0.0004) stages. In terms of local-regional relapse only, age was a prognostic factor (p = 0.048), and a trend was noted for tumor emboli in vessels or nerves (p = 0.061).

CONCLUSION

In patients with oropharyngeal or hypopharyngeal squamous cell carcinoma, the delay between surgical procedure and radiation therapy does not influence survival or risk of local-regional relapse. Radiation therapy might be subjected to complete healing in these patients.

Apigenin inhibits endothelial-cell proliferation in G(2)/M phase whereas it stimulates smooth-muscle cells by inhibiting P21 and P27 expression

Apigenin is a plant flavonoid that is thought to play a role in the prevention of carcinogenesis. However, its mechanism of action has not yet been elucidated. Because of the importance of angiogenesis in tumor growth, we investigated the effect of apigenin on endothelial and smooth-muscle cells in an in vitro model. Apigenin markedly inhibited the proliferation, and, to a lesser degree, the migration of endothelial cells, and capillary formation in vitro, independently of its inhibition of hyaluronidase activity. In contrast, it strongly stimulated vascular smooth-muscle-cell proliferation. The molecular mechanisms of apigenin activity were analyzed in these 2 types of cells. Our results show that apigenin inhibits endothelial-cell proliferation by blocking the cells in the G(2)/M phase as a result of the accumulation of the hyperphosphorylated form of the retinoblastoma protein. Apigenin stimulation of smooth-muscle cells was attributed to the reduced expression of 2 cyclin-dependent kinase inhibitors, p21 and p27, which negatively regulate the G(1)-phase cyclin-dependent kinase.

[Modulation of angiogenesis. A new therapeutic tool for vascular diseases]

Angiogenesis permits the growth of new vessels. This process may be modified during the course of some pathological phenomenon, i.e. cancer, atherosclerosis or diabetes. After a brief description of angiogenesis pathophysiology, the therapeutic possibilities in cardiovascular diseases are discussed. Initial results of therapeutic trials in coronary and peripheral artery diseases are detailed, and perspectives for the future are reviewed.

[Does hepatitis c virus-related autoimmune thyroiditis exist? Reflections on a controlled study of 58 consecutive subjects]

PURPOSE

Interferon alpha treatment for virus C hepatitis may be responsible for autoimmune thyroiditis. Relationships between thyroiditis and virus C infection are still debated. The aim of this study was to evaluate the existence of this association.

METHODS

The prevalence of autoimmune thyroiditis in 58 patients (35 male and 23 female patients, mean age 52.6) with untreated virus C hepatitis was compared to that of 56 alcoholic patients (41 male and 15 female patients, mean age 53.8). Autoimmune thyroiditis was defined as the association of abnormal TSH and an increase in antithyroid antibodies.

RESULTS

We did not find any statistical difference in either autoimmune thyroiditis or antithyroid antibodies prevalences.

CONCLUSION

Both our results and a literature review suggest that the few reported cases of related autoimmune thyroiditis and virus C infection are probably coincidental.

[Langerhans histiocytosis in adults: cutaneous and mucous lesion regression after treatment with thalidomide]

BACKGROUND

Langerhans cell histiocytosis is a rare disorder with a wide spectrum of diseases and various clinical behaviours. The prognosis depends on the patient's age at onset and the extension of the disease. Treatment is function of evolution and extension of the disease.

CASE REPORT

We report one case of Langerhans cell histiocytosis in a 33-year-old woman with resistant vulvar involvement whose cutaneous lesions improved with thalidomide. Complete healing of the genital lesions occurred within 1 month, but the patient discontinued her treatment after 3 months because of somnolence. Recurrence of the symptoms was observed within 2 weeks without treatment, but complete control was obtained with reintroduction of thalidomide. No severe adverse effect was detected at electrophysiological and clinical examinations.

CONCLUSION

The simplicity and the rapid effect of thalidomide on cutaneous lesions suggest that new clinical evaluation of this old drug that can also be used in some systemic disease might be of the value.