The prognostic and predictive role of class III β-Tubulin and hENT1 expression in patients with advanced pancreatic ductal adenocarcinoma

BACKGROUND

FOLFIRINOX and gemcitabine-nabpaclitaxel (GnP) are standard first-line treatment regimens for advanced pancreatic ductal adenocarcinoma (PDAC). However, currently, there is a lack of predictive biomarkers to aid in the treatment selection. We aimed to explore the prognostic and predictive value of class III β-Tubulin (TUBB3) and human equilibrative nucleoside transporter 1 (hENT1) expression, which have previously been shown to be associated with taxane and gemcitabine resistance in advanced PDAC.

METHODS

We conducted a retrospective analysis of 106 patients with advanced PDAC treated with GnP and/or FOLFIRINOX at our institution. TUBB3 and hENT1 immunohistochemical staining was performed on tumor specimens and subsequently evaluated based on the intensity and percentage of expression.

RESULTS

In patients who received the GnP regimen, a high combined score (TUBB3low/hENT1high) was associated with a higher DCR and longer PFS compared to those with intermediate (TUBB3high/hENT1high or TUBB3low/hENT1low) and low score (TUBB3high/hENT1low). In the multivariate analysis, a high combined score was an independent predictor of higher DCR (OR:11.96; 95 % CI:2.61-54.82; p = 0.001) and longer PFS (HR:0.33; 95%CI:0.18-0.60; p < 0.001). However, there was no difference in response rates or PFS based on TUBB3 and hENT1 expression among patients receiving the FOLFIRINOX regimen.

CONCLUSION

Our findings indicate that tumor TUBB3 and hENT1 expression may predict the efficacy of the GnP regimen, and low TUBB3 and high hENT1 expression (TUBB3low/hENT1high) are associated with a higher DCR and longer PFS in patients treated with GnP. Evaluating TUBB3 and hENT1 jointly can identify the patients most (as well as least) likely to benefit from GnP chemotherapy.

AB0331 EFFICACY, RETENTION RATE AND PREDICTORS OF TOFACITINIB EFFICACY AND RETENTION IN RHEUMATOID ARTHRITIS PATIENTS: HUR-BIO REAL-LIFE EXPERIENCE

Background:

Tofacitinib (TOF) is an oral Janus Kinase (JAK) inhibitor and is indicated in the treatment of rheumatoid arthritis (RA). Several interventional or observational studies demonstrated its safety and efficacy, however, its real-life retention rate and related factors need to be elucidated further and its efficacy needs to be approved in real-life.

Objectives:

To assess the real-life efficacy, retention rate and related factors of both parameter in rheumatoid arthritis patients under tofacitinib.

Methods:

We analyzed all RA patients registered to HURBIO database who received at least 1 dose of tofacitinib (for drug retention) and who had at least 1 control visit under tofacitinib (for efficacy). Drug retention rates were calculated using the Kaplan-Meier method and predictors of drug retention were determined by Cox proportional hazard model. Patients were grouped as ‘’responder’’ or ‘’non-responders according’’ to DAS28 at last control visit: DAS28-CRP≤3.2: ‘’Responders’’; DAS28-CRP>3.2: ‘’Non-responders’’. Predictors of response (DAS28-CRP≤3.2 at last visit) were determined by logistic regression analysis. Reasons for switching and discontinuation were also determined.

Results:

For drug retention;a total of 247 (210 (85%) female) patients were recruited. Mean age was 53.1±12.6 years. Mean disease duration was 11.3±8.0 years. Rheumatoid factor and anti-CCP antibodies were positive in 160/240 (66.7%) and 135/207 (65.2%) patients, respectively. Combination with DMARDs was used in 83.3% of patients. 55.5% of patients was biologic-naive. Median follow-up while receiving tofacitinib was 10.2 (IQR:4.0-24.2) months. One-year crude retention rate was 64%. Median duration of drug retention was 24.8 months. Predictors of good tofacitinib retention were (in multivariate analysis):living in Ankara (where our center is located) (HR 1.43 (0.96-2.14); 95% CI) andBMI> 25(HR 1.46 (0.97-2.29); 95% CI).

For efficacy;a total of 204 (174 (85.4%) female) patients were recruited. Mean age was 53.2±12.5 years. Mean disease duration was 11.5±8.1 years. Rheumatoid factor and anti-CCP antibodies were positive in 135/198 (68.1%) and 115/171 (67.2%) patients, respectively. Detailed demographic and clinical characteristics of participants were given in table 1. Median follow-up while receiving tofacitinib was 11.6 (IQR:5.2-26.2) months. DAS28-CRP levels at baseline and last visit were 4.8 (IQR:3.9-5.4) and 3.3 (IQR:2.5-4.6), respectively (p<0.001). At last visit, 19.6% of patients was in low-disease activity (2.6≤DAS28-CRP≤3.2), 26.0% of patients was in remission (DAS28-CRP<2.6) Predictors of good response to tofacitinib were (in multivariate analysis, adjusted for follow-up duration under tofacitinib):biologic-navie(aOR 2.38 (1.30-4.34); 95% CI) andRF negativity(aOR 2.12 (1.13-3.95); 95% CI).

The most common cause of drug discontinuation was primary failure (in 36/108 patients, 33.4%).

Conclusion:

Tofacitinib seems an effective treatment option for rheumatoid arthritis. Relationship between seronegativity and good response to tofacitinib needs to be elucidated. Also, Clinicians should keep in their mind that in addition to patient characteristics, socioeconomic factors may influence the adherence to the treatment.

Disclosure of Interests:

Emre Bilgin: None declared, Furkan Ceylan: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Bayram Farisoğullari: None declared, Gözde Kübra Yardimci: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

FRI0117 INCIDENCE RATE OF HERPES ZOSTER IN RHEUMATOID ARTHRITIS PATIENTS UNDER TOFACITINIB: REAL-LIFE DATA FROM TURKEY – HURBIO REGISTRY

Background:

Tofacitinib (TOF) is an orally administered Janus Kinase (JAK) inhibitor and is commonly used in rheumatoid arthritis. There is a heterogeneity among numbers reported from different continents about herpes zoster (HZ) incidence rate (1-3). However, data about HZ risk in our country, which stands like a bridge between Asia and Europe, is lacking.

Objectives:

To assess the real-life incidence of herpes zoster in RA patients under tofacitinib.

Methods:

We analyzed all patients who had at least 1 control visit under tofacitinib and registered to HURBIO database. We calculated incidence rate by dividing the number of patients with herpes zoster to total follow-up years, then multiplied by 100 (per 100 patient-years).

Results:

A total of 204 (174 (85.4%) female) patients were recruited. Mean age was 53.2±12.5 years. Mean disease duration was 11.5±8.1 years. Rheumatoid factor and anti-CCP antibodies were positive in 135/198 (68.1 %) and 115/171 (67.2 %) patients, respectively. Median follow-up while receiving TOF was 11.6 (IQR:5.2-26.2) months. Combination with DMARDs was used in 83.3% of patients. 55.5% of patients was biologic-naive. Eleven (5.3%, incidence rate: 3.9 (2.3-8.5; % 95 CI) per 100 patient-years) patients had zona zoster. Ten of these patients was female, median age was 59 (IQR; 52-69) and 4 of them was older than 65 years-old. Rheumatoid factor was positive in 9 patients. Only 1 of these patients had diabetes. Median follow-up of these patients under TOF was 8.1(IQR: 6-25) months. Ten of these patients had concomitant DMARDs (9 hydroxycholoroquine, 4 methotrexate, 2 leflunomide; according to last follow-up visit) and 9 of them received concomitant steroids (med(IQR); 4 (1-8) mg- at equivalant methyl-prednisolon dose). Eight of them was biologic-naive. Tofacitinib was discontinued in 4 of these patients.

Conclusion:

In this real-life data from Turkey, we found a HZ incidence rate similar to that reported from USA and global data; however, we found a lower incidence rate that reported from Japan (Figure 1).

Figure 1.

Reported herpes zoster incidence rates across different countries (numbers in paranthesis indicate reference number)

References:

[1]Winthrop KL, Curtis JR, Lindsey S, Tanaka Y, Yamaoka K, Valdez H, et al. Herpes Zoster and Tofacitinib: Clinical Outcomes and the Risk of Concomitant Therapy. Arthritis & rheumatology (Hoboken, NJ). 2017;69(10):1960-8.

[2]Curtis JR, Xie F, Yun H, Bernatsky S, Winthrop KL. Real-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis. Ann Rheum Dis. 2016;75(10):1843-7.

[3]Yamanaka H, Tanaka Y, Takeuchi T, Sugiyama N, Yuasa H, Toyoizumi S, et al. Tofacitinib, an oral Janus kinase inhibitor, as monotherapy or with background methotrexate, in Japanese patients with rheumatoid arthritis: an open-label, long-term extension study. Arthritis Res Ther. 2016;18:34.

Disclosure of Interests:

Emre Bilgin: None declared, Furkan Ceylan: None declared, Emine Duran: None declared, Ertugrul Cagri Bolek: None declared, Bayram Farisoğullari: None declared, Gözde Kübra Yardimci: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

Preliminary results on evaluation of chickpea, Cicer arietinum, genotypes for resistance to the pulse beetle, Callosobruchus maculatus

Abstract The chickpea, Cicer arietinum L. (Fabales: Fabaceae), seeds are vulnerable, both in the field and in storage, to attack by seed-beetles. Beetles of the genus Callosobruchus are major storage pests of chickpea crops and cause considerable economic losses. In the present study, a total of 11 chickpea genotypes including five 'kabuli' (Mexican white, Diyar, CA 2969, ILC 8617 and ACC 245) and six 'desi' chickpeas (ICC 1069, ICC 12422, ICC 14336, ICC 4957, ICC 4969 and ICC 7509) were evaluated for resistance to the pulse beetle Callosobruchus maculatus F. (Coleoptera: Bruchidae). Resistance was evaluated by measuring percent damage to seeds. Damage to seeds by C. maculatus was manifested by the round exit holes with the 'flap' of seed coat made by emerging adults. Of the 11 genotypes tested, only one (ICC 4969) exhibited a complete resistance to C. maculatus in both free-choice and no-choice tests; no seed damage was found over the test period. In general, the 'desi' chickpeas were more resistant to C. maculatus than the 'kabuli' chickpeas. Among the tested chickpea genotypes, only ICC 4969 can be used as a source of C. maculatus resistance in breeding programmes that could then be grown in organic cultivation free from pesticides.

Supplementation with High-Dose Ascorbic Acid Improves Intestinal Anastomotic Healing

BACKGROUND/AIM

Ascorbic acid modulates tissue healing but the value of ascorbic acid supplementation during anastomotic healing remains unclear. We examined the role of ascorbic acid treatment in experimental intestinal resection.

METHODS

Male Wistar albino rats (n = 30) were divided into three groups: sham treatment (group 1), and daily ascorbic acid treatment with 100 mg/kg (group 2) or 200 mg/kg (group 3) via the intramuscular route. Following sacrifice on the 7th postoperative day, bursting pressure of the anastomoses was measured. Hydroxyproline assessment and histological analysis were carried out.

RESULTS

The bursting pressure values of groups 2 (171.4 +/- 4.3 mm Hg) and 3 (196.4 +/- 2.2 mm Hg) were higher than that of group 1 (139.1 +/- 4.1 mm Hg; p < 0.05). In addition, the hydroxyproline level of group 3 (249.2 +/- 25.1 microg/mg) was higher than that of groups 1 (157.9 +/- 14.9 microg/mg) and 2 (187.9 +/- 14.8 microg/mg; p < 0.05). The histopathological scores indicated improved healing in groups 3 (6.0 +/- 0.2) and 2 (4.4 +/- 0.4), compared to group 1 (2.7 +/- 0.3; p < 0.05).

CONCLUSION

In the present study, supraphysiologic doses of ascorbic acid improved anastomotic healing. Therefore, vitamin C supplementation poses as a beneficial treatment in the context of collagen accumulation, inflammatory response, and anastomotic strength. However, the clinical value of high-dose ascorbic acid supplementation in the clinical setting is yet to be established.

Transient bone loss of distal radius and ulna following clean-cut tendon injuries, repair and passive mobilisation

The aim of this study was to investigate whether there is any significant bone loss of the ulna and radius following acute tendon-artery-nerve clean-cut injuries at the wrist level which were repaired and rehabilitated by early passive mobilisation. Fifty-eight patients who underwent such operation were enrolled in this study. Patients in Group I (n=28) had primary tendon repairs alone, in Group II (n=15) primary tendon and nerve repairs and in Group III (n=15) primary tendon, nerve and artery repairs. Bone mineral density (BMD) measurements of the ulna and radius were obtained during the first week, the sixth week, the third month and the 12th month after operation. The results demonstrated that BMD decrease in the ulna was more common than in the radius. When compared with the first week BMD measurements, the highest reduction was seen in the sixth week in Group I and during the third month, when bone loss of both the radius and ulna was considerable in Group II. The bone loss in all groups and subgroups were found to have recovered at the 12th month measurements, except in the distal region of the ulna in Group I. This study suggests that passive immobilisation is deleterious in respect of demineralisation of the forearm bones.