The effects of paclitaxel (PTX) and 2-methoxyestradiol (2-ME2) on tumor oxygenation and HIF-1α in breast cancer

3517

Background: Radiation activates HIF-1a via a free radical mediated mechanism associated with reoxygenation. This response could be inhibited, resulting in reduced tumor vascularity and proliferation. Preclinical breast cancer models and a Phase Ib clinical trial (CT) were employed to look at the effects of chemo with or without an oral HIF-1a inhibitor, 2-ME2 (EntreMed) on tumor oxygenation and HIF-1a. Methods: Preclinical models of chemo effects on HIF-1a/oxygenation used 4T1 tumors and either doxorubicin (DOX) or cyclophosphamide (CTX). In addition, MDA-MB-231 tumors were treated with 2-ME2 (5days), and HIF-1a/MVD was assessed. In the CT, up to 15 pts with metastatic breast cancer, and biopsiable (>2 cm) non-bone sites were eligible. Tx was: D 1: PTX, 90 mg/m2; D 8: PTX, 90 mg/m2 with 2-ME2 (cohorts of 1,000/1,250/1,500 mg, qid). PTX was given 3 out of 4 wks. Bxs were done at enrollment, D8 (post-PTX), and D22 (post-PTX/2-ME2). Tumors were examined for changes in HIF-1a and CA9 levels, MVD, and genomic signatures of hypoxia. Plasma was obtained for osteoponin, PAI-1, and VEGF. Results: DOX and CTX both led to increases in HIF-1a, oxygenation, vascularity, and proliferation 4–10 days post treatment in the 4T1 model, while 2-ME2 reduced HIF-1a and MVD post treatment (5 d) in the MDA-MB-231 model. The CT opened in 6–2006, 9 pts have consented and 8 pts have undergone sequential biopsies and accrual continues. No DLT have been seen. Biopsy sites include chest wall, liver, and LN. Sufficient tissue/RNA/plasma has been obtained and the planned analyses will be presented. Conclusions: HIF-1a and tumor oxygenation appear to be modulated as a response to chemotherapy. The combination of PTX and 2-ME2 is clinically active, well-tolerated, and could serve as one of the first approaches to target HIF-1a in order to optimize therapy. Supported by Komen Grant BCTR0504044.

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E-tablets to collect research-quality patient-reported data

6609

Introduction: Programmed wireless notebook computers (e-tablets) can collect review of systems (ROS) data at point of care. Patients complete surveys in the clinic waiting area; a report is generated for the subsequent clinical visit. Are e-tablets a feasible, acceptable method for collecting data directly from patients in an academic cancer clinic? Can they reliably collect other survey data? Methods: We used PACE e-tablets (SOS, Inc.) to administer Functional Assessment of Cancer Therapy (FACT)-G, FACT-B, MD Anderson Symptom Inventory (MDASI), FACIT-Fatigue, and Self Efficacy instruments, in addition to the PACE Patient Care Monitor (PCM) ROS survey. Participants were 66 breast cancer patients in Duke Breast Cancer Clinic. At 4 visits in 6 months, participants completed all electronic and 1 paper survey. Subscales were compared using paired t-tests. Patients completed an electronic survey of satisfaction with PCM. Results: Mean age, 55 (SD 12); 77% Caucasian; 49% no college degree; 68% married; 61% metastatic cancer. Patients strongly supported e-tablets: easy to read (94%), easy to respond to questions (98%), weight of computer comfortable (87%). Satisfaction increased over time: helpful for reporting symptoms (75–88%), would recommend PCM to other patients (87–94%). 75% indicated PCM helped them remember symptoms to discuss with the clinician. Responses to paper and electronic surveys were nearly identical for 3 of 4 FACT-G, and all FACT-B, MDASI, and FACIT-Fatigue subscales (all p>0.31). Responses on FACT-G Social Wellbeing and 4 Self Efficacy subscales differed from paper to electronic (all p<0.006, all electronic scores poorer). Conclusions: Patients are satisfied with e-tablets. E- tablets furnish comparable data to those collected by paper on nearly all scales tested. PCM offers a valid, feasible method for collecting research-quality, clinically relevant data from patients in outpatient academic oncology.

No significant financial relationships to disclose.

Effects of chemotherapy and tamoxifen on cervical and vaginal smears in bone marrow transplant recipients

OBJECTIVE

To clarify the importance of squamous and glandular atypia in the genital tracts of women undergoing high-dose chemotherapy and receiving tamoxifen.

STUDY DESIGN

The pathology records of 769 female bone marrow transplant recipients from a five-year period at Duke University Medical Center were reviewed. One hundred fifteen cervicovaginal smears from 78 patients were available for evaluation; of these, 85 smears from 61 patients were selected. Only cases from patients with a complete medical history, including menopausal status and therapeutic regimen, were included in this study. Forty-five cases were from patients treated with chemotherapy alone, and 40 were from patients treated with a combination of chemotherapy and tamoxifen.

RESULTS

A normal cellular pattern was the most common finding. Reactive cellular changes associated with therapy effect were identified in 21% of cases. In patients treated with chemotherapy alone, an atrophic smear pattern in a premenopausal woman was identified in 27% of cases. Squamous epithelial cell abnormalities were identified in approximately the same proportion of patients whether they received chemotherapy alone or with tamoxifen. Glandular changes were uncommon.

CONCLUSION

The most common finding was a normal smear pattern. An atrophic smear was more commonly found in patients treated with chemotherapy alone than in those treated with both chemotherapy and tamoxifen. Squamous epithelial cell abnormalities are most probably independent of treatment effect. Glandular changes were rare in patients treated with chemotherapy, alone or in combination with tamoxifen.