Epirubicin and cyclophosphamide (EC) followed by weekly paclitaxel with/without trastuzumab as primary systemic therapy in locally advanced breast cancer: Phase II study

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Background: Primary systemic therapy (PST) has become a standard therapy for locally advanced breast cancer (LABC). The aim of this study was to evaluate the activity and toxicity of EC (epirubicin/cyclophosphamide) followed by weekly paclitaxel with/without trastuzumab as PST in LABC. Methods: Primary endpoint was pathologic complete response (pCR) rate in the breast and axilla, and secondary endpoints were breast conserving rate and toxicities. Patients with histologically diagnosed invasive breast cancer by core needle biopsy of the T2–4 (>3 cm) or N1–3 were included in this study. Eligible patients were age >20 years, had a performance status of 0 to 1, and had adequate organ functions. It was determined that the expected rate of pCR in the trial was 25%, and the sample size was calculated using the Simon method, with a type I error of 5% and a study power of 80%. The target enrollment was estimated to be 40 evaluable patients. Treatment: Patients received epirubicin (100 mg/m2) and cyclophosphamide (600mg/m2 ) every 3 weeks for four cycles followed by paclitaxel (80 mg/m2 ) every week for 12 cycles. Trastuzumab (2mg/kg) was added to paclitaxel in HER2-positive patients. Results: Forty-three patients were enrolled into this study and 3 patients withdrew. pCR were observed in 8 patients and pCR rate was 20.0% (95% confidence interval, 7.6- 32.4). Twenty-four patients (60.0%) underwent breast conserving surgery. In particular, patients with HER2 positive tumor had significantly higher rate of pCR than the others (62.5% vs. 8.6%; p=0.0014). Grade 4 neutropenia was recorded in 27.5% of the patients, and febrile neutropenia occurred in 4 patients (10.0%). No heart failure was seen. Conclusions: EC followed by weekly paclitaxel with/without trastuzumab was an active and well-tolerated treatment for LABC.

No significant financial relationships to disclose.

Safety and efficacy of a recombinant yeast-derived pre-S2 + S-containing hepatitis B vaccine (TGP-943): phase 1, 2 and 3 clinical testing

A recombinant yeast-derived pre-S2 + S-containing hepatitis B vaccine (TGP-943) was clinically evaluated through three phases of testing in a total of 2137 volunteers. We observed the immunogenic purity of TGP-943 (phase 1), the inter-lot reproducibility of both safety and immunogenicity (phase 2), no significant side-effects, a high capability of inducing both anti-HBs and anti-pre-S2 antibodies (phases 1, 2 and 3), and an ability to induce seroconversion in the majority of vaccines who had been non-responsive to conventional hepatitis B vaccines (phases 2 and 3). In conclusion, TGP-943 is a safe and tolerable vaccine, with special merits: the ability to induce an early anti-pre-S2 response that circumvents the problem of delayed appearance of anti-HBs, and efficacy in non-responders to previous vaccination.

[Adoptive immunotherapy of cancer patients with lymphokine-activated killer cells]

We have examined the effects of recombinant human interleukin-2 (rIL-2) on generation of lymphokine-activated killer (LAK) cells and adoptive immunotherapy. rIL-2 generated LAK activity dose- and time-dependently. The generated LAK cells by rIL-2 killed autologous and various allogenic tumor cells but not normal cells. No difference was found in the generation of LAK activity by rIL-2 between healthy donors and cancer patients rIL-2 generated LAK activity of lymphocytes obtained from peripheral blood, spleen, pleural fluid and ascites in cancer patients. Two cancer patients with pleuritis carcinomatosa, who had not responded to various chemotherapeutic agents, were treated with adoptive immunotherapy. LAK cells were generated from the lymphocytes of pleural fluid or peripheral blood incubated with rIL-2 (5 U/ml) for 5 days. LAK cells (0.1-1.0 X 10(9)/100 ml in total) were administered into the pleural cavity followed by injection of rIL-2 (1,000 U) 1 to 7 times. No significant adverse effect was observed except for fever and eosinophilia. Complete disappearance of pleural tumor cells was observed in one patient and decrease in the other.

Yield of routine annual laboratory screening in the institutionalized elderly

We examined the yield of a battery of 19 screening laboratory tests performed routinely in 70 functionally intact patients, averaging 82.6 years of age and residing at a chronic care facility. The 70 patients underwent 3,903 screening tests (70 admission batteries and 156 batteries at annual intervals). Twenty per cent of the admission test results and 17 per cent of all subsequent annual test results were "abnormal". "New abnormal" results (previously unknown to the responsible physicians) occurred primarily in five of the 19 screening tests; they were found in 13 per cent of all admission screening tests and in 6 per cent of all annual tests. However, many of the "new abnormalities" were only minimally outside the normal range, and only 26 (0.7 per cent) led to further diagnostic evaluation. Of these 26, only four (0.1 per cent of all tests ordered) led to changes in patient management, none of which benefited the patient in an important way.