Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with endometrial cancer

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with endometrial cancer was published in 2022. It was therefore decided, by both the ESMO and the Indian Society of Medical and Paediatric Oncology (ISMPO), to convene a virtual meeting in July 2022 to adapt the ESMO 2022 guidelines to take into account the variations in the management of endometrial cancer in Asia. These guidelines represent the consensus opinion of a panel of Asian experts representing the oncological societies of China (CSCO), India (ISMPO), Indonesia (ISHMO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO). Voting was based on scientific evidence and was conducted independently of the current treatment practices and treatment access constraints in the different Asian countries, which were discussed when appropriate. The aim of this guideline manuscript is to provide guidance for the optimisation and harmonisation of the management of patients with endometrial cancer across the different regions of Asia, drawing on the evidence provided by Western and Asian trials whilst respecting the variations in clinical presentation, diagnostic practices including molecular profiling and disparities in access to therapeutic options, including drug approvals and reimbursement strategies.

Abstract P3-08-02: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Harano K, Wang Y, Masuda H, Lim B, Parinyanitikul N, Lee H-J, Seitz RS, Morris SW, Bailey DB, Hout DR, Rao A, Lucci A, Tripathy D, Krishnamurthy S, Ueno NT. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-08-02.

Abstract P4-02-05: Apocrine morphology and LAR molecular subtype predict prognosis of TNBC patients with residual disease after neoadjuvant chemotherapy

Background: TNBC molecular subtype classification updated by Lehmann et al. includes 4 subtypes: basal-like 1 and 2 (BL1), (BL2), mesenchymal (M), and luminal androgen receptor (LAR), and as a modifier of these subtypes, an Immunomodulatory (IM) gene expression signature. However, molecular subtypes have not been linked to morphological features of TNBC. Apocrine carcinoma has been proposed as a TNBC category that expresses androgen receptor. LAR-subtype TNBC has a poor response to neoadjuvant systemic therapy (NST). We hypothesized that defining the apocrine-featured TNBC by morphology and molecular subtype predict the prognosis of patients with residual disease after NST. Methods: We created the Pan-Pacific TNBC Consortium dataset, which contains paired samples of matched pre and post-NST TNBC tumors from 4 institutions. All patients received NST and didn't have a pathological complete response (pCR). Three pathologists examined hematoxylin and eosin-stained slides of 86 pre-NST samples and determined (1) the presence of apocrine differentiation, (2) the level of tumor-infiltrating lymphocytes (TILs), (3) the histological grade (HG), and (4) the rate of necrosis. These morphological features were compared among the subtypes. For a sample to be considered apocrine positive, apocrine differentiation had to be identified by 2 or more pathologists. Fisher's exact test was used to test the association of subtypes and morphological features. The log-rank test was used to compare disease-free survival (DFS). Results: Twelve of 24 (50%) apocrine-positive tumor samples were LAR subtype, and12 of 17 (70%) LAR-subtype tumor samples exhibited apocrine differentiation. The other subtypes showed following: BL1, 11/44 (25%); BL2, 0/7 (0%); M, 1/10 (10%); unclassified, 0/8 (0%). The median follow-up time was 22 months. In all populations, 2-year DFS rates were higher in patients with apocrine-positive tumors than in those whose tumors did not exhibit apocrine differentiation (P = .027; 2-year DFS, 85% vs 54%). The LAR subtype was also associated with lower HG, although LAR tumors had a similar prognosis to the other subtypes. In the combined analysis of subtypes and apocrine differentiation, patients with apocrine-positive LAR tumors had a higher 2-year DFS rate than did those with apocrine-negative LAR tumors (P = .044; 2-year DFS, 88% vs. 30%). However, patients with apocrine-positive BL1 tumors had no better DFS than did those with apocrine-negative BL1 tumors (P = .133). TIL levels and the presence of the IM signature were positively associated (P = .01), and apocrine differentiation positivity tended to be negatively associated with TIL level (P = .06). Neither TIL level nor IM signature was associated with survival. Conclusion: Apocrine differentiation was associated with the LAR subtype of TNBC and better prognosis in patients who did not have a pCR. The LAR subtype alone did not predict DFS; however, LAR tumors with apocrine differentiation had a better prognosis than did LAR tumors without apocrine differentiation. Using a combination of morphologic and genomic testing may be helpful in determining the prognosis of patients with apocrine-positive TNBC tumors who have residual disease after NST.

Citation Format: Masuda H, Miura S, Harano K, Wang Y, Hirota Y, Matsunaga Y, Lim B, Lucci A, Parinyanitikul N, Lee HJ, Gong G, Rao A, Seitz RS, Morris SW, Hout DR, Nakamura S, Tripathy D, Harada O, Krishnamurthy S, Ueno NT. Apocrine morphology and LAR molecular subtype predict prognosis of TNBC patients with residual disease after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-05.

Abstract P5-05-04: Myc as a poor prognostic marker for ER+ inflammatory breast cancer (IBC): Quantitative estrogen receptor (ER) expression analysis and gene expression analysis in ER+ IBC vs non-IBC

Background

Estrogen receptor-positive (ER+) primary inflammatory breast cancer (IBC) has a poorer prognosis than ER+ primary non-IBC. Our objective was to determine the association between ER positivity and survival outcome in order to elucidate the biological reason that ER+ IBC is more aggressive than non-IBC.

Methods

We retrospectively determined the relationship between ER expression by immunohistochemistry staining and neoadjuvant chemotherapy response as well as survival outcome for 189 patients with ER+ and HER2-negative (HER2-) IBC and 896 case-matched patients with stage III non-IBC seen at MD Anderson Cancer Center between January 1989 and April 2015. We performed gene expression (GE) analysis for 39 patients with ER+/HER2- IBC and 40 patients with non-IBC to detect genes that are specifically overexpressed in IBC. Logistic regression and Cox proportional hazards model were used to determine the predictive and prognostic value of percentages of cells positive for ER and progesterone receptor (PR) among the patients with ER+/HER2- IBC and non-IBC. Recursive partitioning analysis (RPA) was used to determine the optimal cutoff points for ER% and progesterone receptor (PR) % that maximized differences in survival. The identified cutoff points were tested in an external cohort of 192 ER+/HER2- IBC patients from Institut Paoli-Calmettes in France.

Results

The median values for ER% for IBC and non-IBC were 85 (range, 1-100) and 90 (range, 1-100), respectively. The logistic regression model demonstrated a lack of a relationship of ER% with pathological complete response rate to neoadjuvant chemotherapy both in IBC (P=0.29) and non-IBC (P=0.14). Expression of ER was significantly associated with distant disease-free survival (DDFS); hazard ratio (HR), 0.56 [95% CI, 0.37-0.83] per 50% increase in ER%; P<0.05). Also, ER% was significantly associated with overall survival (OS) (HR, 0.40 [95% CI, 0.25-0.63] per 50% increase in ER%; P<0.05). RPA showed that 91.5% and 9.0% were the optimal cutoff points for ER% and PR%, respectively, for DDFS and overall survival in IBC patients. However, the cutoff points could not be validated in the French external cohort. In the GE study, 84 genes were detected as significantly distinguishing ER+ IBC from non-IBC. Among the top 15 canonical pathways shown by IPA, the ERK/MAPK signaling pathway, PDGF pathway, insulin receptor signaling pathway, and IL-7 signaling pathway were associated with the ER signaling pathway. MYC upregulation was observed in three of these four pathways. Indeed, ER+/HER- IBC had significantly higher MYC amplification compared to those with non-IBC (P<0.05) and higher MYC level was associated with poor relapse free survival for IBC (HR, 1.85 [95% CI, 1.05-2.70], P<0.05).

Conclusions

Increased ER positivity was significantly associated with improved survival in ER+/HER- IBC patients. ER+/HER- IBC had several activated pathways with MYC upregulation compared to non-IBC. MYC upregulation was associated with a poor survival outcome for ER+/HER- IBC. The results indicate that MYC is a key gene for understanding the aggressive biological behavior of ER+/HER- IBC.

Citation Format: Iwase T, Harano K, Masuda H, Kida K, Espinosa Fernandez JR, Hess KR, Wang Y, Woodward WA, Layman RM, Dirix L, Van Laere SJ, Bertucci F, Ueno NT. Myc as a poor prognostic marker for ER+ inflammatory breast cancer (IBC): Quantitative estrogen receptor (ER) expression analysis and gene expression analysis in ER+ IBC vs non-IBC [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-05-04.

Note: Evaluation of microfracture strength of diamond materials using nano-polycrystalline diamond spherical indenter

Ultra-hard and high-strength spherical indenters with high precision and sphericity were successfully prepared from nanopolycrystalline diamond (NPD) synthesized by direct conversion sintering from graphite under high pressure and high temperature. It was shown that highly accurate and stable microfracture strength tests can be performed on various super-hard diamond materials by using the NPD spherical indenters. It was also verified that this technique enables quantitative evaluation of the strength characteristics of single crystal diamonds and NPDs which have been quite difficult to evaluate.

Abstract P1-16-04: Somatic mutations, clinicopathologic characteristics, and survival in patients with untreated breast cancer with bone-only and non-bone sites of first metastasis

Background: Bone is the most common site of metastasis of breast cancer, and bone metastasis is associated with a high rate of skeletal-related events, all of which contribute to decreased quality of life and poor outcomes. Biological mechanisms of metastasis to bone may be unique, and identification of distinct signaling pathways and somatic mutations may provide biological insight into or rational targets for treatment of and prevention of bone metastasis. The aims of this study were to compare and contrast somatic mutations, clinicopathologic characteristics, and survival in breast cancer patients with bone only versus non-bone as first metastatic site.

Methods: Tumor samples were collected from 389 patients who had metastasis and untreated primary breast cancer. In each sample, 46 or 50 cancer-related genes were selectively amplified and analyzed for mutations by AmpliSeq Ion Torrent next-generation sequencing. We used Fisher's exact test to identify somatic mutations associated with bone-only first metastasis and logistic regression models to identify differences in clinicopathologic characteristics, survival, and somatic mutations between patients with bone-only first metastasis and patients with first metastasis in non-bone sites only (“other-only first metastasis”).

Results: Among the 389 patients, the first metastasis was located in bone only in 72 patients (18.5%), non-bone sites only in 223 patients (57.3%), and both in 94 patients (24.2%). Of the cancer-related genes analyzed, the most commonly mutated were TP53 (N=103), PIK3CA (N=79), AKT (N=13), and PTEN (N=2). Compared to patients with other-only first metastasis, patients with bone-only first metastasis had higher rates of hormone-receptor-positive disease, non-triple-negative subtype, and low nuclear grade (grade 1 or 2) (all 3 comparisons, p<0.001); had a lower ratio of cases of invasive ductal carcinoma to cases of invasive lobular carcinoma (p=0.002); and tended to have a higher 5-year overall survival (OS) rate (78.2% [95% confidence interval (CI), 68.6%-89.0%] vs 55.0% [95% CI, 48.1%-62.9%]; p=0.051). However, in the subgroup of patients with TP53 mutation and in the subgroup of patients with PIK3CA mutation, OS did not differ between patients with bone-only and other-only first metastasis (p=0.49 and p=0.68; respectively). In univariate analysis, the rate of TP53 mutation tended to be lower in patients with bone-only first metastasis than in those with other-only first metastasis (15.3% vs 29.1%; p=0.051). In multivariate analysis, TP53 mutation was not significantly associated with site of first metastasis (p=0.54) but was significantly associated with hormone-receptor-negative disease (p<0.001).

Conclusions: We did not find associations between somatic mutations and bone-only first metastasis in patients with untreated breast cancer. Patients with bone-only first metastasis have longer OS than patients with other-only first metastasis. More comprehensive molecular analysis may be needed to further understand the factors associated with bone-only metastatic disease in breast cancer.

Citation Format: Kono M, Fujii T, Matsuda N, Harano K, Chen H, Wathoo C, Aron JY, Tripathy D, Meric-Bernstam F, Ueno NT. Somatic mutations, clinicopathologic characteristics, and survival in patients with untreated breast cancer with bone-only and non-bone sites of first metastasis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-16-04.

Abstract P1-07-14: Rates of immune infiltration in patients with triple-negative breast cancers by molecular subtype and in patients with inflammatory and non-inflammatory breast cancers

Background

In patients with triple-negative breast cancer (TNBC), tumor-infiltrating lymphocytes (TILs) have been reported to be associated with improved survival. Lehmann et al. identified 6 molecular subtypes of TNBC [basal-like (BL) 1, BL2, mesenchymal (M), mesenchymal stem like (MSL), immunomodulatory (IM), and luminal androgen receptor (LAR)], and we previously reported that TNBC subtype is a predictor of pathologic complete response (pCR). Recently, the IM gene expression signature has been shown to be indicative of the presence of TILs and has been incorporated into TNBC subtyping as a modifier of the other groups rather than a separate subtype. However, the association between TNBC subtype and the presence of TILs is not known. We hypothesized that the BL2 and LAR subtypes, which have low pCR rates, have low rates of immune infiltration. Inflammatory breast cancer (IBC) is an aggressive cancer that is frequently triple-negative. The association between IBC and the presence of TILs also is not known. In this study, we analyzed the association between TNBC molecular subtype and the IM signature and determined whether the IM signature differed between patients with IBC and non-IBC.

Methods

We retrospectively analyzed 88 patients with TNBC from the World IBC Consortium dataset for whom IBC status was known (IBC, n=39; non-IBC, n=49) and tumor gene expression data were available. TNBC specimens were classified using the TNBCtype algorithm (Insight Genetics, Inc., TN, USA), which uses a 101-gene signature. For each tumor, the TNBCtype algorithm reports the TNBC molecular subtype (BL1, BL2, M, MSL, or LAR) and the IM status, which is described as positive (IM+) or negative (IM-). Recently, Fisher's exact test was used to analyze differences in subtype distribution between the IM+ and IM- tumors.

Results

The subtype distribution differed significantly between the IM+ and IM- tumors

IM signature in TNBC subtypesSubtypeTotal (n=88)IM+ (n=32)IM- (n=56)BL13015 (50)15 (50)BL2202 (100)M808 (100)MSL3113 (42)18 (58)LAR121 (8)11 (92)Not determined53 (60)2 (40) (p=0.0087). The majority of IM+ cases occurred in the BL1 and MSL subtypes. No IM+ cases were observed in the BL2 or M subtypes, and only 1 was observed in the LAR subtype. IM+ cases occurred at roughly the same frequency in patients with IBC (33%) and non-IBC (37%, p=0.73).

Conclusions

TNBC molecular subtypes differ in their degree of immune infiltration, and most IM+ TNBCs are of the BL1 and MSL subtypes. Our finding that the proportion of IM+ cases was not different between IBC and non-IBC indicates that TILs are recruited to the tumor microenvironment similarly in IBC and non-IBC tumors. Further, Pietenpol et al recently showed that the MSL signature represents normal stromal cells rather than tumor cells by performing laser-capture microdissection of TNBC specimen. Validation studies are needed to corroborate and further expand upon our findings.

Citation Format: Harano K, Wang Y, Lim B, Seitz RS, Morris SW, Bailey DB, Hout DR, Skelton RL, Ring BZ, Masuda H, Rao AUK, Woodward WA, Reuben JM, Ueno NT. Rates of immune infiltration in patients with triple-negative breast cancers by molecular subtype and in patients with inflammatory and non-inflammatory breast cancers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-07-14.

Clinicopathological and surgical factors associated with long-term survival in patients with HER2-positive metastatic breast cancer

Trastuzumab-based treatment has dramatically improved the outcomes of HER2-positive (HER2+) metastatic breast cancer (MBC) patients, with some patients achieving prolonged survival times. In this study, we aim to identify factors that are associated with long-term survival. Patients with HER2+ MBC treated with anti-HER2 target therapy were identified. Patients were grouped according to overall survival (OS) and categorized as long-term survivors (LTS, OS ≥ 5 years), or non-long-term survivors (non-LTS, OS < 5 years). Descriptive statistics and multivariable logistic regression modeling were used. A sensitivity analysis was carried out, including only patients diagnosed before 2007; therefore, 5 years of potential follow-up was possible. 1063 patients with HER2+ MBC diagnosed between 1994 and 2012 and treated with anti-HER2 therapy were identified. Among them, 154 (14.5 %) patients were categorized as LTS (median OS 92.2 months). Among LTS, 63.4 % were HR-positive and 32 % had de novo stage IV disease. Hormone receptor positivity (OR) 1.69; 95 % CI 1.17-2.44), resection of metastases (OR 2.38; 95 % CI 1.53-3.69), and primary breast surgery in patients with de novo stage IV (OR 2.88; 95 % CI 1.47-5.66) were associated with improved long-term survival. Greater number of metastatic sites (≥3 vs. 1, OR 0.41; 95 % CI 0.23-0.72) and visceral metastases (OR 0.61; 95 % CI 0.4-0.91) were associated with poor survival. Hormone receptor positivity, low burden of disease, metastasis to soft and bone tissues, and surgical management with resection of the metastatic site and the primary tumor were associated with long-term survival in patients with MBC who received anti-HER2 treatment.

Quality-of-life outcomes from a randomized phase III trial of dose-dense weekly paclitaxel and carboplatin compared with conventional paclitaxel and carboplatin as a first-line treatment for stage II-IV ovarian cancer: Japanese Gynecologic Oncology Group Trial (JGOG3016)

BACKGROUND

Dose-dense weekly paclitaxel (Taxol) and carboplatin (dd-TC) improved survival compared with conventional tri-weekly paclitaxel and carboplatin (c-TC) as a first-line chemotherapy for newly diagnosed stage II-IV ovarian cancer in the Japanese Gynecologic Oncology Group 3016 trial. We report the quality-of-life (QoL) results from this trial.

PATIENTS AND METHODS

A total of 637 patients were randomly assigned to receive c-TC or dd-TC (c-TC, n = 319; dd-TC, n = 312) and were asked to complete a QoL assessment at baseline, just after the third and sixth chemotherapy cycles, and at 12 months after randomization. QoL was assessed using Functional Assessment of Cancer Therapy (FACT)-general (FACT-G), FACT-taxane subscale (FACT-T), and FACT-ovary subscale (FACT-Ov). The overall QoL and that according to each subscale were analyzed using mixed-effects models adjusted for treatment and time.

RESULTS

Baseline QoL assessment was completed by 204 out of 319 (63.9%) and 200 out of 312 (64.1%) patients in the c-TC and dd-TC groups, respectively. In these groups, the compliance rates with regard to QoL assessment were 74.5% and 73.0%, respectively, after three chemotherapy cycles; 86.8% and 86.9%, respectively, after six chemotherapy cycles; and 74.2% and 71.6%, respectively, at 12 months after randomization. The overall QoL did not differ significantly between the two treatment groups up to 12 months after randomization (P = 0.46). However, QoL according to the FACT-T subscale was significantly lower in the dd-TC group than in the c-TC group (P = 0.02).

CONCLUSION

dd-TC does not decrease overall QoL compared with c-TC.

Formation mechanism of triketo cage compounds from reaction of phencyclone with benzoquinones: cascade reaction of intermolecular [4+2]π and intramolecular [2+2]π cycloadditions

The [4+2]π cycloadduct (3aa) of phencyclone (1a) and benzoquinone (2a) readily transformed into the corresponding [2+2]π cycloadduct (4aa) during purification. The structure of the triketo cage compound was determined by single crystal X-ray analysis. The structure-reactivity relationships are discussed based on the PM6-calculated energy profiles for the whole photocycloaddition of the [4+2]π cycloadducts of some cyclopentadienones and benzoquinones.

Immunocytochemical study of parvalbumin, calbindin D-28k, and calretinin in the superficial dorsal horn of the rat spinal cord following unilateral hindpaw inflammation

The effect of noxious stimulation on the immunore-activity of the calcium-binding proteins parvalbumin (PV), calbindin-D-28k (CB) and calretinin (CR) was investigated in the superficial dorsal horn of lumbar levels L5-L3 of the rat spinal cord. Freund's adjuvant was injected unilaterally into the hindpaw to induce inflammation. Immunohistochemical techniques were utilized to investigate changes in the calcium-binding proteins 2h and 1, 2, 4, and 7 days after injection. At 24h after injection, a decrease in the intensity of fluorescence of PV-immunoreactive (IR) fibers was observed in the superficial layer (substantia gelatinosa) of the ipsilateral dorsal horn (L5-L3) in most animals. Comparatively fewer animals exhibited changes in the CB- and CR-IR fibers, except at the L3 level 2 days after, and at the L4 level 7 days after the hindpaw injection. After the peak response, at 24h in most animals, there was a decline in the number of responders at 2 days and no differences were noted at 4 days. However, at 7 days, there was again an increase in the number of animals revealing diminished fluorescence intensity in the ipsilateral substantia gelatinosa. Changes in immunoreactivity of calcium binding proteins in the interneurons of the superficial lumbar dorsal horn may reflect hyperactivity within these neurons following noxious stimulation.

Mating disruption by a synthetic sex pheromone in the white grub beetle Dasylepida ishigakiensis (Coleoptera: Scarabaeidae) in the laboratory and sugarcane fields

A serious sugarcane pest, Dasylepida ishigakiensis, remains in the soil during most of its life cycle except for a short period for mating. Mating disruption by an artificial release of the sex pheromone (R)-2-butanol (R2B), therefore, may be a feasible method to control this pest. We examined the effects of artificial release of R2B and its related compounds, (S)-2-butanol (S2B) and the racemic 2-butanol (rac-2B), on the mating success of this beetle both in the laboratory and in the field. In flight tunnel experiments, almost all males orientated towards a R2B-releasing source and 40% of them landed on the source. When the atmosphere was permeated with R2B, the frequency of males landing on the model was significantly reduced. Both rac-2B and S2B were less effective, but substantial reduction in landing success by males was achieved at higher rac-2B concentrations. R2B released from polyethylene dispensers in sugarcane plots greatly reduced not only the proportion of females mated with males but also the number of males caught by R2B-baited traps, indicating that male mate-searching behaviour was strongly affected by the released R2B. Similar inhibitory effects on male behaviour were also observed when tube- or rope-type dispensers released high rac-2B concentrations in the field. These results indicate that it would be highly possible to control D. ishigakiensis through the disruption of the sexual communication by releasing either synthetic R2B or rac-2B.

P5-14-27: Prognostic Factors of Node-Negative, High Risk and 1–3 Positive Lymph Nodes Breast Cancer by Intrinsic Subtype in Patients with Adjuvant Chemotherapy

Purpose: St. Gallen 2007 categorized high risk, node-negative breast cancer (HNBC) and 1–3 lymph nodes positive BC (LNBC) without HER2 overexpression as intermediate risk. We hypothesized that triple negative BC (TNBC) and hormone-receptor positive without HER2 overexpression (H-BC) in intermediate risk have different prognostic factor in patients with adjuvant chemotherapy (AdC).

Methods: We examined disease-free survival (PFS) and overall survival (OS) of TNBC and H-BC with regard to potential prognostic factors. All the patients included in this study were categorized intermediate risk by St.Gallen 2007 and received AdC.

Results: A total of 470 patients were identified; H-BC (n=360) and TNBC (n=110). Age (&lt;35) was significantly associated with DFS in TNBC while it was not in H-BC (p=0.0.1 and p=0.63, respectively). Tumor size (&gt;2cm) and tumor grade related to DFS in H-BC but not in TNBC. Tumor grade was not associated with DFS in both H-BC and TNBC (p=0.64 and p=0.91, respectively). Lymph node metastasis was a significant factor of DFS only for H-BC (p=0.009 and p=0.19). Conclusions: In TNBC, age was only a significant factor associated with DFS while in H-BC, lymph node status and tumor size rather age related to DFS.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-14-27.

What factors affect the place of end-of-life care for patients with metastatic breast cancer?

218

Background: Despite the early detection and treatment, advanced breast cancer is still impossible to cure. Palliative care has become the standard of care at the time of end-of-life (EOL). However, there are limited data about the degree of access to such care and the factors that affect the choice of place to die. The purpose of this study is to identify factors that affect the place of EOL care in patients with metastatic breast cancer in Japan.

Methods: Our study included breast cancer patients who were diagnosed with recurrence or metastatic diseases between 2004 and 2010 at the National Cancer Center Hospital and received EOL care. The following data were obtained: treatments, place of EOL care, and social background such as age, whether patients had young children, whether patients had elderly family members who needed nursing care, whether patients had jobs at the time of recurrence, and where they lived in.

Results: Overall, 124 patients met our inclusion criteria. Among them, only 13% of patients received EOL care at home and 43.5% of patients at hospices, while 43.5% of patients died in acute care beds. Patients who had jobs at the time of recurrence were significantly more likely to receive EOL care in acute care beds (odds ratio 2.46; 95% CI 1.04−5.83). Other social backgrounds were not significantly related to the place of EOL care.

Conclusions: A sizable proportion of patients, especially patients who had jobs at the time of recurrence, received acute care at the EOL and did not have access to palliative care at home or hospices. Familial backgrounds were not the determinant to choose the place of EOL.

New formation mechanism of allylic trithiocarbonates from sodium O-(2-Alkenyl) dithiocarbonates via sequential pericyclic reactions: Density functional theory study

Density functional theory (DFT) calculations at the B3LYP/6-31G(d) level demonstrated that sodium O-(3-phenylallyl) dithiocarbonate undergoes [3,3]-sigmatropic rearrangement to sodium S-(1-phenylallyl) dithiocarbonate, which then isomerizes to the more thermodynamically stable sodium S-(3-phenylallyl) dithiocarbonate. The calculations also showed that sodium 2-alkenyl trithiocarbonates and their esters are more labile towards the allylic rearrangement.

Chemical reactivity of dihydropyrazine derivatives. Cycloaddition behavior toward ketenes

The cycloaddition behavior of dihydropyrazines toward ketenes was investigated using single-crystal X-ray structures of the cycloadducts and density functional theory (DFT) calculation data. The reaction proceeds via a stepwise pathway involving an orientation complex prior to formation of the betaine intermediate. This is followed by electrocyclization to afford the 1 : 1 and 1 : 2 adducts bearing beta-lactam ring(s).

Crystallographic evidence for cyclopropane ring formation in isotwistenes obtained by thermal cascade reactions of cyclopentadienone with acyclic conjugated dienes

The molecular structure of the double Diels-Alder (DDA) adduct derived from three-step thermal cascade reactions of 2,5-bis(methoxycarbonyl)-3,4-diphenylcyclopentadienone with ethyl sorbate is elucidated by single crystal X-ray analysis. The structural features and the reaction mechanism of the adduct are discussed on the basis of density functional theory (DFT) calculation results.

NMR spectroscopic characterization of inclusion complexes comprising cyclodextrins and gallated catechins in aqueous solution: cavity size dependency

The structure of inclusion complexes of gamma-cyclodextrin (gamma-CD), (-)-gallocatechin gallate (GCg), and (-)-epigallocatechin gallate (EGCg) in D(2)O was investigated using several NMR techniques. GCg formed a 1:1 inclusion complex with gamma-CD in which the A and C rings of GCg were inserted deep at the head of the A ring into the gamma-CD cavity from the wide secondary hydroxyl group side. In the 1:1 inclusion complex with GCg and gamma-CD, the GCg moiety maintained a conformation in which the B and B' rings of GCg took both pseudoequatorial positions with respect to the C ring. The structure of the inclusion complex of GCg and gamma-CD obtained from NMR experiments supported well that determined from PM6 semiempirical SCF MO calculations. However, (1)H NMR experiments suggested that EGCg did not form any inclusion complex with gamma-CD in D(2)O. The marked difference between GCg and EGCg in inclusion behavior toward gamma-CD may be explained in terms of the stabilization energy calculated with the PM6 method. .

Ultrahard diamond indenter prepared from nanopolycrystalline diamond

Knoop indenters were prepared from nanopolycrystalline diamonds (NPDs) synthesized by direct conversion sintering from graphite under high pressure and high temperature. Owing to the fine structure (grain size: 10-100 nm) of NPD, high-accuracy sharp edges could be formed at the indenter tips. The indentation tests demonstrated that the NPD indenter can form normal (measurable) indentations on NPD samples without fracture or chipping even at high temperatures of up to 1000 degrees C, while conventional indenters made of single-crystal diamonds break easily above 600 degrees C. This suggests that the NPD indenter has greater potential in high-temperature hardness tests than the conventional single-crystal diamond indenters.

Diastereomeric difference of inclusion modes between (-)-epicatechin gallate, (-)-epigallocatechin gallate and (+)-gallocatechin gallate, with beta-cyclodextrin in aqueous solvent

Inclusion complexes of (-)-epicatechin gallate (ECg) as well as (+)-gallocatechin gallate (GCg) and beta-cyclodextrin (beta-CD) in an aqueous solution were investigated using several NMR techniques and a computational method. ECg and EGCg formed a 1:1 complex with beta-CD, in which the A ring and a portion of the C ring were included from the wide secondary hydroxyl group side of the beta-CD cavity, and the B and B' rings were left outside the cavity. GCg formed a 1:2 complex with beta-CD, in which the A and B rings of GCg were included by two molecules of beta-CD. The difference between the two modes of inclusion of the 1:1 complex of ECg, EGCg.beta-CD and the 1:2 complex of GCg.beta-CD might have resulted from the size of the space between the B and B' rings in aqueous solution. As a result of nuclear Overhauser effect (NOE) experiments, GCg was considered to have a large enough space between the B and B' rings to include the B ring in the beta-CD cavity; on the other hand, ECg and EGCg have no such large space.

New C28 Steroidal Glycosides from Tubocapsicum anomalum

Three new C(28) steroidal glycosides, isotubocaposides A (1), B (2), and C (3), were isolated from the fruits of Tubocapsicum anomalum MAKINO. Their chemical structures were elucidated on the basis of spectroscopic and X-ray diffraction analysis of p-bromobenzoyl derivative (5) of isotubocaposigenin (4), the sapogenol derivative of these three glycosides. Isotubocaposides have the structural peculiarity of an unusual side chain carrying a C-21 bound to C-24 on the lactone ring.

The Relationship between the Chemical Structures of Dihydropyrazine Derivatives and DNA Strand-Breakage Activity

Dihydropyrazine, a compound derived from sugars, possesses DNA strand-breakage activity. The relationship between the activity as assayed using pBR 322 ccc-DNA and the chemical structures of derivatives of dihydropyrazine (DHPs) has been investigated. The addition of Cu(2+) enhanced the activity remarkably. The introduction of a methyl or phenyl group onto the DHP ring or a cyclohexyl group fused onto the DHP ring also increased the activity. These properties indicated that the activity was due to the facility of electron release from the DHP ring, followed by radical generation. The determination of ionization potential and electrostatic potential values, and bond dissociation energy via semi-empirical MO calculations suggested strongly that the activity is induced by a DHP ring structure that contains a configuration suitable for hyperconjugation.

Structure and intramolecular flexibility of beta-cyclodextrin complex with (-)-epigallocatechin gallate in aqueous solvent

The probable structure of the inclusion complex of beta-cyclodextrin (beta-CD) and (-)-epigallocatechin gallate (EGCg) in D2O was investigated using several NMR techniques. EGCg formed a 1:1 complex with beta-CD, in which the A ring and a portion of the C ring of EGCg were included at the head of the phenolic hydroxyl group attached to C7 of EGCg in the beta-CD cavity from the wide secondary hydroxyl group side. In the 1:1 complex with beta-CD, EGCg maintained the conformation in which the B and B' rings of EGCg took pseudoequatorial and pseudoaxial positions with respect to the C ring, respectively. The structure of the inclusion complexes of beta-CD and EGCg obtained from NMR experiments supported those determined from AM1 semiempirical SCF MO calculations well.

[Cascade reactions of unsaturated xanthates and related reactions: computer-assisted molecular design and analysis of reaction mechanisms]

Chugaev reaction provides access to olefins from alcohols without rearrangement through pyrolysis of O-alkyl S-alkyl dithiocarbonates (xanthates) via cis elimination. Xanthates having no beta-hydrogens undergo thione-to-thiol rearrangement to give S,S-dialkyl dithiocarbonates (thiolcarbonates). Based on these backgrounds, we intended to use the dithiolcarbonates as precursors of thiols. Xanthates could be converted to the corresponding dithiolcarbonates by Lewis-acid catalysis. Pyridine N-oxides and 4-dimethylaminopyridine also catalyzed the rearrangement reaction. On the other hand, O-(2-alkenyl) S-alkyl dithiocarbonates undergo [3,3]-sigmatropic rearrangement to give the allylically rearranged S-(2-alkenyl) S-alkyl dithiocarbonates. The homoallylic xanthates gave the corresponding dithiolcarbonates on heating with phenols. Pyrolysis of allylic dithiolcarbonates caused retro-ene type reaction to give the allylic sulfides in which allylic rearrangement also occurs. Coupling of these pericyclic reactions with intramolecular Diels-Alder reaction affords a one-pot synthetic method for the construction of hydroisobenzothiophenes. The mechanisms of the cascade and related reactions are demonstrated by location of the transition states using molecular orbital calculation method at various levels of theory involving density functional theory (DFT).

NMR spectroscopic characterization of metoprolol/cyclodextrin complexes in aqueous solution: Cavity size dependency

The inclusion complex formation of a water-soluble beta(1)-selective adrenoreceptor antagonist Metoprolol (Met) with alpha-cyclodextrin (alpha-CyD), beta-cyclodextrin (beta-CyD), gamma-cyclodextrin (gamma-CyD), and 2-hydroxypropyl-beta-cyclodextrin (HP-beta-CyD) in aqueous solution was studied by ultraviolet (UV), circular dichroism (CD), and nuclear magnetic resonance (NMR) spectroscopies and the modes of interaction were assessed. Continuous variation plots revealed that Met forms the inclusion complexes with alpha-CyD, beta-CyD, and HP-beta-CyD in a stoichiometry of 1:1, whereas gamma-CyD forms the 2:1 complex where two Met molecules are included in one gamma-CyD cavity. NMR spectroscopic studies, including ROESY and GROESY techniques, clearly indicated that alpha-CyD with the small cavity includes the methoxyethylbenzene moiety of Met molecule shallowly in the cavity, depositing the benzene and the methoxy moieties around the secondary and primary sides, respectively, of the cavity. In the case of the beta-CyD complex, the methoxyethylbenzene moiety is more deeply included in the cavity, and it is feasible that Met may be able to enter from both primary and secondary hydroxyl sides of the cavity, forming the 1:1 complex. On the other hand, two Met molecules are included probably in an antiparallel orientation in the large gamma-CyD cavity, and the benzene moieties of Met are in contact with each other.

Pericyclic reaction of ketenes with cascade reaction products of pyridine N-oxides and dipolarophiles. X-ray structures of the adducts and formation mechanism

The structures of the adducts derived from the reactions of substituted ketenes with dihydropyridine derivatives have been clarified by single crystal X-ray analyses and the formation mechanism is discussed on the basis of the reaction-path calculations by semiempirical and density functional theory (DFT) molecular orbital methods.