Abstract P4-01-08: Efficacy of PARP Inhibitors in Patients With BRCA1/2-related Breast Cancer with Prior Platinum Exposure: A Systematic Review and Meta-Analysis

Background: Approximately 5% of breast cancer patients carry a deleterious germline BRCA1/2 mutation, which leads malignant cells to be deficient in the repair of DNA double-strand breaks via homologous recombination. The poly(adenosine diphosphate–ribose) polymerase (PARP) enzymes are important on DNA single-strand break repair and PARP inhibitors (PARPi) cause an accumulation of unresolved DNA damage in tumors with BRCA1/2 mutations, resulting in cell death. However, because platinum salts also ultimately cause double-strand DNA breaks and may have overlapping mechanisms of resistance with PARPi, the efficacy of PARPi in patients with prior platinum therapy is unknown. We sought to evaluate the efficacy of PARPi in patients with BRCA1/2-related breast cancer and previous platinum exposure. Methods: We performed a systematic review and meta-analysis of studies that evaluated the efficacy of PARPi in patients with advanced or metastatic breast cancer and germline BRCA1/2 mutations. Two independent investigators identified double-blind, randomized controlled trials (RCTs) that included the subgroup of previous exposure to platinum. PubMed, Embase, and Cochrane databases were searched for papers up to June 26, 2022. Data extraction from published reports and quality assessment were performed under Cochrane recommendations. Hazard ratios (HRs) with a 95% confidence interval (CI) were pooled, and a p-value of < 0.05 was considered statistically significant. The software Review Manager 5.3 was selected for conducting the statistical analysis. The primary endpoint of interest was progression-free survival (PFS). Results: Out of 2069 database results (487 on PubMed; 1376 on Embase; and 206 on Cochrane), 42 studies were selected for full review, and 4 RCTs, with a total of 249 patients, were included in the final investigation. The PARPi included were Olaparib, Talazoparib, Niraparib, and Veliparib. Pooled analysis showed that PARPi improved PFS in breast cancer patients with prior treatment with platinum-based therapy compared to the control group [HR = 0.72; 95% CI, 0.53-0.97; p = 0.03]. In comparison, the population without previous platinum exposure had a similar but slightly greater benefit from PARPi [HR = 0.68; 95% CI, 0.52-0.89; p = 0.005]. A subgroup analysis containing only the three randomized trials with PARPi monotherapy confirmed the central tendency favoring PARPi over physicians’ choice of single-agent chemotherapy in patients with prior platinum-therapy; however, because of small numbers and wide confidence interval it was not statistically significant [HR = 0.72; 95% CI, 0.51-1.01; p = 0.06]. Conclusions: Our findings suggest that PARPi are associated with longer PFS in patients with advanced breast cancer and previous exposure to platinum therapy, decreasing the concerns about cross-resistance between the drug classes. Nonetheless, more extensive studies are still necessary to investigate the efficacy of PARPi in patients with prior platinum exposure and truly platinum-resistant disease.

Progression-free survival of included studies

Citation Format: Alice D. Marinho, Beatriz Mella S. Pessoa, Gabriela R. Brandao, Caroliny H. Da Silva, Pedro A. Reis, Ana Carolina M. Comini, Felipe Batalini. Efficacy of PARP Inhibitors in Patients With BRCA1/2-related Breast Cancer with Prior Platinum Exposure: A Systematic Review and Meta-Analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-08.

Fucus spiralis as monitoring tool of metal contamination in the northwest coast of Portugal under the European Water Framework Directives

Metals (Cd, Cr, Cu, Fe, Mn and Zn) in coastal seawaters and soft tissues of macroalga Fucus spiralis from the northwest coast of Portugal were determined to assess spatial variations of metal bioavailabilities and bioaccumulation factors to compare different ecological quality classifications. Both coastal seawaters and soft tissues of F. spiralis showed significant spatial variations in their metal concentrations along the coast. The macroalgae F. spiralis accumulated more efficiently Cd, Mn and Zn and showed low bioaccumulation factors to Cr, Cu and Fe. Regarding the metal guidelines of the Norwegian Pollution Control Authority, the entire northwest (NW) coast of Portugal in April 2013 should be classified as 'class I--unpolluted' for all metals, except in Ave for Cu ('class II--moderately polluted') and Cavado for Cd and Cu ('class II-moderately polluted'), revealing the low metal bioavailabilities of these seawaters. As there were always significant positive correlations between all metals in seawaters and F. spiralis, this macroalga species was considered a suitable monitoring tool of metal contamination in the NW coast of Portugal and a useful aquatic organism to be included in the European Environmental Specimen Banks in order to establish a real-time environmental monitoring network under the European Water Framework Directives.

Effects of subtle pollution at different levels of biological organisation on species-rich assemblages

We investigated effects of subtle nutrient enrichment and metal pollution on different levels of biological organization (i.e. whole assemblage, population and individual) of species-rich assemblages. We used rockpools as model system, applying a multi-factorial sampling design to test hypotheses on differences between disturbed and reference locations. Results indicated that disturbed and reference locations supported similar assemblages, as well as individual fitness-related life-traits were ineffective to discriminate between the two conditions. In contrast, assemblages responded to pollution through a reduction of the abundance of sensitive species and a proliferation of tolerant species, although these alterations were detectable only once the influence of dominant taxa was down-weighed by data transformation. Present findings suggest that, contrarily to individual level variables, assemblage structure after data transformation and patterns of distribution and abundance of differently sensitive taxa would be a powerful tool to detect effects of subtle pollution on species-rich assemblages.

Seasonal variation of metal contamination in the barnacles Pollicipes pollicipes in northwest coast of Portugal show clear correlation with levels in the surrounding water

The concentrations of metals were determined in northwest (NW) coast of Portugal seawaters and soft tissues of goose barnacles Pollicipes pollicipes. P. pollicipes can be used for monitoring metal contamination in these coastal seawaters, because there were significant correlations (p<0.05) for all metals between soft tissues and seawaters during the four seasons. Metal concentrations in seawaters and P. pollicipes had significant (p<0.05) spatial and seasonal variations and mean log BAFs for Fe and Cd were higher than for Cr, Cu, Mn and Zn. Regarding the metal concentrations obtained in the coastal seawaters, all NW coast of Portugal should be classified as "Class IV--Bad", except two locations (location 7 at Summer and location 10 at Winter), which should be classified as "Class III--Moderate". However, considering the metal concentrations bioaccumulated in P. pollicipes, all locations should be classified as "Class III--Remarkably Polluted" during all seasons of 2011.

Goose barnacle Pollicipes pollicipes as biomonitor of metal contamination in the northwest coast of Portugal

The main objective of this work was to assess the potential use of goose barnacle Pollicipes pollicipes as biomonitor of metal contamination in northwest (NW) coast of Portugal. The concentrations of Cd, Cr, Cu, Fe, Mn, Ni and Zn were determined in coastal seawaters and tissues of P. pollicipes, which allowed establishing correlations between metals in coastal seawaters and P. pollicipes and calculating metal bioaccumulation factors (BAFs). The results of this study showed that P. pollicipes soft tissues can be used for monitoring metal contamination in these coastal seawaters: (1) there were significant correlations (p < 0.05) between metals in soft tissues and their concentrations in seawaters, except for Zn (p > 0.05); (2) soft tissues were sensitive to spatial variations of metal bioavailabilities and their concentrations ranged 0.70-2.22 mg Cd kg(-1), 0.49-1.40 mg Cr kg(-1), 1.37-2.07 mg Ni kg(-1), 2.4-3.3 mg Cu kg(-1), 5-59 mg Mn kg(-1), 134-578 mg Fe kg(-1)and 728-1,854 mg Zn kg(-1); (3) mean logarithmic bioaccumulation factors (log BAF) of Fe, Cd and Zn were higher, 5.57, 5.47 and 4.41, respectively, than mean log BAFs of Cr, Mn, Cu and Ni, 4.18, 4.14, 3.98 and 3.51, respectively. In contrary, P. pollicipes shell plates were not considered ideal material to monitor metal bioavailabilities in these coastal seawaters. Regarding the very high concentrations of Zn obtained in the coastal seawaters and P. pollicipes soft tissues, the NW coast of Portugal should be classified as "Class III/IV - Remarkably/Highly Polluted".

Chthamalus montagui as biomonitor of metal contamination in the northwest coast of Portugal

The concentrations of seven metals (Cd, Cr, Cu, Fe, Mn, Ni and Zn) were determined in coastal seawaters and soft and hard tissues of the barnacle Chthamalus montagui from the northwest coast of Portugal to assess the potential use of C. montagui as biomonitor of metal contamination. The results of this study showed that C. montagui soft tissues can be used for monitoring metal bioavailabilities in these coastal seawaters: (1) there were significant correlations (p < 0.05) between the metal concentrations in soft tissues and their concentrations in seawaters and (2) barnacle soft tissues were sensitive to spatial variation of metal bioavailabilities, accumulating different amounts of metals in different locations. The range of concentrations in tissues were: 0.59-1.7 mg Cd kg(-1), 0.5-3.2 mg Cr kg(-1), 0.72-3.0 mg Ni kg(-1), 1.2-6.7 mg Cu kg(-1), 9-26 mg Mn kg(-1), 214-785 mg Fe kg(-1) and 178-956 mg Zn kg(-1); (3) mean logarithmic bioaccumulation factors (log BAF) of Fe, Cr and Cd were higher, 5.49, 4.93 and 4.46, respectively, than mean log BAFs of Mn, Zn, Cu and Ni, 4.03, 3.97, 3.74 and 3.61, respectively. In contrary, C. montagui shell plates were not a good matrix to monitor metal bioavailability in these coastal seawaters, with no significant correlations (p < 0.05) between metal concentrations in the shell and in seawater. Regarding the high Zn concentrations obtained in the coastal seawaters and C. montagui soft tissues, all seawaters from northwest coast of Portugal should be classified as "moderately/remarkably polluted".

In vitro and in vivo toxicological evaluation of extract and fractions from Baccharis trimera with anti-inflammatory activity

ETHNOPHARMACOLOGICAL RELEVANCE

Baccharis trimera (Less) DC. (Asteraceae), popularly known in Brazil as "carqueja", have been used in folk medicine to treat gastrointestinal, hepatic and renal diseases, and inflammatory processes as rheumatism.

AIM OF THE STUDY

To evaluate the in vitro and in vivo toxicological effects of anti-inflammatory Baccharis trimera aqueous extract and fractions.

MATERIALS AND METHODS

Aqueous extract of Baccharis trimera (AEBt) was produced by infusion in boiling water. After lyophylization AEBt was extracted with 80% ethanol, originating the ethanolic supernatant fraction (EFBt) and the aqueous sediment fraction (AFBt). Anti-inflammatory properties of AEBt, EFBt or AFBt (3, 30 or 300 μg/kg b.w.) were evaluated by the carrageenan-induced mouse paw edema using indomethacin (10mg/kg) as positive control. The growth of rat hepatoma cells (HTC) and human embryo kidney epithelial cells (HEK) was determined by protein staining assay. Cytotoxicity was assayed by the tetrazolium salt (MTT) reduction. Cyclosporin was used as reference cytotoxic drug for spleen cells and doxorubicin for HTC and HEK cells. For in vivo toxicological evaluation SW male mice were daily and oral (gavage) treated with extract/fractions at 4.2mg/kg or 42 mg/kg during 15 days. After treatment liver or kidney cells were submitted to comet assay to determine the DNA damage index, and the glutathione S-transferase activity was assayed towards ETHA (class Pi) and CDNB (several classes). Mutagenicity was evaluated by the Ames test using Salmonella typhimurium strains TA97, TA98, TA100, and TA102.

RESULTS

The anti-inflammatory effects of EFBt were higher than those of AEBt or AFBt. Mice treatment (3-300 μg/kg) with AFBt reduced the paw edema (3h) at lower levels (29.2-37.3%; P<0.01), than those observed for AEBt (44.7-54.2%; P<0.001), EFBt (49.3-58.2%; P<0.001) or indomethacin (64.6%, P<0.001, 10mg/kg). The growth of kidney cells (HEK) was inhibited by AEBt (IC(50) 182.6 μg/ml), EFBt (IC(50) 78.1 μg/ml) and AFBt (IC(50) 86.2 μg/ml), with lower effects on HTC hepatic cell (IC(50) 308.8 μg/ml, 396.5 μg/ml and 167.9 μg/ml, respectively). As evaluated by MTT test, AFBt exhibited cytotoxicity for HEK cells (IC(50) 372.5 μg/ml), but none for HTC ones; by the way, AFBt stimulated spleen cells (EC(50) 2.2 μg/ml) while cyclosporine, a cytotoxic reference drug inhibited them with IC(50) of 0.42 μg/ml; the IC(50) for doxorubicin for HEK and HTC cells was 0.28 μg/ml and 14.4 μg/ml, respectively, at 96h. No mutagenic potential was observed. Mice treatment with AEBt or AFBt at 42 mg/kg for 15 days altered the kidney relative weight, but not at 4.2mg/kg. Baccharis trimera did not change liver, spleen or popliteal lymph node relative weight. DNA damage index of kidney cells was observed on mice treated with AEBt/AFBt, but not on animals treated with EFBt, while DNA lesions were detected on liver cells only after AFBt treatment. The general activities of hepatic GST and Pi GST were reduced by EFBt and AFBt treatment, respectively.

CONCLUSIONS

Baccharis trimera did not show mutagenicity, inhibited the GST activity, a hepatic detoxification enzyme, and induced in vivo (genotoxicity) and in vitro toxicological effects to kidney cells.

Metal levels in sediments from the Minho estuary salt marsh: a metal clean area?

Total-recoverable metals (Al, Cr, Cu, Fe, Mn, Ni, Pb and Zn) in sediments from Minho estuary salt marsh were determined to evaluate possible increase in anthropogenic contamination by metals and to evaluate the possibility of this area to be considered a pristine area in terms of metals, which can be used as a reference site for other metal-contaminated national and international estuaries/salt marshes. This study revealed that the spatial distribution of metals in the salt marsh sediments was not homogeneous and that two sampling sites (sites 5 and 7) had indications of anthropogenic contamination. However, metal levels in these salt marsh sediments were lower than those observed in the wetlands of the main Portuguese estuaries. Comparison with Portuguese and international reference values used in the evaluation of the ecological quality of sediments, indicated that the sediments can be classified as "clean sediment" and that metal levels were lower or similar (only for Cu and Ni) to the values of ERL, which are the values that define the concentrations ranges that are rarely associated to adverse biologic effects in organisms. In addition, metal levels in the sediments were in chemical forms that were not easily available to organisms, indicating that these sediments probably will not have negative influences in the organisms living in the salt marsh, although no life-form ecological safety tests have been carried out. Therefore, the Minho estuary salt marsh area can probably be considered a pristine area in terms of metals and can be used as a reference for other metal-contaminated estuaries/salt marshes.

Anti-arthritic effect and subacute toxicological evaluation of Baccharis genistelloides aqueous extract

This work studies the potential subacute toxicological effects of the aqueous extract of Baccharis genistelloides (AEBg) and demonstrates a new anti-arthritic therapeutic effect. The treatment of the collagen-induced arthritis (CIA) group with 4.2 mg/kg AEBg induced an important decrease (75%) in CIA severity in all animals, while the 42 mg/kg dose treated only 50% of animals. After AEBg treatment, no significant differences were observed in body weight, aspect, color and relative weight of liver, kidneys, thymus or lungs between CIA groups. CIA and healthy AEBg groups treated with both doses did not show genotoxic effects to liver and kidney cells by the Comet assay, compared to its own control group. The augmented AST in the CIA group, compared to healthy control one was regularized by the AEBg treatment with 4.2 mg/kg but not with 42 mg/kg. No other significant difference was found on serum biochemical parameters, as well as on spontaneous or stimulated lymphocyte proliferation between CIA groups. The treatment of healthy animals with AEBg 4.2 mg/kg did not change the aspect, color or relative weight of kidneys, liver or lungs but reduced the body weight, the thymus and popliteal lymph node (PLN) relative weight and serum glucose and triglyceride levels. Concluding, our results indicate an anti-arthritic effects of AEBg without liver and kidney subacute toxicity and hypoglycemic and hypotriglyceridemic actions on healthy animals.

Acute and topic anti-edematogenic fractions isolated from the seeds of Pterodon pubescens

We previously demonstrated that alcoholic extracts from Pterodon pubescens Benth. (Sucupira branca, Leguminosae) seeds exhibit anti-arthritic activity. In the present work we show that the oleaginous extract obtained from P. pubescens seeds (OEP) exhibits acute or topic anti-edematogenic activity when tested in carrageenan-induced paw edema or in croton oil-induced ear edema assays, respectively. Four fractions were obtained from OEP by sequential liquid-liquid extraction. The anti-edematogenic properties were predominant in the hexanic fraction, which was further fractionated by HPLC, yielding three sub-fractions (PF1.1, PF1.2 and PF1.3). PF1.1 and PF1.3 showed potent acute and topic anti-edematogenic activity. The PF1.2 sub-fraction, although not active in the carrageenan assay, exhibited a potent anti-edematogenic activity in the croton oil-induced ear edema. This sub-fraction shows a maximum efficacy similar to indometacin in a lower dose. The PF1.1 sub-fraction presented a complex mixture containing furane diterpene derivatives of vouacapan. PF1.2 consists of a single substance, geranylgeraniol, as determined by GC/MS and NMR, while PF1.3 contains farnesol.