Abstract P1-12-05: Etirinotecan pegol: Survival advantage over standard of care drugs in a model of brain metastases of breast cancer

BACKGROUND: Brain metastasis of breast cancer is a significant cause of death among women with disseminated breast cancer. Chemotherapy, radiation, and surgery for these metastases provide only minimal benefit with considerable toxicity. The long-acting topoisomerase I inhibitor etirinotecan pegol (EP) is a novel treatment for disseminated breast cancer. EP consists of irinotecan attached to a 20kDa branched polymer via a releasable linker. The large molecular weight of EP results in tumor accumulation, including brain metastases, providing increased and sustained exposure to cytotoxic SN38. In the Phase 3 BEACON study, EP showed a significant survival benefit (HR 0.51; 95% CI 0.30-0.86) in a prespecified subgroup of women with history of treated, stable brain metastases compared to treatment of physicians choice (TPC) consisting of one of seven approved chemotherapy drugs (median OS 10.0 vs 4.8 mo). Nektar has filed a conditional marketing authorization in Europe for EP in patients with advanced breast cancer and brain metastases. A Phase 3 trial in this patient population is being initiated to support a potential U.S. filing. To further support the biological rationale for EP in these patients, an experimental preclinical model of brain metastases of breast cancer was conducted to compare the efficacy of EP to TPC in BEACON and the planned subsequent study.

METHODS: Female athymic nude mice were inoculated with 1.75x105 MDA-MB-231-BrLuc cells via intracardiac injection. Starting on day 21, gemcitabine (60 mg/kg) and eribulin (1.5 mg/kg) were dosed IP every 4 days; EP (50 mg/kg), irinotecan (50 mg/kg), paclitaxel (6 mg/kg), vinorelbine (10 mg/kg), docetaxel (10 mg/kg), and vehicle (saline or dextrose) were dosed weekly via tail vein. Efficacy was measured by tumor burden and survival. Tumor burden was determined based on twice weekly bioluminescence measurements. Animals were euthanized according to international animal care guidelines.

RESULTS: Median survival for all control arm groups (docetaxel, vinorelbine, eribulin, gemcitabine, irinotecan, and paclitaxel) were 39, 43, 41, 48, 35, and 42 days, respectively, none of which were significantly different from vehicle control median survival of 40 days (p>0.05). No animals receiving these drugs survived until the end of the 90-day trial. Median survival for the EP treatment group was 86 days (p<0.05) with a 40% survival rate at 90 days, the trial endpoint. Tumor burden increased nearly 100-fold in all TPC and vehicle groups, whereas EP significantly inhibited tumor growth. Quantitative autoradiography showed that EP accumulated ~10-fold in brain metastases, while accumulation in non-tumor brain tissue was only ~2-fold compared to irinotecan. EP at 50 mg/kg achieved plasma trough concentrations comparable to those observed in patients receiving the recommended dose of 145 mg/m2 every 21 days.

CONCLUSIONS: In this model of brain metastases, EP preferentially accumulates in brain metastases, significantly reduces tumor burden progression and significantly improves survival in brain metastases of breast cancer compared to the most active chemotherapeutic agents available for advanced breast cancer and those used in the BEACON trial and planned subsequent Phase 3 study.

Citation Format: Shah N, Mohammad AS, Adkins CE, Dolan EL, Griffith J, Jagannathan R, Hoch U, Lockman PR. Etirinotecan pegol: Survival advantage over standard of care drugs in a model of brain metastases of breast cancer [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 P1-12-05.

Development of a Fluorescence Detection System Using Optical Parametric Oscillator (OPO) Laser Excitation for in Vivo Diagnosis

In this work, the development and applications of a fluorescence detection system using optical parametric oscillator (OPO) laser excitation for in vivo disease diagnosis including oral carcinoma are described. The optical diagnosis system was based on an OPO laser for multi-wavelength excitation and time-resolved detection. The pulsed Nd-YAG-pumped OPO laser system (6 ns, 20 Hz) is compact and has a rapid, broad, and uniform tuning range. Time-gated detection of intensified charge-coupled device (ICCD) making use of external triggering was used to effectively eliminate the laser scattering and contribute to the highly sensitive in vivo measurements. Artificial tissue-simulating phantoms consisting of polystyrene microspheres and tissue fluorophores were tested to optimize the gating parameters. 51-ns gate width and 39-ns gate delays were determined to be the optimal parameters for sensitive detection. in vivo measurements with the optical diagnosis system were applied to esophagus, stomach, and small intestine using an endoscope in canine animal studies. The rapid tuning capability of the optical diagnosis system contributed greatly to the optimization of wavelength for the observation of porphyrin in the small intestine. When the small intestine was thoroughly washed with water, the emission band which corresponds to porphyrin disappeared. Based on this observation, it was concluded that the detected signal was yielded by porphyrin-containing bile secretion. Also, multispectral analyses using multiple excitations from 415 to 480 nm at 5 nm intervals confirmed the porphyrin detection in the small intestine. The optical diagnosis system was also applied to the detection of human xenograft of oral carcinoma in mice using 5-aminolevulinic acid (5-ALA) which is a photodynamic therapy (PDT) drug. Significant differences in protoporphyrin IX fluorescence intensity between normal and tumor tissue could be obtained 2 hours after the injection of 5-ALA into mice due to the preferential accumulation of 5-ALA in tumors. Results reported herein demonstrate potential capabilities of the LIF-OPO system for in vivo disease diagnosis.

Amino versus imino-transition metallic complexes in functionalized mesoporous silica: a lone pair degenerated into a singlet electron system

Imine terminated mesoporous silica nanoparticles (IMSNP) appear to be an effective mesoporous media with potential for multifarious applications such as catalytic support, effluent treatment, and sensors.

Optical and spectral studies on pure and europium doped olgite type Na(Sr,Ba)PO4 ceramics

Europium ion doped olgite type Na(Sr,Ba)PO4 ceramics, a new generation of light emitting bulb, was prepared by a high temperature solid-state reaction method. The synthesized materials were subjected to various characterizations such as X-ray powder diffraction, Scanning electron microscopy and FT-IR spectra measurements. The EPR spectrum of the sample exhibits a well-resolved hyperfine structure of 151Eu2+ and 153Eu2+ isotopes and the g value has been calculated. Fluorescence spectra revealed that europium ions were present in divalent as well as in the trivalent oxidation states. The critical distance for energy transfer between Eu2+ and Eu2+ ion is calculated as 20Å, which is in good agreement with that of experimental data. The FTIR analysis reveals all the vibrations of PO4(3-) ions.

A nano-granular Sn impregnated NiTi alloy matrix anode for high voltage Li-ion pouch cells

A nano-granular Sn impregnated inactive NiTi alloy matrix has been synthesized through a viable and facile mill-heat method and explained with the schematic illustration of flexibility for active Sn sites(s).

Delocalization of electronic states in graphene oxide stabilised mesoporous silica nanoparticles revealed using photoluminescence

Mesoporous silica aerogel obtained through a sol–gel process when surface treated with 2-D graphene oxide sheets reveals many fascinating features particularly, leading to multiple coordination complexes based on amide linkages.

Simultaneous measurement of force and respiratory profiles during chest physiotherapy in ventilated children

There are currently no objective means of quantifying chest wall vibrations during manual physiotherapy. The aims of the study were to (i) develop a method to quantify physiotherapy-applied forces and simultaneous changes in respiratory flow and pressure, (ii) assess the feasibility of using this method in ventilated children and (iii) characterize treatment profiles delivered by physiotherapists in the paediatric intensive care unit. Customized sensing mats were designed and used in combination with a respiratory profile monitor. Software was developed to align force and flow data streams. Force and respiratory data were successfully collected in 55 children (median age 1.6 years (range 0.02-13.7 years)). Physiotherapists demonstrated distinctive variations in the pattern of force applied and manual lung inflations. The maximum applied force ranged from 15 to 172 N, and was correlated with the child's age (r = 0.76). Peak expiratory flow increased significantly during manual inflations both with and without chest wall vibrations (p < 0.05). This method provides the basis for objective assessments of the direct and independent effects of vibration forces and manual lung inflations as an essential precursor to developing evidence-based practice.

Distinction of cervical cancer biopsies by use of infrared microspectroscopy and probabilistic neural networks

Fourier-transform infrared spectroscopy has shown alterations of spectral characteristics of cells and tissues as a result of carcinogenesis. The research reported here focuses on the diagnosis of cancer in formalin-fixed biopsied tissue for which immunochemistry is not possible and when PAP-smear results are to be confirmed. The data from two groups of patients (a control group and a group of patients diagnosed with cervical cancer) were analyzed. It was found that the glucose/phosphate ratio decreases (by 23-49%) and the RNA/DNA ratio increases (by 38-150%) in carcinogenic compared with normal tissue. Fourier-transform microspectroscopy was used to examine these tissues. This type of study in larger populations may help to set standards or classes with which to use treated biopsied tissue to predict the possibility of cancer. Probabilistic neural networks and statistical tests as parts of these biopsies predict the possibility of cancer with a high degree of accuracy (> 95%).

Fourier transform infrared microspectroscopy as a quantitative diagnostic tool for assignment of premalignancy grading in cervical neoplasia

The early diagnosis and proper identification of cervical squamous intraepithelial lesions plays an important role in a good prognosis for the patient. However, the present practice of screening based on PAP (Papanicolaou) smear and histopathology makes it tedious and prone to human errors. We assess the validity of FTIR microspectroscopy (FTIR-MSP) of biopsies as a method to properly assign the correct stage of premalignancy in patients with symptoms of cervical intraepithelial neoplasia. For the first time we evaluate the biopsies based on the FTIR spectra for different grades of neoplasia in tandem with probabilistic neural networks (PNNs) and histopathology. The results show that the grading of neoplasia based on FTIR-MSP and a PNN differentiates the normal from premalignant with a high level of accuracy. The false positive identification of the normal as cervical intraepithelial neoplasia 1 (CIN1), CIN2, and CIN3 patients is 9.04, 0.01, and 0.01%, respectively. The false negative identification of CIN2 patients as normal and CIN1 patients is 0.01 and 4.4%, respectively. Similarly, the false negative identification of CIN3 patients as normal, CIN1, and CIN2 is 0.14, 6.99, and 9.61%, respectively. The small errors encountered in the grading are comparable to current methods, encouraging advanced studies for the development of mechanized equipment for the diagnosis and grading of premalignant cervical neoplasia.

Fluorescence spectroscopy for detection of malignancy: H-ras overexpressing fibroblasts as a model

Autofluorescence from intracellular chromophores upon illumination of cells by monochromatic light has been studied towards the development of novel noninvasive and sensitive technology for the early detection of cancer. To investigate the relationship between biochemical and morphological changes underlying malignant disease and resulting fluorescence spectra, an in vitro model system of a paired normal and malignant murine fibroblasts cell lines, differing in cancer-associated H-ras expression was employed. A comparison of fluorescence excitation and emission spectra of proliferative cells revealed that fluorescence intensity of malignant cells was significantly less than that of normal cells upon excitation at 290 nm. Fluorescence of both cell lines decreased with decreasing cell concentration, but at each concentration, normal cells had higher fluorescence intensity than malignant cells. Similar differences between the cell lines were observed when brought to quiescence or at stationary phase. Results suggested that the chromophore contributing most significantly to these spectra is tryptophan and its moieties in proteins. This model system demonstrates the specific contribution of H-ras to subcellular chromophores, resulting in a significant difference in their autofluorescence intensity, and implies the potential use of the technique for cancer detection. This model system is potent for analysis of the contribution of other oncogenes and their combinations towards spectral detection of cancer.

Relying on surveys to understand abortion behavior: some cautionary evidence

OBJECTIVES

The reliability of abortion self-reports has raised questions about the general usefulness of surveys in research about abortion behavior; however, the extent of underreporting remains a subject of some debate. This study sought to examine abortion reporting in a sample of welfare mothers and to determine factors in underreporting.

METHODS

In New Jersey, which covers abortions requested by welfare recipients under its Medicaid program, the responses of a randomly drawn sample of 1236 welfare mothers about abortion events were compared with the Medicaid claims records of these women.

RESULTS

Only 29% of actual abortions were self-reported by the women in the sample. This finding varied dramatically by race, with substantially higher rates of underreporting by Blacks than by Whites or Hispanics.

CONCLUSIONS

Although race is the most consistent predictor of underreporting behavior, attitudinal factors and survey technology also help in explaining abortion reporting behavior.

Interaction of pyridostigmine and physical stress on antioxidant defense system in skeletal muscle of mice

Pyridostigmine bromide (PB), a reversible anticholinesterase drug, had been used against possible nerve gas exposure during the Persian Gulf War. The Gulf War veterans used PB and they were under physical stress. This study investigated the delayed and interactive effects of pyridostigmine and physical stress on the antioxidant defense system in triceps muscle of mice. Male NIH Swiss mice were divided into four groups and treated as follows: sedentary control; pyridostigmine (1.2 mg kg(-1) p.o.); exercise; and PB plus exercise. Mice were exercised for 10 weeks, but PB was administered daily during the 5th and 6th weeks. Mice were sacrificed 24 h after the last treatments and the triceps muscle was isolated and analyzed. There was a significant increase in total superoxide dismutase (CuZn-SOD + Mn-SOD) activity (141% of control) with PB plus exercise, suggesting that any influx of superoxide anions was scavenged efficiently. The Mn-SOD enzyme protein levels were reduced significantly (63% of control) by PB plus exercise. Catalase enzyme protein levels were increased significantly by exercise (132% of control) as well as by PB plus exercise (139% of control). Glutathione levels were increased significantly by exercise alone (123% of control). Pyridostigmine bromide plus exercise significantly increased the malondialdehyde concentration (124% of control) in the triceps muscle, indicating an oxidative stress response of the combination. The data indicate that a combination of PB ingestion and exercise training significantly altered the antioxidant enzyme activities, enzyme protein levels and lipid peroxidation, leading to oxidative injury. Physical stress amplified the delayed effects of PB in the skeletal muscle of mice.

Flying personal planes: modeling the airport choices of general aviation pilots using stated preference methodology

This study employed stated preference (SP) models to determine why general aviation pilots choose to base and operate their aircraft at some airports and not others. Thirteen decision variables identified in pilot focus groups and in the general aviation literature were incorporated into a series of hypothetical choice tasks or scenarios. The scenarios were offered within a fractional factorial design to establish orthogonality and to preclude dominance in any combination of variables. Data from 113 pilots were analyzed for individual differences across pilots using conditional logit regression with and without controls. The results demonstrate that some airport attributes (e.g., full-range hospitality services, paved parallel taxiway, and specific types of runway lighting and landing aids) increase pilot utility. Heavy airport congestion and airport landing fees, on the other hand, decrease pilot utility. The importance of SP methodology as a vehicle for modeling choice behavior and as an input into the planning and prioritization process is discussed. Actual or potential applications include the development of structured decision-making instruments in the behavioral sciences and in human service programs.

Extramedullary plasmacytoma presenting as upper back pain

Extramedullary plasmacytoma (EMP) is a rare soft tissue plasma cell tumour, usually presenting as a mass within the upper respiratory tract. It is most unusual for it to present in the posterior mediastinum as a primary solitary lesion. Discussed here is the case report of a patient who initially presented with musculoskeletal pain. Subsequent investigations, however, revealed the cause to be an EMP; diagnosis was made on finding aggregates of plasma cells on histological examination of the tissue specimen. The latter had been obtained by way of a computerised tomography scan guided biopsy of the tumour. Bone marrow aspiration studies showed no evidence of multiple myelomatosis. There was significant clinical improvement in response to radiotherapy. It is possible that this might represent one of the first documented reports of a primary solitary EMP in the posterior mediastinum.

Lie algebraic treatment of dioptric power and optical aberrations

The dioptric power of an optical system can be expressed as a four-component dioptric power matrix. We generalize and reformulate the standard matrix approach by utilizing the methods of Lie algebra. This generalization helps one deal with nonlinear problems (such as aberrations) and further extends the standard matrix formulation. Explicit formulas giving the relationship between the incident and the emergent rays are presented. Examples include the general case of thick and thin lenses. The treatment of a graded-index medium is outlined.

Modeling all-cause mortality: projections of the impact of smoking cessation based on the NHEFS. NHANES I Epidemiologic Follow-up Study

OBJECTIVES

A model that relates clinical risk factors to subsequent mortality was used to simulate the impact of smoking cessation.

METHODS

Survivor functions derived from multivariate hazard regressions fitted to data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Followup Study, a longitudinal survey of a representative sample of US adults, were used to project deaths from all causes.

RESULTS

Validation tests showed that the hazard regressions agreed with the risk relationships reported by others, that projected deaths for baseline risk factors closely matched observed mortality, and that the projections attributed deaths to the appropriate levels of important risk factors. Projections of the impact of smoking cessation showed that the number of cumulative deaths would be 15% lower after 5 years and 11% lower after 20 years.

CONCLUSIONS

The model produced realistic projections of the effects of risk factor modification on subsequent mortality in adults, Comparison of the projections for smoking cessation with estimates of the risk attributable to smoking published by the Centers for Disease Control and Prevention suggests that cessation could capture most of the benefit possible from eliminating smoking.

Comparison of two surveys of hospitalization: the National Hospital Discharge Survey and the NHANES I Epidemiologic Followup Study

OBJECTIVES

This report compares hospitalization data from the NHANES I Epidemiologic Followup Study (NHEFS) with data from the National Hospital Discharge Survey (NHDS), the benchmark for hospitalization in the United States, for men and women 35 years and older for the period 1971-87. The comparison is intended to help analysts evaluate the validity and generality of analyses based on the NHEFS.

METHODS

Hospital stays per 1,000 population and average lengths of stay are compared year by year for each age-sex group and for the entire period. Regression analyses test for differences between the two surveys by age and sex, and for differences in trends over time and the effect of the Medicare program's prospective hospital payment system.

RESULTS

Hospital stays per 1,000 population were lower in NHEFS than in NHDS in all age-sex groups at the beginning of the period, but the differences had almost disappeared by 1987. Lengths of stay, although somewhat longer in NHEFS, matched NHDS more closely. Differentials by age and sex were similar in the two surveys for both hospital stays per 1,000 population and length of hospital stay. With its extensive information on baseline risk factors, the NHEFS offers a unique opportunity to study determinants of hospitalization in a representative sample of U.S. adults. The evaluation presented here suggests two points for researchers who want to use the NHEFS. First, including age as a control should largely correct for differences in age distribution between NHEFS and NHDS. Second, a time trend should also be included to capture the effects of several factors that caused the count of stays to be low in the early years of NHEFS followup.

Risk assessment in child protective services: a canonical analysis of the case management function

This study examined the relationship between levels of risk and the patterns of service intervention in child protective services. A stratified, random sample of 239 cases from the New Jersey Division of Youth and Family Services was examined using canonical correlation techniques. Risk was measured using the Washington Risk Assessment Matrix while case management and service strategies were recorded from case records. Principal results indicate that three distinctive risk profiles operate in the data: older children with behavior problems, children from disadvantaged households, and children with an unemployed parent. Each can be linked to a distinctive service intervention pattern. Implications of these results for workflow management and workload are discussed as well as the implications for future research in the areas of risk assessment and case management.

In vitro and in vivo experiments with the new inhibitor of mycobacterium leprae brodimoprim alone and in combination with dapsone

The antibacterial effect of brodimoprim alone and in combination with dapsone has been studied in vitro in cell-free systems and in whole mycobacterial cells as well as in vivo in mice and humans. The obtained inhibitory effects in vitro and in vivo against model mycobacterial strains and M. leprae, the pharmacokinetic properties in human and its synergistic effect with the most used drug in the chemotherapy of leprosy, dapsone, make brodimoprim a promising candidate in the therapy of leprosy.

Correlation of in vitro Fc receptor assay with in vivo mouse foot pad method

Resistant strains of M. leprae have been reported to the various antileprosy drugs. There is currently no accepted test to identify the susceptibility pattern of M. leprae to the drugs in a short period. The only accepted test is the mouse foot method which takes a long period to yield results. The Fc receptor assay using the ability of viable M. leprae to alter the membrane of the macrophage is well established. It takes only ten days and is inexpensive. In 6 cases of leprosy patients the susceptibility pattern was worked out both with the in vitro Fc receptor assay and the vivo in mouse foot method The results correlated very well leading to the fact that the assay system is reliable. Hence it can be used not only to study the status of a patient, but also to shortlist the number of compounds to be tested on the mouse foot pad as anti-leprosy drug candidates.