Abstract 1992: Is the ubiquitin ligase WWP2 playing a role in PTEN degradation in endometrial cancer

Objective: The ubiquitin ligase WWP2 has recently been described to directly interact with PTEN, the major tumor suppressor gene in the PI3K pathway commonly altered in endometrial cancer. Whether alterations of WWP2 contribute to post-translational modifications of the PTEN protein in endometrial cancer are unknown. We sought to determine if WWP2 gene expression levels differ in human endometrial cancer tissues with evidence of post-translational PTEN degradation. We also wished to determine if elevated WWP2 gene expression was associated with clinical prognostic variables.

Methods: Twenty-four endometrial cancer specimens collected at hysterectomy were available for analysis. These tumors were stained for PTEN by immunohistochemistry (IHC) and scored using a scale of 0-6. Frozen tissue was then used to determine PTEN and WWP2 expression by Real time PCR (RT PCR). Gene expression was then compared with findings on immunohistochemistry. Patient clinical characteristics including stage, grade, lymph node metastases, recurrence or 2 year disease status were then compared with PTEN and WWP2 expression.

Results: Three tumors had elevated PTEN gene expression (at least 2 fold) but low (score of less than 4) PTEN protein on IHC, indicating post-translational modification of PTEN. In these tumors, however, WWP2 expression was not elevated (range 0.004-0.09). There were three tumors with elevation in WWP2 expression (1.9-4.7). PTEN was low in these tumors on IHC, but was also low by RT-PCR indicating genomic, epigenetic or post-transcriptional modification of PTEN. Neither PTEN nor WWP2 expression on RT PCR was associated with stage, grade, lymph node metastases, recurrence or 2 year disease status.

Conclusions: In this cohort of tumors, WWP2 did not contribute to post-translational degradation of PTEN. WWP2 expression was not associated with stage, grade, lymph node metastases, recurrence, or 2 year disease status.

Citation Format: Aine Clements, Joseph McElroy, Adrian Suarez, Sarmila Majumder, David Cohn, Gustavo Leone. Is the ubiquitin ligase WWP2 playing a role in PTEN degradation in endometrial cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1992. doi:10.1158/1538-7445.AM2013-1992

A nonsynonymous polymorphism in IRS1 modifies risk of developing breast and ovarian cancers in BRCA1 and ovarian cancer in BRCA2 mutation carriers

BACKGROUND

We previously reported significant associations between genetic variants in insulin receptor substrate 1 (IRS1) and breast cancer risk in women carrying BRCA1 mutations. The objectives of this study were to investigate whether the IRS1 variants modified ovarian cancer risk and were associated with breast cancer risk in a larger cohort of BRCA1 and BRCA2 mutation carriers.

METHODS

IRS1 rs1801123, rs1330645, and rs1801278 were genotyped in samples from 36 centers in the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). Data were analyzed by a retrospective cohort approach modeling the associations with breast and ovarian cancer risks simultaneously. Analyses were stratified by BRCA1 and BRCA2 status and mutation class in BRCA1 carriers.

RESULTS

Rs1801278 (Gly972Arg) was associated with ovarian cancer risk for both BRCA1 (HR, 1.43; 95% confidence interval (CI), 1.06-1.92; P = 0.019) and BRCA2 mutation carriers (HR, 2.21; 95% CI, 1.39-3.52, P = 0.0008). For BRCA1 mutation carriers, the breast cancer risk was higher in carriers with class II mutations than class I mutations (class II HR, 1.86; 95% CI, 1.28-2.70; class I HR, 0.86; 95%CI, 0.69-1.09; P(difference), 0.0006). Rs13306465 was associated with ovarian cancer risk in BRCA1 class II mutation carriers (HR, 2.42; P = 0.03).

CONCLUSION

The IRS1 Gly972Arg single-nucleotide polymorphism, which affects insulin-like growth factor and insulin signaling, modifies ovarian cancer risk in BRCA1 and BRCA2 mutation carriers and breast cancer risk in BRCA1 class II mutation carriers.

IMPACT

These findings may prove useful for risk prediction for breast and ovarian cancers in BRCA1 and BRCA2 mutation carriers.

Abstract 2802: Selective inhibition of signal transducers and activators of transcription 3 overexpressing endometrial cancer cells, using HO-3867, a novel STAT3 inhibitor

OBJECTIVE: Signal transducer and activator of transcription 3 (STAT3) proteins have important roles in cancer cell survival and proliferation. Recent studies show constitutive activation of STAT3 is associated with tumor growth and oncogenic transformation in several human cancers; however, little is known about STAT3 expression in endometrial cancer. The objectives of this study were to examine the expression of the STAT family of proteins in endometrial cancer cell lines and to evaluate the efficacy of HO-3867, a novel STAT3 inhibitor. METHODS: Expression of STAT family proteins, cell cycle and apoptotic proteins were evaluated via western blot on Ishikawa, AN3-CA, RL95-2, HEC1B, HEC-1A, and SK-UT1B human endometrial cancer cell lines. Cell viability and proliferation of these cell lines were analyzed with MTT and nucleo counter assay after treatment with increasing concentrations of HO-3867. Cell cycle analysis and apoptosis were performed using flow cytometry and annexin V staining. An ubiquitination assay was used to examine the inhibition of CDK5 degradation. Finally, STAT3 over-expression or suppression experiments were performed using wild-type STAT3 cDNA and STAT3 siRNA. RESULTS: Expression of activated STAT1, 2, 5, and 6 was inconsistent among cell lines tested, while pSTAT3 Ser727 had consistently high expression. HO-3867 decreased cell viability through induced G2/M arrest and apoptosis within 24h of treatment. HO-3867 inhibited pSTAT3 Ser727 with no change in total STAT3. This was associated with an increase in expression of cell cycle related proteins p53 and p21, a decrease in anti-apoptotic proteins Bcl2 and Bcl-XL, as well as increased cleavage of caspases. After 24h of treatment with HO-3867, 55-88% of cells were apoptotic. The downregulation of Ser727 was, at least in part, due to an accelerated inhibition of ubiquitin-dependent CDK5 degradation, as a positive regulator of STAT3 Ser727. Suppression of STAT3 expression with siRNA significantly reduced cell survival. In addition, we confirmed that over-expression of STAT3 cDNA provides resistance to HO-3867. CONCLUSION: Endometrial cancer cells express high levels of pSTAT3 Ser727. HO-3867 induces cell cycle arrest and apoptosis by targeting pSTAT3 Ser727. Our findings suggest a specific role of serine-phosphorylated STAT3 that is independent of tyrosine phosphorylation. HO-3867 may be a potential adjunct to chemotherapy and radiation in the treatment of endometrial cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2802. doi:1538-7445.AM2012-2802

Temporary extracorporeal circulatory support and pulmonary embolectomy for catastrophic amniotic fluid embolism

Amniotic fluid embolism is usually a life-threatening complication of an otherwise healthy pregnancy. Medical management of the coagulopathy and cardiovascular collapse is challenging and is often unsuccessful. We present a case and advocate the use of temporary circulatory support and pulmonary embolectomy in what would otherwise have been a fatal scenario.

Common variants at 12p11, 12q24, 9p21, 9q31.2 and in ZNF365 are associated with breast cancer risk for BRCA1 and/or BRCA2 mutation carriers

INTRODUCTION

Several common alleles have been shown to be associated with breast and/or ovarian cancer risk for BRCA1 and BRCA2 mutation carriers. Recent genome-wide association studies of breast cancer have identified eight additional breast cancer susceptibility loci: rs1011970 (9p21, CDKN2A/B), rs10995190 (ZNF365), rs704010 (ZMIZ1), rs2380205 (10p15), rs614367 (11q13), rs1292011 (12q24), rs10771399 (12p11 near PTHLH) and rs865686 (9q31.2).

METHODS

To evaluate whether these single nucleotide polymorphisms (SNPs) are associated with breast cancer risk for BRCA1 and BRCA2 carriers, we genotyped these SNPs in 12,599 BRCA1 and 7,132 BRCA2 mutation carriers and analysed the associations with breast cancer risk within a retrospective likelihood framework.

RESULTS

Only SNP rs10771399 near PTHLH was associated with breast cancer risk for BRCA1 mutation carriers (per-allele hazard ratio (HR) = 0.87, 95% CI: 0.81 to 0.94, P-trend = 3 × 10-4). The association was restricted to mutations proven or predicted to lead to absence of protein expression (HR = 0.82, 95% CI: 0.74 to 0.90, P-trend = 3.1 × 10-5, P-difference = 0.03). Four SNPs were associated with the risk of breast cancer for BRCA2 mutation carriers: rs10995190, P-trend = 0.015; rs1011970, P-trend = 0.048; rs865686, 2df-P = 0.007; rs1292011 2df-P = 0.03. rs10771399 (PTHLH) was predominantly associated with estrogen receptor (ER)-negative breast cancer for BRCA1 mutation carriers (HR = 0.81, 95% CI: 0.74 to 0.90, P-trend = 4 × 10-5) and there was marginal evidence of association with ER-negative breast cancer for BRCA2 mutation carriers (HR = 0.78, 95% CI: 0.62 to 1.00, P-trend = 0.049).

CONCLUSIONS

The present findings, in combination with previously identified modifiers of risk, will ultimately lead to more accurate risk prediction and an improved understanding of the disease etiology in BRCA1 and BRCA2 mutation carriers.

A single-institution approach to total pelvic exenteration

The objective of this study was to describe in detail the technique of total pelvic exenteration. Total pelvic exenteration (TPE) was first described in 1948 by Brunschwig. Since its description, complications of the procedure and surgical innovations have changed the approach to this radical surgery. We have described our institutional approach and outcomes of TPE. Fifty-four patients underwent TPE between 2004 and 2010 by the Division of Surgical Oncology at the Ohio State University Medical Center. Fifty-three patients have complete medical records available for review. Outcomes are described and have shaped these techniques. Patients were divided into various groups based on their histology: colorectal (n = 36), gynecologic (n = 6), urologic (n = 5), squamous cell (n = 2), sarcomatous disease (n = 3), and severe infections (n = 1). These were divided into two groups-colorectal (n = 36) and noncolorectal (n = 17)-for analysis. Demographics, operative time, length of stay, and complication rates were similar between the two groups. The median survival was 21.4 months for the colorectal group and 6.9 months for the noncolorectal group. Total pelvic exenteration for colorectal tumors has improved survival when compared with patients undergoing exenteration for pelvic malignancies of other origins. Total pelvic exenteration continues to be associated with high morbidity; however, with appropriate patient selection and proper operative technique, a perioperative mortality of 0 per cent can be achieved.

A Single-Institution Approach to Total Pelvic Exenteration

The objective of this study was to describe in detail the technique of total pelvic exenteration. Total pelvic exenteration (TPE) was first described in 1948 by Brunschwig. Since its description, complications of the procedure and surgical innovations have changed the approach to this radical surgery. We have described our institutional approach and outcomes of TPE. Fifty-four patients underwent TPE between 2004 and 2010 by the Division of Surgical Oncology at the Ohio State University Medical Center. Fifty-three patients have complete medical records available for review. Outcomes are described and have shaped these techniques. Patients were divided into various groups based on their histology: colorectal (n = 36), gynecologic (n = 6), urologic (n = 5), squamous cell (n = 2), sarcomatous disease (n = 3), and severe infections (n = 1). These were divided into two groups—colorectal (n = 36) and noncolorectal (n = 17)—for analysis. Demographics, operative time, length of stay, and complication rates were similar between the two groups. The median survival was 21.4 months for the colorectal group and 6.9 months for the noncolorectal group. Total pelvic exenteration for colorectal tumors has improved survival when compared with patients undergoing exenteration for pelvic malignancies of other origins. Total pelvic exenteration continues to be associated with high morbidity; however, with appropriate patient selection and proper operative technique, a perioperative mortality of 0 per cent can be achieved.

Abstract 2059: HO-3867-induced apoptosis in hypoxic ovarian cancer cells occurs via ubiquitin-dependent degradation of signal transducer and activator of transcription 3 (STAT3)

Objectives: Hypoxia plays a role in tumorigenesis and the development of resistance to radio- and chemotherapy. We have shown that human xenograft tumors in mice are severely hypoxic and that hypoxic exposure increases the phosphorylation of STAT3 at the Tyr705 residue in A2780 cell lines and is associated with chemotherapeutic resistance. HO-3867, a novel curcumin analogue designed with our institution, induces cell cycle arrest and apoptosis via inhibition of the STAT3 signaling pathway. The goal of this study was to understand the mechanistic pathways involved. Methods: The study was performed using A2780 and SKOV3 human ovarian cancer cell lines grown under normoxic (21% O2) and hypoxic (1% O2) conditions for 24 hours. Hypoxia-exposed cells were subsequently treated with 10 or 20 uM of HO-3867 for 2 and 24 hours. The expression levels of pSTAT3, associated proteins, and apoptotic markers were evaluated by Western blot and RT-PCR. Quantification of apoptosis was performed by staining with Annexin V. We also examined cell viability and involvement of ubiquitin-dependent degradation of pSTAT3. Results: Treatment with HO-3867 under hypoxic conditions resulted in decreased protein expression of pSTAT3 Tyr705 and Ser727. Rapid downregulation of STAT3 correlated with accelerated ubiquitin-dependent degradation of Tyr705-phosphorylated STAT3. Treatment was associated with decreased levels of STAT3-targeting proteins VEGF, Bcl-2, Bcl-xL, and cyclin D1. RT-PCR revealed decreased BCL-2 mRNA expression with treatment. There was no change in expression of proteins upstream of STAT3 including pJAK1, JAK1, pTYK2, TYK2, SOCS1 and SOCS2. An induction in apoptosis contributed to inhibition of cell proliferation as HO-3867-exposed cells exhibited elevated levels of cleaved caspase-3, caspase-7, and PARP as well as an increase in apoptotic cell count measured by flow cytometry. Conclusion: Under hypoxic growth conditions, HO-3867 demonstrates cytotoxicity via inhibition of STAT3. The use of HO-3867 may be a potential adjunct in the treatment of hypoxia-mediated chemotherapy-resistant ovarian cancers.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2059. doi:10.1158/1538-7445.AM2011-2059

Abstract 124: Cellular context in epigenetics: Per-cell quantitation of miR-let-7d and its putative target in caspase-3 in reovirus-infected cancer cells

An oncolytic virus, due to its ability to replicate and lyse cancer cells while leaving normal cells intact, is an example of targeted cancer therapy. Reovirus is intrinsically oncolytic without the need for any genetic manipulation due to its ability to target cells with an activated ras pathway. micro RNAs (miRNA) play critical role in both viral infection and oncogene activation. While significant advances in the role of miRNA in a variety of diseases including cancer have been made, the majority of the studies done on miRNA signatures have been done using homogenized tissue, typically via RT PCR. While useful, one drawback of this methodology is that it is, in essence, a population study, sampled from a heterogeneous collection of cells and tissue types. The miRNA signatures found via these methods are not able to determine whether the miR and target protein were found in the same tissue type (tumor, stroma, etc). Microscopy-based multi-analyte methods offer the benefit of visualizing miRNAs and their putative targets within the context of disease-specific molecular anatomy and on a per-cell basis.The development of simple spectral imaging systems capable of both brightfield and fluorescence multispectral imaging and morphologic image analysis packages that can be trained to recognize specific morphometric regions of interest have greatly facilitated the imaging, visualization and quantitative analysis of multicolor tissue samples. This study describes the means by which tissue sections labeled for multiple markers (proteins and microRNAs) can be analyzed and then be displayed as scatter plots, in a manner analogous to flow cytometry data, and multimarker phenotypes can be determined from threshold-based quadrant analysis.We have shown that reovirus infection of a variety of cancers, such as melanomas, head and neck squamous cell cancers, and ovarian serous carcinomas, induces increased cell death that is accentuated with taxol therapy. In situ based co-expression analysis showed that reovirus induced caspase-3 protein expression which, in turn, increased cancer cell death via apoptosis, as documented by the TUNEL assay. Reovirus plus taxol accentuated the caspase-3 expression compared to reovirus infection alone. microRNA nanostring analysis showed that miRNA-let-7-d was the most down-regulated in the cancer cells after reovirus infection. Analysis by the InForm system after co-expression analysis showed that reovirus was directly downregulating miR-let-7-d. Target Scan analysis documented that caspase-3 is directly targeted by miR-let-7d. Hence, the direct in situ co-expression testing via the InForm system is a powerful adjunct to microRNA analysis as it allows documentation of physiologic modulation of protein expression by the microRNA of interest.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 124. doi:10.1158/1538-7445.AM2011-124

Activity of sorafenib in recurrent ovarian cancer and primary peritoneal carcinomatosis: a gynecologic oncology group trial

PURPOSE Sorafenib is a kinase inhibitor targeting Raf and other kinases (ie, vascular endothelial growth factor receptor [VEGFR], platelet-derived growth factor receptor [PDGFR], Flt3, and c-KIT). This study assessed its activity and tolerability in patients with recurrent ovarian cancer (OC) or primary peritoneal carcinomatosis (PPC). METHODS This open-label, multi-institutional, phase II study used a two-stage design. Eligible patients had persistent or recurrent OC/PPC after one to two prior cytotoxic regimens, and they experienced progression within 12 months of platinum-based therapy. Treatment consisted of sorafenib 400 mg orally twice per day. Primary end points were progression-free survival (PFS) at 6 months and toxicity by National Cancer Institute criteria. Secondary end points were tumor response and duration of PFS and overall survival. Biomarker analyses included measurement of ERK and b-Raf expression in tumors and phosphorylation of ERK (pERK) in peripheral-blood lymphocytes (PBLs) before and after 1 month of treatment. Results Seventy-three patients were enrolled, of which 71 were eligible. Fifty-nine eligible patients (83%) had measurable disease, and 12 (17%) had detectable disease. Significant grade 3 or 4 toxicities included the following: rash (n = 7), hand-foot syndrome (n = 9), metabolic (n = 10), GI (n = 3), cardiovascular (n = 2), and pulmonary (n = 2). Only patients with measurable disease were used to assess efficacy. Fourteen survived progression free for at least 6 months (24%; 90% CI, 15% to 35%). Two patients had partial responses (3.4%; 90% CI, 1% to 10%); 20 had stable disease; 30 had progressive disease; and seven could not have their tumor assessed. ERK and b-Raf were expressed in all tumors. Exploratory analyses indicated that pERK in post-treatment PBL specimens was associated with PFS. CONCLUSION Sorafenib has modest antitumor activity in patients with recurrent OC, but the activity was at the expense of substantial toxicity.

A GOG 210 aCGH study of gain at 1q23 in endometrioid endometrial cancer in the context of racial disparity and outcome

The goal of this study was to identify recurrent regions of genomic gain or loss in endometrial cancer of the endometrioid type in the context of racial disparities in mortality for this disease. Array comparative genomic hybridization (aCGH) analysis was performed on 80 frozen primary tumors from the Gynecologic Oncology Group (GOG)-210 bank using the RPCI 19K BAC arrays. The 80 patients included 20 African American (AA) Stage I, 20 White (W) Stage I, 20 African American (AA) Stage IIIC/IV, and 20 White (W) Stage IIIC/IV. A separate subset of 220 endometrial cancers with outcome data was used for validation. A 1.6-Mbp region of gain at 1q23 was identified by aCGH in all AA patients and high grade W patients, but not W low grade patients. In the validation arm of 220 patients copy number gain at this region was validated using FISH and locus specific BACs. The number of AA patients in the validation arm was too small to confirm the aCGH association with racial disparity. Kaplan-Meier curves for survival showed a significant difference for gain at 1q23 versus no gain (log rank P = 0.0014). When subdivided into various groups of risk by stage and grade the survival curves showed a decreased survival for high grade and/or stage tumors, but not for low grade and/or stage endometrioid tumors. Univariate analyses for gain at 1q23 showed a significant association (P = 0.009) with survival. Multivariate analysis for gain at 1q23 did not show a significant association with survival (P = 0.14).

Health-related quality of life outcomes associated with four cisplatin-based doublet chemotherapy regimens for stage IVB recurrent or persistent cervical cancer: a Gynecologic Oncology Group study

PURPOSE

To assess the differences in health-related quality of life (HRQL) of 4 cisplatin containing doublet chemotherapy combinations in women with advanced/recurrent cervical carcinoma.

METHODS

Patients were randomized to three-week cycles of paclitaxel + cisplatin (PC); vinorelbine + C (VC); gemcitabine + C (GC); or topotecan + C (TC). We report HRQL results from data available on 434 eligible patients enrolled into this 513 patient trial. HRQL was assessed with the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx) the FACT/Gynecologic Oncology Group (FACT/GOG) four-item neurotoxicity scale, and the 0-10 "worst pain" item from the Brief Pain Inventory, at baseline (pre-treatment), prior to beginning cycle 2, prior to beginning cycle 5, and at 9 months after enrollment. As reported by Monk et al. (2009) [13] VC, GC and TC were found not to be superior to PC with regard to progression-free survival or overall survival.

RESULTS

The trial was terminated early due to planned interim futility analysis, reducing power for HRQL analysis from 85% to 55%. Patients receiving VC, GC and TC doublets did not report significantly different HRQL, neuropathy, or pain from those who received the PC (control) doublet. Patients receiving PC tended to report worse neuropathy during treatment than patients who received other doublets (especially GC and TC), but the differences were not statistically significant.

CONCLUSION

None of the 3 experimental doublets was different from PC in terms of HRQL during treatment. Long-term toxicity data are inconclusive. Except where patients may wish to reduce their risk of worsening pre-treatment neuropathy, PC remains the standard of care for this disease.

A Gynecologic Oncology Group study of frequent copy number aberrations in African American versus Caucasian women with stage I versus stage IIIC/IV endometrioid endometrial cancer

e16501

Background: An array-based comparative genomic hybridization (aCGH) analysis was performed to determine if frequent (>40%) copy number aberrations (CNAs) exist in African American (AA) versus Caucasian (C) women with stage I versus stage IIIC/IV endometrioid endometrial cancers (EEC). Methods: Tumor DNA was isolated from 80 frozen primary tumors from the GOG-210 protocol. RPCI 19K BAC arrays were hybridized (GeneTAC HybStation) and scanned (Gene Pix 4200AL Laser Scanner). Spot fluorescence values were quantified using ImaGene, vetted for quality and loess corrected with adjustments for chip-specific spatial effects. The genome was segmented to identify regions with common copy number means (DNAcopy software). Posterior aberration probabilities for the regions were obtained using CGHcall and data was visualized and annotated using iGenomicViewer in R. Validation will be performed by fluorescence in situ hybridization using select BAC probes and endometrial cancer tissue microarrays (TMAs) with either 400 cases linked with clinical, treatment and outcome data or 180 AA versus 120 C women from GOG-136. Results: Recurrent CNAs were identified in all stage and race groups. Distinct genomic losses and gains were observed that appear to segregate Caucasian women with stage I disease from African American women with stage I disease and African American or Caucasian women with stage IIIC/IV disease. Conclusions: The GOG-210 bank yielded high quality DNA for detecting and mapping CNAs in frozen primary tumors with high resolution. Our results would imply that racial disparity for AA EEC has a genetic basis regardless of stage. Validation studies are currently underway in two endometrial cancer TMAs. [Table: see text]

No significant financial relationships to disclose.

Clinical and pathologic correlation of p73 expression in surgically staged endometrial cancer

e22153

Background: p73 is a p53 homologue that has been implicated both as a tumor suppressor and oncogene. While known to play a role in the apoptotic response, homozygous p73 knockout mice have not shown an increased susceptibility to tumor formation. However, recent literature suggests that p73 dysregulation may play a role in retinoblastoma, ovarian and bladder cancer. We sought to correlate p73 status with clinical-pathologic factors including mismatch repair status, in a large cohort of comprehensively staged endometrial cancers. Methods: Primary endometrial and colon cancers were used to create a tissue microarray (TMA). Two-hundred eight endometrial specimens were available for evaluation. Immunohistochemistry with p73 was performed using commercial available antibodies. Positive staining was defined as > 10% cells having positive nuclear staining. Microsatellite (MSI) instability testing as well as IHC for p53 had been previously performed. Statistical analysis was performed using Fisher's exact test. Results: In six non-neoplastic control endometrial samples examined, p73 appears to stain mainly surface epithelial cell nuclei and superficial glands. p73 expression was identified in 71 (34%) of endometrial cancer specimens. There was no correlation between p73 status and histology, stage, grade or MSI status. Strong correlation that was noted between p53 status and p73 status. Ninety-eight (71%) of the 137 p73 negative tumors were noted to be wildtype(negative staining) for p53 (p<.001). However, when the (-)p73 (+)p53 and (+) p73 (+)p53 phenotypes were examined separately, there was no correlation with stage or grade. Conclusions: p73 is a p53 homologue with uncertain potential as an oncogene and tumor suppressor gene. To date, we offer the largest study of p73 expression in comprehensively staged endometrial cancer. While we show significant loss of p73 expression among cancer specimens, we were unable to demonstrate a relationship between p73 and clinical factors. However, an interesting correlation between p53 status and p73 does appear. The potential role for p73 and p53 in the apoptotic response to cytotoxic chemotherapy is interesting and deserves further study.

No significant financial relationships to disclose.

Abstract A46: Ablack raspberry extract inhibits the proliferation of cervical cancer cells partially through proapoptotic effects

A46

Cervical carcinoma, the second most common female cancer worldwide, is the seventh leading cause of cancer death in women. Although pap smears to screen abnormal cervical cytology have helped reduce mortality rates, it remains a challenge to manage preinvasive and invasive cervical lesions. The long latency of cervical cancer allows preventive and therapeutic interventions before progressing onto invasive disease. Thus, phytochemical-based cancer chemoprevention and the role of bioactive food components have attracted significant interest in current cancer-fighting interventions. We have previously shown that lyophilized black raspberries (LBR, Rubus occidentalis) inhibit the cell proliferation of human oral squamous cell carcinoma cells in vitro as well as oral tumorigenesis in vivo. Given the similar epidemiologic basis of oral and cervical cancers, we evaluated whether an LBR extract had anti-proliferative effects in cervical cancer cells in vitro and began to elucidate the possible regulatory molecular mechanisms. We found that LBR inhibited the proliferation of three human cervical cancer cell lines, HeLa (HPV16−/HPV18+) SiHa (HPV16+/HPV18−) and C-33A (HPV18−/HPV16−), in a dose-dependent manner (at 25, 50, 100 or 200µg/ml for 1, 3 and 5 days, respectively) to a maximum of 44%, 53% and 45% respectively (P&lt;0.005). While exogenous hydrogen peroxide (H2O2, 100µM), a common reactive oxygen species (ROS) intermediate and inhibitor of cell growth, inhibited C-33A proliferation, HeLa and SiHa cells were not significantly affected. The anti-proliferative effects of either LBR or LBR+catalase were similar in all cell lines as shown by WST1 (tetrazolium salt cleavage) and crystal violet assays, which supporting the hypothesis that decreased proliferation is specific to LBR bioactive components and independent in vitro peroxide generation. Flow cytometric analysis of propidium iodide and Annexin V staining showed that LBR induced apoptotic markers in all three cells lines, and did not change cell cycle progression. LBR treatment induced hypercondensation and volume contracted nuclei in Hela cells as demonstrated by fluorescence microscopy analysis of Hoechst 33342 staining. In conclusion, an extract of lyophilized black raspberries demonstrated significant anti-proliferative and pro-apoptotic activities in human cervical cancer cells in vitro. Therefore, black raspberries and their bioactive components may represent promising candidates for the phytochemical-based chemoprevention of cervical cancer and warrant further investigation.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):A46.

The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients

The aim of the study was to determine the impact of the absolute number and ratio of positive lymph nodes on the survival in node-positive endometrioid uterine cancer. Data were obtained from the National Cancer Institute Registry from 1988 to 2001. Analyses were performed using Kaplan–Meier and Cox proportional hazard methods. A total of 1222 women were diagnosed with stage IIIC-IV node-positive endometrioid corpus cancer. The 5-year disease-specific survival of women with 1, 2–5, and >5 positive nodes were 68.1, 55.1, and 46.1%, respectively (P<0.001). Increasing lymph node ratio, expressed as a percentage of positive nodes to total nodes identified (⩽10, >10–⩽50, and >50%), was associated with a decrease in survival from 77.3 to 60.7 to 40.9%, respectively (P<0.001). The absolute number of positive nodes and the lymph node ratio remained significant after adjusting for stage (IIIC vs IV) and the extent of lymphadenectomy (⩽20 vs >20 nodes). On multivariate analysis, the absolute number of positive nodes and lymph node ratio were significant independent prognostic factors for survival. Increasing absolute number of positive nodes and lymph node ratio are associated with a poorer survival in women with node-positive uterine cancers. The stratification of node-positive uterine cancer for prognostic and treatment purposes warrants further investigation.

CD4+ count-guided interruption of antiretroviral treatment

BACKGROUND

Despite declines in morbidity and mortality with the use of combination antiretroviral therapy, its effectiveness is limited by adverse events, problems with adherence, and resistance of the human immunodeficiency virus (HIV).

METHODS

We randomly assigned persons infected with HIV who had a CD4+ cell count of more than 350 per cubic millimeter to the continuous use of antiretroviral therapy (the viral suppression group) or the episodic use of antiretroviral therapy (the drug conservation group). Episodic use involved the deferral of therapy until the CD4+ count decreased to less than 250 per cubic millimeter and then the use of therapy until the CD4+ count increased to more than 350 per cubic millimeter. The primary end point was the development of an opportunistic disease or death from any cause. An important secondary end point was major cardiovascular, renal, or hepatic disease.

RESULTS

A total of 5472 participants (2720 assigned to drug conservation and 2752 to viral suppression) were followed for an average of 16 months before the protocol was modified for the drug conservation group. At baseline, the median and nadir CD4+ counts were 597 per cubic millimeter and 250 per cubic millimeter, respectively, and 71.7% of participants had plasma HIV RNA levels of 400 copies or less per milliliter. Opportunistic disease or death from any cause occurred in 120 participants (3.3 events per 100 person-years) in the drug conservation group and 47 participants (1.3 per 100 person-years) in the viral suppression group (hazard ratio for the drug conservation group vs. the viral suppression group, 2.6; 95% confidence interval [CI], 1.9 to 3.7; P<0.001). Hazard ratios for death from any cause and for major cardiovascular, renal, and hepatic disease were 1.8 (95% CI, 1.2 to 2.9; P=0.007) and 1.7 (95% CI, 1.1 to 2.5; P=0.009), respectively. Adjustment for the latest CD4+ count and HIV RNA level (as time-updated covariates) reduced the hazard ratio for the primary end point from 2.6 to 1.5 (95% CI, 1.0 to 2.1).

CONCLUSIONS

Episodic antiretroviral therapy guided by the CD4+ count, as used in our study, significantly increased the risk of opportunistic disease or death from any cause, as compared with continuous antiretroviral therapy, largely as a consequence of lowering the CD4+ cell count and increasing the viral load. Episodic antiretroviral therapy does not reduce the risk of adverse events that have been associated with antiretroviral therapy. (ClinicalTrials.gov number, NCT00027352 [ClinicalTrials.gov].).

A Gynecologic Oncology Group randomized trial of whole abdominal irradiation (WAI) vs cisplatin-ifosfamide+mesna (CIM) in optimally debulked stage I-IV carcinosarcoma (CS) of the uterus

5001

Background: Besides initial surgery, there has been no established consensus regarding adjunctive therapy for optimally debulked patients with uterine CS. This study was designed to compare progression-free interval (PFI), overall survival (OS), toxicity, and failure patterns using WAI vs CIM chemotherapy for this uncommon group of female malignancies. Methods: Patients with stage I-IV disease, ≤ 1 cm residual tumor, and no extra-abdominal involvement were randomly assigned to either WAI (approximately 30 Gy followed by pelvic boost) or cisplatin 20 mg/m2/d × 4, ifosfamide 1.5 g/m2/d × 4 and mesna 120 mg/m2 loading dose, then 1.5 g/m2/d × 24 h, repeated q 3 weeks × 3 cycles. Results: 224 patients were enrolled, of whom 207 (WAI = 105; CIM = 102) were eligible. Patient demographics and characteristics were similar between arms. FIGO stage (both arms) was: I = 64 (31%); II = 26 (12%); III = 93 (45%); IV = 24 (11%). GI toxicity ≥ grade 2 occurred frequently and similarly (31%, both arms). CIM was associated with more ≥ grade 3 anemia (11% vs 1%) and neurotoxicity (9% vs 0%) compared to WAI. Two deaths were attributed to RT-induced hepatitis. Sites of first recurrence in WAI vs CIM among the 97 (47%) patients who relapsed were: vagina, 4 vs 10; pelvis, 12 vs 12; abdomen, 23 vs 14; lung, 13 vs 13; other, 13 vs 9. The estimated probability of recurring within 5 years is 55% (WAI) and 49% (CIM). Adjusting for stage, the recurrence rate was 28.5% lower for CIM patients relative to WAI patients (hazard ratio [HR]: 0.715, 95% confidence interval [CI]: 0.474–1.077, p = 0.108, 2-tail test). The estimated death rate for CIM is 32.8% lower relative to WAI (HR: 0.672, 95% CI: 0.458–.986, p = 0.042). Conclusion: Compared to WAI, adjuvant CIM reduces the recurrence rate and significantly prolongs OS in optimally debulked uterine CS patients; however, due to a high relapse rate and poor OS, the imperative for new adjuvant therapies remains.

No significant financial relationships to disclose.

Efficacy and toxicity of the novel chemotherapeutic agent KW-2170 in recurrent epithelial ovarian cancer

OBJECTIVES

KW-2170 is a novel DNA intercalating agent whose mechanism of action is similar to doxorubicin HCl, yet is associated with less cardiac toxicity. The objective of this study was to evaluate the activity and toxicity of this novel chemotherapeutic agent in patients with recurrent ovarian carcinoma.

METHODS

A prospective phase II trial was performed in patients with persistent or recurrent epithelial ovarian or primary peritoneal carcinoma and measurable disease. Patients could have platinum-sensitive or refractory disease and could have received any number of prior treatments. One treatment cycle consisted of KW-2170 administered at a dose of 18 mg/m(2) weekly for 3 weeks followed by a 21-day rest period. Toxicity was assessed using the NCI Common Toxicity Criteria (Version 2.0), and dose reduction was allowed for significant toxicity. Response to therapy was assessed in patients who completed at least 2 cycles using RECIST criteria.

RESULTS

A total of 28 patients were enrolled in this phase II trial at 5 separate centers. Of the 28 patients evaluated, all had stage III/IV disease at initial diagnosis. The median number of prior therapeutic regimens in these patients was 4 (range 1-8). The median number of KW-2170 cycles administered was 2 (range 1-5). Treatment-related toxicity in this heavily pretreated population was acceptable as only 6 patients (21%) had grade 3-4 neutropenia. Dose reductions occurred in 6 patients (21%) for grades 1-4 neutropenia, and no patient had febrile neutropenia. Four patients completed less than 1 cycle; 3 secondary to progressive disease, and one due to Gram-positive sepsis. Of patients receiving at least 2 full cycles, 10 patients (55%) had stable disease with a median of 4.5 months (range 3-10) to disease progression. All other patients were removed from the study after 1-2 cycles of therapy with no significant clinical effect noted.

CONCLUSIONS

Although associated with relatively little toxicity, KW-2170 at the dose and schedule evaluated demonstrated little clinical activity in this heavily pretreated population of recurrent ovarian cancer patients. Whether KW-2170 would have greater clinical activity in a more treatment naive group of patients at an increased dose awaits clinical trial evaluation.

The efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC)

OBJECTIVE

To determine the efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC).

METHODS

A retrospective multi-institutional investigation was performed to identify surgically staged patients with Stage I UPSC who were (1) treated after surgery with 3-6 courses of platinum-based chemotherapy without radiation from 1990-2003, and (2) followed for a minimum of 12 months, or until recurrence.

RESULTS

Six patients (IA-2, IB-3, IC-1) were treated with carboplatin (AUC 6) or cisplatin (50 mg/m2) alone. One patient recurred to the vagina, was treated with chemo-radiation, and is alive and well at 122 months. One patient recurred to the lung, liver, and brain, and died of disease at 24 months. The remaining 4 patients are alive with no evidence of disease 15-124 months (mean 62 months) after treatment. Two patients (IB-1, IC-1) were treated with cisplatin (50 mg/m2) and cyclophosphamide (1000 mg/m2), and both are alive and well with no evidence of disease 75 and 168 months after treatment. Twenty-one patients (IA-5, IB-13, IC-3) were treated with a combination of carboplatin (AUC 6) and paclitaxel (135 mg/m2-175 mg/m2). One patient recurred to the vagina after 3 cycles of carboplatin/paclitaxel, and was treated with chemo-radiation. She is now without evidence of disease 10 months after treatment. At present, all 21 patients with Stage I UPSC treated following surgical staging with carboplatin/paclitaxel chemotherapy are alive and well with no evidence of disease 10-138 months (mean 41 months) after treatment.

CONCLUSION

Combination carboplatin/paclitaxel chemotherapy following surgery is effective in the treatment of Stage I UPSC.

Tiroidectomía profiláctica en niños y jóvenes con cáncer medular tiroideo hereditario: Experiencia chilena

BACKGROUND

With the availability of the RET proto-oncogene genetic testing, it is possible to perform prophylactic total thyroidectomy among carriers of RET mutation.

AIM

To evaluate the histological findings and the effects of the prophylactic total thyroidectomy in first-degree relatives of Chilean patients with multiple endocrine neoplasia type 2 (MEN 2) based on the Ret proto-oncogene analysis.

SUBJECTS AND METHODS

Nineteen patients belonging to 11 MEN 2 families underwent total thyroidectomy. Of these, 16 either with C cell hyperplasia (CCH) or microscopic medullary thyroid carcinoma (MTC) were selected for the final analysis.

RESULTS

The age at the moment of thyroidectomy ranged from 3 to 24 years (median 9.5). The most common mutation was located in codon 634 (69%) followed by codon 620 (25%). Histopathology revealed MTC in 13 patients (81%, youngest 3 years, oldest ones 19 and 24 years) and CCH in 3. A significant correlation was observed between basal preoperative serum calcitonin/tumor size (r = 0.53, P < 0.05) and age/tumor size (r = 0.56, P < 0.03), but not between basal preoperative serum calcitonin and age. Stimulated preoperative calcitonin levels were confounding and not useful for differentiating CCH from MTC. None of patients in whom cervical dissection was done (9/16) presented lymph node metastases, including the oldest ones. All patients but the older ones were biochemically cured after a mean of 5 years of follow-up.

CONCLUSION

Prophylactic total thyroidectomy should be done early in life because there is an age-dependent progression from HCC to MTC. MTC often precedes biochemical detection of the disease.

Designing biodegradable multiblock PCL/PLA thermoplastic elastomers

A series of poly(epsilon-caprolactone)/poly(L-lactic acid) (PCL/PLA) biodegradable poly(ester-urethane)s, was synthesized and characterized. The first step of the synthesis consisted of the ring opening polymerization of L-lactide, initiated by the hydroxyl terminal groups of the PCL chain, followed by the chain extension of these PLA-PCL-PLA triblocks, using hexamethylene diisocyanate (HDI). The trimers comprised PCL2000 flexible segments, while the length of each PLA block covered the 550-6000 molecular weight range. The morphology of the copolymers gradually changed, as the length of the PLA blocks increased. The multiblock copolymers produced displayed enhanced mechanical properties, with ultimate tensile strength values around 32 MPa, Young's modulus as low as 30 MPa and elongation at break values well above 600%. The longer the PLA block, the slower the in vitro degradation of the material, with all copolymers degrading faster than the respective homopolymers.

Maternity and pediatrics hospital, Madrid

Rafael Moneo combines two health-care facilities under one roof, crafting an urban oasis of crisp, shimmering volumes.

Lack of toxicity from concomitant directly observed disulfiram and isoniazid-containing therapy for active tuberculosis

We retrospectively evaluated the use of disulfiram among alcoholic patients being treated for active tuberculosis. There were 13 alcoholics treated with disulfiram, 105 alcoholics not on disulfiram, and 249 non-alcoholics. Rates of toxicity were higher among alcoholics than among non-alcoholics (58% vs. 32%), but there was no difference between alcoholics taking and those not taking disulfiram (61% vs. 57%). There were no neurological side effects in the disulfiram group. Disulfiram appeared to be safe when added to intermittent, directly observed isoniazid-containing tuberculosis treatment, and was useful in managing complications of alcohol abuse. However, the small number of patients on disulfiram limits the strength of this negative finding.

Surface oxidation of polyethylene fiber reinforced polyolefin biomedical composites and its effect on cell attachment

Three different compositions of butene-ethylene copolymer composites reinforced by polyethylene fibers and produced by filament winding are potentially suitable for biomedical applications. This study examines the effect of various processing and finishing conditions and of sterilization on the extent and composition of surface oxidation. An XPS analysis revealed only insignificant differences between the various treatments, while fibroblast cell attachment tests indicated good attachment with no signs of cytotoxity or cell degeneration for any of the materials.