Abstract 4434: Role of Deubiquitinase Usp9x in pancreatic cancers: Tumor promoter or tumor suppressor

Deubiquitinase Usp9x has been shown to promote tumor cell survival and resistance to chemo- and radiotherapy through effects on the Mcl-1 pro-survival protein. It is predicted that a small molecule Usp9x inhibitor could have a major impact in cancer therapy. However, recent data has raised caution about therapeutic targeting of Usp9X in cancer. In a study to identify genes that reduce the latency of pancreatic tumor formation in a mutant Kras model, Pérez-Mancera et al. 2012 reported that the Usp9x locus was frequently inactivated in pancreatic cancer cells, resulting in protection from anoikis and enhanced transformation. In order to clarify the role of Usp9X in pancreatic cancer, we used a newly created cell line 4668 established from mouse pancreatic tumors with doxycycline (DOX) inducible expression of KrasG12D and Tp53R172H. Stable Usp9x knockdown (KD) in 4668 cells had no effect on their proliferation or phenotype in 2D cultures. However, withdrawal of DOX from DOX-treated Usp9x KD 4668 cells resulted in 4-fold increase in colony formation, unlike DOX depleted control KD 4668 cells which undergo apoptosis resulting in colony disintegration. DOX treated control KD and Usp9x KD 4668 cells did not show any difference in basal 3D colony formation. These results suggest that Usp9x loss in the absence of continuous mutant Kras/p53 expression is sufficient to sustain 3D cancer cell growth, confirming a tumor suppressor role for Usp9x in a Kras mouse model of pancreatic cancer. To determine if Usp9x also plays a tumor suppressor role in human pancreatic tumors, we did Usp9x KD in three human pancreatic cancer cell lines with varied Kras mutational status; BxPC3 (wild type), PANC1 (heterozygous) and MIA-PACA2 (homozygous) which expressed high basal levels of Usp9x. MIA-PACA2-Usp9x KD cells undergo apoptosis and caspase activation. In contrast, BxPC3-Usp9x KD cells showed no effect on growth in 2D or in 3D culture. However, PANC1-Usp9x KD cells showed more rapid (38% p=0.004) 2D growth, but 3D colony formation was consistently reduced by >50%, (p=0.03). These results suggest that the effect of Usp9x loss in established human pancreatic tumor cells is distinct from that detected in a murine pancreatic tumor model. Distinctions may be partially dependent on their Kras mutational status or Usp9x substrate utilization in human vs. murine cells. To further assess the clinical relevance of our observations, Usp9x KD was evaluated in four recently established, low passage number human pancreatic patient tumor cell lines (UM2, UM6, UM16, UM76). Usp9x KD did not affect 2D growth but fully suppressed 3D colony growth. This activity was phenocopied by our small molecule Usp9x inhibitor, EOAI3402143 (G9), with nM efficacy. Together, these results suggest that possible species distinctions exist in the tumorigenic functions of Usp9x and necessitate further assessment of its role in pancreatic tumor development and treatment.

Citation Format: Anupama Pal, Marina Pasca di Magliano, Moshe Talpaz, Michelle Dziubinski, Diane Simeone, Nicholas J. Donato. Role of Deubiquitinase Usp9x in pancreatic cancers: Tumor promoter or tumor suppressor. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4434. doi:10.1158/1538-7445.AM2014-4434

Abstract 2866: Proteins associated with pancreatic cancer survival in patients with resectable pancreatic ductal adenocarcinoma

The prognosis of pancreatic ductal adenocarcinoma (PDAC) is dismal. Very rarely, patients will survive for more than10-years after pancreatic surgery. A few clinicopathological characteristics have been demonstrated to have significant effect on long-term survival. However, the molecular characteristics of the pancreatic adenocarcinomas from these very long-term survivors (VLTS) remain to be uncovered. Our study investigated the tissue proteome of pancreatic tumor and sought to characterize protein signatures associated with pancreatic cancer survival. A comparative label-free proteomics approach was applied to investigate the formalin-fixed paraffin-embedded tumor tissues from five VLTS patients (survival >10 years) and five short-term survival patients (STS, survival <14 months) to identify differentially expressed proteins associated with VLTS and STS. The major functional clusters of the STS associated proteins included cytoskeleton, ribonucleoprotein complex/ protein biosynthesis/RNA processing, and generation of precursor metabolites and energy. In contract, the major functional clusters of the VLTS associated proteins included copines, mitochondrion, and generation of precursor metabolites and energy. Pathway analysis identified MYC, IGF1R and p53 as the top three upstream regulators for the STS associated proteins, and VEGFA, APOE, and TGFβ-1as the top three upstream regulators for the VLTS associated proteins. One VLTS-associated protein, prolargin (PRELP), and one STS-associated protein, ribosomal protein S8 (RPS8) were further validated by immunohistochemistry in an independent cohort of patients, constructed in a tissue microarray with 145 cases of PDAC. Increased expression of PRELP was significantly associated with longer survival time (hazard ratio=0.61, 95% confidence interval 0.42-0.91, p=0.015), and increased expression of RPS8 was significantly associated with shorter survival time (hazard ratio=1.79, 95% confidence interval 1.13-2.82, p=0.012). The combination of “RPS8 and PRELP” displayed improved prognostic value over single protein alone. Multivariate Cox analysis confirmed that “High-RPS8 and Low-PRELP” was significantly associated with shorter survival time (HR=2.69, 95% CI 1.46-4.92, p=0.001) in a model with other significant pathologic variables including high histologic grade and positive lymph node involvement. In addition, galectin-1 (LGALS1) - a STS-associate protein, was further evaluated for its significance in cancer associated fibroblasts. Knockdown of galectin-1 in pancreatic cancer associated fibroblasts dramatically reduced cell migration and invasion, suggesting the important role of galectin-1 in tumor microenvironment. The study suggested that PRELP, LGALS1 and RPS8 might be significant prognostic factors or potential therapeutic target to improve pancreatic cancer survival.

Citation Format: Ru Chen, Sheng Pan, Anirban Maitra, Diane Simeone, David Dawson, Teresa Brentnall. Proteins associated with pancreatic cancer survival in patients with resectable pancreatic ductal adenocarcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2866. doi:10.1158/1538-7445.AM2014-2866

Abstract 3477: Continuous isolation, labeling and collection of viable CTCs using an integrated microfluidic device

The concept of studying tumor-derived circulating tumor cells (CTCs) from a simple blood-draw of a patient, has acquired significant attention in recent years. This relatively non-invasive approach opens many avenues in understanding and monitoring quite a number of cancers where correlations have since been made with CTCs and patient survival as well as patient response to therapeutics. Additionally, studies geared towards identifying genetic markers as well as gene profiling of CTCs are ongoing in efforts to develop early screening markers as well as gain a more holistic understanding of the various forms of the disease. Moreover, the concept of personalized medicine in treating several types of cancer is deemed indispensable due to the highly heterogeneous nature of the disease. Extensive studies involving genetic material of CTCs are expected to considerably develop effective therapeutics that are tailored to meet each patient's need. However, several challenges need to be overcome in order to harness the wealth of information that can be gained from CTC studies, such as the rarity of such cells among other blood cells, where CTCs occur as rarely as 1 to 1 million among other mononuclear blood cells. In this vein we discuss the development of an integrated, continuous microfluidic device designed to isolate and label CTCs disseminated from cancer tumors. The 3-part device initially exploits the size disparity of the majority of CTCs with other blood cells and couples this with the use of size-based inertial forces to presort CTCs from whole blood at 1.2mL/min. The CTC-rich fluid stream is then mixed passively, on-chip, with EpCAM coated micro-beads which allows the cells and beads to mix at the micron length scale. This is followed by a brief period of incubation which allows cells to be sufficiently labeled, where the majority of cells have experienced at least two-thirds magnetic bead coverage using this mixing-incubation approach. Thereafter on-chip magnetic sorting of CTCs from any remaining blood cells is achieved by application of an external magnet along the magnetic sorter of the integrated device. Cells with as little as one-third bead coverage experience magnetic deflection to the CTC collection stream. To identify CTCs, cells were stained positively for DAPI and CK-19, and CD45 was used to distinguish leukocytes. We demonstrate that the isolated CTCs are not only viable but that the range of WBC decontamination is the lowest yet reported in literature. Based on PANC-1 cell-line experiments with the device, an 80% recovery rate of cancer cells from other blood cells was consistently achieved. Testing of metastatic patient samples with the device has yielded high counts of CTCs, coupled with high purity rates. We believe that the use of this system in characterizing CTCs and studying cancer will contribute to understanding this aggressive disease in a non-invasive, efficient manner.

Citation Format: Rhonda M. Jack, Meggie MG Grafton, Robert A. Cieslak, Denise C. Jue, Cathy Griffith, Danika Rodrigues, Sunitha Nagrath, Diane Simeone. Continuous isolation, labeling and collection of viable CTCs using an integrated microfluidic device. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3477. doi:10.1158/1538-7445.AM2014-3477

Clinical evaluation, imaging studies, indications for cytologic study and preprocedural requirements for duct brushing studies and pancreatic fine-needle aspiration: The Papanicolaou Society of Cytopathology Guidelines

The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) biopsy, techniques for EUS-FNA, terminology and nomenclature to be used for pancreaticobiliary disease, ancillary testing and postbiopsy management. All documents are based on expertise of the authors, literature review, discussions of the draft document at national and international meetings and synthesis of online comments of the draft document. This document selectively presents the results of these discussions. This document summarizes recommendations for the clinical and imaging work-up of pancreatic and biliary tract lesions along with indications for cytologic study of these lesions. Prebrushing and FNA requirements are also discussed.

Post-brushing and fine-needle aspiration biopsy follow-up and treatment options for patients with pancreatobiliary lesions: The Papanicolaou Society of Cytopathology Guidelines

The Papanicolaou Society of Cytopathology (PSC) has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) biopsy, techniques of EUS-FNA, terminology and nomenclature for pancreatobiliary cytology, ancillary testing and post-procedure management. All documents are based on the expertise of the authors, a review of the literature and discussions of the draft document at several national and international meetings over an 18 month period and synthesis of online comments of the draft document on the PSC web site (www.papsociety.org). This document selectively presents the results of these discussions and focuses on the follow-up and treatment options for patients after procedures performed for obtaining cytology samples for the evaluation of biliary strictures and solid and cystic masses in the pancreas. These recommendations follow the six-tiered terminology and nomenclature scheme proposed by committee III.

Clinical evaluation, imaging studies, indications for cytologic study, and preprocedural requirements for duct brushing studies and pancreatic FNA: the Papanicolaou Society of Cytopathology recommendations for pancreatic and biliary cytology

The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) biopsy, techniques for EUS-FNA, terminology and nomenclature to be used for pancreaticobiliary disease, ancillary testing, and post-biopsy management. All documents are based on expertise of the authors, literature review, discussions of the draft document at national and international meetings, and synthesis of online comments of the draft document. This document selectively presents the results of these discussions. This document summarizes recommendations for the clinical and imaging work-up of pancreatic and biliary tract lesions along with indications for cytologic study of these lesions. Prebrushing and FNA requirements are also discussed.

In vivo optical spectroscopy for improved detection of pancreatic adenocarcinoma: a feasibility study

Pancreatic adenocarcinoma has a five-year survival rate of less than 6%. This low survival rate is attributed to the lack of accurate detection methods, which limits diagnosis to late-stage disease. Here, an in vivo pilot study assesses the feasibility of optical spectroscopy to improve clinical detection of pancreatic adenocarcinoma. During surgery on 6 patients, we collected spectrally-resolved reflectance and fluorescence in vivo. Site-matched in vivo and ex vivo data agreed qualitatively and quantitatively. Quantified differences between adenocarcinoma and normal tissues in vivo were consistent with previous results from a large ex vivo data set. Thus, optical spectroscopy is a promising method for the improved diagnosis of pancreatic cancer in vivo.

Abstract 313: ATDC drives bladder cancer formation by promoting methylation of the PTEN promoter and inhibition of p53 function

Bladder cancer is the 5th most common malignancy and a significant cause of morbidity and mortality, but the molecular events leading to its development are incompletely understood. We have identified an oncogene, Ataxia-Telangiectasia Group D Complementing (ATDC) gene, which drives formation and progression of pancreatic and bladder tumors. To better characterize the oncogenic function of ATDC, we generated transgenic (tg) mice which overexpress ATDC and the predominant phenotype of these mice was the development of non-invasive and muscle-invasive urothelial carcinomas. Tg bladder tumors were histologically identical to human tumors and displayed a similar gene expression signature to human invasive bladder tumors. ATDC expression was assessed in a tissue microarray and was highly up-regulated in 70% of human invasive bladder tumors (173/252). High expression of ATDC correlated with more advanced stage disease and worse survival after chemotherapy (p = 0.002). ATDC knockdown in human bladder cancer cell lines correlated with increased sensitivity to chemotherapy in vitro and decreased proliferation and invasion both in vitro and in vivo in a human bladder cancer xenograft model. To understand the mechanism of ATDC-mediated tumor formation, we modulated ATDC expression in normal and bladder cancer cells lines. ATDC overexpression down-regulated PTEN levels via DNA promoter methylation by DNMT3A in both tg mouse tumors and human cell lines. IHC analysis of ATDC, PTEN and DNMT3A expression in human bladder tumors specimens demonstrated similar findings. ATDC was also found to bind to p53 and inhibit p53 mediated functions. These findings establish ATDC as a novel determinant of bladder cancer initiation, progression and resistance to treatment which mediates tumorigenesis by down-regulation of PTEN expression and inhibition of p53.

Citation Format: Phillip Palmbos, Lidong Wang, Huibin Yang, Taylor Detzler, Gina Ney, Justin Hart, Stephanie Daignault-Newton, L. Priya Kunju, Chandan Kumar-Sinha, Monica Liebert, Mats Ljungman, Diane Simeone. ATDC drives bladder cancer formation by promoting methylation of the PTEN promoter and inhibition of p53 function. [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 313. doi:10.1158/1538-7445.AM2013-313

Characterizing human pancreatic cancer precursor using quantitative tissue optical spectroscopy

In a pilot study, multimodal optical spectroscopy coupled with quantitative tissue-optics models distinguished intraductal papillary mucinous neoplasm (IPMN), a common precursor to pancreatic cancer, from normal tissues in freshly excised human pancreas. A photon-tissue interaction (PTI) model extracted parameters associated with cellular nuclear size and refractive index (from reflectance spectra) and extracellular collagen content (from fluorescence spectra). The results suggest that tissue optical spectroscopy has the potential to characterize pre-cancerous neoplasms in human pancreatic tissues.

Abstract 4555: Protein and glycan biomarkers of malignant potential in pancreatic cyst fluid

The early detection of a portion of pancreatic cancer precursors_cystic neoplasms of the pancreas_is possible through high-resolution abdominal imaging, providing an opportunity to successfully treat these lesions before they become invasive. The increased use of abdominal imaging has led to a higher rate of identifying pancreatic cysts, but currently it is not possible to accurately determine which cysts have high malignant potential and should be removed. Our previous work showed that the glycosylation and abundance of specific proteins in the cyst fluid was significantly different between potentially malignant cysts and benign cysts, providing leads for biomarkers to guide patient management. In this work we tested the hypothesis that a panel of specific protein glycoforms forms an accurate biomarker for pancreatic cysts with high malignant potential. Using antibody-lectin sandwich arrays, screens of nearly 100 different candidate markers and multiple glycoforms of each marker confirmed previous results and also showed that two distinct glycan structures are present on several proteins at high levels in the cyst fluid of cancer precursors (intraductal pancreatic mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN)) but not in benign cysts (serous cystadenomas (SC) and pseudocysts (PC)). The glycans, N-acetyl glucosamine and the blood group H structure, previously have not been recognized as cancer biomarkers. A six-marker panel comprising the measurement of one of these glycans on MUC5AC, MUC16, endorepellin, and fibronectin correctly detected 37 of 39 (95%) potential cancer precursors and 16 of 18 (89%) of the benign cysts. This performance significantly surpasses current diagnostic accuracy. The validation of this biomarker panel could lead to more accurate treatment decisions for patients with potentially malignant cysts while sparing patients with benign cysts from unnecessary procedures.

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 4555. doi:1538-7445.AM2012-4555

Abstract 2216: Enhanced discrimination of malignant from benign pancreatic disease by measuring the CA 19-9 antigen on specific protein carriers

The CA 19-9 assay detects a carbohydrate antigen on multiple protein carriers, some of which may be preferential carriers of the antigen in cancer. We tested the hypothesis that the measurement of the CA 19-9 antigen on individual proteins could improve performance over the standard CA 19-9 assay. We used antibody arrays to measure the levels of the CA 19-9 antigen on multiple proteins in serum or plasma samples from patients with pancreatic adenocarcinoma or pancreatitis. Sample sets from three different institutions were examined, comprising 420 individual samples. The measurement of the CA 19-9 antigen on any individual protein did not improve upon the performance of the standard CA 19-9 assay (79-88% sensitivity at 75% specificity), owing to diversity among patients in their CA 19-9 protein carriers. However, a subset of cancer patients with no elevation in the standard CA 19-9 assay showed elevations of the CA 19-9 antigen specifically on the proteins MUC1, MUC5AC, or MUC16 in all three sample sets. By combining measurements of total CA 19-9 with CA 19-9 on these individual proteins, the sensitivity of cancer detection was raised to 85-100% in the three sample sets, at a specificity of 75%. This finding demonstrates the potential value of measuring glycans on specific proteins for improving biomarker performance. Furthermore, the definition of subgroups of patients based on the protein carriers of the CA 19-9 antigen and other glycans will guide the further development of informative biomarker panels. Diagnostic tests with improved sensitivity for detecting pancreatic cancer could have important applications for improving the treatment and management of patients suffering from this disease.

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 2216. doi:10.1158/1538-7445.AM2011-2216

Photon-tissue interaction model enables quantitative optical analysis of human pancreatic tissues

A photon-tissue interaction (PTI) model was developed and employed to analyze 96 pairs of reflectance and fluorescence spectra from freshly excised human pancreatic tissues. For each pair of spectra, the PTI model extracted a cellular nuclear size parameter from the measured reflectance, and the relative contributions of extracellular and intracellular fluorophores to the intrinsic fluorescence. The results suggest that reflectance and fluorescence spectroscopies have the potential to quantitatively distinguish among pancreatic tissue types, including normal pancreatic tissue, pancreatitis, and pancreatic adenocarcinoma.

Cascade fragmentation under ion beam irradiation: a fractal approach

Based on the fractal nature of collisions, the fragmentation of displacement cascades is investigated. Introducing the caliper diameter to take into account large displacements of atoms in a collision cascade, it is possible to describe this fragmentation in terms of a threshold energy Ec. From the knowledge of Ec, the number and the volume fraction of subcascades produced is then derived. This last information allows us to classify the efficiency of impinging particles to induce structural changes of solids.

Concentration profile distortion under ion beam mixing: an example of Levy flight

In order to model the evolution of concentration profiles induced by ion beam mixing in thick layers, Monte Carlo simulations were performed to study in detail the transition probability controlling the evolution of this profile within the binary collision approximation. We demonstrate that this transition probability can be factorized in two distinct functions. The first one can be understood as a scale factor. The second one controls the dynamics of ion beam mixing which can be analyzed as a Levy flight. The power law form of the tail of this function closely linked to the cross section of a collision event is responsible for long tails of concentration profiles. We demonstrate that the Levy flight nature of ion beam mixing induces an enhancement of the evolution of the initial concentration profile.

Spectral areas and ratios classifier algorithm for pancreatic tissue classification using optical spectroscopy

Pancreatic adenocarcinoma is one of the leading causes of cancer death, in part because of the inability of current diagnostic methods to reliably detect early-stage disease. We present the first assessment of the diagnostic accuracy of algorithms developed for pancreatic tissue classification using data from fiber optic probe-based bimodal optical spectroscopy, a real-time approach that would be compatible with minimally invasive diagnostic procedures for early cancer detection in the pancreas. A total of 96 fluorescence and 96 reflectance spectra are considered from 50 freshly excised tissue sites-including human pancreatic adenocarcinoma, chronic pancreatitis (inflammation), and normal tissues-on nine patients. Classification algorithms using linear discriminant analysis are developed to distinguish among tissues, and leave-one-out cross-validation is employed to assess the classifiers' performance. The spectral areas and ratios classifier (SpARC) algorithm employs a combination of reflectance and fluorescence data and has the best performance, with sensitivity, specificity, negative predictive value, and positive predictive value for correctly identifying adenocarcinoma being 85, 89, 92, and 80%, respectively.

Consensus report of the national cancer institute clinical trials planning meeting on pancreas cancer treatment

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer mortality, despite significant improvements in diagnostic imaging and operative mortality rates. The 5-year survival rate remains less than 5% because of microscopic or gross metastatic disease at time of diagnosis. The Clinical Trials Planning Meeting in pancreatic cancer was convened by the National Cancer Institute's Gastrointestinal Cancer Steering Committee to discuss the integration of basic and clinical knowledge in the design of clinical trials in PDAC. Major emphasis was placed on the enhancement of research to identify and validate the relevant targets and molecular pathways in PDAC, cancer stem cells, and the microenvironment. Emphasis was also placed on developing rational combinations of targeted agents and the development of predictive biomarkers to assist selection of patient subsets. The development of preclinical tumor models that are better predictive of human PDAC must be supported with wider availability to the research community. Phase III clinical trials should be implemented only if there is a meaningful clinical signal of efficacy and safety in the phase II setting. The emphasis must therefore be on performing well-designed phase II studies with uniform sets of basic entry and evaluation criteria with survival as a primary endpoint. Patients with either metastatic or locally advanced PDAC must be studied separately.

Optical spectroscopy detects histological hallmarks of pancreatic cancer

An empirical model was developed to interpret differences in the experimentally measured reflectance and fluorescence spectra of freshly excised human pancreatic tissues: normal, adenocarcinoma, and pancreatitis (inflammation). The model provided the first quantitative links between spectroscopic measurements and histological characteristics in the human pancreas. The reflectance model enabled the first (to our knowledge) extraction of wavelength resolved absorption and reduced scattering coefficients for normal and diseased human pancreatic tissues. The fluorescence model employed reflectance information to extract attenuation free "intrinsic" endogenous fluorescence spectra from normal pancreatic tissue, pancreatic adenocarcinoma, and pancreatitis. The method developed is simple, intuitive, and potentially useful for a range of applications in optical tissue diagnostics. This approach is potentially applicable to in vivo studies, because it can account for the absorptive effects of blood in tissues.

Pancreatic cancer patients who smoke and drink are diagnosed at younger ages

BACKGROUND & AIMS

Cigarette smoking is an established risk factor for pancreatic cancer, but there is conflicting evidence regarding the effects of alcohol consumption. The effects of cigarettes and alcohol on age of sporadic pancreatic cancer diagnosis have not been examined; we evaluated the independent and synergistic effects of lifetime cigarette smoking and alcohol consumption on age at pancreatic cancer diagnosis in the United States.

METHODS

We analyzed data on cigarette smoking and alcohol consumption from the IMPAC Services, Inc Cancer Information Resource File (CIRF), collected from June 1, 1993, to December 31, 2003, for 29,239 reported, histologically confirmed cases of pancreatic adenocarcinoma. We also analyzed data on cigarette smoking and alcohol consumption for 820 histologically confirmed cases of pancreatic adenocarcinoma from the University of Michigan Pancreatic Cancer Registry (UMPCR), collected from January 2004 to October 2007.

RESULTS

Current cigarette smokers were diagnosed at significantly younger ages than never smokers, according to data from the CIRF and UMPCR (8.3 and 6.3 y, respectively); the UMPCR data indicated dose effects. Past and current alcohol consumption were associated with younger age at diagnosis in both databases. Current smokers who were current drinkers were diagnosed significantly earlier (CIRF, 10.2 y; UMPCR, 8.6 y) than abstainers. Past cigarette smoking was associated modestly with younger diagnosis age.

CONCLUSIONS

Cigarette smoking and alcohol consumption were associated with younger age at pancreatic cancer presentation and have a combined effect on diagnosis age. Past cigarette smoking is less influential. Smoking cessation programs could help prevent pancreatic cancer.

Prevalence of depression, sleep-related disturbances, and anxiety and their effect on quality of life in patients with adenocarcinoma of the pancreas

e15678

Purpose: To evaluate the prevalence of depression, sleep related disturbances and anxiety and their effect on quality of life in patients with recently diagnosed adenocarcinoma of the pancreas who present to a multidisciplinary pancreatic cancer clinic. Methods: Cross-sectional and longitudinal psychosocial distress was assessed utilizing Personal Health Questionnaire 9 (PHQ9) to screen for depression and monitor symptoms during the course of care, the Penn State Worry Questionnaire (PSWQ) for generalized anxiety, and the Sleep Problems Questionnaire 4 (SPQ4)/ University of Michigan Sleep Questionnaire to monitor sleep symptoms. Patients were evaluated at their intake consultation and at subsequent follow up visits. Results: 24 patients (pts; mean age 66 years, 48% females) consented to participate during the 6 month pilot study with longitudinal follow up for 13. The PHQ9 scores on presentation revealed mild to moderate depressive symptoms in 54% (13 pts) of pts and moderately severe depressive symptoms in only 8% (2 pts). A minority (2 pts, 8%) had PSWQ scores characteristic of an anxiety disorder, while 33% (8 pts) had moderate anxiety scores. Only 3 pts (12.5%) scores revealed a clear sleep problem; 10 pts, (41.67%) had no sleep problem and 10 pts had a potential sleep problem. Due to the limited follow up, a statistical difference in scores over time was not observed. Conclusions: Our results indicate that mild to moderate depressive symptoms, anxiety and potential sleep problems are common in patients referred to a multidisciplinary pancreatic cancer clinic. Moderately severe depressive symptoms, severe anxiety and clear sleep problems are not as prevalent as is generally believed. To better characterize the relationship of depression (and potential causes) with pancreatic cancer, additional prospective longitudinal studies are needed.

No significant financial relationships to disclose.

Gemcitabine-based combination chemotherapy followed by radiation with capecitabine as adjuvant therapy for resected pancreas cancer

PURPOSE

To report outcomes for patients with resected pancreas cancer treated with an adjuvant regimen consisting of gemcitabine-based combination chemotherapy followed by capecitabine and radiation.

PATIENTS AND METHODS

We performed a retrospective review of a series of patients treated at a single institution with a common postoperative adjuvant program. Between January 2002 and August 2006, 43 resected pancreas cancer patients were offered treatment consisting of 4, 21-day cycles of gemcitabine 1 g/m(2) intravenously over 30 min on Days 1 and 8, with either cisplatin 35 mg/m(2) intravenously on Days 1 and 8 or capecitabine 1500 mg/m(2) orally in divided doses on Days 1-14. After completion of combination chemotherapy, patients received a course of radiotherapy (54 Gy) with concurrent capecitabine (1330 mg/m(2) orally in divided doses) day 1 to treatment completion.

RESULTS

Forty-one patients were treated. Median progression-free survival for the entire group was 21.7 months (95% confidence interval 13.9-34.5 months), and median overall survival was 45.9 months. In multivariate analysis a postoperative CA 19-9 level of >or=180 U/mL predicted relapse and death. Toxicity was mild, with only two hospitalizations during adjuvant therapy.

CONCLUSIONS

A postoperative adjuvant program using combination chemotherapy with gemcitabine and either cisplatin or capecitabine followed by radiotherapy with capecitabine is tolerable and efficacious and should be considered for Phase III testing in this group of patients.