Cisplatin based chemotherapy in patients with advanced differentiated thyroid carcinoma refractory to I131 treatment

Purpose:

The purpose of the study was to evaluate the activity and toxicity of cisplatin based chemotherapy in patients with advanced differentiated thyroid cancer refractory to radioactive iodine (I131).

Patients and Methods:

We retrospectively reviewed the records of 20 patients with advanced thyroid cancer treated with cyclophosphamide 500 mg/m² on day 1, doxorubicin 50 mg/m² day 1 and cisplatin 50 mg/m² day 1 of a 21 days cycle community-acquired pneumonia (CAP) or the same regimens without cyclophosphamide adriamycin and Platinum (AP).

Results:

Median age of patients was 65 years (range 54-80). The majority of patients had lung metastases (60%). 4 (20%) patients achieved a partial response. Stable disease was achieved in 6 (30%) patients. Overall clinical response was 50%. Mean follow-up time was 8 months (range 4-17). Mean progression free survival was 6 months (range 3-12). Mean overall survival was 9 months (range 4-17). Patients with partial remission had a mean time to disease progression of 9 months. 4 (20%) patients had Grade 3 or 4 neutropenia. One patient had febrile neutropenia. Mild neuropathy was recorded in 5 (25%) of patients. There were no treatment related deaths.

Conclusion:

The combination of CAP is active in the treatment of advanced thyroid cancer with tolerable toxicity. This regimen may still be used in patients who could not be treated with targeted therapy or combined with antiangiogenic drugs in future studies.

Anaplastic variant of classical seminoma of the testis: northern Israel oncology center experience and brief review of literature

OBJECTIVES

There are only sporadic reports on the clinical behavior and appropriate treatment of anaplastic seminoma. This retrospective study summarizes our experience with the anaplastic variant of classical (typical) seminoma.

METHODS

Between 1986 and 2006, seven anaplastic seminoma patients were staged and treated at the Northern Israel Oncology Center. Staging procedures included meticulous physical and neurological examinations, complete blood count, full biochemistry profile, specific tumor markers, testicular ultrasound, and other radiological measures. All patients underwent inguinal orchiectomy and were staged properly. Six patients had stage I disease, and one patient had stage IIA disease. Patients were irradiated with doses ranging from 2,500 to 3,000 cGy, and the stage IIA patient received an additional 1,000 cGy boost to radiographically involved lymph nodes.

RESULTS

After a mean follow-up of 11 years, six patients are alive with no evidence of disease. One patient died due to an unknown, non-oncological, cause, unrelated to his previous testicular tumor, while in complete remission.

CONCLUSIONS

Despite the low patient numbers and the retrospective nature of our study, it can be concluded that radiotherapy treatment for early-stage anaplastic seminoma patients might achieve the same excellent survival as for classical seminoma. However, the general consensus achieved through large-scale studies suggests that active surveillance should be offered to all stage I seminoma patients, regardless of the pathologic variant.

Arterial elasticity in obese subjects with coronary slow flow phenomenon

BACKGROUND

Coronary slow flow phenomenon (CSFP) is a functional and structural disease that is diagnosed by coronary angiogram.

OBJECTIVES

To evaluate the possible association between CSFP and small artery elasticity in an effort to understand the pathogenesis of CSFP.

METHODS

The study population comprised 12 patients with normal coronary arteries and CSFP and 12 with normal coronary arteries without CSFP. We measured conjugated diene formation at 234 nm during low density lipoprotein (LDL) oxidation, as well as platelet aggregation. We estimated, noninvasively, arterial elasticity parameters. Mann-Whitney nonparametric test was used to compare differences between the groups. Data are presented as mean +/- standard deviation.

RESULTS

Waist circumference was 99.2 +/- 8.8 cm and 114.9 +/- 10.5 cm in the normal flow and CSFP groups, respectively (P = 0.003). Four patients in the CSFP group and one in the normal flow group had type 2 diabetes. Area under the curve in the oral glucose tolerance test was 22% higher in the CSFP than in the normal group (P = 0.04). There was no difference in systolic and diastolic blood pressure, plasma concentrations of total cholesterol, triglycerides, high density lipoprotein, LDL and platelet aggregation parameters between the groups. Lag time required until initiation of LDL oxidation in the presence of CuSO4 was 17% longer (P = 0.02) and homocysteine fasting plasma concentration was 81% lower (P = 0.05) in the normal flow group. Large artery elasticity was the same in both groups. Small artery elasticity was 5 +/- 1.5 ml/mmHg x 100 in normal flow subjects and 6.1 +/- 1.9 ml/mmHg x 100 in the CSFP patients (P = 0.02).

CONCLUSIONS

Patients with CSFP had more metabolic derangements. Arterial stiffness was not increased in CSFP.

Haplotype analysis of the 185delAG BRCA1 mutation in ethnically diverse populations

The 185delAG* BRCA1 mutation is encountered primarily in Jewish Ashkenazi and Iraqi individuals, and sporadically in non-Jews. Previous studies estimated that this is a founder mutation in Jewish mutation carriers that arose before the dispersion of Jews in the Diaspora ~2500 years ago. The aim of this study was to assess the haplotype in ethnically diverse 185delAG* BRCA1 mutation carriers, and to estimate the age at which the mutation arose. Ethnically diverse Jewish and non-Jewish 185delAG*BRCA1 mutation carriers and their relatives were genotyped using 15 microsatellite markers and three SNPs spanning 12.5 MB, encompassing the BRCA1 gene locus. Estimation of mutation age was based on a subset of 11 markers spanning a region of ~5 MB, using a previously developed algorithm applying the maximum likelihood method. Overall, 188 participants (154 carriers and 34 noncarriers) from 115 families were included: Ashkenazi, Iraq, Kuchin-Indians, Syria, Turkey, Iran, Tunisia, Bulgaria, non-Jewish English, non-Jewish Malaysian, and Hispanics. Haplotype analysis indicated that the 185delAG mutation arose 750-1500 years ago. In Ashkenazim, it is a founder mutation that arose 61 generations ago, and with a small group of founder mutations was introduced into the Hispanic population (conversos) ~650 years ago, and into the Iraqi-Jewish community ~450 years ago. The 185delAG mutation in the non-Jewish populations in Malaysia and the UK arose at least twice independently. We conclude that the 185delAG* BRCA1 mutation resides on a common haplotype among Ashkenazi Jews, and arose about 61 generations ago and arose independently at least twice in non-Jews.

Effect of young age (<50) on clinical, pathologic features and survival of patients with colorectal cancer

e14025

Background: Colorectal cancer is one of the most common malignancies in both men and women in Israel. Most patients with colon cancer are older than 50 years of age. However young patients are not rare. There is no consensus in the literature regarding the behavior of this disease in young patients. Clinical and pathological characteristics of colon cancer patients treated at Oncology Institute in Ziv Medical Center were retrospectively analyzed. The aim of the present study is to compare clinical and pathological features of colon cancer between young and old patients. Methods: A total of 200 patients with colon cancer were treated at our institute during 8 years. Twenty five (12.5%) of them were <50 years age (young patients) at diagnosis. All clinical and pathological characteristics were taken retrospectively from the hospital files. In situations where the pathological findings were not noted in the chart, review of the stored tumor was requested from the pathology department. Acceptable statistical methods were used for statistical calculations. Results: Among the 200 patients 25 (12.5%) were <50 years age at diagnosis (mean age 41 years) and 175 were >50 years (mean age 70 years). Males were 56% of the young group and 60.1% of the old one. Arab patients were 52% of the young and only 12.6% of the old group although total number of Arabs was 35 of 200 patients. No significant difference was found in stage of tumor at diagnosis between the young group (YG) and the old group (OG). Twenty percent of YG had distant metastases compared to 26.5% in the OG. Histopathological grade 3 tumors were found in 33.3% of the YG versus 7.7% in the OG. Surgery and chemotherapy were done in 96% and 88% in YG versus 95.4% and 69.7% in the OG respectively. In a median follow up period of 96 months 35% of young patients died of their disease compared to 33.1% of the old patients. Conclusions: Young patients with colon cancer were diagnosed at the same stage of the disease as old patients. More tumors were high grade in YG. More patients were candidates for chemotherapy in the YG. Significantly more Arab patients were young at the time of diagnosis than Jewish patients. Further studies with higher number of patients are suggested to clarify our findings.

Curcuma as a functional food in the control of cancer and inflammation

PURPOSE OF REVIEW

Several nutritional compounds are the focus of public attention because of their potential beneficial health effects. Turmeric is a spice that comes from the root Curcuma longa. Extensive research over the past half century and especially in recent years has revealed important functions of curcumin and a timely review of clinical state-of-the-art using curcumin.

RECENT FINDINGS

In-vitro and in-vivo research has shown various activities, such as anti-inflammatory, antiviral, antifungal, cytokines release, antioxidant, immunomodulatory, enhancing of the apoptotic process, and antiangiogenic properties. Curcumin also have been shown to be a mediator of chemo-resistance and radio-resistance.

SUMMARY

Various in-vitro and in-vivo and scarce number of clinical studies on curcumin were identified. The various effects and properties of curcumin are summarized in this review, including preclinical and especially clinical studies. This review concentrates on recent knowledge and research with curcumin clinical applications, and clinical studies, focusing on studies published between 2008 and 2011 demonstrating the gap between preclinical and clinical research.

Effect of letrozole on plasma lipids, triglycerides, and estradiol in postmenopausal women with metastatic breast cancer

PURPOSE

The aromatase inhibitor letrozole effectively treats breast cancer by decreasing estrogen levels in postmenopausal women. The aim of this prospective study was to evaluate the effect of letrozole on plasma lipids, triglyceride lipase (TGL), and estradiol levels in women with metastatic breast cancer (MBC).

MATERIALS AND METHODS

Fifty-two postmenopausal women with MBC received letrozole, 2.5 mg/day. Blood samples for assessment of plasma levels of total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, TGL, and estradiol were taken at baseline and after 3, 6, and 12 months of treatment.

RESULTS

A nonsignificant increase was found in TC and HDL cholesterol levels after 3 months, which returned to baseline levels after 6 months (p = .794 and p = .444, respectively). LDL cholesterol increased nonsignificantly after 6 months and returned to baseline thereafter (p = .886). The mean estradiol level was suppressed from 44 pmol/l before treatment to <18 pmol/l after 6 months (p = .014). No difference was found in the estradiol suppression rate whether baseline levels were >40 or <40 pmol/l.

CONCLUSION

Letrozole has a safe effect on the lipid and TGL profiles of postmenopausal women with MBC. Estradiol levels were maximally suppressed within 6 months of treatment. The increased levels of TC during treatment were reversible and returned to normal levels after 3 months.

Comparison of Arab breast cancer survivors and healthy controls for spousal relationship, body image, and emotional distress

BACKGROUND

Cultural perceptions and norms affect individuals' psychological reactions to cancer and quality of life, but very few studies have assessed reactions to breast cancer in specific cultural groups. Such assessments are especially rare for Arab women with breast cancer.

AIMS

To assess the effect of spousal support, sharing household tasks, and body image in relation to emotional distress in Arab breast cancer survivors compared with matched healthy controls.

METHOD

Fifty-six Israeli Arab breast cancer survivors (stages I-III), and 66 age- and education-matched women answered Brief Symptoms Inventory-18, Perceived Body Image, Perceived Spousal Support and Division of Household Labor scale questionnaires.

RESULTS

Breast cancer patients experienced higher psychological distress, especially anxiety and somatization. They reported receiving more support from their spouses and higher sharing of household tasks than did matched healthy controls, but were not different regarding body image. Twenty-eight percent of the variance of psychological distress was explained, with group, perceived support, and group × body image interaction. Thus, higher psychological distress was more likely to occur in participants receiving lower support and in breast cancer survivors with lower body image.

CONCLUSIONS

The study described the effects of breast cancer on Arab women compared to healthy women. It highlights the need for culture-sensitive care for Arab breast cancer patients, as well as other patients from minority groups residing in other Western countries.

Characteristics of common solid liver lesions and recommendations for diagnostic workup

Due to the widespread clinical use of imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging (MRI), previously unsuspected liver masses are increasingly being found in asymptomatic patients. This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup. Likely diagnoses include hepatocellular carcinoma (the most likely; a solid liver lesion in a cirrhotic liver) and hemangioma (generally presenting as a mass in a non-cirrhotic liver). Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women. In 70% of cases, MRI with gadolinium differentiates between these lesions. Fine needle core biopsy or aspiration, or both, might be required in doubtful cases. If uncertainty persists as to the nature of the lesion, surgical resection is recommended. If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up, histology is required only when the nature of the liver lesion is doubtful.

Clinical and pathological features of breast cancer in Arab compared to Jewish women in Northern Israel

e22201

Background: Breast cancer (BC) is the most common malignancy in both Jewish and Arab women in Israel. Although the incidence of BC is lower in Arab women it is diagnosed in younger age and seems to have worse prognosis. Recent data have suggested considerable molecular differences in BC from various ethnical groups. Molecular features are increasingly used for predicting cancer prognosis and response to treatment. The purpose of this study to compare clinical, pathological and molecular characteristics of BC in Arab and Jewish women in the Upper Galilee Methods: The files of 481 patients (pts) with breast cancer (BC) treated at the Oncology Institute, Ziv Medical Center between 2001 and 2007 were reviewed retrospectively. Type of breast operation and both clinical and all pathological findings of patients were summarized and correlated to the ethnicity of women. Results: Of the total 481 pts 380 were Jewish and 100 were Arab women. The main age at diagnosis was 49,4 years for Arabs and 59,5 years for Jews (p<0,01). At diagnosis 3% of Arab pts had DCIS compared to 7,4% in Jewish pts, stage I in 19% and 49,9%, stage II in 36% and 31,7%, stage III in 33,3% and 7,6%, stage IV in 9% and 3,7% of Arab and Jewish pts respectively (p<0,05). Well differentiated, moderately and poorly differentiated in 12%, 59% and 29% compared with 43,9%, 41,4% and 12,5% in Arabs versus Jews. Estrogen receptor was 69% in Arabs and 79% in Jews. HER-2 overexpression evaluated by IHC and CISH was diagnosed in 39% of Arab pts and in 24% Jewish pts (p<0,05). Lumpectomy was done in 36% in Arabs versus 64% in Jews (p<0,05). Conclusions: Our data demonstrate younger age and more advanced tumor at diagnosis in Arab compared to Jewish women. All pathological and molecular figures were more aggressive in Arab compared to Jewish women in Israel. Mammography for screening may be started at age 40 years in Arab women and treatment could be more aggressive.

No significant financial relationships to disclose.

Ezetimibe's effect on platelet aggregation and LDL tendency to peroxidation in hypercholesterolaemia as monotherapy or in addition to simvastatin

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Statins demonstrate a pleiotropic effect which contributes beyond the hypocholesterolaemic effect to prevent atherosclerosis.

WHAT THIS STUDY ADDS

Ezetimibe has an antioxidative effect when given as monotherapy or as an add-on to the statin, simvastatin. AIMS To investigate the effect of lowering low-density lipoprotein-cholesterol (LDL-C) on platelet aggregation and LDL tendency to peroxidation by ezetimibe alone or with simvastatin in hypercholesterolaemia.

METHODS

Sixteen patients with LDL-C >3.4 mmol l(-1) received ezetimibe for 3 months (Part I). Twenty-two patients on fixed simvastatin dose with LDL-C >2.6 mmol l(-1) were enrolled (Part II). Part II patients continued simvastatin treatment 20 mg day(-1) for 6 weeks, then received 20 mg day(-1) simvastatin combined with ezetimibe 10 mg day(-1) for another 6 weeks. The tendency of LDL to peroxidation measured by lag time in minutes required for initiation of LDL oxidation and by LDL oxidation at maximal point (plateau) was measured before and after ezetimibe treatment.

RESULTS

Part I: Ezetimibe 10 mg daily for 3 months decreased plasma LDL-C level 16% (P = 0.002), prolonged lag time to LDL oxidation from 144 +/- 18 min to 195 +/- 16 min (P < 0.001), decreasing maximal aggregation from 83 +/- 15% to 60 +/- 36% (P = 0.04). Part II: Serum level LDL-C decreased 23% (P = 0.02) and lag time in minutes to LDL oxidation was prolonged from 55.9 +/- 16.5 to 82.7 +/- 11.6 (P < 0.0001) using combined simvastatin-ezetimibe therapy. There were no differences in platelet aggregation.

CONCLUSIONS

Ezetimibe was associated with decreased platelet aggregation and LDL tendency to peroxidation. Treatment with ezetimibe in addition to simvastatin has an additive antioxidative effect on LDL.

A novel MSH2 germline mutation in a Druze HNPCC family

Germline mutations in DNA mismatch repair (DNA-MMR) genes, mainly MLH1, MSH2, and MSH6, underlie Hereditary non-polyposis colorectal cancer (HNPCC) and are mostly family-specific, with few reported founder mutations in MSH2 (Ashkenazim) MLH1 (Finnish). No mutations in colon cancer susceptibility genes have ever been reported in Druze individuals, a Moslem related faith encompassing approximately 1,000,000 individuals worldwide. A novel MSH2 mutation is described in a Druze HNPCC family: a multigenerational family with 10 members in 4 generations affected with colorectal cancer (mean age of diagnosis 46.5 years), two with gastric cancer and one--endometrial cancer. Mutational analysis of the MSH2 gene using denaturing gradient gel electrophoresis (DGGE) and direct sequencing revealed the c.702delA mutation in codon 234 of exon 4 of the MSH2 gene leading to a premature early stop in codon 245, p.Thr234fsX245. Analysis of mutation-carrying or presumed carriers individuals' offspring, revealed 11/42 asymptomatic mutation carriers, age range 17-50 years. The mutation was not present in two additional Druze HNPCC families and 20 Druze sporadic colon cancer patients. This is the first mutation ever reported in a colon cancer susceptibility gene in a Druze family and it appears not to be a founder mutation in Druze individuals with HNPCC.

Influence of letrozole on plasma estrogen levels in postmenopausal patients with metastatic breast cancer and the effect of estrogen levels on response rates

1078

Background: The aromatase inhibitor (AI) letrozole and other members of this treatment group are very effective in the treatment of postmenopausal women with breast cancer. AIs markedly reduce estrogen levels in postmenopausal women by inhibiting aromatase. At menopause estradiol levels are about 25 pmol/l. Estradiol levels are higher in plasma of women with breast cancer as compared with women with no breast cancer. The purpose of this prospective study is to evaluate estradiol levels before and during letrozole treatment and the effect of primary estradiol levels and their decrease on response rate. Methods: Letrozole 2.5 mg/day orally was given to 50 patients (pts) with metastatic and locally advanced breast cancer (MBC). All pts had measurable disease. Overnight fasting clotted blood samples used for assessment of serum levels of estradiol at baseline and after 3, 6 and 12 months. Estradiol levels were compared to clinical response in this single stage study. Results: Mean age was 56 years (range 46–89 y). Mean years from menopause to starting letrozole was 9 years.12% of pts received previous hormonotherapy and and 30% received chemotherapy for their metastatic disease. Estradiol levels decreased from a mean of 40 pmol/l before letrozole to 40 pmol/l and <40 pmol/l in 19 pts (38%). No difference in estradiol depression rate was found between the 2 groups. In the first group (estradiol >40 pmol/l) objective response rate was 48%: 4 complete responses (CR) and 11 partial responses (PR) out of 31 pts, 12 pts had stabilization of the disease (SD). In the second group 3 pts had CR, 5 had PR: objective response rate of 42% (8/19), and 42% SD. There is a trend (not significant) for higher response rate in pts with higher estradiol levels at the beginning of treatment. Conclusions: Letrozole was found to cause very high estradiol suppression and high response rates in postmenopausal women with advanced breast cancer. A trend was found for higher response rates in pts with higher estradiol levels at baseline although difference was not significant. This is the first study to address this issue.

No significant financial relationships to disclose.

The P1812A and P25TBRCA1and the 5164del4BRCA2Mutations: Occurrence in High-Risk Non-Ashkenazi Jews

Founder mutations in the BRCA1 and BRCA2 genes have been discovered in the Ashkenazic Jewish population, but a founder mutation(s) has not been discovered among non-Ashkenazi Jews (NAJ). Two BRCA1 mutations (P1812A, P25T), and a BRCA2 mutation (5164del4) have been detected in NAJ high-risk families. We studied the prevalence of these three mutations in 270 high-risk NAJ families, including 85 from Iraq/Iran, 67 from North Africa, 27 from Yemen, 50 from the Balkan region, and 41 with mixed ancestry. The three mutations were detected only in individuals related to the original families. We conclude that the P1812A and P25T BRCA1 and 5164del4 BRCA2 mutations are not likely to be founder mutations in NAJ high-risk families. We also assessed the pathogenicity of the BRCA1 P1812A mutation in vitro using reporter gene assays in yeast and mammalian cells. We found that the BRCA1 P1812A variant activity assays yielded a slightly reduced reporter gene activity. Thus, there is some uncertainty as to the pathogenicity of BRCA1 P1812A.

Capecitabine combined with Irinotecan (CapIri) as first line treatment of advanced colorectal carcinoma (ACRC): A phase ll study

13569

Background: The combination of 5-FU + LV with irinotecan as first line treatment of advanced colorectal cancer (ACRC) has shown higher response rate compared with 5-FU +LV with the same progression free survival. Capecitabine is more active than 5-FU.The aim of this study is to determine the side-effect profile, dose limiting toxicity and response rate to CapIri combination as first line treatment in ACRC, on an outpatient basis. Methods: Inclusion criteria: age >18–75 years, ECOG ≤ (0–3), measurable disease, no previous treatment for advanced disease, previous adjuvant chemo-therapy more than 6 months is allowed, signed informed consent and adequate hepatic, renal and hematological function. Exclusion criteria: Serious concurrent medical disorders, prior other malignancy, pregnancy or breast-feeding and patients with poor compliance. Capecitabine 1000mg/m2 twice daily was given for 14 days followed by 7 days rest and Irinotecan (100mg/m2) was given days 1 and 8. Treatment was repeated on day 2. Results: 28 patients (pts) were included. All patients were assessable for response and toxicity. Average age was 64 years, male/female ratio 20/8. Fourteen pts had liver metastases, 5 had lung and 9 had abdominal metastases. Median No of cycles was 4. Grade III and IV diarrhea was observed in 12 (44%) pts, vomiting in 9 (31%) pts, fatigue in 12 (44%) pts, grade IV leucopenia in 5 (17%) pts. Complete response was achieved in 3 (11%) pts, partial response in 15 (53%), stabilization of disease in 5 (18%) and tumor progression in 5 (18%) pts. Progression free survival is 8.4 months. Overall survival is not yet available. Conclusions: This regimen appears feasible with acceptable toxicity except for grade III diarrhea, on an outpatient treatment basis, with significant antitumor activity, without the requirement for indwelling catheters. It is also feasible for older patients.

No significant financial relationships to disclose.

Prevention of Chemotherapy-Induced Neutropenia by Special Honey Intake

Febrile neutropenia is a serious side effect of chemotherapy. Colony-stimulating factors (CSFs) are used for primary and secondary treatment in patients with grade 4 neutropenia. The use of CSFs is expensive and accompanied by side effects. In the current study, Life-Mel Honey (LMH) was administered to prevent neutropenia and to reduce the need for CSFs in patients treated with chemotherapy. Thirty cancer patients receiving chemotherapy for primary or metastatic disease were included. All patients had grade 4 neutropenia and were treated with CSFs. The patients repeated the same chemotherapy schedule, with the addition of LMH for 5 d. Blood count was performed weekly. There was no recurrence of neutropenia after LMH intake and no need for treatment with CSFs in 12 (40%) of patients. Eighteen (60%) patients with LMH developed neutropenia grade 4 and were treated with CSFs (p=0.007). Hemoglobin levels remained >11 g/dL during LMH intake in 19 (64%) patients. Only three (10%) patients had thrombocytopenia. Eight (32%) patients reported improvement in quality of life. The use of LMH in patients who are at high risk of developing neutropenia as a result of chemotherapy decreases the risk of pancytopenia and the need for CSFs. LMH is inexpensive, has no side effects, and is easy to administer.

Mutational analysis of hMsh6 in Israeli HNPCC and HNPCC-like Families

Germline mutations in DNA mismatch repair (DNA-MMR) genes, mainly hMlh1 and hMsh2, underlie Hereditary Non-Polyposis Colorectal Cancer (HNPCC). Germline hMSH6 gene mutations have been reported in a small subset of HNPCC families. In the present study, ethnically diverse individuals with HNPCC and HNPCC-like features were genotyped for hMsh6 germline mutations using exon-specific PCR, DGGE, and DNA sequencing. The study encompassed 92 individuals representing 88 unrelated families who were previously analyzed for Msh2 and Mlh1 mutations: Jewish Ashkenazim (n = 44), non-Ashkenazim (n = 27), Israeli Moslem-Arab (n = 15), Druze (n=3), and Cypriot non-Jews (n = 3). Of the study population, 71 had colon cancer (CRC), mean age at diagnosis was 50.9+/-13.2 years (range 16-73 years), 5 had endometrial cancer (two with concurrent CRC), (mean 43.6+/-3.26 years, range 38-45 years), and unaffected individuals (n = 18) were first degree relatives within HNPCC families and were genotyped at a mean age of 48.3+/-11.7 years (range 30-69 years). Of the 92 individuals analyzed, none showed a truncating hMsh6 mutation, and 6 (6.6%) harbored one of three germline missense mutations: a previously reported one (V878A), and two novel mutations (V509A, S227I). The pathogenic significance of these three missense mutations is yet unclear. In addition, 5 polymorphisms were detected, 2 of which were novel. We conclude that the rate of pathogenic hMsh6 mutations in HNPCC families of Jewish and Mediterranean origin is low, and that mutations in other genes probably account for the phenotype in these families.

Comparison of HER-2 overexpression in primary breast cancer and metastatic sites and its effect on biological targeting therapy of metastatic disease

HER-2 overexpression, a predictive marker of tumour aggressiveness and responsiveness to therapy, occurs in 20-30% of breast cancer. Although breast cancer is a heterogeneous disease, HER-2 measurement is carried out in primary tumour. This study aims to evaluate HER-2 overexpression in primary and metastases and its effect on treatment decisions. Biopsies from primary breast cancer and corresponding metastases from 58 patients were studied. HER-2 overexpression was evaluated immunohistochemically in all primary and metastatic sites. Positive overexpression in primary and/or metastases was confirmed by fluorescence in situ hybridisation (FISH). Discordance in HER-2 overexpression between primary and metastatic sites was 14% (eight of 58 patients). Concordance was found in 50 (86%) of patients (95% CI: 77-95). In one patient (2%), HER-2 was negative in metastasis but positive in primary. In seven (12%) patients, HER-2 was positive in metastases and negative in primary (95% CI: 3.7-20), and three of them responded to trastuzumab. Gene amplification by FISH was found in all cases with HER-2 positive (+2 and +3) by immunohistochemistry. Our data suggest that a possible discordance of HER-2 overexpression between primary and metastases should be considered when making treatment decisions in patients with primary HER-2-negative tumours.