Serum uric acid levels and metabolic syndrome

OBJECTIVE

To investigate the relationship among serum uric acid levels and metabolic syndrome.

MATERIALS AND METHODS

Anthropometric parameters, serum uric acid and metabolic parameters were evaluated in 139 subjects.

RESULTS

Serum uric acid levels were significantly higher in subjects with than without metabolic syndrome (p < 0.0001), and raised gradually with the increasing number of metabolic syndrome components (p for trend < 0.0001). Serum uric acid significantly correlated with various anthropometric and serum metabolic parameters.

DISCUSSION AND CONCLUSIONS

Serum uric acid levels were higher in individuals with rather than without metabolic syndrome and raised gradually as the number of metabolic syndrome components increased. The relationship between serum uric acid levels and various metabolic parameters suggests that uric acid might be considered as a component of metabolic syndrome.

CONTEXT

Hyperuricemia is a common finding in patients with the metabolic syndrome. Recent studies indicated that hyperuricemia may be also a predictor of metabolic syndrome development.

Relationship between mastication and cognitive function in elderly in L'Aquila

Patients with cognitive deficit have poor oral health and fewer teeth than cognitive normal elderly. The aim of the study was to investigate potential differences in masticatory function between elderly with dementia and those with normal cognitive function. Fifty-five patients (age >61; 82.05 ± 3.53) were enrolled in the study. Twenty-five subjects cognitively normal (10 females/15 males; 81.04 ± 4.89 years), were randomly selected and were assigned to Control Group. Thirty subjects (15 females/15 males; 83.16 ± 6.017 with cognitive impairments were randomly selected from hospitalized patients (Medically Assisted Residences RSA) and were assigned to Test Group. MMSE test, B-ADL and number of teeth were evaluated for each subject. The number of teeth in relation to levels of schooling is not resulted significative. In the cognitively impaired group 26 subjects had fewer than 20 teeth (86.6%); in the cognitively normal group 9 subjects had fewer than 20 teeth (36%). The correlation between number of teeth and age in both groups is significative (p<0.05). There is also a significative correlation between subjects with renal diseases and type II diabetes and number of teeth (p<0.05). Finally a significative correlation is present between number of teeth and sex of the patients (p<0.05) (Table 1). The results of the Wilcoxon's test revealed a significative correlation between MMSE in the two groups (p<0.01). There is also a significative correlation between the two groups and the educational background (p<0.01). The results of the study shows a clear correlation between tooth loss and cognitive function in elderly of L'Aquila.

Anthracycline-based induction chemotherapy followed by concurrent cyclophosphamide, methotrexate and 5-fluorouracil and radiation therapy in surgically resected axillary node-positive breast cancer

The present study aimed to determine the toxicity and efficacy of 4 courses of anthracyclines-taxane (AT) chemotherapy followed by radiation therapy (XRT) concurrent with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in surgically resected axillary node-positive (N+) breast cancer. A total of 200 women with N+ breast cancer were treated with adriamycin and docetaxel followed by XRT concurrent with six courses of CMF. Two courses of dose-dense chemotherapy with ifosfamide, carboplatin and etoposide, supported by pegfilgrastim, were administered to patients with >5 histologically confirmed axillary lymph node metastases and patients with triple-negative disease. Additional treatments included 1 year of trastuzumab in human epidermal growth factor receptor 2-positive patients, 5 years of a luteinizing hormone-releasing hormone analogue in premenopausal women and 5 years of an aromatase inhibitor (AI) in estrogen receptor-positive (ER+) patients. The mean number of positive axillary lymph nodes was 4.4 (range, 2-37), 52% of the patients were premenopausal, 74% were ER+ and 26% had triple-negative disease. After a median follow-up of 73 months, grade 2 and 3 hematological toxicity was observed in 20% of the patients. The 10-year disease-free survival (DFS) and overall survival (OS) rates were 73 and 77%, respectively. There was no significant difference in DFS between ER+ and estrogen receptor-negative (ER-) patients (P>0.05), whereas the OS was better in ER+ vs. ER- patients (P<0.05) and in premenopausal vs. postmenopausal patients (P<0.005). In conclusion, induction AT concurrent CMF and XRT and dose-dense chemotherapy followed by AI in N+ high-risk breast cancer was associated with a low level of systemic and late cardiac toxicity and excellent local control, DFS and OS.

The correspondence between abnormal transformation zone grade 1 and grade 2 colposcopic parameters and histology. Clinical implications

OBJECTIVE

To analyse the correlation between the colposcopic parameters of Grade 1 and Grade 2 abnormal transformation zone (ANTZ G1-ANTZ G2) and histological examination of the cone.

MATERIALS AND METHODS

A retrospective analysis of medical records of 600 women who underwent colposcopy and conisation (large loop excision of the transformation zone - LLETZ) between January 1, 2009 and July 31, 2012. The correlation between colposcopic and histological parameters was analysed using the Spearman nonparametric test.

RESULTS

In ANTZG1 there was no correlation (r = - 0.03; p = 0.55); in ANTZG2 however, a low degree of correlation (r = 0.21; p = 0.03) was found. Sensitivity, specificity, and positive and negative predictive values of an ANTZ G2 colposcopic picture were 33.45% (confidence interval [CI] 95% 28.0% to 39.2%), 95.48% (CI 95% 92.5% to 97.5%), 87.4% (CI 95% 79.7% to 92.9%), and 60.5% (CI 95% 56% to 64.9%), respectively.

CONCLUSIONS

The decisive factor in the diagnosis of the cervical oncologic pathologies is the histological examination of the cone, and not the colposcopy which should be seen as a "guiding" investigation in predicting conisation and application of the most appropriate treatment.

Impact of surgery and radiotherapy in women with uterine malignancies

According to the National Health and Social Life Survey, sexual dysfunction affects about 43% of perimenopausal women. A diagnosis of cancer has a profound physical, emotional, and social impact, influencing the relationship with the body, the perception of illness and death, family, social and professional relationships, and the relationship with the partner and, consequently, sexuality. Loss of desire, dyspareunia, orgasmic disorder, difficulties in emotional and physical closeness to the partner, feelings of shame, and inadequacy commonly occur after treatment for uterine cancer; however, if these problems are associated with surgery or with radiotherapy, still remains unclear. According to this study, the authors may conclude that the experience of cancer could lead patients to a rediscovery of. their own sexuality and to an improvement in the relationship with their partner, showing that, sometimes, the relational and psychological factors assume greater importance than physical effects on sexuality, and they can somewhere compensate the morphofunctional failure.

Abstract P6-09-06: Estrogen (E2) suppression following diagnosis of node positive (N+) breast cancer (BC) in premenopause. Long term follow-up of a phase II study

Background: E2 plays a key role in human reproduction and in premenopausal BC growth through the induction of vascular endothelial growth factor (VEGF) and the expansion of T-Regulatory cells (T-Regs). In addition, few clinical data exist on long-term outcome of high-risk N+ premenopausal BC treated with E2 deprivation, by luteinizing hormone releasing hormone (LH-RH). We hypothesized that E2 suppression, following diagnosis of N+ BC in young premenopausal patients, could decrease VEGF and T-Regs and, therefore, could reduce the recurrence rate. Primary endpoint of this study was the evaluation of T-Regs and VEGF of premenopausal patients with high-risk N+, estrogen receptor positive (ER+) and negative (ER-) early BC, treated with an LH-RH analogue. Secondary endpoints were the 10 and 15-year disease-free survival (DFS) and overall survival (OS) rates. Methods: Between 06-1997 and 06-2007, 200 premenopausal high risk early BC patients were entered into the study. Before starting chemotherapy, the LH-RH analogue was administered, 3.75 mg every 28 days for 1 year to the first 64 patients. The same monthly dose was given, for 2 years, to 36 patients. Having observed a decrease of 31% in the recurrence rate for the longer administration of LH-RH analogue, we gave the 11.25 mg dose every 84 days, for 5 years, to the remaining 100 patients. Breast conserving and radical surgery were performed in 74% and 26% of patients, respectively. Systemic therapy was tailored to the biological characteristics of each patient and followed by radiation therapy, and hormonal therapy in ER+ tumors. Results: Median patient's age was 43 years (range 26-45). Mean number of positive axillary nodes was 3.2 (range 1-25). 71% of patients were ER+ and/or progesterone receptor (PGR+), 29% were ER - and PGR-. Median KI-67 was 30% (range 15% -100%). 21% of patients were c-ErbB-2 positive and 11 of them were treated with trastuzumab for 1 year. After a median follow up of 102 months (range 60-180), a statistically significant decrease of VEGF and T-Regs was observed, both in ER+ (P&lt;0.0001) and ER- patients (P&lt;0.0001). Ten-year DFS and OS rate were 86% and 90%, respectively, while the 15-year DFS and OS rate were 62%, and 73%, respectively. Two c-ErbB-2 positive patients (4.7%), had disease recurrence. ER+ patients had a better DFS (P&lt;0.05) and OS (P&lt;0.0001) with respect to ER- patients. The standard pattern of toxicity of chemotherapy was observed, while hot flashes and G1 osteopenia occurred after LH-RH analogue administration. Conclusions: E2 deprivation with an LH-RH analogue is able to decrease plasma VEGF and T-Regs in premenopausal high risk ER+ and ER- BC patients, at the price of a mild toxicity. A favourable impact on DFS and OS was observed. ER- patients had late new primaries, but no recurrence after 5 years, while ER+ patients had disease recurrence even after 15 years. Long term therapy should have further evaluation in premenopausal patients with ER+ tumors.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-09-06.

Health-related quality of life in children and adolescents with celiac disease: survey of a population from central Italy

Background

Celiac Disease (CD) is an increasingly common autoimmune disorder. It requires a strict lifelong adherence to a gluten-free diet (GFD) which can influence health-related quality of life (HRQOL). This study assesses HRQOL in children and adolescents with CD and explores how several demographic and clinical characteristics and GFD adherence affect their perceived health status.

Methods

We recruited 140 consecutive children and adolescents with CD confirmed by small bowel biopsy. HRQOL was assessed using the SF-12 questionnaire plus some CD-specific questions exploring wellbeing and lifestyle. Patients, aged 10 to 18 years, were identified by pediatric gastroenterologists and guided in filling out the questionnaire by trained psychologists. Parametric or non-parametric tests were applied to analyze continuous variables and frequencies as appropriate.

Results

The SF-12 mean mental component summary score (MCS12) was lower than in the general Italian population (p < 0.001), whereas differences in terms of physical health were not significant (p = 0.220). More than one third of those interviewed reported feeling angry “always” or “most of the time” about having to follow the GFD, and nearly 20% reported feeling different from others and misunderstood because of CD “always” or “most of the time”.

Conclusions

Our findings highlight the need for health professionals to identify adolescents with major disease-related problems. The food industry should improve its range of gluten-free food products and public bodies and institutions should promote informative campaigns and help promote the overall quality of life of children and adolescents with CD.

Cognitive behavioral therapy for young people after l'aquila earthquake

Objective:

Cognitive behavior therapy (CBT) emerges as the best validated therapeutic approach for children and adolescents who experienced trauma-related symptoms, particularly associated with anxiety or mood disorders. The aim of this study was to evaluate the CBT efficacy among young people exposed to L’Aquila earthquake, in 2009.

Methods:

one year after the disaster, 39 young subjects as a case group (CBT treated) and 24 as a comparison group (no CBT treated) were evaluated with the Impact of Event Scale Revised (IES-R), the General Health Questionnaire-12 items (GHQ-12) and the Brief Cope. CBT was conducted in 12 sessions (once per week for 3 months). After CBT intervention, both groups were evaluated again with the same psychometric instruments.

Results:

our results show a significantly decrease in post traumatic symptoms and psychological distress severity in CBT group. It was attributable to an improvement in each of three PTSD dimensions (intrusion, avoidance, and arousal) and in the total score of IES-R (p< 0.04). Among CBT treated group, subjects that adopted “planning/problem solving” coping strategies (p < .02) and “religiosity” (p < .045) show higher improvement in psychological distress.

Conclusions:

our findings show the efficacy of CBT and the influence of individual coping strategies in the improvement of posttraumatic stress symptoms and psychological distress among young people seeking help from an outpatients service for young people with psychiatric problems (the SMILE) after the catastrophic disaster in L’Aquila.

Alcohol consumption and awareness of the risks related in alcohol-abuse in high school students: evidence from a Health Education program

BACKGROUND

The unceasing and widespread increase of alcohol consumption represents an important problem for the European Union. For this reason, we wanted to investigate the patterns of alcohol consumption among high-school students of Rieti, a city in central Italy, and of surrounding rural areas. Furthermore, the study intends to investigate students' awareness on alcohol-related health risks and on the consequences of driving in a state of intoxication.

METHODS

In the investigation 7 schools including senior high schools and technical schools were involved, for a total of 669 students aged between 15 and 19 years. As part of a program of health education, a self-administered anonymous questionnaire was proposed to each student. A descriptive and multivariate analysis was carried out.

RESULTS

The prevalence of usual drinkers was equal to 12.7 per cent. The logistic regression analysis showed a statistically significant association between usual consumption of alcohol and the attendance of Technical Institutes (OR=3.43; 95% IC: 2.07 - 5.69), and the residence in rural areas (OR=2.19; 95% IC: 1.38 - 3.47). The area of residence in the multivariate analysis loses significance. Only 54.6 % of the students answered the questions regarding the state of driving under the effect of alcohol; of these, 11.0 % declared of having driven at least once under the effect of alcohol, whereas 18.0 % declared that they had been passengers of a driver who was drunk. The answer to the question whether the consumption of alcohol is harmful to health was "no" for 15.7 % of usual drinkers against 2.2 % of the non drinkers or occasional (episodic) drinkers.

CONCLUSIONS

Our study shows that the drinking habits of high school students of Rieti are worse for those attending technical schools. Usual drinkers show lower consciousness of alcohol-related harm. Our study may provide clues useful for the identification of the target population at high risk for alcohol abuse in order to create targeted prevention programs.

Does orthodontic treatment provide a real functional improvement? a case control study

Background

Electromyographic analysis of the masticatory muscles provides useful data on the behavior of these muscles during stomatognathic system functioning and allows a functional assessment of orthodontic treatments. This study was undertaken to verify if achieving an Angle Class I bite through orthodontic treatment can lead to neuromuscular balance.

Methods

This study enrolled 30 patients (20 females, 10 males, mean age: 15.78 years) with an Angle Class II, division 1 malocclusion that was orthodontically treated. A group of 30 subjects (19 females, 11 males; mean age: 16.15 years), randomly selected among subjects with an Angle Class II, division 1 malocclusion that had not been orthodontically treated served as the Control group. Both groups were subjected to electromyography to study their neuromuscular characteristics. The Shapiro-Wilk's test revealed a non normal distribution, therefore we used a Friedman two way ANOVA by ranks test to compare differences of surface electromyography values between treated and untreated subjects at closed and open eyes condition.

Results

A statistically significant interaction between orthodontic treatment and open eyes conditions was detected for anterior temporal muscles. A significant imbalance of the anterior temporal muscles, which is indicative of an asymmetric electromyographic pattern, was also found.

Conclusions

The present data indicate that achieving a correct occlusal target does not necessarily correspond to a neuromuscular balance.

Effects of correction of Class II malocclusion on the kinesiographic pattern of young adolescents: a case- control study

AIM

The aim of this study was to assess the dynamic activity of the mandible by means of a computerised kinesiograph in Class II patients treated with orthodontic therapy and to compare the results of this group with those of a sample of untreated Class II patients.

METHODS

Twenty young adolescents who had undergone orthodontic treatment for correction of Class II malocclusion and twenty age and sex-matched adolescents exhibiting Class II malocclusion, whose parents refused the orthodontic treatment, were enrolled. Maximum vertical opening (MVO), maximum anterior-posterior movement (MAPM), maximum right deviation (MRD), maximum left deviation (MLD), MVO/ MAPM ratio, maximum velocity in opening (MVIO), maximum velocity in closure (MVIC), verticality (ID-V), anterior-posteriority (ID-AP) and laterality (ID-L) were recorded during the kinesiographic evaluations. Differences in the kinesiographic data were analysed using the Wilcoxon sum rank test; data are expressed as means and standard deviations (SD). Differences between groups in age were analysed using unpaired t-test, while differences in gender distribution were assessed using the Fisher's exact test. The level of significance was set at p < 0.05.

RESULTS

No differences were detected in the distribution of sex and age between the two groups. Significant differences between the two groups were observed for MVO, MAPM, that were higher in the control group, and MLD, which was higher in the case group; no other significant differences were detected for MRD, MVO/ MAPM, MVIO, MVIC, ID-V, ID-AP, ID-L.

CONCLUSION

Orthodontic treatment of young patients with Class II malocclusion may reduce the maximum vertical opening as well as the maximum anterior-posterior movement and enhance the lateral displacement; however, further studies are needed to assess the relationship between impaired mandible kinetics of orthodontic treatment in patients with Class II malocclusion and craniomandibular disorders.

Prevalence of vision problems in a hospital-based pediatric population with malocclusion

PURPOSE

The purpose of this study was to evaluate the prevalence of vision defects (myopia, astigmatism, strabismus, and hyperopia) in Class I, Class II, and Class III malocclusions.

METHODS

A total of 1,326 patients were screened to assess the prevalence of vision defects and malocclusion. All the patients classified as Class I, Class II, and Class III malocclusions were submitted to an ophthalmologic visit for the evaluation of vision problems. The occurrence rates of vision defects were calculated as percentages of the total sample. Differences in incidence rates of each vision defect by sex were analyzed by chi-square test.

RESULTS

Myopia was the most common (22 percent), followed by astigmatism (∼20 percent), hyperopia (∼12 percent), and strabismus (∼4 percent). The prevalence of myopia was higher in Class II malocclusions, while the prevalence of astigmatism and hyperopia was higher in Class I malocclusion. No significant difference in vision defects by sex was found.

CONCLUSIONS

No significant difference in vision defects by sex was found. The prevalence of astigmatism and hyperopia was higher in patients with Class I malocclusion. The prevalence of myopia was higher in patients with Class II malocclusion.

Abstract 480: Maintenance immunotherapy following carboplatin (CBDCA) - pemetrexed (PEM) chemotherapy in advanced adenocarcinoma (ADK) of the lung: A phase II study

Background: Continuation maintenance therapy with PEM vs. placebo has been shown to improve progression-free survival (PFS) and overall survival (OS), in patients with advanced non squamous non small cell lung cancer, at the price of a substantial toxicity. Nevertheless, in these patients the observed lymphocytopenia induced by chemotherapy, is a negative independent prognostic factor. Bacterial extracts (OM-85) have been shown to enhance the activation of both IgM memory B lymphocytes (CD24+/CD27+ cells) and inteleukin-2 receptor-expressing lymphocytes (CD25+ cells) (Int J Immunopathol Pharmacol. 2006;19:551). In addition, we have demonstrated that 13-cis retinoic acid (RA) restored the chemotherapy-depressed immune function (Clin Cancer Res 2001;7:1251). With this rationale, we designed a phase II study of maintenance immunotherapy after first line CBDCA-PEM chemotherapy in order to maintain an achieved response, or at least stable disease, for as long as possible, with acceptable side effects.

Methods: Histologically/cytologically confirmed patients with stage IIIB or IV non operable ADK of the lung with measurable disease, ECOG PS 0-2, age 18-75 years and adequate bone marrow, renal and liver function were eligible for the study. Treatment consisted of 6 courses of PEM 500 mg/m2 and CBDCA, AUC=5, on day 1 every 3 weeks. Patients with a clinical benefit were treated with OM-85, 7 mg/day, 10 days/month and RA 0.5 mg/kg, 5 days/week, 3 weeks/month, both given until progression.

Results: From September 2007 to March 2012, 54 patients, with a median age of 65 years (range 33-75), 50% stage IIIB and 50% stage IV, were entered into the study. At a median follow up of 22 months, clinical benefit was observed in 41 patients (75%); Complete response 8 (14%), partial response 21 (39%), stable disease 12 (22%), progressive disease 13 (25%). One-year OS rate was 69%. After immunotherapy, a statistically significant (P&lt;0.001) increase in lymphocyte number was observed in responders. Median PFS was 10.2 months, while median OS was 27.6 months. Four patients, rendered operable with treatment, underwent a radical surgical procedure. Grade 4 renal toxicity was observed in 1 patient, while grade 3-4 hematologic toxicity occurred in 9 patients (17%).

Conclusion: This study shows that maintenance immunotherapy with the combination of OM-85 and RA, administered after chemotherapy in advanced ADK of the lung, is feasible and induces a statistically significant raise in lymphocyte number. In addition a favorable impact on PFS and OS was observed. Future randomized studies to investigate the role of maintenance immunotherapy strategies, are in program

Citation Format: Francesco Recchia, Giampiero Candeloro, Alisia Cesta, Anna Di Blasio, Cornelia O.C. Recchia, Stefano Necozione, Giovambattista Desideri, Silvio Rea. Maintenance immunotherapy following carboplatin (CBDCA) - pemetrexed (PEM) chemotherapy in advanced adenocarcinoma (ADK) of the lung: A phase II study. [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 480. doi:10.1158/1538-7445.AM2013-480

Vascular endothelial growth factor expression and T-regulatory cells in premenopausal breast cancer

Estradiol (E2) plays a key role in human reproduction through the induction of vascular endothelial growth factor (VEGF) and T-regulatory cells (T-Regs), which are also important in breast cancer (BC) growth. The primary endpoint of the present study was the investigation of whether E2 suppression, chemotherapy and radiation therapy decreased the levels of VEGF and T-Regs of premenopausal patients with high-risk early BC. The secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS). Between April 2003 and July 2008, 100 premenopausal women with early, high-risk BC were entered into the study. The characteristics of the patients were as follows: median age, 43 years (range, 26–45); median number of positive axillary nodes, 3.3; median Ki-67, 33%. Plasma E2, VEGF and T-Reg were measured at baseline and every year. Treatment comprised luteneizing hormone-releasing hormone (LH-RH) analogue, tailored chemotherapy, radiation therapy and hormonal therapy in oestrogen receptor-positive (ER⁺) tumours. At 4 years, a statistically significant decrease in E2, VEGF and T-Reg levels was observed; the PFS and OS rates were 94 and 98%, respectively. Hot flushes and G1 osteopenia occurred following LH-RH analogue administration, while no unexpected toxicity was observed following chemotherapy. E2 deprivation with an LH-RH analogue, tailored chemotherapy, radiation therapy and hormonal therapy in ER⁺ tumours decreased plasma VEGF levels and T-Regs numbers in premenopausal high-risk ER⁺ and ER- BC patients. In addition, a favorable impact on PFS and OS was observed.

Benefits in cognitive function, blood pressure, and insulin resistance through cocoa flavanol consumption in elderly subjects with mild cognitive impairment: the Cocoa, Cognition, and Aging (CoCoA) study

Flavanol consumption is favorably associated with cognitive function. We tested the hypothesis that dietary flavanols might improve cognitive function in subjects with mild cognitive impairment. We conducted a double-blind, parallel arm study in 90 elderly individuals with mild cognitive impairment randomized to consume once daily for 8 weeks a drink containing ≈990 mg (high flavanols), ≈520 mg (intermediate flavanols), or ≈45 mg (low flavanols) of cocoa flavanols per day. Cognitive function was assessed by Mini Mental State Examination, Trail Making Test A and B, and verbal fluency test. At the end of the follow-up period, Mini Mental State Examination was similar in the 3 treatment groups (P=0.13). The time required to complete Trail Making Test A and Trail Making Test B was significantly (P<0.05) lower in subjects assigned to high flavanols (38.10±10.94 and 104.10±28.73 seconds, respectively) and intermediate flavanols (40.20±11.35 and 115.97±28.35 seconds, respectively) in comparison with those assigned to low flavanols (52.60±17.97 and 139.23±43.02 seconds, respectively). Similarly, verbal fluency test score was significantly (P<0.05) better in subjects assigned to high flavanols in comparison with those assigned to low flavanols (27.50±6.75 versus 22.30±8.09 words per 60 seconds). Insulin resistance, blood pressure, and lipid peroxidation also decreased among subjects in the high-flavanol and intermediate-flavanol groups. Changes of insulin resistance explained ≈40% of composite z score variability through the study period (partial r(2)=0.4013; P<0.0001). To the best of our knowledge, this is the first dietary intervention study demonstrating that the regular consumption of cocoa flavanols might be effective in improving cognitive function in elderly subjects with mild cognitive impairment. This effect appears mediated in part by an improvement in insulin sensitivity.

Triple-negative breast cancer: multipronged approach, single-arm pilot phase II study

Anthracyclines (A) and taxanes (T) are standard first-line chemotherapy agents for patients with advanced breast cancer. Platinum analogues have also shown activity in the triple-negative breast cancer (TNBC) histology, but clinical data are limited. Here we report the long-term follow-up of a phase II study on TNBC treated with a combined modality therapy, including induction with AT, cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) with concurrent radiation therapy, and a dose-dense consolidation chemotherapy (HDCT) with carboplatin (CBDCA), ifosfamide (IFX), etoposide (VP-16). Patients' median age was 44 years, with 73% premenopausal. Epirubicin 75 mg/m(2) and docetaxel 75 mg/m(2) were administered to 70 patients with TNBC: as neoadjuvant and adjuvant therapy to 12 and 58 patients, respectively. Postoperative radiation therapy, 5000 cGy, was delivered, synchronous with triweekly CMF. After radiation therapy, two courses of HDCT with CBDCA, IFX, VP-16, were given, with hematological growth factors. After a median follow-up of 81 months, all patients were evaluable for toxicity and response. Most important toxicity were grade 3 skin reaction and grade 4 hematological in 3% and 31% of patients, respectively. Pathological complete response was observed in 25% of patients receiving preoperative chemotherapy. Treatment failures were as follows: eight visceral, four contralateral breast cancer, four locoregional, and one leukemia. Five-year progression-free survival and overall survival rate were 78% and 91%, respectively. Induction chemotherapy, followed by chemoradiation therapy and HDCT, provides a prolonged disease-free period and a significant increase in overall survival in TNBC, with an acceptable toxicity profile.

A multicenter, open-label phase II trial of liposomal doxorubicin (LD) and docetaxel (DX), followed by concurrent chemotherapy and radiation therapy in locally advanced high-risk, early breast cancer (HRBC)

e11041

Background: Taxanes and anthracyclines (ANs) are among the most active agents in the treatment of breast cancer. However, ANs are associated with dose-related cardiac toxicity, which can lead to progressive myocardial damage. Non-pegylated liposome-encapsulated doxorubicin (Myocet®), has been shown to significantly reduce cardiac toxicity even though providing comparable antitumor efficacy. Primary endpoint of this phase II study was the assessment of early and late cardiac toxicity of young patients with HRBC treated with LD and DX. Secondary end-points were the incidence of hematological toxicity, time to progression and overall survival in this cohort of patients. Methods: From 05-2006 to 10-2009, 60 HRBC patients were entered into the study. They were treated with LD 60 mg/m2 and DX 75 mg/m2 every three weeks for six courses. Hematological growth factors were given when indicated. Cyclophosphamide 600 mg/m2, methotrexate 60 mg/m2 and 5-fluorouracil 600 mg/m2 were given for six courses concomitantly with radiation therapy to the breast, axilla and supraclavicular nodes. After chemo-radiation therapy, a hormonal therapy was given to estrogen receptors positive (ER+) patients and trastuzumab to Herb-2 positive patients. LVEF was evaluated at baseline and after 6 months, thereafter, up to 5 years. Results: Median age was 49 years. Mean number of positive axillary nodes was 4.9 (range 0-20). 70% were ER+, 30% were ER - and progesterone receptor (PGR) negative. Median Ki-67 was 30% (range 20%-100%), 18% of patients were Herb-2 positive and 18% of patients had pre-existing hypertension. Delivered dose was 95.7% of the planned dose. No patient showed neither a decrease of EF > 10%, nor congestive heart failure. Febrile neutropenia was observed in 12% of patients. At 44 months of median follow-up, 86% of patients were disease-free and 94% were alive. Conclusions: Chemotherapy with LD and DX has shown low cardiac toxicity and high activity in this group of HRBC patients.

Abstract 5366: Extended phase II study of maintenance immunotherapy in advanced cancer

Purpose: Chemotherapy can induce prolonged remissions in patients with stage IV cancer (AC), yet nearly the majority of them, will ultimately relapse. In vitro studies suggest that natural killer cells (NK) mediate lytic activity against cancer cell lines and that high expression of vascular endothelial growth factor (VEGF) promotes tumor progression through neoangiogenesis. We have shown that a combination of low-dose interleukin-2 (IL-2) and 13-cis retinoic acid (RA) increased NK cells and decreased VEGF, in patients with AC with a clinical benefit from chemotherapy (Clin Cancer Res 7: 1251, 2001). Therefore, IL-2 and RA may improve long-term disease-free survival (DFS) and overall survival (OS) when administered in a post-chemotherapy minimal residual disease setting. Primary endpoint of the study was to evaluate if IL-2 and RA increased NK cells and decreased VEGF of patients with AC that had a clinical benefit from chemotherapy. Secondary endpoint was the evaluation of DFS, OS and toxicity of this regimen in various tumor types. Patients and methods: 500 patients with a wide range of AC that had a clinical benefit from chemotherapy were treated with self-administered subcutaneous IL-2, 1.8 X 106 IU and oral RA, 0.5 mg/Kg for 5 days/week for 2 consecutive cycles of 3 weeks, with a 1-week rest, for 1 year. Therapy was continued, with intermittent schedules for five years or until progression. NK cells, serum VEGF, tumor response and toxicity were assessed every 4 months. Results: Median age was 61 years (range 21-80), all patients had a good performance status and there were 248 females. After a median follow-up of 60 months (range 24-180), 4400 courses of chemotherapy and 2634 courses of immunotherapy were administered. A statistically significant improvement of NK cells [from a mean of 309 ± 76/mm3 to a mean of 579 ± 74 (p&lt;0.001)] and a decrease of VEGF [from a mean of 520 ± 75 pg/mm3 to a mean of 150 ± 12 pg/mm3, (p&lt;0.001)], with respect to baseline, post-chemotherapy values, were observed. 15 years DFS and OS were 32.6 and 36.8, respectively. Even with all the limitations of different patient populations, a significant improvement, with respect to NCI SEER data (*), could be observed in the 5-year OS rate for the most common treated metastatic cancers: Breast cancer 42.7% vs. 23.3% *, lung cancer 26.4% vs. 3.6% *, colorectal cancer 43.6% vs. 11.7%*, renal cancer 23% vs. 11% *. No WHO grade 3 or 4 toxicity was observed, while grade 2 cutaneous toxicity and fever occurred in 20% and 13% of patients, respectively. Mild hypothyroidism and grade 2 triglyceride elevation was observed in 5% and 15% of patients, respectively. 1 patient had to stop treatment for grade 2 urticaria. Conclusions: These data show that the administration of IL-2/RA, determines, with a modest toxicity profile, a sustained improvement of NK cells, a decrease of VEGF, and unexpected 5-year survival rates. Phase III randomized studies have been started, in Europe, for several tumor types.

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 5366. doi:1538-7445.AM2012-5366

Chemoembolization of unresectable hepatocellular carcinoma: Decreased toxicity with slow-release doxorubicin‑eluting beads compared with lipiodol

Chemoembolization with lipiodol (TACE) improves survival of selected patients with unresectable hepatocellular carcinoma (HCC), but results in substantial toxicity. To improve treatment tolerance, we conducted this phase II study using doxorubicin-loaded beads (DC Beads®) delivered by selective transcatheter arterial chemoembolization (DEB-TACE). We compared the results with those obtained with TACE in our historical controls. Thirty-five patients were recruited with diagnoses of HCC. Patients received DEB-TACE with doxorubicin loaded on DC Beads. Computed tomography of the upper abdomen was performed one month after DEB-TACE. Historical controls were a group of 70 patients with matched characteristics treated with TACE. After a median follow-up of 14.1 months (range, 6-36 months), 22 patients (63%) had an objective response. There was a statistically significant decrease in liver enzymes (p<0.001), lactate dehydrogenase, (p<0.001) in DEB-TACE-treated patients compared to TACE-treated patients. DEB-TACE with doxorubicin-loaded DC Beads, a safe and reliable treatment for HCC, leads to decreased toxicity compared to TACE.

Integrated staging systems for conventional renal cell carcinoma: a comparison of two prognostic models

OBJECTIVE

The objective of the current study was to compare, in a single center experience, the discriminating accuracy of two prognostic models to predict the outcome of patients surgically treated for conventional renal cell carcinoma (RCC).

PATIENTS AND METHODS

We retrospectively evaluated the clinical and pathological data of 100 patients surgically treated for RCC between 1998-2008 at our institution. For each patient, prognostic scores were calculated according to two models: the University of California Los Angeles integrated staging system (UISS) and the Stage, Size, Grade, and Necrosis (SSIGN) developed at the Mayo Clinic. The prognostic predictive ability of models was evaluated using receiver operating characteristic (ROC) curves.

RESULTS

The median follow-up was 62 months (range 12-120). All clinical and pathological features that compound the algorithms were significantly associated with death from RCC in univariate and multivariate setting. The 5-year cancer-specific survival (CSS) according to the SSIGN score were 95% in the '0-2' category, 88% in '3-4', 60% in '5-6', 37% in '7-9' and 0% in the '> or = 10' group (long-rank p value < 0.001); according to the UISS the 5 yr CSS probabilities in non-metastatic patients were 100% in low, 80% in intermediate and 54% in high-risk groups; in metastatic patients, the respectively CSS were 40% in low and 25% in high-risk groups (long-rank p value < 0.001). The area under the ROC curve was 0.815 for the SSIGN score and 0.843 for the UISS (p = 0.632).

CONCLUSION

In our series the SSIGN and UISS discriminated well, without relevant differences. Currently both algorithms represent usefuls clinical tools that allow risk assessment after surgical treatment of RCC. We encourage the uro-oncologist to begin to routinely rely on them in real-life practice.

Abstract 5055: The role of estrogens and vascular endothelial growth factor (VEGF) in premenopausal breast cancer carginogenesis and disease progression

Background. Estrogen is important in breast cancer development and there is evidence in vitro, that it modulates VEGF expression in breast cancer cells through transcriptional activation. However few clinical studies have investigated the association between VEGF and estrogens in humans. Objective of this study was to evaluate weather estrogen suppression with an LH-RH analogue was able to downregulate VEGF expression, and thus decrease its plasma concentration, in premenopausal patients with high-risk early breast cancer.

Patients and methods: From April 2003 to October 2008 we conducted this study on 100 premenopausal early breast cancer patients. At baseline, after surgery, before any type of therapy, plasma VEGF and sex hormones (estradiol, progesterone, FSH, LH) were evaluated. Evaluation was repeated each year. Patients received an LH-RH analogue for 5 years, a chemotherapy that was tailored to the biological characteristics of each patient, radiation therapy, and hormonal therapy in estrogen receptor positive (ER+) tumors. Primary end point was the evaluation of VEGF. Secondary end points were progression-free survival (PFS) and overall survival (OS).

Results: Median age was 43 years (range 26-45); mean number of positive axillary nodes was 3.3. (Range 0-25). Fifty-three patients were ER+ and progesterone receptor positive (PGR+), 17 were ER negative (−) and PGR-, 30 were ER+ and PGR-, Median KI-67 was 33% (range 15%-100%). Twenty patients were Herb-2 positive by FISH. A statistically significant decrease of VEGF was observed after 1 year. At 5 years and during the study period, plasma VEGF continued to decrease (p&lt;0.001) in 94% of patients that were disease-free, while in 6% of patients with disease relapse, VEGF increased with respect to baseline values. No unexpected toxicity of chemotherapy was observed, while hot flashes and G1 osteopenia occurred after LH-RH analogues administration. After a median follow-up of 50 months (range 24-90), 8-year disease free survival and overall survival rated were 94% and 100%, respectively.

Conclusion: Estrogen deprivation with an LH-RH analogue is able to decrease plasma VEGF levels in premenopausal high risk breast cancer patients. These data show how estrogens, through VEGF modulation, may be responsible for the worst prognosis that is observed in premenopausal breast cancer patients.

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 5055. doi:10.1158/1538-7445.AM2011-5055

Premenopausal hormone-responsive breast cancer with extensive axillary nodes involvement: total estrogen blockade and chemotherapy

BACKGROUND

Poor prognosis is associated with estrogen- and/or progesterone receptor-positive (ER(+), PGR(+)) premenopausal breast cancer (PM-BC) with high Ki-67 labeling index and extensive axillary lymph node involvement. The role of adjuvant chemotherapy (CT) and hormonal therapy have not yet been established in these patients.

PATIENTS AND METHODS

Twenty-five PM-BC patients received, in sequence, leuprorelin, taxane-anthracycline induction chemotherapy, radiation therapy, a platinum-based intensification high-dose CT, followed by leuprorelin and anastrazole for five years. Vascular endothelial growth factor (VEGF) levels were measured as the primary end-point; secondary end-points were 10-year relapse-free survival (RFS) and overall survival (OS) rates.

RESULTS

The median patient age was 44 years, and the mean number of positive axillary nodes was 14. All patients were ER(+) and/or PGR(+), with a median Ki-67 index of 33%. Five patients were Cerb-B2 positive. Grade 4 hematologic toxicity was observed in all patients, no patient showed a decrease of cardiac ejection fraction and hot flashes and arthralgias were of moderate intensity. After a median follow-up of 70 months, VEGF levels significantly decreased (p<0.001); 10-year RFS and OS were 76% and 78%, respectively.

CONCLUSION

Total estrogen blockade and high-dose CT in PM-BC patients is feasible, has moderate toxicity, significantly reduces VEGF levels, and seems to improve the expected RFS and OS.

Long-term follow-up of a multicenter phase II study of chemo-immunotherapy in the treatment of metastatic colorectal cancer (MCC)

536

Background: The combination of low-dose interleukin-2 (IL-2) and 13-cis retinoic acid (RA) has been shown to decrease vascular endothelial growth factor (VEGF) of patients with MCC (Anticancer Res, 2005). Moreover, results of various studies have shown that the addition of IL-2 and RA to chemotherapy (CT) increased treatment efficacy, inducing a statistically significant decrease of VEGF, with a low cost.

Methods: Patients with MCC, deemed unresectable, were given the following treatment for two consecutive days (D1-D2): Oxaliplatin 50 mg/m2, Leucovorin (LV), 200 mg/m2, 5-fluorouracil (5-FU) 400 mg/m2, Capecitabine (C) 2,000 mg/m2 (FOCFOX). After 2 weeks Camptothecin, 90 mg/m2 (D1-D2), was administered with the same doses of LV, 5-FU and C (FOCFIRI) as first-line treatment of MCC. Subcutaneous IL-2 1.8 x 106 I.U. and oral RA, 0.5 mg/kg were given 5 days/week. Induction CT was administered for 12 courses, alternating FOCFOX and FOCFIRI, followed by maintenance treatment with the same schedule of IL-2 + RA, for 3 weeks/month. The primary endpoint was the decrease ≥ 30% of VEGF of patients with MCC. Secondary endpoints were the cost of IL-2 and RA with respect to bevacizumab, toxicity, progression- free survival (PFS), and overall survival (OS).

Results: From 08/2000 to 08/2006, fifty-four patients with MCC were entered into the trial. After a median follow up of 64 months (95% CI 62-85%), a statistically significant > 30% (p<0.001) decrease of VEGF was observed. Costs of therapy were $ 304.00/month for IL-2/RA and $ 1,700.00/month for bevacizumab (82% cost reduction). The most common adverse events of CT were grade 3/4 neutropenia, leukopenia, thrombocythopenia, and anemia in 33%, 9%, 2%, and 2% of patients, respectively, peripheral neuropathy in 10% of patients. Mild cutaneous skin rash, fever and autoimmune reactions were observed in the patients who received the maintenance immunotherapy. PFS at 10 months was 76% (95% CI 62-86). Median PFS was 27.8 months, while median OS was 48.8 months.

Conclusions: These data show that maintenance immunotherapy with low-dose IL-2 and oral RA in patients with MCC has a low toxicity profile, is cost effective, decrease VEGF and seems to improve expected PFS and OS.

No significant financial relationships to disclose.

High-risk early breast cancer in patients under 40 years of age: Improved clinical outcome with total estrogen blockade and tailored chemotherapy

This multicenter prospective trial assessed the outcome in 63 patients, 40 years of age or younger, with high-risk early breast cancer (HREBC), included in an ovarian protection study. The patients were treated with a luteinizing hormone-releasing hormone (LH-RH) analogue administered for 5 years, tailored chemotherapy and an aromatase inhibitor, in estrogen receptor-positive (ER(+)) patients. T-regulatory cells (T-regs) and vascular endothelial growth factor (VEGF) were measured at baseline and yearly. The mean age of the patients was 36 years (range 26-40). Sixty-five percent had ER(+) tumors, 24% had negative axillary nodes with tumors >1 cm and high histological grade with lymphovascular invasion, while 76% had a mean of 3.6 positive axillary nodes (range 1-21). Serum estradiol was maintained at values <40 pg/ml in all of the patients. A statistically significant decrease in VEGF (P<0.0001) and T-regs (P<0.0001), with respect to baseline values, was observed after LH-RH administration. After a median follow-up of 110 months, the 10-year progression-free and overall survival rates were 86.1 and 89.7%, respectively. These data revealed that the administration of an LH-RH analogue to HREBC patients, followed by chemotherapy and hormonal therapy, decreased VEGF and T-regs and improved the expected clinical outcome.

Smell and preclinical Alzheimer disease: study of 29 patients with amnesic mild cognitive impairment

OBJECTIVES

To evaluate the olfactory function in patients with amnesic mild cognitive impairment (aMCI) and the relationship to the progression from aMCI to Alzheimer disease (AD).

DESIGN

Cohort prospective study on aMCI patients at the first evaluation (T0) and at the 18-month follow-up (T1).

SETTING

Alzheimer Unit of the University of L'Aquila, Italy.

METHODS

Twenty-nine aMCI patients were enrolled in this study.

MAIN OUTCOME MEASURES

Olfactory function was studied with the Sniffin' Sticks Screening Test (SSST) and the Sniffin' Sticks Extended Test (SSET). Olfactory functions were related to neurocognitive functions assessed by the Mini-Mental State Examination (MMSE) and the Mental Deterioration Battery (MDB).

RESULTS

At T0, aMCI patients showed an olfactory impairment and all of the aMCI patients had lower olfaction scores at T1. At T1, 9 of the 29 aMCI patients (31%) developed AD and had lower mean SSST and SSET scores than 20 aMCI patients who did not develop AD. The most significant relationship was found between olfactory discrimination and visuospatial ability, language skill, and the Rey Immediate test of the MDB and between olfactory identification and the Rey Delayed test.

CONCLUSION

Odour discrimination and identification performance correlated more prominently than detection thresholds with performance on neuropsychological tests. We concluded that the olfactory deficit occurs early in aMCI, so we suggest introducing the clinical routine use of the olfactory test for early identification of the progression of the decline from aMCI to AD.

Prolonged disease control after myeloablative chemotherapy, autologous transplantation and immunotherapy in high-risk early breast cancer

BACKGROUND

Failure to eradicate all cancer stem cells, lymphocytopenia, and high levels of vascular endothelial growth factor (VEGF) may explain the limited efficacy of high dose-chemotherapy (HDCT) with peripheral progenitor cell transplantation (PBPCT) in high-risk early breast cancer with more than 10 axillary nodes (HRBC).

PATIENTS AND METHODS

With the aim of increasing patient's lymphocyte count and reducing VEGF, wich could translate into an improved immune function and a better clinical outcome, patients with HRBC, received HDCT, PBPCT and immunotherapy with interleukin-2 (IL-2) and 13-cis retinoic acid (RA).

RESULTS

A total of 30 HRBC patients were entered into the study. Grade 4 hematological toxicity was universal, while major adverse effects of IL-2 were fever, rash and autoimmune reactions. After a median follow-up of 61 months, immune function improved with a statistically significant increase of lymphocyte count and a decrease in VEGF levels. This translated into an unexpected 5-year relapse-free and overall survival rates of 76% and 85%, respectively.

CONCLUSION

These data show that IL-2 and RA administration after HDCT and PBPCT is feasible and, as well as giving a statistically significant improvement in lymphocyte count and a decrease of VEGF, also seems to improve the expected clinical outcome.

Immunologic Mechanisms Mediate Benefits of Lutenizing Hormone-Releasing Hormone (LH-RH) in High Risk Premenopausal Breast Cancer Patients (HR-Pre-BC)

Background: Systematic reviews have found that LH-RH agonists are effective in the treatment of premenopausal women with early breast cancer. In an extended phase II study, 180 premenopausal women with HR-Pre-BC were treated with an LH-RH analogue in order to protect ovaries from the damage of chemotherapy. We hypothesized that the benefits of LH-RH administration could extend, far beyond ovarian protection, to the improvement of immune function and to the decrease of vascular endothelial growth factor (VEGF). In fact estradiol (E2) at physiological doses not only expands T regulatory cells (T-regs) in different tissues but also increases expression of the Foxp3 gene, a hallmark for CD4+CD25+ T-reg cell function, and the interleukin-10 gene as well. In addition, recent studies indicate that E2 modulates VEGF expression in breast cancer cells through transcriptional activation.Methods: From 05-1997 to 05-2007 180 patients with HR-Pre-BC were entered into the study. At baseline, one week before chemotherapy, patients received an LH-RH analogue which was continued for five years. Adjuvant chemotherapy was tailored to the peculiar biologic features of each patient, including cyclophosphamide, methotrexate, and 5-fluorouracil in 24 patients, an anthracycline and taxane based regimens in 156 patients (40 with positive c-erb-2 tumors). Seventeen patients with &gt; 10 positive axillary lymph nodes and 36 patients with triple negative tumors, received a platinum-based consolidation high-dose chemotherapy with or without autologous peripheral blood progenitor cell transplantation, respectively. Radiation therapy was administered to 145 patients. During the 5 years of LH-RH analogue, patients received a strong psychological support, biphosphonates, and after the end of chemotherapy, estrogen receptor positive (ER+) patients received an aromatase inhibitor.Results: Characteristics of patients. The mean patient age was 42 years (range, 26–50 yrs). One hundred-twenty five women were ER+, 55 were estrogen receptor negative (ER-). Total number of positive nodes was 479, with a mean of 2.6 for each patient (range 0-25). UICC stage was II in 114 women and III in 66 women. All patients had their serum E2 suppressed to values &lt; 40 pg/mL. A statistically significant improvement was observed in lymphocyte number (p&lt; 0.005), and a decrease in T-reg number (p&lt; 0.005) and VEGF (p&lt; 0.005) with respect to baseline values, after LH-RH administration. After a median follow-up of 97 months, 10-years overall progression-free survival and overall survival rate were both 83.2% with no statistical significant difference between ER+ and ER- patients.Conclusions: These data show that the administration of an LH-RH analogue improves lymphocyte number, decreases T-regs and VEGF, and seems to improve the expected outcome of HR-Pre-BC patients through immunologic mediated mechanisms.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4092.

Enhanced proatherogenic inflammation after recombinant human TSH administration in patients monitored for thyroid cancer remnant

OBJECTIVE

To evaluate the effect of recombinant human TSH (rhTSH) on biomarkers of vascular endothelial cell and platelet activation in patients monitored for thyroid carcinoma remnant.

METHODS

Circulating levels of soluble(s) intercellular adhesion molecule (sICAM)-1 and sE-selectin, as indices of vascular endothelial cell activation, of sP-selectin and sCD40 ligand (sCD40L), as indices of platelet activation, and of 8-iso-prostaglandin F(2alpha) (8-iso-PGF(2alpha)), as an index of lipid peroxidation, were evaluated in 20 patients (16 females, 48.0 +/- 13.6 years) at baseline and after intramuscular rhTSH injection (0.9 mg/day on two consecutive days).

RESULTS

At baseline, serum TSH values were below normal whereas free T3 and free T4 were within the normal range. After rhTSH injection, serum TSH increased significantly but free T3 and free T4 remained unchanged. Concomitantly, plasma sICAM-1 concentrations increased significantly (from 155.9 +/- 39.1 to 183.6 +/- 38.1 ng/ml, P < 0.03), as did those of sE-selectin (from 74.8 +/- 15.4 to 91.4 +/- 12.2 ng/ml, P < 0.0006), sP-selectin (from 56.4 +/- 13.7 to 72.2 +/- 14.9 ng/ml, P < 0.002), sCD40L (from 2.1 +/- 0.9 to 2.8 +/- 1.1 ng/ml, P < 0.03) and total 8-iso-PGF(2alpha)(from 238.5 +/- 47.0 to 307.8 +/- 41.2 pg/l, P < 0.0001). Changes in circulating levels of sCD40L were directly correlated with changes in levels of plasma total 8-iso-PGF(2alpha) (r = 0.523, P < 0.02) and sP-selectin (r = 0.480, P < 0.03).

CONCLUSIONS

Supraphysiological concentrations of rhTSH might exert proatherogenic effects by promoting activation of vascular endothelial cells and platelets probably through enhanced oxidative stress.

Multicenter phase II study of sequential chemotherapy, radiotherapy, and immunotherapy in locally advanced pancreatic (Pa) and biliary tree (Bt) adenocarcinoma (ADK)

3047

Background: The aim of this study was to evaluate the activity and toxicity of a multistep, sequential treatment including induction chemotherapy (ICT), consolidation chemoradiotherapy (CXRT), and maintenance immunotherapy (MI) in untreated patients with locally advanced (LA), inoperable, or incompletely resected Pa and Bt ADK. MI with low-dose interleukin-2 (IL-2) and 13-cis-retinoic acid (RA) was given in order to enhance the immune function, which could eradicate minimal residual disease, as previously shown (Clin Cancer Res 2001). Methods: From September 2003 to September 2007, 54 patients, 32 men, 22 women, 63% with Pa and 37% with Bt ADK, mean age of 63 years (range 36–75), were treated with an ICT consisting of 3 courses of cisplatin, 70 mg/m2 day 1, gemcitabine 1000 mg/m2 day 1 and 8 every 3 weeks. Patients who were progression-free (PF) after ICT received CXRT, 45 Gy in 25 fractions, using coplanar four-field technique, with concurrent capecitabine 850 mg/m2/day. Six weeks after completion of CXRT, patients were restaged: In the absence of disease progression, they received, as an MI, IL-2, 1.8 x 106 I.U. and RA, 5 mg/kg, 5 days/week, 3 weeks/month for 1 year and thereafter until progression. Results: After a median follow-up of 27.5 months, all patients were evaluable. A response rate of 26% (95% c.i. 15–40%), was observed, with 44.5% of patients achieving stable disease. Thirty-eight patients, 27 with Pa and 11 with Bt ADK, had a clinical benefit from ICT, and were treated with CXRT. Fourteen PF patients, 7 Pa and 7 Bt ADK, received an MI with IL-2 and RA. Median progression-free survival (PFS) and overall survival (OS) for all 54 patients were 6.8 and 12.1 months, respectively, while the 14 patients treated with MI had a 5-year PFS and OS rate of 36% and 58%, respectively. Grade 3–4 hematological and gastrointestinal toxicity were observed in 30% and 37% of patients, respectively, while 28% of patients had grade 1–2 autoimmune reactions. Conclusions: These results support the efficacy and safety of a multistep sequential treatment with ICT, followed by CXRT, and an MI with IL-2 and RA, in patients with LA, inoperable or incompletely resected Pa and Bt ADK. Further studies are necessary to validate this strategy.

No significant financial relationships to disclose.

Accuracy of N-terminal pro-brain natriuretic peptide in the identification of left ventricular dysfunction in high-risk asymptomatic patients

OBJECTIVE

The role of natriuretic peptides in the screening of left ventricular dysfunction is still unclear. The aim of this study was to assess the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement in asymptomatic patients at high risk of developing left ventricular dysfunction.

METHODS

One hundred and thirty-four consecutive ambulatory patients (mean age 56.1 +/- 7 years) were studied and selected on the basis of a history of hypertension of at least 5 years. Systolic dysfunction was defined as an ejection fraction of 45% or less. Statistical analysis was performed by both parametric and nonparametric approaches. Diagnostic accuracy was evaluated by receiver operating characteristic analysis.

RESULTS

Echocardiography showed normal left ventricular function in 40 patients, diastolic dysfunction in 80 patients and systolic dysfunction in 14 patients. NT-proBNP levels were significantly higher in patients with systolic dysfunction (356.1 +/- 294.8 vs. 85.2 +/- 85.8 pg/ml; P < 0.05). Receiver operating characteristic analysis showed a high value of the area under the curve (0.89) for the detection of systolic dysfunction with a sensitivity of 83% and a specificity of 80% for a cut-off value of 114 pg/ml and with a negative predictive value of 0.98.

CONCLUSION

In asymptomatic patients at high risk for heart failure because of a history of hypertension, the measurement of NT-proBNP levels may represent a useful screening test for left ventricular systolic dysfunction. Therefore, more expensive examinations, such as echocardiography, may be restricted only to patients with higher NT-proBNP levels.

Intrauterine insemination with or without mild ovarian stimulation in couples with male subfertility due to oligo/astheno- and/or teratozoospermia or antisperm antibodies: a prospective cross-over trial

Seventy-three couples with male subfertility, which was due to oligo/astheno- and/or teratozoospermia (n = 63) or antisperm antibodies (n = 10), were randomly assigned to sequential timed natural intercourse, intrauterine insemination (IUI) and IUI + mild ovarian hyperstimulation. From the analysis of 384 observed cycles, IUI was shown to be effective in oligo/asthenozoospermia without severe teratozoospermia, when it was associated with moderate multifollicular induction, and in male immunologic subfertility, IUI was highly effective in nonstimulated cycles also.

Immunotherapy in patients with less than complete response to chemotherapy

BACKGROUND

Patients with metastatic solid tumors (MST) with less than a complete response to chemotherapy (L-CR), a depressed immune system and elevated serum vascular endothelial growth factor (VEGF) lack defined treatment options. The primary endpoint evaluated in this study was whether interleukin-2 (IL-2) and 13-cisretinoic acid (RA) treatment reduced VEGF and improved immune function in such patients. Secondary endpoints were objective response, relapse-free survival (RFS), and overall survival (OS).

PATIENTS AND METHODS

One hundred consecutive MST patients with L-CR and a mean serum VEGF of 421.0 pg/mm3 were enrolled. Patients self-administered subcutaneous IL-2 1.8 x 10(6) IU/day, and oral RA 0.5 mg/kg/day x 5 days/week for 2 cycles of 3 weeks/month for 1 year and continued until progression.

RESULTS

After a median follow-up of 78 months, a statistically significant VEGF decrease and improvements in lymphocyte, NK, and CD4+/CD8+ ratio were observed. Twenty-four patients were converted to a CR; their 5-year RFS and OS rates were each 96%. No WHO grade 3 or 4 toxicities were observed.

CONCLUSION

Administration of IL-2/RA to this patient population produced a significant decrease in VEGF, improvement of prognostically relevant immunological parameters, and durable response in 25% of patients.

Immunotherapy following high-dose chemotherapy (HDCT) and peripheral blood progenitor cell transplantation (PBPCT) in the treatment of high-risk early breast cancer (HREBC) and metastatic breast cancer (MBC)

Abstract #2159

Background: Meta-analyses have shown that HDCT with PBPCT is not superior to standard dose chemotherapy in the treatment of high risk early breast cancer (HREBC) and metastatic breast cancer (MBC). The reason for the limited efficacy is due to failure to eradicate all cancer stem cells, resistant to chemotherapy, and capable to reproduce the tumor in immunodeficient mice. Lymphopenia has been described after HDCT. We have previously shown that low dose inteterleukin 2 (IL-2) and oral 13-cis- retinoic acid (RA) improved lymphocyte (L) count, and decreased vascular endothelial growth factor (VEGF), of patients with advanced tumors having a clinical benefit from chemotherapy. Primary endpoint of this study was to verify if IL-2 and RA, improving L count, and decreasing VEGF after HDCT with PBPCT of patients with advanced breast cancer, reduced angiogenic switch. Secondary endpoints were the evaluation of progression-free survival (PFS) and overall survival (OS).&#x2028; Methods: From 02-1998 to 02-2003, 30 patients with HREBC and 18 with MBC were entered into the study. One month after HDCT, patients received, for 1 year, 5 days/week, 3 weeks/month, subcutaneous IL-2 (1.8 x 106 IU daily) plus RA (0.5 mg/kg body weight). Immunotherapy was continued, with intermittent schedules, up to 5 years. Patients with estrogen receptor positive (ER+) tumors received hormonal therapy, while those in premenopause received also a LHRH analogue for 5 years.&#x2028; Results: Characteristics of HREBC patients: median age, 48 years (range 34-60); median number of positive axillary nodes, 13 (range-11-27); ER+/ER-: 20/10; characteristics of MBC patients: median age, 46 years (range 28-60); median number of disease sites 1.5, (range-1-4); ER+/ER-: 5/13; Major adverse effects from IL-2 were fever, rash and autoimmune reactions; no treatment-related mortality was seen. After a median follow-up of 61 months, a statistically significant improvement of L and decrease of VEGF were observed for both HREBC and MBC. 5 years PFS and OS rate were, for HREBC 76% and 85%, respectively, for MBC, 22% and 35%, respectively.&#x2028; Conclusions: These data show that IL-2 administration after HDCT and PBPCT is feasible, has a moderate toxicity, gives a statistically significant improvement of L a decrease of VEGF, and seems to give an improvement of expected PFS and OS, both in HREBC and MBC.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2159.

Maintenance immunotherapy in metastatic breast cancer

Maintenance chemotherapy provides only a modest survival advantage in metastatic breast cancer (MBC). We have previously shown that a maintenance immunotherapy (MI) regimen based on low-dose interleukin-2 (IL-2) and 13-cis retinoic acid (RA) improved the lymphocyte and natural killer cell (NK) counts, and CD4+/CD8+ ratio in patients with a clinical benefit from chemotherapy. With the aim of improving progression-free survival (PFS), 100 consecutive MBC patients with a clinical benefit from chemotherapy were treated with an MI. Patients with MBC were eligible if they had no evidence of progression after 6-8 courses of epirubicin-paclitaxel induction chemotherapy. Treatment consisted of low-dose IL-2 and oral RA given until progression. The primary endpoint was progression-free survival (PFS); secondary endpoints were toxicity, overall survival (OS), and changes in immunological parameters. From 04/1997 to 04/2002, 100 patients with MBC were enrolled. After a median follow-up of 49 months, median PFS and OS were 37.1 and 57.5 months, respectively. No WHO grade 3 or 4 toxicity was observed; grade 2 cutaneous toxicity and autoimmune reactions occurred in 19 and 16% of patients, respectively. A sustained improvement in lymphocytes, NKs, and in the CD4+/CD8+ ratio was observed, with respect to baseline values. In conclusion, MI with IL-2 and RA in MBC patients who do not progress after 6-8 courses of chemotherapy is well-tolerated, improves lymphocyte, NK, CD4+/CD8+ ratio, and appears to delay disease recurrence. A randomized trial is warranted.