Percutaneous anterior transarticular screw fixation for atlantoaxial instability

We reviewed the outcome of a retrospective case series of eight patients with atlantoaxial instability who had been treated by percutaneous anterior transarticular screw fixation and grafting under image-intensifier guidance between December 2005 and June 2008.

The mean follow-up was 19 months (8 to 27). All eight patients had a solid C1–2 fusion. There were no breakages or displacement of screws. All the patients with pre-operative neck pain had immediate relief from their symptoms or considerable improvement. There were no major complications. Our preliminary clinical results suggest that percutaneous anterior transarticulation screw fixation is technically feasible, safe, useful and minimally invasive when using the appropriate instruments allied to intra-operative image intensification, and by selecting the correct puncture point, angle and depth of insertion.

The transcriptome of Populus in elevated CO reveals increased anthocyanin biosynthesis during delayed autumnal senescence

*The delay in autumnal senescence that has occurred in recent decades has been linked to rising temperatures. Here, we suggest that increasing atmospheric CO2 may partly account for delayed autumnal senescence and for the first time, through transcriptome analysis, identify gene expression changes associated with this delay. *Using a plantation of Populus x euramericana grown in elevated [CO2] (e[CO2]) with free-air CO2 enrichment (FACE) technology, we investigated the molecular and biochemical basis of this response. A Populus cDNA microarray was used to identify genes representing multiple biochemical pathways influenced by e[CO2] during senescence. Gene expression changes were confirmed through real-time quantitative PCR, and leaf biochemical assays. *Pathways for secondary metabolism and glycolysis were significantly up-regulated by e[CO2] during senescence, in particular, those related to anthocyanin biosynthesis. Expressed sequence tags (ESTs) representing the two most significantly up-regulated transcripts in e[CO2], LDOX (leucoanthocyanidin dioxgenase) and DFR (dihydroflavonol reductase), gave (e[CO2]/ambient CO(2) (a[CO2])) expression ratios of 39.6 and 19.3, respectively. *We showed that in e[CO2] there was increased autumnal leaf sugar accumulation and up-regulation of genes determining anthocyanin biosynthesis which, we propose, prolongs leaf longevity during natural autumnal senescence.

Hepatocyte nuclear factor 4alpha attenuates hepatic fibrosis in rats

BACKGROUND AND AIMS

Hepatocyte nuclear factor 4alpha (HNF4alpha) is a central transcriptional regulator of hepatocyte differentiation and function. The aim of this study was to evaluate the effect of HNF4alpha on attenuation of hepatic fibrosis.

METHODS

The adenoviruses carrying HNF4alpha gene or containing siRNA targeting HNF4alpha were injected through tail vein on two distinct hepatic fibrosis models either induced by dimethylnitrosamine or by bile duct ligation in rats. Moreover, HNF4alpha, epithelial-mesenchymal transition (EMT)-related and fibrotic markers in hepatocytes, hepatic stellate cells (HSCs) and liver tissues were detected by real time PCR, immunofluorescence or immunohistochemistry.

RESULTS

We demonstrated that decreased expression of HNF4alpha and epithelial markers accompanied by enhanced expression of mesenchymal markers occurred in fibrotic liver. More importantly, forced expression of HNF4alpha remarkably alleviated hepatic fibrosis and improved liver function with suppression of EMT in both fibrosis models. In contrast, downregulation of HNF4alpha by siRNA aggravated hepatic fibrosis and decreased the expression of E-cadherin in association with the enhanced expression of vimentin and fibroblast-specific protein-1. In vitro study revealed that HNF4alpha could suppress the EMT process of hepatocytes induced by transforming growth factor-beta1 and increase the expression of liver-specific genes. A similar phenomenon of the EMT process was observed during the activation of HSCs, which was abrogated by HNF4alpha. Additionally, HNF4alpha deactivated the myofibroblasts through inducing the mesenchymal-to-epithelial transition and inhibited their proliferation.

CONCLUSIONS

Our study suggests that HNF4alpha is critical for hepatic fibrogenesis and upregulation of HNF4alpha might present as an ideal option for the treatment of hepatic fibrosis.

Efficacy and Safety Data of Taiwan Breast Cancer Patients Enrolled in the Lapatinib Expanded Access Program (LEAP)

Background: LEAP is a single-arm, open-label, expanded access study of lapatinib in combination with capecitabine in 42 countries. The primary objective of LEAP was to provide patients with pre-approval access to lapatinib based on positive clinical data from a pivotal Phase III trial.Methods: Enrolled patients had locally advanced or HER2 positive metastatic breast cancer (MBC), progressive disease (PD, by modified RECIST) following prior therapy with anthracycline-, taxane-, and trastuzumab-containing regimens, including some patients previously treated with capecitabine, and were ineligible for ongoing lapatinib trials. Patients received lapatinib (1250 mg/day) and capecitabine (2000 mg/m2/day, days 1-14, every 21 days). Baseline characteristics, including prior therapies, were collected. Response was assessed using RECIST criteria.Results: From Mar 2007 to Sep 2008, 238 patients were enrolled at 10 centers in Taiwan. At the 11 June 2009 data cut-off, data were collected and analyzed for 166 patients. Patients received an average of 5 prior cytotoxic therapies, including trastuzumab and capecitabine.Of 166 patients, 3 (2%) had complete response, 49 (30%) had partial response, 62 (37%) had stable disease, 42 (25%) had PD, and 10 (6%) were unknown. The median duration of treatment was 5.5 mo and the median time to progression was 5.3 mo, respectively. Per protocol, only serious adverse events (SAEs) were reported. Thirty SAEs were reported for 238 patients; 6 (20%) were considered treatment-related by investigators, were not fatal, and included stomatitis (2), vomiting (2), diarrhea (1), and cellulitis (1). As of 11 June 2009, 66 (40%) patients were alive and 149 withdrew from LEAP, the majority (85%) because of progressive disease.Conclusion: Although data were collected retrospectively via case report forms, these results reflect the real world setting in Taiwan for the treatment of erbB2+ MBC patients and confirms that lapatinib, in combination with capecitabine, demonstrates efficacy in this patient population including those who are heavily pretreated.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5093.

Epidemiology of Triple Negative Breast Cancer in China

Background:The classification of tumors based on the gene expression may define intrinsic breast cancer subtypes in which the effect of risk factors could be more obvious. We sought to assess the risk factors for triple negative breast cancer on Chinese population.Methods: A retrospective study of 5761 patients was carried out from a large database of breast cancer patients undergoing surgery between January 1, 1991 and June 31, 2008 in Cancer Hospital, Fudan University, Shanghai, China. Univariate analyses were performed by chi-square test of Student's t test and multivariate analyses by logistic regression.Results: A total of 1108 women were identified as having triple negative breast cancer and were compared with the 4653 women with non-triple negative. Regardless the pathological discrepancy, women with triple negative breast cancers were significantly more likely to be younger age(P=0.001; OR=1.615, 95%CI=1.207-2.160), premenopausal (P = 0.003; OR = 1.570, 95% CI = 1.171-2.106) and parous women (P = 0.001; OR = 1.741, 95% CI = 1.269-2.387).There seems no associations with increasing risk of triple negative breast cancer for breastfeeding (P=0.126), younger age at menarche (P=0.129), first degree family history (P=0.111) and oral contraceptive usage (P=0.251).Conclusion:Based on this large population study in Chinese breast cancer patients, the risk factors for triple negative phenotype may be somewhat different from those for Western women. Therefore, a better knowledge of this issue is warranted due to it may have impact on clinical outcomes and may offer some insight into the process of carcinogenesis and therapeutic efficacy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2065.

Expression of Notch1, Jagged1 and beta-catenin and their clinicopathological significance in hepatocellular carcinoma

The Notch/Jagged signaling pathway is important for cellular differentiation and proliferation. Notch1/Jagged1 can either suppress or promote tumors depending on the cell type and context. beta-catenin, one of the mediators of the Wnt signalling pathway, represents a key element in one of the most important pathways of carcinogenesis. The aim of this study was to examine the expression of Notch1/Jagged1 and beta-catenin in hepatocellular carcinoma and to assign clinicopathological correlations. Immunohistochemical detection of Notch1/Jagged1 and beta-catenin was performed in tissue microarrays including 339 Hepatocellular carcinomas, 174 adjacent non-tumor livers and 94 normal livers. The results showed that the rate of expression was 66%, 98% and 97% for Notch1 and 36%, 85% and 92% for Jagged1 respectively in hepatocellular carcinoma, adjacent non-tumor liver and normal liver. Decreased expression of Notch1/Jagged1 was correlated significantly with Edmondson-Steiner grade. However, nuclear beta-catenin was expressed in 37% of hepatocellular carcinoma tissue, which was significantly higher than its non-tumor counterparts. Increased nuclear beta-catenin expression was correlated with HBs-Ag status and Edmondson-Steiner grade. Moreover, The positive expression of Notch1 was parallel with Jagged1 expression (r =0.235, p=0.000) and reduced Notch1 expression was associated with increased beta-catenin expression in hepatocellular carcinoma (r =-0.125, p =0.023). In conclusion, Notch1/Jagged1 were frequently low expressed in hepatocellular carcinoma and correlated with the high expression of beta-catenin suggesting that downregulation of Notch1/Jagged1 signaling may sustain tumor progression.

Negative impacts of unreported COPD exacerbations on health-related quality of life at 1 year

Unreported chronic obstructive pulmonary disease (COPD) exacerbations are common, but their intermediate-to-long-term impacts on health-related quality of life (HRQoL) are unknown. The aim of the present study was to examine the impact of unreported exacerbations on HRQoL at 1 yr. A multicentric prospective cohort study in 491 COPD patients was conducted in China. HRQoL was measured using the St George's Respiratory Questionnaire (SGRQ). Other measurements included sociodemographic, clinical, psychosocial and treatment profiles. Patients were monitored monthly for 12 months to document exacerbations (at least one symptom worsening for > or =48 h). Patients were categorised into six groups: no exacerbation, one unreported exacerbation only, more than one unreported exacerbation only, one reported exacerbation only, more than one reported exacerbation only, and both unreported and reported exacerbations. Generalised estimating equations were used to estimate the adjusted associations between exacerbations and HRQoL change. A total of 466 unreported and 410 reported exacerbations were recorded. Compared with patients with no exacerbations, the change in SGRQ total score was similar amongst patients with one unreported exacerbation (adjusted mean change 1.22 points (95% CI -4.05-6.48)), but significantly worse among patients with more than one unreported exacerbation (4.61 (95% CI 0.09-9.13)). Development and evaluation of self-management programmes emphasising early recognition of exacerbations and consequent action appear to be warranted.

CIGARETTE SMOKE-INDUCED HYPERCAPNIC EMPHYSEMA IN C3H MICE IS ASSOCIATED WITH INCREASES OF MACROPHAGE METALLOELASTASE AND SUBSTANCE P IN THE LUNGS

The authors tested whether macrophage metalloelastase (MMP-12) and substance P (SP) were increased in the cigarette smoke (CS)-exposed female C3H/HeN mice with hypercapnic emphysema. The authors found that as compared to control (filtered air), 16 weeks of CS exposure significantly up-regulated mRNA and protein levels of MMP-12, the ratio of MMP-12/tissue inhibitor of matrix metalloproteinase-1, and SP/preprotachykinin-A (a precursor to SP) in the lungs. Importantly, a significant correlation was found between MMP-12 and SP, and between MMP-12/SP and the degrees of hypoxemia/hypercapnia denoted in CS-exposed mice. These data suggest a possible involvement of SP and MMP-12 in the pathogenesis of severe COPD.

Outcomes of conservatively managed localized prostate cancer

5010

Background: The natural history of screen-detected prostate cancer has not been well described. Methods: Cancer-specific and overall mortality, assessed through competing risk analyses, were determined for 14,516 men aged 65 years or older diagnosed between 1992–2002 and did not receive surgery or radiation within 6 months of cancer diagnosis. The population-based cohort was identified from US cancer registries, which had 98% completeness in case ascertainment. Results: Compared to earlier era studies, survival has improved considerably for conservatively managed patients diagnosed in the contemporary prostate specific antigen (PSA) era ( Table ). Conclusions: Men diagnosed with prostate cancer in the PSA era have survival outcomes significantly better than those in the past. Patients and healthcare providers may need to reassess some treatment options in light of these data.

[Table: see text]

No significant financial relationships to disclose.

Prediction of response to alkylator-based chemotherapy in metastatic melanoma (MM) using gene expression and promoter methylation signatures

9009

Background: Temozolomide and dacarbazine (TMZ and DTIC) remain the mainstay of alkylator-based chemotherapy for MM, despite response rates of 10–15% and the absence of any impact on survival. Classification of patients according to responsiveness can guide the individualization of therapy and inform approaches to abrogate mechanisms of chemotherapy resistance. Epigenetic mechanisms play an important role in regulation of genes associated with resistance and were evaluated in tandem with gene expression profiling in biological samples from MM patients (pts) to refine our understanding of the epigenomic-genomic-phenotypic interplay. Methods: We examined promoter methylation and gene expression in tumor tissues of 21 pts with MM treated with TMZ or DTIC, using high throughput technologies (Illumina Inc). The cases were divided into responder (R) and non-responder (NR) groups based on clinical response. The data were analyzed using Prediction Analysis of Microarrays (PAM) from BRB array tools. Results: Differential promoter methylation analysis revealed that 63.6% of promoter sites were hypomethylated in tumors obtained from R pts (p<0.0001). PAM analysis of gene expression data revealed that a classifier set consisting of 82 genes was able to predict NRs from Rs with 83% sensitivity and 89% specificity. Promoter methylation profiling did not independently correlate with R status. A simultaneous analysis of the promoter methylation and gene expression values first stratified into 3 data-driven categories and then combined into a 3 by 3 matrix allowed us to identify a common gene expression/methylation signature of 15 genes that classified both NR and R groups accurately 100% of the time. Conclusions: Gene expression signatures independently predict response to chemotherapy in MM, however promoter methylation profiling alone does not. Analysis of combined gene expression and promoter methylation in a well- annotated clinical data set dichotomized according to response identified a highly predictive signature. The findings from this study are qualified by the relatively small sample size and are currently being validated in an expanded sample set. Supported in part by the ECOG Paul Carbone, MD, Fellowship Award.

No significant financial relationships to disclose.

Phase I study of gemcitabine, docetaxel, and imatinib in refractory and relapsed solid tumors

e13538

Background: The combination of the tyrosine kinase inhibitor imatinib with cytotoxic chemotherapy targets multiple pathways of tumor progression. In a previous phase I study, the combination of gemcitabine and imatinib was tolerable and had broad activity. The maximally tolerated dose (MTD) was gemcitabine 1500 mg/m2/150 minute and imatinib 400 mg days 1–5, 8–12, and 15–19. Given the activity seen when combining gemcitabine and docetaxel in some solid tumors, this phase I trial studied the addition of docetaxel to gemcitabine/imatinib. Methods: Twenty patients with relapsed/refractory solid tumors were enrolled in this IRB-approved study at the Cancer Institute of New Jersey and University of Michigan. The mean age was 64, mean ECOG PS 1. Five patients had lung cancer; 5, sarcoma; 3 ampullary-biliary tumors; 2 mesothelioma and bladder, 3, other. Imatinib was administered at 400 mg daily on days 1–5, 8–12 and 15–19. Gemcitabine was started at 600 mg/m2 at the fixed dose infusion of 10 mg/min on days 3 and 10 and docetaxel at 30 mg/m2 on day 10. Results: Because of unexpectedly severe hematological toxicities seen with escalating either gemcitabine or docetaxel, the protocol was amended to eliminate days 15–19 of imatinib. The MTD is gemcitabine 600 mg/m2, on days 3 and 10, docetaxel 30 mg/m2 on day 10, and imatinib 400 mg PO given on days 1–5 and 8–12. The dose limiting toxicities were neutropenic fever, pleural and pericardial effusion after cycle 1 of chemotherapy. The best response achieved was stable disease at 6 cycles in one patient each with mesothelioma and non small cell lung cancer (NSCLC) at the MTD. Two other patients with NSCLC had stable disease at 4 cycles. Discussion: An unexpectedly low MTD for this triplet was identified, an outcome different from prior experience with the doublets gemcitabine/imatinib or gemcitabine/docetaxel where much higher dosages are tolerated. Our results suggest possible drug-drug interactions that amplify toxicities with little initial evidence of improved tumor control. Given the unexpectedly high toxicity of the combination of gemcitabine, docetaxel and imatinib at low dosages, further development of this regimen is not indicated.

[Table: see text]

Rationally designed treatment for solid tumors with MAPK pathway activation

2532

Background: Preclinical studies shed light to the mechanism conferring paclitaxel resistance in solid tumors with active Ras/Raf/Mitogen-Activated Protein Kinase (MAPK) pathway, and determined a molecular mechanism by which addition of the proteasome inhibitor bortezomib abrogated this resistance, enabling tumor regression in animals in vivo. Methods: A Phase I study was contacted to determine the MTD of paclitaxel and bortezomib combinatorial treatment. Sixteen patients with refractory solid tumors were treated with weekly paclitaxel and bortezomib. Six patients had NSCLC; 4, colon cancer; 2, pancreatic; 2, melanoma; 1, breast; 1, ovarian. Patients with baseline neuropathy greater than or equal to Grade 1 were excluded. The starting dose was 40 mg/m2 for paclitaxel and 0.7 mg/m2 for bortezomib. A modified continual reassessment method (MCRM) was used for dose escalation with 3-patient cohorts treated at each dose level. The Target Toxicity Level (probability of DLT at the MTD) was set at 25%. Maximum dose escalation was no more than 75% of the previous SED level, if no Grade 3 hematologic toxicity or DLT were observed. Otherwise, the maximum dose escalation was no more than 50% of the previous SED level. The process continued until SED changes were no more than 10% for two consecutive cohorts. Results: The MTD for the combinatorial treatment was reached at 60 mg/m2 paclitaxel and 1.0 mg/m2 bortezomib. Of 15 evaluable patients, 1 patient with paclitaxel-resistant NSCLC had PR and 5 patients (2, NSCLC; 1, pancreatic; 1, colon; 1, ovarian) had stable disease. Median TTP was 2.3 months (0.8 to 6 months). Three NSCLC patients achieved TTP longer than 5 months. The combination of paclitaxel and bortezomib was relatively well tolerated. Paclitaxel PK parameters are being determined, and paraffin-embedded tumor specimens are being evaluated for MAPK pathway activation by IHC for phospho-ERK. Results will be correlated with clinical response. Conclusions: The MTD for the proposed combinatorial treatment is 60 mg/m2 for paclitaxel and 1.0 mg/m2 for bortezomib, and is relatively well tolerated. Combination of paclitaxel with bortezomib is effective in taxane-resistant NSCLC, and worthy of further investigation.

No significant financial relationships to disclose.

Postsurgical drainage and the risk of breast cancer recurrence in Chinese breast cancer patients

e22234

Background: Clinical investigations suggest that while primary breast cancer surgical removal favorably modifiers the natural history of breast cancer. Postoperative drainage, a surgery-derived discharge after breast cancer surgery, reflecting some biological features of surgical stimulation, was assessed and explored its relationship with breast cancer recurrence in this study. Methods: A total of 1445 women undergoing surgery between Jan 1, 2000 and Dec31, 2002 in Cancer Hospital of Fudan University, Shanghai, China was retrospectively studied. Survival curves were performed with Kaplan-Meier method and the predictive value of postsurgical drainage was estimated using proportional Cox regression model. Conclusions: The larger drainage volume POD 1 is a useful marker, suggesting a greater stimulation to surgical treatment compared to the lower ones. Awareness of the relationship between early surgery-stimulated effects and harmful wound healing response might help to explore new strategies to block or deplete these harmful effects, resulting in improving patients' survival.

No significant financial relationships to disclose.