Monocentric evaluation of erlotinib in advanced prostate cancer

15569

Background: The human epidermal growth factor receptor (HER1/EGFR) is known to be over expressed in a variety of cancers, including prostate cancer. Erlotinib is an orally active small molecule tyrosine kinase inhibitor (TKI) targeted against HER1/EGFR (ErbB1). Methods: Pts with advanced or metastatic prostate cancer, adequate organ function and Karnofsky performance status (KPS) ≥ 50% were enrolled in a phase II single institution study. Pts were required to have documented PSA progression before study entry. The primary objective was to determine the efficacy of erlotinib defined as a decrease or stabilization of PSA. Pts received erlotinib 150 mg/day; if no acceptable toxicity was reported in the first 3 weeks, the dose was increased to 200 mg at week 4, and continued until disease progression or unacceptable toxicity. Results: Thirty patients were treated between April 2004 and February 2006, Median age was 69 years (range 51–77) median KPS was 80 (70–100). Median PAL was 85 UI/L (range 33–732), median LDH 224 UI/L (144–1,016) and PSA 102 ng/ml (3, 4–1213). Twenty-eight pts had metastatic disease, 2 had PSA relapse only and 29 were androgeno-independant. Twenty three had received prior chemotherapy (median 2 lines, range (1–7)). Dose escalation was possible in 16 (55%) pts and median duration of treatment was 60 days (14–99). The most common grade 3 toxicities were fatigue (3 ), anaemia (2), diarrhea (2) vomiting (2) cutaneous toxicity (1); one pt. had grade 4 anemia. Median PFS was 29 days (IC 95 [28–33]), median OS 17,38 months. PSA stabilization was observed in 4 pts; no pt had a decrease in PSA. Clinical benefit evaluation based on KPS and pain was achieved in 8 of 20 evaluable pts (40%). Conclusion: Erlotinib demonstrated some activity in advanced prostate cancer with 14% of pts achieving PSA stabilization and 40% a clinical benefit. Erlotinib was well tolerated. Future directions might include evaluating its use in less advanced disease and in pts with EGFR kinase domain mutations. Understanding which biomarkers predict response to erlotinib will likely be important in its application in the metastatic setting.

No significant financial relationships to disclose.

Techniques, indications et résultats de la curiethérapie interstitielle par implants permanents dans le cancer localisé de la prostate

Permanent seed brachytherapy as a monotherapy is an appropriate treatment in patients with low risk localized prostate cancer such as intraprostatic cancer, T1-2 stage, PSA less than 10 ng/mL, low tumour volume, well differentiated cancer (Gleason score less than 7), gland size less than 50 mL, no micturition symptoms that could decompensate after implantation. A brachytherapy program needs a specialized multidisciplinary team with the collaboration of urologists, radiotherapists (authorized person to manipulate radioactive elements), and physicists. The 10-year oncologic and morbidity results have been published in the literature and are comparable to those of other standard treatments of localized prostate cancer such as radical prostatectomy and external beam radiation therapy.

Comparison of Solution Chemistries of Orthophthalaldehyde and 2,3-Naphthalenedicarboxaldehyde

Polarography was used to obtain the concentrations of the dialdehydic (10%), monohydrated acyclic (5%), and cyclic hemiacetal form (85%) of orthophthalaldehyde (OPA). For 2,3-naphthalenedicarboxaldehyde (NDA) these values were estimated to be 15, 7, and 78%. Addition of water in unbuffered solutions followed first-order kinetics with rate constants 0.0018 s-1 for OPA and 0.0012 s-1 for NDA. Dehydration to form both the dialdehyde and the monohydrate is both acid- and base-catalyzed. Both dialdehydes yield on reaction with OH- ions geminal diol anion, which is electro-oxidized to a carboxylic acid. In the most frequently used pH range for the determination of amino acids, NDA can undergo reaction with OH- ions, but OPA does not. In aqueous solutions, NDA is less strongly hydrated than OPA.

Serum pharmacoproteomics of erlotinib-treated advanced prostate cancer patients: A SELDI-TOF mass spectrometry analysis

14603

Background: EGFR (Epidermal Growth Factor Receptor) is a promising target in various epithelial cancers. Erlotinib is an orally active small molecule tyrosine kinase inhibitor (TKI) targeting EGFR, under evaluation in prostate cancer. To identify protein biomarkers associated with EGFR TKI treatment we performed serum protein profiling in advanced prostate cancer patients receiving erlotinib, using Surface Enhanced Laser Desorption/Ionization-Time of Flight Mass Spectrometry (SELDI-TOF MS). Method: Serums from 23 advanced or metastatic prostate cancer patients enrolled in a phase II study of erlotinib as single agent were collected before treatment, on D28 and D56 and kept frozen in liquid nitrogen until analysis. Serum samples from each patients and each time points were first urea treated and then incubated with 3 different ProteinChip arrays (Ciphergen Biosystems): IMAC-Cu, CM10 and H50 using a fully automated platform (Tecan). After adding SPA matrix, arrays were analysed using a PBSIIc ProteinChip reader (Ciphergen Biosystems). After noise reduction, baseline substraction, and data normalisation, protein peaks were detected using the Biomarker Wizard tool integrated to the ProteinChip Software 3.1. Numeric data were then exported to excel files that were used for further biostatistic processing. Results: Combining protein profiles resolved from each experimental condition, several hundreds of protein peaks were obtained. Protein profiles from untreated and D28 and D56-treated patients were compared using non-parametric statistical methods and several protein peaks appeared differentially expressed between pre and post-treatment samples. Supervised methods identified protein peaks correlating with specific erlotinib toxicity on day 28. Since only minimal activity was noted in this trial, no protein profile correlating with anti-tumor effect was identified. Purification and identification of proteins modulated by treatment and associated with toxicity are ongoing. Conclusion: Serum protein profiling using SELDI-TOF MS is a promising method to characterize pharmacoproteomics of innovative compounds under development and to identify protein biomarkers potentially associated with drug effects.

No significant financial relationships to disclose.

Phase I trial and pharmacokinetic study of oral gimatecan in adults with malignant glioma

1559

Background: Gimatecan (GT) is an orally available camptothecin analogue with potent preclinical antitumor activity. A phase I trial was conducted to determine the maximum tolerated dose (MTD), toxicity profile, and pharmacokinetics (PK) of GT in patients (pts) with recurrent malignant glioma. Methods: GT was given orally once daily for 5 days every 28 days. The starting dose, 1.6 mg/m2 over 5 days, was independently escalated in pts who were and were not concurrently receiving enzyme inducing antiseizure drugs (±EIASD). PK samples were obtained up to 24 after dosing on day 1 and 168 h after dosing on day 5 of cycle 1. Results: A total of 43 pts were enrolled, 18 in the +EIASD arm and 25 in the -EIASD arm, with a median age of 51 years (range, 23–70) and median KPS of 80 (range, 60–100). All pts had prior irradiation and 84% had prior chemotherapy. Dose levels evaluated were 1.6, 3.2, 5.3, 8.0, 11.2, and 15.0 mg/m2 in the +EIASD arm and 1.6, 3.2, 5.3, 6.1, and 8.0 mg/m2 in the -EIASD arm. No dose-limiting toxicities (DLTs) occurred during 49 cycles of therapy in the +EIASD arm with dose escalation terminated at 15.0 mg/m2. Grade 3–4 myelosuppression was the DLT in the -EIASD arm, occurring in 1/11 pts at the MTD of 6.1 mg/m2, and 2/3 pts at 8.0 mg/m2. Gastrointestinal disorders, the most common side effects, were grade >3 in only 7% of pts. Pts in the +EIASD arm received a median of 6 cycles of therapy and there were 2 partial responses and 6 pts with stable disease. Pts in the -EIASD arm received a median of 2 cycles of therapy and 11 pts had stable disease. GT exhibited linear PK. EIASDs significantly affected the PK, decreasing the biological half-life 2-fold from 53 ± 25 to 25 ± 12 h (mean ± SD) and increasing the apparent oral clearance (CL/F) nearly 5-fold from 1.3 ± 1.7 L/h to 6.2 ± 4.3 L/h. CL/F was independent of body surface area. Conclusions: The MTD of GT for pts not receiving EIASDs is 6.1 mg/m2 and an MTD was not established for pts receiving EIASDs due to practical limitations on dose administration. Median duration of disease stabilization or response was 6 cycles for 44% of +EIASD pts and 2 cycles for 44% of -EIASD pts.

[Table: see text]

Overexpression of dopamine receptor genes and their products in the postnatal rat brain following maternal n-3 fatty acid dietary deficiency

A combination of PCR-Select cDNA subtraction and gene array hybridization was used to identify differentially expressed genomic markers in brains of rats fed for 3 weeks in utero and 2 weeks after birth on an n-3 polyunsaturated fatty acid (PUFA)-deficient diet supplied to dams. Total RNA was isolated, switch mechanism at 5'-end of the RNA transcripts (SMART) applied and used for PCR-Select subtraction of PUFA-deficient and adequately-fed control preparations. Subtracted and amplified ds-cDNA end-products were fragmented, terminally labeled with biotin-ddUTP and hybridized with a RN-U34A gene array. A 10-fold increase in potential genes with log2(Tester/Driver) = 1.4 was found compared with traditional gene array technology when the same chip was tested using non-subtracted targets. Reverse transcription-real-time relative PCR confirmed 30% of the transcripts. Among the validated transcripts, D1 and D2 receptors for dopamine (DA), were most prominent among a number of over-expressed neurotransmitter receptors and retinoic acid receptor (RXR alpha-2 and alpha-1). Immunohistochemical staining of brain sections from 2-week-old pups revealed a substantial enrichment of the D2 receptor in discrete regions of the mesolimbic and mesocortical pathways as well as in a large number of brain areas from the n-3 PUFA-deficient pups. Punches of the same areas run on western blots showed similar results. The overwhelming expression of D1 and D2 receptors may be attributed to a behavioral hypersensitivity caused by the possible impairment of DA production during brain development, which may have implications in certain disorders of the nervous system.

X-linked reticulate pigmentary layer. Report of a new patient and demonstration of a skewed X-inactivation

We report a boy, born to healthy first cousin parents, with diffuse hyperpigmentation of the skin and guttate hypomelanotic lesions, photophobia, abnormal hair, developmental delay, and recurrent bronchitis. Skin histology showed pigmentation incontinence with numerous melanophages. Electron microscopy showed a very high number of melanosomes and some degenerating keratinocytes. These features correspond to a rare genodermatosis, the X-linked reticulate pigmentary disorder with systemic manifestations. Skewed X-inactivation patterns were detected in the mother's lymphocytes.

European Collaborative Group on Prostate Brachytherapy: Preliminary Report in 1175 Patients

OBJECTIVE

To establish a multi-centre database of a large number of patients treated with brachytherapy across Europe.

METHODS

A total of 1175 patient files were registered in the database and the completeness of the data on these patients resulted in the majority being included in the analysis.

RESULTS

The database of patients treated with brachytherapy across Europe indicates that optimal patient selection for this procedure has been made, both in terms of outcome and side-effects, which will be subject of future analyses. This should enable refinement of the treatment choice and administration as well as provide useful guidance to other centres that want to establish this procedure for their patients. It will also set the ground for prospective studies.

CONCLUSIONS

The established database indicates that brachytherapy as a treatment option for prostate cancer is well established in many centres.

[Hereditary sideroblastic anemia: a rare diagnosis]

Hereditary sideroblastic anemia is a very rare disease recessive and X-linked that affect heme biosynthesis by deficit or decreased of delta aminolevulinic acid synthase (ALAS) activity. We report a case of a six-month-old boy, admitted in the hospital for anemic syndrome. The hemogram showed anemia (hemoglobin: 4.5 g/dL), frankly hypochronic microcytic and a regenerated (mean corpuscular hemoglobin concentration: 26 g/dL, mean cell volume: 53 fl, reticulocytes: 10 x 10(9)/L) with red cells morphologic disorders in smears (anisopoikylocytosis) without attack of the other lineages; white blood cells: 11 x 10(9)/L (neutrophils: 64% and lymphocytes: 35%); platelets: 350 x 10(9)/L. Examination of bone marrow showed an important erythroid hyperplasia (about 69%) with dyserythropoiesis. Perls stain revealed intense siderosis with 90% of ringed sideroblasts and a large number of siderocytes. Exploration of ALAS2 and ABC7 genes on the DNA of the infant was not found abnormalities. Treatment with pyridoxine corrects moderately the anemia. By the way, we proposed to remind that iron deficiency, inflammatory syndrome and thalassemia are the common microcytic anemia. However, it's mandatory to explore other causes if diagnosis is not solved.

Endometrial metastasis from signet-ring breast carcinoma: case report

Breast cancer rarely metastasizes to the endometrium. The signet-ring variety of breast cancer is very rare and has been reported to metastasize to the endometrium in only three previous reports. We present a patient with signet-ring breast carcinoma with metastasis to the endometrium. The patient presented with vaginal bleeding and was found to have wide spread metastasis. Endometrial metastasis in patients with signet-ring breast cancer usually denotes a poor prognosis.

[Iodine-125 transperineal prostate brachytherapy with preplanning technique: pre and post-implant dosimetry results analysis]

PURPOSE

Post-implant CT-based dosimetry is the only method of assessing the quality of permanent prostate brachytherapy. As a consequence of our permanent feedback with the preplanned technique, geometric and dosimetric criteria for optimal seed implantation are proposed and pre and post-implantation dosimetric results are presented.

PATIENTS AND METHODS

In 2000 and 2001, one hundred and twenty patients with early stage prostate cancer were treated with transperineal I-125 preplanned brachytherapy (RAPID Strand, Amersham Health). The prescription dose was 145 Gy to the planning target volume. For the pre-planning and post-implant dosimetry the Variseed 6.7 version software was used (Varian Medical Systems). The D90, V100 and V150 values, the position of the dose peak [Dose] peak) and the full width at half maximum (FWHM) on differential dose volume histogram from both planned and post-implant dosimetry were compared for all patients.

RESULTS

For preplanned dosimetry, the mean values for D90, V100, V150, [Dose] peak, FWMH were respectively of 199Gy, 100%, 70%, 220Gy, 113Gy. For post-implantation, these values became respectively of 157Gy, 90%, 62%, 220Gy, 194Gy.

CONCLUSION

In our practice, differences are noted between preplanned and post-implant dosimetry parameters that should be anticipated to assure optimal definitive result. A working methodology both for performing the preplanned dosimetry and for evaluating the post-implantation dosimetric results is proposed.

A technique for the in vivo study of multiple stable isotope-labeled essential fatty acids

A novel tracer technique is presented for the simultaneous and independent measurement of multiple stable isotopically labeled essential fatty acids. Gas chromatography/negative chemical ionization mass spectrometry was employed for high sensitivity detection of the following isotopes: deuterium-labeled-linolenate, carbon-13-U-labeled-eicosapentaenoate, carbon-13-U-labeled-linoleate, and deuterium-labeled-dihomo-gamma-linolenate. These isotope-labeled fatty acids in vehicle oil were given to rats either singly or together as a single oral dose. Rat blood was collected after dosing and the isotopomers of the precursors and their main metabolites, including those containing both(13) C and (2)H, were detected simultaneously with good resolution and without interference from other isotopes due to differences in mass and chromatographic retention.

[Initial antibiotic therapy in maternal-fetal infections which include ampicillin even in countries where listeriosis is an incidental disease]

Neonatal listeriosis is an exceptional disease in Northern Africa. Hence, protocols for maternal-fetal infection treatment include only a third generation cephalosporin and an aminoside. This protocol does not take into account the possibility of Listeria monocytogenes infection. We report a fatal case of neonatal listeriosis in Tunisia. The use of first antibiotics in maternal-foetal infection must be reconsidered when lacking sufficient bacteriological data and include systematically ampicillin in presumptive antibiotic protocols.

Campylobacter upsaliensis: Another pathogen for consideration in the United States

While evaluating quinolone resistance in a sample of Campylobacter isolates recovered from patients with campylobacteriosis in Los Angeles County, California, in 1998, we discovered that the second most frequently isolated species was Campylobacter upsaliensis (6 [4%] of 155 isolates). The ability of laboratories to recover this species may be dependent on the culture conditions and the media used. Three dogs living in the households of 2 of these 6 patients had C. upsaliensis isolated in their stool specimens.

[Genotypic exploration of a hospital neonatal outbreak due to Klebsiella pneumoniae producing extended-spectrum-betalactamase]

BACKGROUND

The aim of the study was to explore nosocomial neonatal outbreak of Klebsiella pneumoniae producing extended-spectrum-betalactamase by macrorestriction genotyping.

PATIENTS AND METHODS

Over a 25 days period, a hospital neonatal outbreak due to Klebsiella pneumoniae producing extended-spectrum-betalactamase affected 14 newborn infants admitted to a university hospital in Sousse (Tunisia). We collected 21 strains of Klebsiella pneumoniae producing extended-spectrum-betalactamase. Susceptibility testing to 17 antibiotics was determined. Macrorestriction genotyping of strains was determined by pulsed-field-electrophoresis. Neonatal intensive care unit survey was undertaken.

RESULTS

A macrorestriction genotyping subdivided 21 strains into 3 clonally groups. Only cefoxitin, colistin, imipenem, amikacin and quinolons were active on the whole of strains. All infected babies died. The hygiene insufficiency and contamination of transfusion products at the time of their dividing in neonatal intensive care unit were incriminated. Handholding due to work overcharge was the main cause of bacterial diffusion.

CONCLUSION

Multiclonal outbreak of Klebsiella pneumoniae producing extended-spectrum-betalactamase appeared following hygiene insufficiency related to work overcharge.

[Clinical and biological surveillance after radiotherapy for localized prostate cancer]

Serum PSA is an excellent marker of disease status after external beam radiotherapy or brachytherapy for patients with prostate carcinoma. A low PSA nadir < or = 1 even < or = 0.5 ng/mL has been shown to be as a surrogate end point for disease control. Three successive increases of this marker after achieving the nadir defines recurrence as recommended by the American Society for Therapeutic Radiology and Oncology. The biochemical relapse or PSA failure after treatment precedes clinical disease relapse by several months. PSA profile or kinetics may have implications for patterns of failure and prognosis. Prostate post-radiotherapy biopsies should not be part of routine follow-up as its interpretation is frequently problematic. Other exams should not be performed unless clinical symptoms are present. Post-radiotherapy relapse treatment has generally no curative intent.

Ethanol consumption alters electroretinograms and depletes neural tissues of docosahexaenoic acid in rhesus monkeys: nutritional consequences of a low n-3 fatty acid diet

BACKGROUND

Alcohol amblyopia is a rare neuropathy characterized by the development of blurred vision and a reduction in visual acuity. Further diagnostic details of this condition have shown abnormalities in the electroretinogram (ERG) that include an increase in implicit times in the a- and b-waves and a depression of b-wave amplitude.

METHODS

Periodically, the ERGs and the fatty acyl composition of nervous tissue were analyzed from alcohol-consuming rhesus monkeys (Macaca mulatta) (mean consumption 2.6 g kg/day over a 5-year period) and controls that were maintained on a nutritionally sufficient diet that had low, yet adequate, amounts of linoleic acid but very low alpha-linolenic acid.

RESULTS

Animals consuming alcohol had increased a- and b-wave implicit times and decreased b-wave amplitudes in their electroretinograms compared with those of the dietary control group at 2.5 and 5 years. The fatty acyl composition of brain specimens obtained by surgical biopsy at baseline, 2.5 years, and 5 years demonstrated that docosahexaenoic acid (DHA) had decreased in both groups of animals compared with baseline values. In the brains of the alcohol-treated animals, DHA was even further decreased (2.5 years: -20%; 5 years: -33%) compared with the diet controls. In the retinas of the alcohol-consuming animals at 5 years, there was a similar decrease in DHA (-35%) compared with controls. Generally, the n-6 fatty acid, docosapentaenoic acid (DPAn-6) increased in these tissues, apparently compensating for the loss of DHA.

CONCLUSIONS

A reciprocal change in the DHA/DPAn-6 ratio is known to be associated with abnormal electroretinograms in a number of species. Thus, a marginal intake of n-3 fatty acids in some alcohol abusers may, in part, be responsible for the biochemical changes that underlie the diminished retinal function associated with the visual abnormalities observed in alcohol-amblyopic patients.

Chronic nutritional deprivation of n-3 alpha-linolenic acid does not affect n-6 arachidonic acid recycling within brain phospholipids of awake rats

Using an in vivo fatty acid model and operational equations, we reported that esterified and unesterified concentrations of docosahexaenoic acid (DHA, 22 : 6 n-3) were markedly reduced in brains of third-generation (F3) rats nutritionally deprived of alpha-linolenic acid (18 : 3 n-3), and that DHA turnover within phospholipids was reduced as well. The concentration of docosapentaenoic acid (DPA, 22 : 5 n-6), an arachidonic acid (AA, 20 : 4 n-6) elongation/desaturation product, was barely detectable in control rats but was elevated in the deprived rats. In the present study, we used the same in vivo model, involving the intravenous infusion of radiolabeled AA to demonstrate that concentrations of unesterified and esterified AA, and turnover of AA within phospholipids, were not altered in brains of awake F3-generation n-3-deficient rats, compared with control concentrations. Brain DPA-CoA could be measured in the deprived but not control rats, and AA-CoA was elevated in the deprived animals. These results indicated that AA and DHA are recycled within brain phospholipids independently of each other, suggesting that recycling is regulated independently by AA- and DHA-selective enzymes, respectively. Competition among n-3 and n-6 fatty acids within brain probably does not occur at the level of recycling, but at levels of elongation and desaturation (hence greater production of DPA during n-3 deprivation), or conversion to bioactive eicosanoids and other metabolites.