Chemoresistance in gastric-type mucinous adenocarcinoma of the uterine cervix: Multi-institutional study by Sankai Gynecology Study Group (SGSG)

5526

Background: Gastric-type adenocarcinoma (GAS) is a novel variant of mucinous adenocarcinoma of the uterine cervix, characterized by aggressive clinical behavior and absence of high risk HPV detection. However, the cause of its aggressive nature remains unknown. Methods: We have evaluated the chemosensitivity of GASs, which were diagnosed by central pathological review of cases enrolled in the phase II study of neoadjuvant chemotherapy with docetaxel and carboplatin for stage Ib2 to IIb non-squamous cervical cancer (SGSG-005) as an advance study. Results: In a total of 47 cases enrolled in the study, 20 (42.6%), 13 (27.7%), and 12 (25.5%) tumors were diagnosed as usual-type endocervical adenocarcinoma (UEA), GAS, and adenosquamous carcinoma, and each one (2%) as small cell carcinoma and serous adenocarcinoma, respectively. Response rate of UEA and GAS to the protocol was 85.0% and 46.2%, respectively (p = 0.018). Among 47 patients, 33 (70.2%) were assigned FIGO stage II, and 31 of these patients underwent surgery, while remaining 2 were inoperable because of progressive disease or intraabdominal dissemination. By microscopic examination of radical hysterectomy specimens, 12 of 14 (80%) UEAs were down-staged, whereas none of 6 (0%) GASs showed any response with residual vaginal and/or parametrial invasion even after chemotherapy (P<0.001). Two inoperative tumors were GAS. Median follow-up duration was 41 months with a range of 10-65 months. The 3-years progression-free survival rate in cases of UEA and GAS were 73.7% and 35.9%, respectively (p = 0.023), and 3-years overall survival rate were 88.9% and 51.9%, respectively (p <0.001). Conclusions: Our data suggests that GAS is distinguished from UEA by chemoresistance, which appears to be an intrinsic nature of this particular tumor. Alternative treatment strategy should be established for GAS. Clinical trial information: 000000560.

A phase I/II study of multiple peptides cocktail vaccine for advanced/recurrent ovarian cancer

TPS3116

Background: Despite improvement in chemotherapy including the molecular targeting agents, advanced or recurrent ovarian cancer (A/ROC) are still incurable. Some tumor associated proteins, hypoxia-inducible protein 2 (HIG2), and tumor related vascular endothelial growth factor receptor 1,2 (VEGFR1,VEGFR2) were found to be candidates as new targets, and their epitope peptides have been shown to have the ability to induce specific cytotoxic T lymphocyte ( CTL) responses. We conducted a phase I/II study of these peptides cocktail vaccine (PCV) in patients with A/ROC in order to evaluate toxicity, immunological response, and tumor response. Methods: 23 patients positive for human leukocyte antigen (HLA)-A2402 (A24) and 15 patients with HLA-A0201(A02) were enrolled in this study. Enrollment is still on going up to 30 evaluable patients in each group. PCV for A24 comprises FOXM1(Forkhead Box M1), MELK(maternal embryonic leucine zipper kinase), HJURP(Holliday junction recognition protein), VEGFR1 and VEGFR2. As for A02- PCV comprises HIG2, VEGFR1and VEGFR2. Cocktails were made at a dose of 1mg of each peptide with GMP grade-adjuvant, MONTANIDE ISA51. Vaccination schedule included weekly subcutaneous administration for first 12 weeks, then bi-weekly administration for next 16 weeks, then further vaccination was done monthly for 8 times and 3-6 months as a maintenance step according to patient’s need. Pre- and post-vaccination blood samples were obtained from the patients for toxicity assessment and immunological evaluation. Clinical responses were evaluated every three months by RECIST v 1.1. Results: PCV were generally well tolerated with no major adverse events, and most of the patients developed specific CTL responses. One patient showed complete response, two showed partial response and 10 showed stable disease in 22 evaluable patients. At the time of the analysis, median overall survival was 5 months (from 30 to 623 days) and 9 months(from 54 to 921 days),in A24 and A02, respectively. 11 patients remained alive with median follow up of 9 months. Conclusions: These findings suggest these peptides cocktail vaccines are safe and applicable for advanced/recurrent ovarian cancer. Clinical trial information: UMIN000003862, UMIN000003860.

Neoadjuvant chemotherapy using platinum- and taxane-based regimens for bulky stage Ib2 to IIb non-squamous cell carcinoma of the uterine cervix

PURPOSE

There are no reports on the use of neoadjuvant chemotherapy (NAC) in non-squamous cell cervical carcinoma. We examined the effectiveness and safety of paclitaxel/carboplatin (TC) and docetaxel/carboplatin (DC).

METHODS

Stage Ib2 to IIb disease was present in 23 patients scheduled for radical hysterectomy. We administered 1-3 courses of either the TC or the DC regimen. Anti-tumor effects were found superior by Response Evaluation Criteria in Solid Tumors. Safety was assessed with National Cancer Institute Common Terminology Criteria for Adverse Events.

RESULTS

Median age was 50 years (range 32-63 years), with stage Ib2 in 6 cases (26.1%) and IIb in 17 cases (73.9%). Complete response was achieved in 5 cases (21.7%), partial response in 13 (56.5%), stable disease in 5 (21.7%); the response rate was 78.3%, and surgery completion rate was 78.3%. Leukopenia or neutropenia ≥grade 3 was seen in 12 (52.2%) and 21 (91.3%) cases, respectively, with grade 3 febrile neutropenia in 2 cases (8.7%) and no anemia or thrombocytopenia ≥grade 3. Median progression-free survival was 26 months (95% Cl, 13.5-38.5 months); median overall survival was 35 months (95% Cl, 20.9-49.1 months).

CONCLUSION

NAC for non-squamous cell cervical carcinoma showed potent anti-tumor effects and manageable adverse events.

Olfactory discriminating ability of lacustrine sockeye and masu salmon in various freshwaters

In order to study the olfactory discriminating ability of lacustrine sockeye salmon (Oncorhynchus nerka) and masu salmon (O. masou), the integrated olfactory nerve response to various freshwaters was recorded by electrophysiological techniques. In both species independent of sex and gonadal maturity, each freshwater caused a different olfactory response. Source and effluent waters of the culture pond at Toya Lake Station (the source and culture pond waters) evoked the minimum and maximum response magnitude, respectively. In cross-adaptation experiments, the culture pond water abolished all secondary responses to other freshwaters, and no freshwater abolished the secondary response to the culture pond water. The concentration response study revealed that the minimum concentration (threshold) to induce response to the culture pond water after adaptation to Lake Toya water was between 0.1 and 1.0%. The present study indicates that the olfactory organ of lacustrine salmonids may discriminate different intensities of various freshwater odors.

Are platinum agents, paclitaxel and irinotecan effective for clear cell carcinoma of the ovary? DNA damage detected with γH2AX induced by anticancer agents

Objectives

Differences in the incidences and types of DNA damage induced by antitumor agents for clear cell carcinoma (CCC) were determined in 2 ovarian CCC cell lines using γH2AX.

Material and methods

The antitumor activity of anticancer agents, CDDP, CBDCA, PTX and SN-38, was examined using ovarian clear cell carcinoma cultured cell lines (OVISE and RMG-I). After culture, each cell line was treated with each anticancer agent, the cells were collected, fixed, and then reacted with the anti-γH2AX antibody. γH2AX and nuclear DNA were then simultaneously detected by flow cytometry using FITC and propidium iodide, respectively, to determine γH2AX in each cell cycle phase.

Results

After administration of CDDP, DNA damage was frequent in S-phase cells, while cell-cycle arrest occurred in the G1 and G2/M phases and γH2AX did not increase in CDDP-resistant cells. Sensitivities to CDDP and CBDCA differed between the two cell lines. The antitumor effect of PTX is induced by G2/M arrest, and combination treatment with CBDCA, inducing DNA damage in G2/M-phase cells, might be effective.

Conclusions

This is the first study in Japan to evaluate the antitumor activity of anticancer agents by focusing on the relationship between the cell cycle and DNA damage using γH2AX as an indicator. The immunocytochemical method used in this study detects γH2AX, which indicates DNA damage even at very low concentrations and with high sensitivity. Therefore, a promising method of easily and rapidly identifying agents potentially effective against CCC.

Neoadjuvant chemotherapy of docetaxel and carboplatin in patients with stage Ib2 to IIb nonsquamous cervix cancer of the uterus

5103

Background: Non-squamous carcinoma of the uterine cervix has a resistance to radiation therapy and chemotherapy, and this is associated with worse prognosis compared with squamous carcinoma. This is a phase II study to assess an efficacy and safety of neoadjuvant chemotherapy of docetaxel and carboplatin (DC therapy) in patients with stage Ib2 to II non-squamous cervix cancer of the uterus. Methods: Patients with histologically confirmed, stage Ib2-II non-squamous uterine cervix cancer were received DC therapy prior to type III radical hysterectomy. IV doceaxel was administered at 60 mg/m2 followed by IV carboplatin administration based on AUC=6. The treatment was repeated every 21 days for a total of 1 to 3 cycles. Surgery was performed as soon as sufficient response was obtained. Results: Fifty-three women with non-squamous cervical carcinoma (FIGO stage Ib2,15; IIa, 7; IIb, 31) received DC therapy. Median age and tumor size were 49 years old (range: 27-71) and 52mm (range: 10-92), respectively. Fourty of 47 patients (74%) received 2 cycles of chemotherapy. Clinical response occurred in 69.8% of patients (complete response, 5; partial response, 32; stable disease, 15; disease progression, 1), and 96% (52/54) of patients completed the surgery. Incidences of grade 3/4 hematological toxicities were 98% (53/54) for neutrocytopenia, 4% (2/54) for thrombocytopenia, and 9% (5/54) for anemia. Febrile neutropenia was observed in three patients. Observed grade 3/4 non-hematological toxicities included were 5 for nausea, 2 for vomiting, 3 for constipation, 4 for allergic reaction. Median follow-up duration was 860 days with a range of 147- 1635 days. The 2-years progression-free survival rate and 2-years overall survival rate were 63% and 79% in stage IB2, 71% and 86% in stage IIA2, and 67% and 86% in stage IIB, respectively.Twenty patients recurred and twelve patients died. Conclusions: Neoadjuvant chemotherapy using DC therapy was well tolerated and had good response. It seems to be benefical in patients with satge Ib2 to II nonsquamous cervical cancer.

Case of peptide-YY-producing strumal carcinoid of the ovary: a case report and review

Ovarian carcinoid is a rare tumor accounting for approximately 0.1% of all ovarian malignancies. We describe a case of peptide-YY-producing strumal carcinoid of the ovary associated with severe constipation. A 48-year-old woman was found to have a pelvic mass on ultrasonography when she visited her primary doctor for a health check-up. She was thus referred to our department. Magnetic resonance imaging revealed a solid right ovarian tumor 60 × 50 mm in size. The patient underwent a right adnexectomy and was histopathologically diagnosed as having strumal carcinoid of the ovary. On immunohistochemical examination, the tumor cells were positive for peptide YY. The patient's constipation resolved rapidly after surgery. Based on her clinical course, her constipation was considered to have been caused by the strumal carcinoid of the ovary. The clinical course of this case supports the previously recognized correlation between peptide-YY-producing ovarian carcinoid and constipation.

A close-coupling multi-antenna type radio frequency driven ion source

A newly close coupling multi-antenna type radio frequency driven ion source is tested for the purpose of essentially improving plasma coupling on the basis of our old type ion source, which reuses a NNBI (negative ion source for neutral beam injection) ion source used in 1∕5th scale of the Large Helical Device NNBI. The ion source and the antenna structure are described, and the efficient plasma production in terms of the positive ion saturation current (the current density) is studied. The source is made of a metal-walled plasma chamber which is desirable from the point of view of the structural toughness for fusion and industrial application, etc. At around 160 kW of rf input power, the ion saturation current density successfully reaches the 5 A∕cm(2) level with a gas pressure of 0.6-2 Pa in hydrogen for 10 ms pulse duration. The rf power efficiency of the plasma production with a close coupling configuration of the antenna is improved substantially compared to that with the previous antenna unit in the old type ion source. The power efficiency is assessed as competing with that of other types of sources.

Efficacy of neoadjuvant chemotherapy followed by radical hysterectomy in locally advanced non-squamous carcinoma of the uterine cervix: a retrospective multicenter study of Tohoku Gynecologic Cancer Unit

OBJECTIVE

Radical hysterectomy (RH) is a standard treatment for locally advanced non-squamous cell carcinoma (N-SCC) of the uterine cervix, but there have been no reports on whether neoadjuvant chemotherapy (NAC) followed by radical hysterectomy could improve the outcome of patients with this disease.

MATERIALS AND METHODS

This multicenter retrospective study enrolled 77 patients with Stage IB2 to IIB N-SCC of the uterine cervix. Of these, 27 patients were treated with NAC prior to radical hysterectomy (NAC group) and 50 with RH alone (RH group). The two-year recurrence-free survival (RFS) rate, progression-free survival (PFS), and overall survival (OS) were compared between the two groups. Clinical parameters such as clinical stage, histological type, and postoperative treatment were also examined between the groups.

RESULTS

While the two-year RFS rates were 81.5% and 70.0% in NAC and RH groups, respectively (p = 0.27) and the median PFS was 51 months and 35 months in NAC and RH groups, respectively (p = 0.35), the median OS was 58 months and 48 months in NAC and RH groups, respectively, which was significant (p = 0.0014). The median OS of patients with mucinous adenocarcinoma in NAC group was significantly higher than that in RH group: 58 months versus 37 months (p = 0.03).

CONCLUSION

NAC prior to RH may offer the prognostic advantage of patients with locally advanced N-SCC of the uterine cervix, especially mucinous adenocarcinoma.

Water irradiation by high-frequency ultrasonic wave: effects on properties of passive film formed on stainless steel

In this paper an aqueous solution was irradiated with a 1.63MHz ultrasonic wave. It is shown that if stainless steel can passivate under dynamic polarization in this medium, under static polarization, the latter does not show any repassivation behaviour with time. This is attributed to a diminution of the diffusion layer thickness that is developed at the electrode/electrolyte interface, which is associated with a production of H(2) species by sonolysis and which maintains reductive conditions at the interface. The oxide film formed under ultrasonic irradiation for 1h at a passive potential of+0.2V(SCE) shows an early stage of passivation and an increased disordered state, which implies a considerable decrease in the corrosion resistance behaviour of the sample. The polarization resistance of the stainless steel R(p) is divided by a value of 4.5 under ultrasonic conditions.

Objective evaluation of the alleviating effects of Goshajinkigan on peripheral neuropathy induced by paclitaxel/carboplatin therapy: A multicenter collaborative study

Paclitaxel/carboplatin chemotherapy for cancer (TC therapy) exhibits neurotoxicity and causes peripheral neuropathy at a high frequency, which is difficult to cope with. In this study, we investigated the efficacy of Goshajinkigan, a traditional Japanese herbal medicine, for TC therapy-induced peripheral neuropathy. The subjects included in our study were patients with ovarian or endometrial cancer who underwent TC therapy and developed peripheral neuropathy. The patients were randomly divided into Group A, comprising of 14 patients (vitamin B12 treatment), and Group B, comprising of 15 patients (vitamin B12 + Goshajinkigan treatment). The observation period was 6 weeks following treatment initiation, and the evaluation items were as follows: i) the current perception threshold (CPT value) of the peripheral nerve, ii) visual analogue scale for numbness, iii) National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 grade of neurotoxicity, and iv) a questionnaire on the subjective symptoms of peripheral neuropathy (functional assessment of cancer therapy-taxane). These were compared between the groups and no significant differences were noted in any item. However, CTCAE grade 3 neurotoxicity developed in 2 patients (14.3%) after 6 weeks of administration in Group A, whereas no neurotoxicity was observed in Group B. When the change in the frequency of abnormal CPT ratio at 6 weeks of administration from that before treatment was compared between the groups, the frequency of abnormal value was significantly lower in Group B than in Group A (p<0.05). This suggests that Goshajinkigan inhibits the progression of peripheral neuropathy.

Do type 2 diabetes patients without diabetic retinopathy or subjects with impaired fasting glucose have impaired colour vision? The Okubo Color Study Report

AIMS

To investigate associations between fasting plasma glucose level and the prevalence of acquired colour vision impairment in type 2 diabetes patients without diabetic retinopathy.

METHODS

Participants in this cross-sectional study of male officials aged 20-60 yr in the Japanese Self Defence Force, underwent colour vision testing, ophthalmic examination, a standardized interview and examination of venous blood samples. Ishihara plates, a Lanthony 15-hue desaturated panel and Standard Pseudoisochromatic Plates Part 2 were used to examine colour vision. The Farnsworth-Munsell 100-hue test was performed to define acquired colour vision impairment. Cardiovascular disease risk factors were determined from serum blood samples, physical records and an interview. We performed logistic regression analysis adjusted for age, diagnosed hypertension, dyslipidaemia, cataract, glaucoma, being overweight, smoking status and alcohol intake. Crude and adjusted odds ratios were calculated for three glucose levels, which included normal fasting glucose, impaired fasting glucose and diabetes.

RESULTS

Out of a total of 1042 men enrolled, 872 were eligible for the study, and 31 were diagnosed with acquired colour vision impairment. As compared with the subjects with normal fasting glucose (< 5.6 mmol/l), the crude odds ratio for acquired colour vision impairment was 0.93 (95% CI 0.32-2.74) for the subjects with impaired fasting glucose (5.6-6.9 mmol/l) and 8.07 (95% CI 2.48-26.22) for the patients with type 2 diabetes. The multiple-adjusted odds ratios were 0.77 (95% CI 0.25-2.34) for the subjects with impaired fasting glucose and 5.89 (95% CI 1.55-22.40) for the patients with type 2 diabetes.

CONCLUSIONS

Our findings suggest that there is a dramatically increased prevalence of acquired colour vision impairment in type 2 diabetes patients without diabetic retinopathy which might be attributable to another pathogenesis associated with diabetic retinopathy.

Less maintenance immunosuppression in lung transplantation following hematopoietic stem cell transplantation from the same living donor

Living-donor lobar lung transplantation (LDLLT) is one of the final options for saving patients with pulmonary complications after hematopoietic stem cell transplantation (HSCT). We retrospectively investigated 19 patients who had undergone LDLLT after HSCT in Japan. Eight patients underwent LDLLT after HSCT in which one of the donors was the same living donor as in HSCT (SD group), while 11 received LDLLT from relatives who were not the HSCT donors (non-SD group). In the SD group, three patients underwent single LDLLT. The 5-year survival rate was 100% and 58% in the SD and non-SD groups, respectively. In the SD group, postoperative immunosuppression was significantly lower than in the non-SD group. Two patients died of infection and one died of post-transplant lymphoproliferative disease (PTLD) in the non-SD group, while only one patient died of PTLD 7 years after LDLLT in the SD group. Hematologic malignancy relapsed in two patients in the non-SD group. For the three single LDLLTs in the SD group, immunosuppression was carefully tapered. In our study, LDLLT involving the same donor as for HSCT appeared to have advantages related to lower immunosuppression compared to LDLLT from relatives who were not the HSCT donors.