Plasma Epstein-Barr virus DNA level strongly predicts survival in metastatic/recurrent nasopharyngeal carcinoma treated with palliative chemotherapy

BACKGROUND

Plasma Epstein-Barr virus (EBV) DNA is widely used in screening, monitoring, and prediction of relapse in nonmetastatic nasopharyngeal carcinoma (NPC). However, data regarding utility of plasma EBV DNA in metastatic NPC are rare. The current study was to test the prognostic implication of plasma EBV DNA level in metastatic/recurrent NPC patients treated with palliative chemotherapy.

METHODS

Plasma EBV DNA level was measured at baseline and thereafter at the start of each treatment cycle in 127 histologically proven metastatic/recurrent NPC patients treated with palliative chemotherapy. Correlations of pre-treatment and post-treatment plasma EBV DNA levels to survival and response were analyzed.

RESULTS

Patients with a low pre-treatment plasma EBV DNA level (<median) had significantly better survival than those with a high pre-treatment plasma EBV DNA level (≥median). Patients with a post-treatment plasma EBV DNA decline to an undetectable level had better survival and better tumor response compared with those with a sustained detectable post-treatment plasma EBV DNA level. The early decrease of post-treatment plasma EBV DNA to an undetectable level after 1 cycle of chemotherapy was associated with significantly increased survival. Patients with low pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA showed a favorable prognosis (5-year overall and progression-free survival of 50.6% and 21.7%, respectively).

CONCLUSIONS

Plasma EBV DNA is of predictive value for prognosis in metastatic/recurrent NPC patients undergoing palliative chemotherapy. The pre-treatment plasma EBV DNA level as well as the early decrease of plasma EBV DNA after chemotherapy enabled easy and early discrimination between patients who will and those who will not benefit from continued treatment.

Elevated neutrophil to lymphocyte ratio predicts survival in advanced pancreatic cancer

BACKGROUND

Elevated neutrophil to lymphocyte ratio (NLR) is linked with worse survival in many malignancies, whereas its association with pancreatic cancer (PC) remains unclear.

METHODS

We retrospectively reviewed 95 patients with locally advanced or metastatic PC receiving gemcitabine-based chemotherapy. The prognostic value of NLR was evaluated.

RESULTS

Elevated pretreatment NLR (> 5) was observed in 16 out of 89 eligible patients, which was identified as an independent prognostic factor for overall survival (OS). The median OS for patients with elevated and normal NLR were 2.4 months and 7.7 months, respectively (p < 0.001).

CONCLUSIONS

Elevated NLR is a predictor of shorter survival in patients with advanced PC.

Beclin 1 expression: a predictor of prognosis in patients with extranodal natural killer T-cell lymphoma, nasal type

Beclin 1 plays an important role in autophagy, differentiation, antiapoptosis and the development and progression of cancer. The function and expression of Beclin 1 in natural killer T-cell lymphoma is largely unexplored. The study aimed to investigate Beclin 1 expression and its relationship with prognosis in extranodal natural killer T-cell lymphoma, nasal type (EN KL). Beclin 1 protein expression in 65 tumor specimens from patients newly diagnosed with EN KL was examined by immunohistochemistry (IH C). The clinical significance of Beclin 1 in EN KL was statistically analyzed. Immunopositivity for Beclin 1 was found in 56 (86.2%) of the 65 samples. Low Beclin 1 expression was significantly associated with advanced Ann Arbor stage, intermediate to high IPI risk and elevated LDH level. Low Beclin 1 expression was associated with worse overall survival (OS; p = 0.001) and progression-free survival (PFS; p = 0.017). In multivariate analysis, Beclin1 expression, advanced Ann Arbor stage and B symptoms were found to be independent prognostic factors of OS and PFS. Consequently, a new clinico-pathological prognostic model was proposed. The model could discriminate different survival outcomes between low risk and high risk groups based on OS and PFS (p < 0.0001, respectively). Beclin1 expression is predictive of prognosis in EN KL. The new clinico-pathological prognostic model may be help identify patients with different clinical outcomes.

Molecular characterization and phylogenetic analysis of a yak (Bos grunniens) κ-casein cDNA from lactating mammary gland

κ-Casein is one of the major proteins in the milk of mammals. It plays an important role in determining the size and specific function of milk micelles. We have previously identified and characterized a genetic variant of yak κ-casein by evaluating genomic DNA. Here, we isolate and characterize a yak κ-casein cDNA harboring the full-length open reading frame (ORF) from lactating mammary gland. Total RNA was extracted from mammary tissue of lactating female yak, and the κ-casein cDNA were synthesized by RT-PCR technique, then cloned and sequenced. The obtained cDNA of 660-bp contained an ORF sufficient to encode the entire amino acid sequence of κ-casein precursor protein consisting of 190 amino acids with a signal peptide of 21 amino acids. Yak κ-casein has a predicted molecular mass of 19,006.588 Da with a calculated isoelectric point of 7.245. Compared with the corresponding sequences in GenBank of cattle, buffalo, sheep, goat, Arabian camel, horse, and rabbit, yak κ-casein sequence had identity of 64.76-98.78% in cDNA, and identity of 44.79-98.42% and similarity of 53.65-98.42% in deduced amino acids, revealing a high homology with the other livestock species. Based on κ-casein cDNA sequences, the phylogenetic analysis indicated that yak κ-casein had a close relationship with that of cattle. This work might be useful in the genetic engineering researches for yak κ-casein.

Elevated neutrophil to lymphocyte ratio predicts poor prognosis in nasopharyngeal carcinoma

Elevated neutrophil to lymphocyte ratio (NLR) has been reported to be associated with worse survival in many malignancies, whereas its role in nasopharyngeal carcinoma (NPC) remains unclear. We retrospectively reviewed 363 consecutively, newly diagnosed, non-disseminated, and biopsy-proven NPC patients. Disease-specific survival (DSS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRFS) rates were compared according to NLR level. Multivariate analysis was performed to assess the prognostic value of NLR. The 5-year DSS, DMFS, and LRFS rates for patients with elevated or non-elevated NLR (> or ≤3.73) were 59.6% vs. 76.6% (p = 0.03), 69.7% vs. 86.6% (p = 0.002), and 78.5% vs. 87.3% (p = 0.105), respectively. For patients with locoregionally advanced disease, NLR was not only an independent prognostic factor, but also a predictor of response to chemoradiotherapy. The 5-year DSS, DMFS, and LRFS rates for patients with elevated or non-elevated NLR were 47.2% vs. 73.7% (p < 0.001), 59.2% vs. 85.1% (p < 0.001), and 72.3% vs. 84.6% (p = 0.041), respectively. Compared with radiation alone, chemoradiotherapy significantly improved DSS and LRFS for patients with non-elevated NLR, but not for those with elevated NLR. Pre-treatment NLR is a strong prognostic factor for NPC patients. For patients with locoregionally advanced disease, NLR might also be a useful indicator for selection of treatment strategies.

Absolute lymphocyte count is a novel prognostic indicator in extranodal natural killer/T-cell lymphoma, nasal type

BACKGROUND

extranodal natural killer (NK)/T-cell lymphoma (ENKL) is a heterogeneous entity with poor survival, requiring risk stratification in affected patients. We proposed absolute lymphocyte count (ALC) as a new prognostic factor in ENKL.

PATIENTS AND METHODS

we retrospectively analyzed 128 patients newly diagnosed with ENKL. Independent prognostic factors of survival were determined by Cox regression analysis.

RESULTS

patients with low ALC (<1.0 × 10(9)/l) at diagnosis tended to have more adverse clinical features. Patients with high ALC (≥1.0 × 10(9)/l) at diagnosis had better overall survival (OS; P < 0.0001) and progression-free survival (PFS; P<0.0001), and achieved higher complete remission rates (P=0.001). Multivariate analysis with known prognostic factors showed that ALC, B symptoms and advanced stage were independent predictors for OS and PFS. Using the International Prognostic Index, Prognostic Index for Peripheral T-cell lymphoma unspecified, or Korean Prognostic Index for nasal NK/T-cell lymphoma, the majority of patients were in the low-risk category (with no or one adverse factor). ALC was helpful to differentiate the low-risk patients with different survival outcomes (P < 0.0001).

CONCLUSIONS

our data suggest that ALC at diagnosis is a novel, powerful predictor of prognosis in ENKL. Immune status at diagnosis might have an important influence on survival in patients with ENKL.

Carcinoembryonic antigen surge in metastatic colorectal cancer patients responding to irinotecan combination chemotherapy

BACKGROUND AND OBJECTIVE

Oxaliplatin (OXA)-induced carcinoembryonic antigen (CEA) surge was reported to be associated with a clinical benefit. The aim of this study was to investigate the phenomenon of CEA surge in irinotecan-based chemotherapy.

METHODS

We retrospectively reviewed 132 patients with metastatic colorectal cancer treated with irinotecan-based chemotherapy. Incidence of a CEA surge and chemotherapy efficacy were investigated.

RESULTS

Eleven of 99 eligible patients (11.1%) had CEA surges. None of the 11 patients showed progressive disease (four had a partial response, seven had stable disease).

CONCLUSION

A CEA surge can be induced by irinotecan-based chemotherapy. An early increase in CEA after irinotecan-based chemotherapy does not usually indicate progression of disease and failure of therapy, and should not lead to a change of chemotherapy.

Characterization of the GHR gene genetic variation in Chinese indigenous goat breeds

The aim of the present work was to investigate single nucleotide polymorphism (SNP) of growth hormone receptor (GHR) gene exon 10, characterize the genetic variation in three Chinese indigenous goat breeds, and search for its potential association with cashmere traits. In this study, a polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) protocol has been developed for rapid genotyping of the GHR gene in goats. One hundred seventy-eight goats from Liaoning Cashmere (96), Inner Mongolia White Cashmere (40), and Chengdu Grey (42) breeds in China were genotyped at GHR locus using the protocol developed. In all goat breeds investigated, a SNP in exon 10 of GHR gene has been identified by analyzing genomic DNA. The polymorphism consists of a single nucleotide substitution A → G, resulting in two alleles named, respectively, A and G based on the nucleotide at the position. The allele A was found to be more common in the animals investigated, and seems to be more consistent with cattle and zebu at this polymorphic site found in goats. The Hardy-Weinberg equilibrium of genotype distributions of GHR locus was verified in Liaoning Cashmere, and Inner Mongolia White Cashmere breeds. According to the classification of polymorphism information content (PIC), Chengdu Grey was less polymorphic than Liaoning Cashmere and Inner Mongolia White Cashmere breeds at this locus. The phylogenetic tree of different species based on the nucleotide sequences of GHR gene exon 10 is generally in agreement with the known species relationship. No significant association was found between the polymorphism revealed and the cashmere traits analyzed in present work.

Hypertonic saline ameliorates cerebral edema through downregulation of aquaporin-4 expression in the astrocytes

Osmotherapy with 10% hypertonic saline (HS) alleviates cerebral edema through osmotic force. Aquaporin-4 (AQP4) has been reported to be implicated in the pathogenesis of cerebral edema resulting from a variety of brain injury. This study aimed to determine if 10% hypertonic saline ameliorates cerebral edema through downregulation of AQP4 expression in the perivascular astrocytes in the ischemic cerebral edema. Adult male Sprague-Dawley (SD) rats were subjected to permanent right-sided middle cerebral artery occlusion (MCAO) and treated with a continuous i.v. infusion of 10% HS. Brain water content (BWC) analyzed by wet-to-dry ratios in the ischemic hemisphere of SD rats was attenuated after 10% HS treatment. This was coupled with the reduction of neuronal apoptosis in the peri-ischemic brain tissue. Concomitantly, downregulated expression of AQP4 in the perivascular astrocytes after 10% HS treatment was observed. Our results suggest that in addition to its osmotic force, 10% HS exerts anti-edema effects possibly through downregulation of AQP4 expression in the perivascular astrocytes. The reduction of brain edema after 10% HS administration can prevent ischemic brain damage.

[Clinical significance of a transient increase in carcinoembryonic antigen and carbohydrate antigen 19-9 in patients with metastatic colorectal cancer receiving chemotherapy]

BACKGROUND AND OBJECTIVE

An increase in carcinoembryonic antigen (CEA) and/or carbohydrate antigen 19-9 (CA19-9) levels is generally considered as tumor progression in patients with metastatic colorectal cancer (MCRC). However, a transient CEA surge has been observed in patients with MCRC responding to chemotherapy. This study was to investigate the clinical significance of transient CEA/CA19-9 surges in Chinese MCRC patients.

METHODS

One hundred and twenty-one MCRC patients with histologically proven adenocarcinoma and baseline ECOG performance status of < or =2 were treated with oxaplatin and (or) irinotecan-based chemotherapy regimens. Serum CEA and CA 19-9 levels were measured before and after chemotherapy.

RESULTS

Of the 121 patients, 14 (11.6%) had transient CEA surges with median baseline CEA level of 45 microg/L (9.67-2208 microg/L) and median surge peak level of 80.1 microg/L (13.38-4044 microg/L). The transient CEA surge occurred at a median of 4 weeks (2-6 weeks), and lasted for a medium of 6.5 weeks (4-14 weeks). Of the 14 patients, 11 received oxaplatin-based chemotherapy; three received irinotecan-based chemotherapy. All the 14 patients showed clinical benefit from chemotherapy, among which seven achieved partial response and seven had stable disease. In the meantime, five patients (3.8%) had transient CA19-9 surges. However, no significant correlation was found between an increase in the CA19-9 level and clinical benefits.

CONCLUSIONS

Transient CEA surges can be observed in Chinese MCRC patients receiving oxaplatin or irinotecan-based chemotherapy, which does not indicate tumor progression, but good therapeutic efficacy. A transient elevation of CA19-9 is not correlated to short-term clinical benefits.

[Efficacy of FORFIRI regimen on oxaliplatin-based chemotherapy-failed advanced colorectal cancer]

BACKGROUND AND OBJECTIVE

Irinotecan (CPT-11), oxaliplatin, 5-fluorouracil (5-FU) and capecitabine are main active agents for advanced colorectal cancer. FORFIRI regimen is recommended for the patients who were treated with oxaliplatin plus 5-FU or capecitabine previously. This study was to investigate the efficacy and safety of FORFIRI regimen in treating advanced colorectal cancer failing to prior oxaliplatin-based chemotherapy, and analyze the impacts of clinical factors on the responses.

METHODS

A total of 90 patients with advanced colorectal adenocarcinoma, who had received prior adjuvant FOLFOX6 regimen and progressed within 12 months after the completion of therapy or had no response to prior FOLFOX6/CapeOX regimen as first-line therapy, were treated with FORFIRI regimen. The efficacy and adverse events were observed.

RESULTS

Of the 81 evaluable patients, two achieved complete remission, 20 achieved partial remission and 34 had stable disease. The overall response rate was 27.2% and disease control rate was 69.1%. The median time to progression was 6.8 months (95% CI, 4.9-8.8 months) and median overall survival time was 18.8 months (95% CI, 17.5-20.2 months). The main adverse events time were nausea, vomiting, neutropenia, alopecia, fatigue, impaired liver function, oral mucositis and diarrhea. Grade III adverse events included alopecia in 15 patients (16.7%), vomiting in 10 patients (11.1%), nausea in eight patients (8.9%), neutropenia in five patients (5.6%), impaired liver function in two patients (2.2%) and oral mucositis in two patients (2.2%).

CONCLUSION

FOLFIRI regimen is effective and well-tolerated as salvage therapy for advanced colorectal cancer failing to prior FOLFOX6/CapeOX regimen, and thus can be used widely.

Apogossypolone inhibits cell growth by inducing cell cycle arrest in U937 cells

We examined the effect of apogossypolone (ApoG2), a new derivative from gossypol on cell cycle regulation in U937 human leukemic monocyte lymphoma cells in vitro. ApoG2 decreased the viability of U937 cells by inducing G1 arrest followed by apoptosis in a dose-dependent manner. The G0/G1 phase of the cell cycle is regulated by cyclin-dependent kinases (Cdk), cyclins and cyclin-dependent kinase inhibitors (Cdki). We show by western blot analysis, that the ApoG2-induced G1 arrest was mediated through the increased expression of Cdki proteins (p21cip1/waf1) with a simultaneous decrease in cdk2, cdk4, cyclin D1 and cyclin E expression. The induction of apoptosis after treatment with ApoG2 for 12, 24 and 48 h was demonstrated by flow cytometry analysis. ApoG2 also induced cytochrome c release and activation of caspase-3. To our knowledge, this is the first time that ApoG2 has been reported to potently inhibit the proliferation of human monocytic lymphoma U937 cells through G1 arrest. These findings suggest that ApoG2 may be a potential chemotherapeutic agent for the treatment of cancer.

Rapid detection of bovine milk in yak milk using a polymerase chain reaction technique

Yak milk contains a greater percentage of protein and has better quality than bovine milk. There has been an increasing focus on yak milk and milk products during the last few years. In the present study, a PCR-based assay was developed for the specific identification of bovine milk in yak milk by designing 3 primers targeting the mitochondrial ND1 gene. The use of 3 primers in a single PCR reaction set yielded 2 amplification fragments of 293 and 190 bp from bovine milk DNA, whereas only 1 amplification fragment of 293 bp was obtained in yak milk DNA. The technique was applied to raw and heat-treated binary mixtures of yak and bovine milks and enabled the specific detection of bovine milk with a detection limit of 0.1%. The assay developed is sensitive, fast, and straightforward, and it might be useful in the quality control of yak milk and milk products.

Prognostic value of serum CA19-9 in patients with advanced pancreatic cancer receiving gemcitabine based chemotherapy

BACKGROUND AND OBJECTIVE

Gemcitabine is used as an effective drug for patients with advanced pancreatic cancer. Serum CA19-9 has been proven as the most sensitive and specific serum marker for pancreatic cancer. This study was to investigate the value of serum CA19-9 in evaluating treatment efficacy and predicting prognosis of patients with pancreatic cancer treated by gemcitabine-based chemotherapy.

METHODS

Seventy-one patients with histologically confirmed, locally advanced or metastatic pancreatic adenocarcinoma, whose karnofsky's performance status (KPS) score was >or= 70 were treated with gemcitabine alone or with gemcitabine-based chemotherapy. CA19-9 was measured before and after chemotherapy.

RESULTS

Ten out of 71 patients had normal baseline CA19-9 levels, and 61 patients had increased baseline CA19-9 levels. The overall survival of patients were similar between the two groups, which were 9.0 months and 7.9 months respectively (P=0.797). The median baseline CA19-9 level for patients who had increased CA19-9 was (682+/-558) U/mL before treatment. Patients whose pretreatment CA19-9 levels were <682 U/mL achieved better survival than those whose pretreatment CA19-9 levels were >or=682 U/mL (9.6 months vs. 5.1 months, p=0.001). In addition, patients with a pretreatment CA19-9 level of <682 U/mL also had a better tumor response (43.5% vs. 15.8%, p=0.051) and clinical benefit response (48.1% vs. 29.2%, P=0.125) than those whose pretreatment CA19-9 level was <682 U/mL, but the differences were not significant. Patients with a fall of >or=25% in the baseline CA19-9 level after chemotherapy achieved a longer median overall survival (10.2 months vs. 5.0 months, p<0.001), better tumor response (47.8% vs. 10.5%, p=0.002) and better clinical benefit response (69.2% vs. 8.0%, P=0.000) than those without a decrease of baseline CA19-9 or with a fall of <25%. Multivariate analysis revealed that the baseline CA19-9 level before chemotherapy, decreased percentage of the CA19-9 level after chemotherapy, and the differentiation degree of tumor cells were independent risk factors for patients whose baseline CA19-9 levels were increased.

CONCLUSION

The level of pretreatment base-line CA19-9 and the decreased percentage of baseline CA19-9 level after chemotherapy are of predictive values for survival of patients with advanced pancreatic cancer undergoing gemcitabine-based chemotherapy and with an increased level of baseline CA19-9.

Short-term efficacy of rituximab-CHOP and CHOP regimens on two subtypes of diffuse large B-cell lymphoma

BACKGROUND AND OBJECTIVE

Diffuse large B-cell lymphoma (DLBCL) can be divided into two subgroups as germinal center B-cell like (GCB) and non-GCB DLBCL, according to the origin of tumor cells. The prognosis of GCB DLBCL is better than that of non-GCB DLBCL after receiving the CHOP regimen on initial therapy. This study was to compare the short-term efficacy of rituximab(R)-CHOP and CHOP regimens on GCB and non-GCB DLBCL, thus to explore the optimal first-line regimen for the initial treatment of DLBCL patients.

METHODS

In total, eighty-three patients with de novo DLBCL initially treated at Sun Yat-sen University Cancer Center from November 2006 to February 2008 were enrolled. Patients were divided into GCB and non-GCB groups. The short-term efficacy of the CHOP or R-CHOP regimen as the first-line therapy on the two groups was evaluated according to the revised response criteria for lymphoma. Bcl-2 expression and its correlation to the short-term efficacy of the two groups were assessed.

RESULTS

There were 35 cases (42.2%) in the GCB group and 48 cases (57.8%) in the non-GCB group. The total remission rate was 74.3% in the GCB group and 60.4% in the non-GCB group (p = 0.006). There was no significant difference in Bcl-2 expression in the two groups. The remission rate was higher in Bcl-2 positive patients receiving R-CHOP regimen than those receiving CHOP regimen (75.6% vs. 47.8%, p = 0.023). There was no significant difference in the remission rate of Bcl-2 negative patients, regardless of chemotherapy regimen.

CONCLUSION

The prognosis is better in the GCB group than in the non-GCB group. Addition of rituximab to CHOP could improve the short-term efficacy of Bcl-2 positive patients.

Clinical analysis of primary systemic anaplastic large cell lymphoma: a report of 57 cases

BACKGROUND AND OBJECTIVE

The clinical characteristics and prognosis of primary systemic anaplastic large cell lymphoma (ALCL) are various according to different reports. Anaplastic lymphoma kinase (ALK), a specific marker of primary systemic ALCL, is related with its clinical characteristics and prognosis. This study was to investigate the clinical characteristics and prognosis of primary systemic ALCL, and to explore the expression and clinical significance of ALK.

METHODS

Clinical data of 57 primary systemic ALCL patients, treated in Cancer Center of Sun Yat-sen University from January 1997 to January 2006, were reviewed. The expression of ALK in 46 tumor specimens was detected by SP immunohisochemistry.

RESULTS

The median age of the 57 patients was 30. The male/female ratio was 1.9:1. Of the 57 patients, 33 (57.9%) had B symptoms, 23 (40.4%) had Ann Arbor stage III-IV tumors, and 23 (40.4%) had extranodal disease at diagnosis. All patients received chemotherapy. Of the 56 evaluable patients, 40 (71.4%) achieved complete remission. The overall response rate was 96.4%. With a median follow-up of 49.1 months, the median time to progression was 35.2 months and the expected 5-year survival rate was 65.2%. The expected 5-year survival rate was significantly higher in low/low-intermediate International Prognostic Index (IPI) risk group than in high-intermediate/high IPI risk group (68.9% vs. 33.3%, p = 0.010). The positive rate of ALK was 63.0% in the 46 cases detected. Compared with ALK-negative patients, ALK-positive patients were younger (p = 0.001) and had higher expected 5-year survival rate (p < 0.01). Multivariate analysis confirmed the independent prognostic values of ALK expression, primary disease site and lactate dehydrogenase (LDH) level.

CONCLUSIONS

Primary systemic ALCL usually occurs in young patients, with good response to chemotherapy and good prognosis. No ALK expression, high-intermediate/high IPI, extranodal disease and elevated LDH level are correlated to unfavorable prognosis.

[Efficacy and toxicity of trastuzumab combined with docetaxel for Her-2/neu overexpressing metastatic breast cancer]

BACKGROUND & OBJECTIVE

HER2 is overexpressed in approximately 20.0% to 30.0% of breast cancer patients. This alteration is associated with poor prognosis, and may affect response to hormonal therapy and chemotherapy. Chemotherapy combined with trastuzumab can significantly improve the treatment efficacy and survival of Her-2/neu overexpressing breast cancer patients. Docetaxel is an effective drug used for metastatic breast cancer recently. This study was to evaluate the efficacy and toxicity of trastuzumab combined with docetaxel in the treatment for metastatic breast cancer patients with overexpressed Her-2/neu.

METHODS

Twenty-two metastatic breast cancer patients with overexpressed HER2/neu were entered into the study. Trastuzumab and docetaxel (75 mg/m(2)) were administrated on day 1 and repeated every 21 days. The initial dose of trastuzumab was 8 mg/kg and subsequent doses were 6 mg/kg.

RESULTS

Overall 96 cycles were administrated to the 22 patients (medium three cycles per patient, range 2-6 cycles). All cases were evaluable. The overall response rate was 63.6% (14/22). Two patients achieved complete response (CR), 12 patients achieved partial response (PR), four patients achieved stable disease (SD), and four patients had progressive disease (PD). The median time to progression was 5.4 months. One year overall survival was 59.0%. The major toxicity was myelosuppression. A few patients had fever at first infusion of trastuzumab and minor heart failure.

CONCLUSION

Trastuzumab combined with docetaxel is an effective and well-tolerated therapy for Her-2/neu overexpressing metastatic breast cancer.

The effectiveness of lamivudine in preventing hepatitis B viral reactivation in rituximab-containing regimen for lymphoma

In rituximab-containing regimen for lymphoma, the role of lamivudine therapy has not been well established. Therefore, in this nonrandomized phase II clinical study, hepatitis B virus (HBV) carriers with B-cell lymphoma who received rituximab-containing regimen were treated with oral administration of lamivudine. The incidence and severity of hepatitis along with other adverse clinical outcomes were analyzed. Between January 2003 and March 2006, 29 consecutive patients were enrolled. Four of the 29 patients (13.8%) developed hepatitis during chemotherapy, none of which was attributed to HBV reactivation. According to WHO acute toxicity assessment criteria, the severity of hepatitis was grade I in two patients (6.9%) and grade II in two patients (6.9%). In these four patients, only one (3.5%) had interval delay in chemotherapy. No patient had total abnormal bilirubin. No patient had died as the result of hepatitis during the treatment. Interestingly, one of the 29 patients developed HBV activation 5.1 months after the withdrawal of lamivudine. This patient recovered after reinstallation of lamivudine therapy and is still alive. Consequently, our study confirmed previous reports that prophylactic lamivudine therapy can prevent HBV reactivation in HBV carriers who were receiving rituximab-containing regimen for lymphoma.

[A survival of 103 cases of T-cell non-Hodgkin lymphoma]

OBJECTIVE

T-cell non-Hodgkin lymphoma was heterogeneous and relatively high incident in our country. It's response and prognosis were poor. This study was to analyze clinical feature and survival of T-NHL.

METHODS

Records of 103 cases with T-NHL, treated from Dec 1998 to Dec 2004 in Cancer Center of Sun Yat-sen University, were retrospectively analyzed. All the patients were classified according to WHO 2001 Classification Criteria.

RESULTS

Median age of the whole group was 35 (ranged 2-78) years-old. Of the 103 cases, 68 were male, 35 were female; 25 (24.3%) received chemoradiotherapy, 70 (68.0%) received chemotherapy alone, 3 received radiotherapy and 5 received stem cell transplantation after complete remission. Median survival was 24.1 (ranged 0.8-84) months. 5-year survival rate was 24.3%. Kaplan-Meier analysis discovered that age > 60 years, advanced stage (stage II, IV), extranodal involvement, bulky disease, B symptom, performance status (PS) > or = 2, LDH elevated, hypoalbumin, median-high IPI (IPI > or = 2) were bad to prognosis, but Cox regression found that age > or = 60 years, performance status (PS) > or = 2S, hypoalbumin were the independent bad factors to prognosis.

CONCLUSION

This study proved that age, albumin, PS were the independent factors to prognosis.

[Efficacy and toxicity of gemcitabine combined vinorelbine on metastatic breast cancer: a report of 34 cases]

BACKGROUND & OBJECTIVE

Chemotherapy is one of major treatments of metastatic breast cancer. Anthracyclines and taxanes are usually considered as the most active agents in breast cancer and are often used as adjuvant or first-line therapy. Gemcitabine and vinorelbine are active agents in breast cancer. This study was to evaluate the efficacy of gemcitabine combined vinorelbine on the patients with metastatic breast cancer, who had previously received treatment of anthracyclines and/or taxanes.

METHODS

Thirty-four patients with metastatic breast cancer, who had been previously treated with anthracyclines alone or with taxanes, were enrolled. The patients received 30-minute intravenous injection of gemcitabine (1 000 mg/m(2)) and intravenous bolus injection of vinorelbine(25 mg/m(2)) on Days 1 and 8; the regimen was repeated every 21 days.

RESULTS

A total of 109 cycles were given to the 34 patients (median, 3 cycles; range, 1-6 cycles). The treatment responses were evaluable in all patients. Of the 34 patients, 9 achieved partial remission (PR), 19 had stable disease (SD), 6 had progressive disease (PD)û the response rate was 26.47%. The median time to progression was 5.4 months. The median overall survival was 17.8 months. The 1-year overall survival rate was 68% [95% confidence interval (CI): 50%-86%], the 2-year overall survival rate was 46% (95% CI: 26%-66%). The major adverse events were grade I-II myelosuppression, peripheral neurologic toxicities, nausea and vomiting. Some patients had rash and hepatic dysfunction.

CONCLUSION

The combination of gemcitabine and vinorelbine is an effective and well tolerated regimen for the patients with metastatic breast cancer.

[Efficacy of gemcitabine combined oxaliplatin on advanced pancreatic cancer]

BACKGROUND & OBJECTIVE

Gemcitabine (GEM) is efficient in treating advanced pancreatic cancer. Preliminary clinical studies showed that the efficacy of gemcitabine combined oxaliplatin (GEMOX regimen) is better than that of gemcitabine alone. But in China, the use of GEMOX regimen for advance pancreatic cancer has seldom been reported. This study was to analyze the efficacy of GEMOX regimen on advanced pancreatic cancer, and observe the adverse events.

METHODS

Clinical data of 32 chemonaive patients with stage III-IV pancreatic cancer, treated with GEMOX regimen [intravenous injection of gemcitabine (1 000 mg/m(2)) at Day 1 and Day 8, and intravenous injection of oxaliplatin (85-130 mg/m(2)) at Day 1; repeated every 21 days] at Cancer Center of Sun Yat-sen University from Feb. 2001 to Jun. 2006, were reviewed.

RESULTS

Of the 32 patients, 8 achieved partial remission (PR), 8 had stable disease (SD), and 12 had progressive disease (PD)û the objective responses were not assessable (NA) in 4 patients. The response rate was 25.0%, and the clinical benefit response (CBR) rate was 46.9% (15 patients). The progression-free survival (PFS) was 4.7 months; the median overall survival was 8.6 months; the 1-year survival rate was 32.6%. The total occurrence rate of myelosuppression was 70.9%û the occurrence rate of grade III-IV myelosuppression was 32.3%: 12.9% for anemia, 19.4% for neutropenia, and 22.6% for thrombocytopenia. The occurrence rate of gastrointestinal adverse events was 56.2%û only 2 patients had grade III vomiting. Liver function damage (grade I-II) occurred in 8 (25.0%) patients; peripheral neurotoxicity (grade I) occurred in 14 (43.8%) patients. No chemotherapy-related death occurred.

CONCLUSIONS

GEMOX is an effective regimen for pancreatic carcinoma with good clinical tolerance. The main adverse event is myelosuppression.

[Responses of 109 adult soft tissue sarcoma patients to chemotherapy]

BACKGROUND & OBJECTIVE

The response of adult soft tissue sarcoma (STS) to chemotherapy is uncertain. This study was to evaluate the role of chemotherapy in treating adult soft tissue sarcoma.

METHODS

Clinical data of 109 adult soft tissue sarcoma patients, treated with chemotherapy at Cancer Center of Sun Yat-sen University from Jan. 2000 to Dec. 2005, were analyzed.

RESULTS

Of the 109 patients, 66 received palliative chemotherapy, 40 received adjuvant chemotherapy, and 3 received neoadjuvant chemotherapy. The overall response rate for first line chemotherapy was 22.7%. The median survival was 16.9 months. The 1-and 2-year survival rates were 63.6% and 33.3%. The patients with lung metastasis had a significantly longer median survival than those with liver metastasis did (25.1 months vs. 11.8 months, P<0.05). MAID and CYVADIC were the most commonly used first-line chemotherapy regimens; the response rates were 28.0% and 22.2%, respectively. When anthracycline and/or standard dose ifosfamide failed, the patients could still benefit from high dose ifosfamide (14.0 g/m(2)). The median survival was significantly shorter in the patients who got metastasis within 6 months after diagnosis than in those that got metastasis more than 6 months after diagnosis (11.8 months vs. 42.9 months, P=0.04). Of the 40 patients who received adjuvant chemotherapy, 16 developed progression during follow-up: 10 had relapse and 6 had distant metastasis.

CONCLUSIONS

MAID and CYVADIC are two effective chemotherapy regimens for adult soft tissue sarcoma. We recommend to take a high dose ifosfamide when anthracycline and/or standard dose ifosfamide failed. The patients with liver metastasis are more resistant to chemotherapy than those with lung metastasis. Developing metastasis within 6 months after diagnosis is a poor prognostic factor.

[Antitumor immune responses induced by idiotype-pulsed dendritic cells with cell-penetrating peptide vaccination in vivo]

OBJECTIVE

To confirm the therapeutic effect of dendritic cell (DC) vaccine on treatment for mice with lymphoma and the protective effect of DC vaccine loaded with different antigens on the tumor-bearing BAL B/c mice.

METHODS

Firstly, a mouse tumor model was set up by s. c. inoculation of 1 x 10(6)/mouse A20 tumor cells. Then different DC vaccines were injected, respectively, and the tumor size and survival time were observed. Secondly, the immunized mice with DC vaccines were challenged with A20 tumor cells, and observed whether a new tumor occurred in the mice and the time of survival.

RESULTS

The tumor of mice immunized with Id-DC vaccines grew slower than the controls (mean time of survival was 40.4 days vs. 33.4 days), but statistically not significantly different. The tumor of mice injected with CPP-Id-DC vaccines grew slower than that injected with Id-DC vaccines and controls, and one of 5 mice got CR and the tumor in another one mouse became stable. The median survival time was 70.8 days during a 90-days observation period. The difference was significant (P<0.01). The mice injected with Id-DC vaccines were challenged with A20 tumor cells showed new tumor occurred at 7 - 12 days, and 1 of the 5 mice survived for 60 days. The mice injected with CPP-Id-DC vaccines had no tumor.

CONCLUSION

The DC loaded with CPP-Id was better than that loaded with Id alone in treating B cell lymphoma, and It can enhance their antitumor responses and prolong the survival time of the A20 tumor animal models. The vaccine of DC loaded with CPP-Id can protect mice from A20 tumor cell challenge.