Interfacial Structures of MoSi2-Mo5Si3 Eutectic Alloys

Script lamellar microstructures which occur in certain intermetallic eutectic alloys, such as in the Mo-Si system, may provide desirable mechanical properties. Arc-melted specimens of MoSi2-Mo5Si3 eutectic alloys which exhibit the interlocking lamellar phases were examined in this study. We have observed, by conventional transmission electron microscopy (TEM), an orientation relationship between the MoSi2 and the Mo5Si3 phases, (110)[001]1-2 ‖ (330)[110]5-3, which is consistent with the crystallographic coordinate transformation matrix. High resolution transmission electron microscopy (HRTEM) discloses the interfacial dislocations to be of <100> and 1/2<111> types and the interfaces are regularly faceted. A shear fault which may be consisting of antiphase boundary (APB)-coupled 1/6<331> superpartial dislocations was observed in MoSi2 grain near the interface. Crack propagation paths suggest that the eutectic has a strong, low energy interface which is consistent with the observations of a low index orientation relationship between the two phases and the faceted interfacial structures.

Plasticity Enhancement of MoSi2 at Elevated Temperatures Through the Addition of TiC

Monolithic MoSi2 and MoSi2-TiC particulate composites with 10 vol % and 15 vol % TiC were tested in compression between 950°C and 1200°C. The MoSi2-TiC composites can be deformed plastically at lower temperatures than MoSi2 can before brittle fracture occurs. The composites exhibit much lower strain hardening rates and attain zero strain hardening rate at much lower strains than monolithic MoSi2. The differences between the composites and monolithic MoSi2 in plasticity and in strain hardening behavior is attributed to efficient dislocation generation into the matrix from sources at the MoSi2-TiC interfaces.

Application of Western patients-based Adjuvant! Online (AOL) model on Korean colon cancer patients

599

Background: Adjuvant! Online (AOL) is a web-accessible risk-assessment model that predicts the mortality and the benefits of adjuvant therapy ( www.adjuvantonline.org ). AOL has never been validated for Asian colon cancer patients.

Methods: Using the Yonsei Tumor Registry (YTR) database, we calculated the survival for the patients with T1-4, N0-2, M0 colon cancer who were treated at the Yonsei Cancer Center between 1990 and 2005. Observed and predicted 5-year survival was compared for each patient.

Results: The median age of the study population was 60 years (range, 15-87 years) and the median follow-up duration was 7.9 years (range, 0.06-19.8 years) for all 1,431 patients. While AOL underestimate overall survival (OS) (predicted-observed=-1.02%, P=0.008), it overestimate colon cancer-specific survival (CCSS) (predicted-observed=3.8%, P<0.001) in Korean patients. Especially, AOL underestimated OS and CCSS in younger patients than age 50 years (predicted-observed=-4.3%, P<0.001 and predicted-observed=-3.5%, P<0.001, respectively). We conducted an internal model validation by using a Korean version of AOL (KAOL), which was a new model for prognosis based on AOL's parameters. 5-year OS and CCSS between the observed and the KAOL predicted survival were not different (77.25 vs. 77.15, P=0.873 and 77.4% vs. 77.6%, P=0.78, respectively). The concordance indexes about OS and CCSS were 0.75 and 0.74, respectively.

Conclusions: KAOL model for Korean colon cancer patients is more suitable to predict 5-year outcomes compared to ALO model for Western patients.

No significant financial relationships to disclose.

Gene-expression profiles related to a synergistic effect of taxane and suberoylanilide hydroxamic acid combination treatment in gastric cancer cells

50

Background: We evaluated the cytotoxic effects of combining of suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor, with taxanes in human gastric cancer cell lines, and evaluated the pre-treatment difference of gene profile to identify genes that could potentially mediate the cytotoxic response.

Methods: Twenty-five gastric cancer cell lines with 22K gene expression data were treated with SAHA and paclitaxel or docetaxel, and the synergistic interaction between the drugs was evaluated in vitro using the combination index (CI) method. We performed significance analysis of microarray (SAM) to identify chemosensitivity-related genes in gastric cancer cell lines that were concomitantly treated with SAHA and taxane. We generated a correlation-matrix between gene expression and CI values to identify genes whose expression correlated with a combined effect of taxanes and SAHA.

Results: Taxane and SAHA combination had a synergistic cytotoxic effect against taxane-resistant gastric cancer cells. We selected 49 chemosensitivity-related genes, which were commonly identified in paclitaxel and docetaxel combined with SAHA, via SAM analysis. Among them, nine common genes (SLIT2, REEP2, EFEMP2, CDC42SE1, FSD1, POU1F1, ZNF79, ETNK1, and DOCK5) were extracted from the subsequent correlation-matrix analysis.

Conclusions: Taxane and SAHA combination could be efficacious for the treatment of gastric cancer. The genes which were related with the synergistic response to taxane and SAHA could serve as surrogate biomarkers to predict the therapeutic response in gastric cancer patients. We are researching to determine the expression of the nine genes in malignant human gastric cancer tissue and to correlate them with clinical information.

No significant financial relationships to disclose.

Phase II study of everolimus in patients with advanced gastric cancer refractory to chemotherapy including fluoropyrimidine and platinum

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Background: To evaluate feasibility with activity and toxicities of everolimus, a novel inhibitor of mammalian target of rapamycin (mTOR), in patients with advanced gastric cancer (AGC) who failed chemotherapy including both fluoropyrimidine and platinum (FP).

Methods: Fifty-four patients were enrolled between Jul 2008 and Feb 2010. Everolimus, 10 mg daily, was given until disease progression or unacceptable toxicity. Primary objective was to determine 4-month progression-free survival (PFS) and secondary objectives were to investigate response rate, toxicity and overall survival OS rate. Pre- (n = 28) and on-treatment (n = 19) tumor biopsies were evaluated for phosphorylated (p) mTOR, pS6 kinase1, pS6 and eukaryotic initiation factor 4E binding protein 1 expression.

Results: A total of 180 cycles of everolimus were administered with a median of 2 (range, 1-20) cycles in each patient. Two patients (3.7%) achieved confirmed partial response and 19 patients (35.2%) showed stable disease, resulting in a disease control rate of 38.9%. At a median follow-up duration of 8.7 months in surviving patients (range, 3.0–19.4 months), a 4-month PFS rate was 18.4% with a median PFS of 1.7 months (95% CI, 1.5-2.2 months) and a median OS time was 8.3 months (95% CI, 4.5-12.1 months). Peritoneal metastasis (Hazard ratio [HR], 3.97; 95% CI, 1.54-10.23; p = 0.010) and low expression level of pS6Ser240/4 at baseline (HR, 7.64; 95% CI, 2.591-22.51; p = 0.001) were significantly associated with shorter PFS time. Treatment was in general well tolerated. Toxicities of grade 3/4 included anemia (9.4%), thrombocytopenia (9.4%), hepatic dysfunction (11.3%) and pulmonary toxicities (one interstitial pneumonitis and a diffuse alveolar hemorrhage [DAH] case). The DAH and cardiopulmonary dysfunction in another case resulted in treatment-related mortalities.

Conclusions: Everolimus monotherapy showed modest activity against AGC refractory to FP. pS6Ser240/4 might be a potential biomarker for the clinical activity of everolimus. The toxicity profile was generally mild. However, careful monitoring for treatment-related pulmonary complication seems to be required.

[Table: see text]

Use of class III beta tubulin to predict efficacy from paclitaxel- or docetaxel-based chemotherapy in patients with advanced gastric cancer

52

Background: To predict clinical outcome in patients with advanced gastric cancer (AGC) received paclitaxel or docetaxel based chemotherapy, we evaluated expression of class III beta tubulin (bTubIII).

Methods: Expression of bTubIII was evaluated by immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded tumors from the primary gastric cancer. Tumors were classified as bTubIII “low” and “high” according to median of IHC score [intensity (0-3) × portion (0-100)]. The expression of bTubIII was investigated for their association with clinical outcomes of efficacy and toxicity.

Results: One hundred twenty-four AGC pts who were treated with paclitaxel or docetaxel combined with an infusional 5-fluorouracil and low-dose leucovorin as first and second-line palliative chemotherapy were enrolled. Thirty-three patients (26.7%) were confirmed to have high expression of bTubIII. The patients with high expression of bTubIII showed higher disease control rate (DCR) and longer progression-free survival (PFS) than those with low expression in patients treated with paclitaxel (79.3 % vs. 57.3 %, p = 0.039, and 3.0 months vs. 1.5 months, p = 0.073). By contrast, there was no difference of DCR and PFS according to expression of bTubIII in patients treated with docetaxel. The expression of bTubIII was not associated with toxicity in both patients treated with paclitaxel or docetaxel.

Conclusions: The expression of bTubIII may be a predictive marker in AGC patients received paclitaxel based chemotherapy, but not docetaxel.

No significant financial relationships to disclose.

Changes in imatinib plasma trough level during long-term treatment of patients with advanced gastrointestinal stromal tumors

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Background: Pharmacokinetic study in patients with gastrointestinal stromal tumors (GISTs) suggested that plasma concentrations of imatinib decrease following long-term exposure. We therefore measured changes in imatinib plasma trough levels (Cmin) after long-term exposure.

Methods: Between November 2009 and May 2010, follow-up (FU) imatinib Cmin was measured in 65 patients who received the same dose of imatinib for at least 9 months after a previous baseline (BL) measurement. Total 244 blood samples were obtained (127 at BL and 117 at FU) and plasma level was measured by liquid chromatography-tandem mass spectrometry.

Results: Median patient age was 54 years (range, 28–76 years) and 42 (64.6%) patients were male. Sixty-one (93.8%) patients were treated with 400 mg/day imatinib and 4 (6.2%) with 300 mg/day. The median interval from initiation of imatinib to BL test was 6.4 months (range, 0.5–66.6 months), and the median interval between BL and FU test was 13.1 months (range, 9.6–18.4 months). The mean ± standard deviation imatinib Cmin was significantly higher at FU than at BL (1442 ± 693 ng/mL vs 1221 ± 624 ng/mL, p<0.001). The mean inter- and intra-subject variabilities were 49.2% and 25.5%, respectively, at BL, and 44.2% and 20.4%, respectively, at FU. Multivariate analysis showed a significant correlation between the ratio of FU to BL imatinib Cmin and that of albumin (r=-0.397, p=0.001). In per-sample analysis, imatinib Cmin was significantly correlated with age, hemoglobin, albumin, creatinine clearance, previous major gastrectomy and time between initiation of imatinib and plasma level tests.

Conclusions: Steady-state imatinib Cmin did not decrease but remained stable in most GIST patients during long-term treatment. Changes in imatinib Cmin were associated with changes in albumin concentration. Monitoring of imatinib Cmin only for concerns about time-dependent decreases in imatinib exposure is not necessary.

[Table: see text]

An application of monotone functions decomposition to the reconstruction of gene regulatory networks

We describe the reconstruction of a gene regulatory network involved with the Toll-like Receptor signaling pathways. By applying our recent identification algorithm to a time series gene expression dataset, we identify regulatory interactions between genes and construct discrete-time piece-wise affine regulatory functions. Our validation shows that our model predicts the expression levels of the genes involved in the network with good accuracy.

A control theoretic approach to venom immunotherapy with state jumps

We investigate a model-based control method to boost the immune response. We apply this control method to select the appropriate immune response between the Th1 and Th2 responses. The idea of state jump is discussed using hybrid models notation. To implement the control idea we propose physically available methods.

Development and application of an indirect immunohistochemical method for the detection of duck plague virus vaccine antigens in paraffin sections and localization in the vaccinated duckling tissues

The objective of the present study was to develop and apply a streptavidin-alkaline phosphatase labeling system of indirect immunohistochemistry (SP-IHC) to detect antigenic distribution and localization regularity of duck plague virus (DPV) vaccine antigens in paraformaldehyde-fixed paraffin-embedded tissues of experimentally vaccinated ducklings. Male New Zealand rabbits were immunized with purified DPV antigens, which were engaged by a combination of differential centrifugation and sucrose-density gradient ultracentrifugation. The rabbit anti-DPV polyclonal antibodies were purified and used as the primary antibodies. Forty-eight 28-d-old DPV-free Pekin ducklings were subcutaneously inoculated with attenuated DPV vaccine in the immunization group and sterile PBS in the control group. The tissues were collected at sequential time points between 4 h and 18 wk postvaccination (PV) and were prepared for SP-IHC observation. The presence of DPV-specific antigens was first observed in the liver and spleen at 12 h PV; in the bursa of Fabricius, thymus, Harderian gland, esophagus, and intestinal tract at 1 d PV; and in the heart, lung, kidney, pancreas, and brain at 3 d PV. The positive staining reaction could be detected in the vaccinated duckling tissues until 18 wk PV, and no positive staining cells could be observed in the controls. The highest levels of positive staining reaction were found in the liver, spleen, bursa of Fabricius, thymus, and intestinal tract, whereas a few DPV vaccine antigens were distributed in the heart, pancreas, and esophagus. The target cells had a ubiquitous distribution, especially in the mucosal epithelial cells, lamina propria cells, macrophages, hepatocytes, and lymphocytes, which served as the principal sites for antigen localization. These findings demonstrated that SP-IHC was a reliable method for detecting antigenic distribution and localization regularity of DPV vaccine antigens in routine paraffin sections. The present study may be useful for describing proliferation and distribution regularity of DPV vaccine in the vaccinated duckling tissues and enhance further studies and clinical application of attenuated DPV vaccine.

Multiscale iterative voting for differential analysis of stress response for 2D and 3D cell culture models

Three-dimensional (2D) cell culture models have emerged as the basis for improved cell systems biology. However, there is a gap in robust computational techniques for segmentation of these model systems that are imaged through confocal or deconvolution microscopy. The main issues are the volume of data, overlapping subcellular compartments and variation in scale or size of subcompartments of interest, which lead to ambiguities for quantitative analysis on a cell-by-cell basis. We address these ambiguities through a series of geometric operations that constrain the problem through iterative voting and decomposition strategies. The main contributions of this paper are to (i) extend the previously developed 2D radial voting to an efficient 3D implementation, (ii) demonstrate application of iterative radial voting at multiple subcellular and molecular scales, and (iii) investigate application of the proposed technology to two endpoints between 2D and 3D cell culture models. These endpoints correspond to kinetics of DNA damage repair as measured by phosphorylation of γH2AX, and the loss of the membrane-bound E-cadherin protein as a result of ionizing radiation. Preliminary results indicate little difference in the kinetics of the DNA damage protein between 2D and 3D cell culture models; however, differences between membrane-bound E-cadherin are more pronounced.

Loss of ALX4 expression in epithelial cells and adjacent stromal cells in breast cancer

BACKGROUND

Loss of the stromally-restricted homeodomain transcription factor, Alx4, causes defective mouse mammary epithelial morphogenesis.

AIMS

To begin to define the role of ALX4 in the human breast and in breast cancer, the expression pattern of ALX4 in the normal human breast and changes in expression in breast cancer were determined.

METHODS

Cells expressing ALX4 in the human breast were identified by co-immunofluorescence using alpha-ALX4 antibodies and markers of specific mammary cell types. ALX4 expression in breast cancer was then determined by immunohistochemistry on tumour sections that also harboured regions of normal breast tissue. Using criteria that required ALX4 staining in both stromal and epithelial cells, changes in ALX4 expression in tumours on a tissue microarray were determined.

RESULTS

ALX4 was expressed in both stromal and luminal epithelial cells in the human breast. Scoring tissue sections of duct carcinoma in situ (DCIS) or invasive ductal carcinoma (IDC) that also harboured regions of normal breast tissue, a loss of ALX4 (p<0.001) in stromal and epithelial cells in breast tumours was observed. Analysis of ALX4 expression in 123 sections on a tissue microarray confirmed a highly significant loss (p<0.001) of ALX4 in breast cancer in the tumours themselves and in adjacent stromal cells.

CONCLUSIONS

These data show a distinct pattern of expression of ALX4 in the human breast relative to the murine mammary gland. Furthermore, characterisation of ALX4 in breast cancer showed that loss of ALX4 in tumours and the surrounding untransformed stroma is a basic characteristic of DCIS and IDC.

Efficacy of inactivated vaccine against H5N1 influenza virus infection in mice with type 1 diabetes

We sought to determine susceptibility to highly pathogenic avian influenza (HPAI) H5N1 virus and to explore immune protection of inactivated H5N1 vaccine in streptozotocin-induced type 1 diabetic mice. Susceptibility of diabetic mice to an H5N1 virus was evaluated by comparing the median lethal dose (LD(50)) and the lung virus titers with those of the healthy after the viral infection. To evaluate the influence of diabetes on vaccination, diabetic and healthy mice were immunized once with an inactivated H5N1 vaccine and then challenged with a lethal dose of H5N1 virus. The antibody responses, survival rates, lung virus titers and body weight changes were tested. Mice with type 1 diabetes had higher lung virus titers and lower survival rates than healthy mice after H5N1 virus infection. Inactivated H5N1 vaccine induced protective antibody in diabetic mice, but the antibody responses were postponed and weakened. In spite of this, diabetic mice could be protected against the lethal virus challenge by a single dose of immunization when the amount of the antigen increased. These results indicated that type 1 diabetic mice were more susceptible to H5N1 influenza virus infection than healthy mice, and can be effectively protected by inactivated H5N1 vaccine with increased antigen.

Clinical Advantages of Neoadjuvant Docetaxel (T) and Carboplatin (C) ± Trastuzumab (H) in Locally Advanced Breast Cancer (LABC)

Background: Neoadjuvant systemic treatment has become a standard choice for locally advanced breast cancer with many proposed benefits in achieving clear margins, preserving breasts, reducing relapse and improving survival. Recently, we completed a neoadjuvant trial studying the effects of 4 cycles of docetaxel (75 mg/m2) and carboplatin (AUC=6) with or without trastuzumab (4mg/kg loading dose and 2 mg/kg weekly dose) on LABC. In this report, we assessed whether clinical complete response (cCR) or pathologic complete response (pCR) correlated better with having breast conservation surgery, fewer relapses and improved survival outcomes.Materials and Methods: Seventy-one of the 74 consented patients with T2-T4 non-metastatic breast cancer completed the preoperative treatment and had evaluable data on tumor response, surgical treatment and clinical outcome. We used the Kaplan Meier method to estimate survival probabilities and log rank test to compare relapse-free and survival curves.Results: Clinical outcomes from a preplanned 2-year analysis of a phase II neoadjuvant are reported. Of the 19 patients with pCR, 16 occurred in patients with cCR (n=32) and 3 were in the group of non-cCR (n=39). Although cCR overestimated tumor response, 84.2% pCR occurred in the cCR group and only 15.8% in the non-cCR group. The relapse-free survival at 2 and 3 years for pCR vs. non-pCR were 93.8% and 83.3% vs. 78.4% (p=0.122) and 58%, respectively; and for cCR vs. non-cCR were 80.9% and 65% vs. 83.9% and 64.3% (p=0.999). The pCR was also more predictive than cCR for overall survival. Of the 30 HER2 positive breast cancer, 15 received trastuzumab throughout the neoadjuvant and adjuvant phases for a total of 52 weeks. The remaining 15 patients received identical chemotherapy but trastuzumab was started after the surgery and continued for 52 weeks. While distinctively different pCR between the two treatment groups was expected, the better survival rate observed in the group receiving neoadjuvant TCH was not expected. Our study showed that pCR was strongly associated with a more frequent use of lumpectomy than the non-pCR group 63.2% vs. 36.5% (p=0.045).Conclusion: The effects of preoperative systemic treatment on LABC can be assessed both clinically and pathologically. Our data suggests that pathologic complete response was a better predictor for having breast conservation surgery and relapse-free survival rates. Our data also suggests that patients with HER2 positive breast cancer may benefit from receiving preoperative trastuzumab and chemotherapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1100.

Enhancement of the immune response to chronic myeloid leukaemia via controlled treatment scheduling

We study the differential equations describing the chronic myeloid leukaemia. We propose a novel drug scheduling method to enhance the T-cell mediated immune response. The control strategy relies on the understanding of the immune boosting mechanism. The feasibility of the strategy is illustrated via simulations.

Concurrence of multiple myeloma and idiopathic erythrocytosis

The association of erythrocytosis and multiple myeloma is rare. We encountered a 76-year-old male patient with erythrocytosis followed by the diagnosis of multiple myeloma 8 months later. Related laboratory examinations revealed absolute erythrocytosis, normal oxygen saturation and erythropoietin (EPO) levels, the absence of endogenous erythroid colony (EEC) and JAK2-V617F mutations. The diagnosis of idiopathic erythrocytosis (IE), instead of polycythemic vera (PV), was made. In the literature, about 20 cases of erythrocytosis associated with myeloma can be found. Based on elevated EPO levels, 2 of such cases should be considered secondary erythrocytosis while others are reported as PV. None of them is considered to be have idiopathic erythrocytosis. Our present case is the first one with multiple myeloma developing in a patient with the diagnosis well established by extensive laboratory workup. The pathogenic role of these two entities remains to be established.

Occult hepatocellular carcinoma: a case report of a special icteric-type hepatoma and literature review

Hepatocellular carcinoma (HCC) presenting with obstructive jaundice due to bile duct tumour thrombi is classified as icteric-type hepatoma. This report describes a case of unusual icteric-type HCC with common bile duct thrombus, which is herein named 'occult HCC', as no detectable primary lesion in liver was defined pre-operatively and intra-operatively. A thrombectomy followed by a T biliary drainage tube placement was carried out, and the final post-operative pathological evaluation demonstrated the tumour thrombus originated from a moderately differentiated HCC. The clinicopathological features and logical clinical interventions of this rare type of HCC were discussed with a review of the literature. The HCC patients with bile duct thrombi receiving palliative biliary drainage alone had a poor outcome. With respect to improving prognosis, a curative resection of primary HCC and tumour thrombi was suggested on the basis of performing an intensive post-operative monitoring for early detection of primary liver lesion.

Prevalence of low hemoglobin levels and associations with other disease parameters in rheumatoid arthritis patients: evidence from the CORRONA registry

OBJECTIVE

To estimate the prevalence of low hemoglobin (Hb) levels in a large US cohort of patients with rheumatoid arthritis (RA) and examine the relationship between Hb levels and RA severity, associated comorbidities, and quality-of-life parameters by cross-sectional analysis of data from the Consortium of Rheumatology Researchers of North America (CORRONA) registry.

METHODS

The study population comprised patients with RA >18 years of age and clinical information recorded in the CORRONA registry between October 1, 2001 and February 1, 2007. Patients were separated into low (Hb <13 g/dl for men; <12 g/dl for women) and normal Hb groups (Hb >13 g/dl for men; >12 g/dl for women). Hb levels were calculated from recorded hematocrit values.

RESULTS

Of the 10,397 study patients, 1734 (16.7%) had low Hb levels and 8663 (83.3%) had normal Hb levels. More patients in the low Hb group had a history of comorbid cardiovascular disease, diabetes, and gastrointestinal disease. The low Hb group exhibited greater disease severity and activity (p<0.05) as reported by patients and rheumatologists. In multivariate analyses, RA severity ([odds ratio] OR 1.24; 95% confidence interval [CI]: 1.07-1.44) and ESR (OR 1.04; 95% CI: 1.03-1.05), and comorbid bleeding ulcers (OR 2.04; 95% CI: 1.01-4.12) were predictive of low Hb levels.

CONCLUSION

Despite changes in treatment paradigms, low Hb levels remain prevalent in RA patients. This analysis suggests that low Hb levels may be associated with RA disease severity and the presence of certain comorbidities.

A phase I/II study of combination therapy of S-1 and irinotecan in patients with previously untreated metastatic or recurrent colorectal cancer

e15023

Background: To investigate S-1 and irinotecan (CPT-11) combination as an alternative to infusional 5- fluorouracil/leucovorin plus CPT-11, we performed a phase I/II trial to determine maximum tolerated dose (MTD), efficacy and toxicity in metastatic or recurrent colorectal cancer. In addition, we evaluated the association between genotypes of candidate genes and phenotypes. Methods: S-1 was administered orally at a dose of 70 mg/m2 (level I-III) or 80 (IV and V) from day 1 to 14. CPT-11 was given i.v. on day 1, stepping up to 175 (level I), 200 (II), 225 (III and IV) or 250 (V) mg/m2 . The treatment was repeated every 3 weeks. The association of the UGT1A1 genotypes (*6, *28, and *60) and CYP2A6 genotypes (*4, *7, and *9) with toxicities or efficacy were analyzed in patients who participated in phase II portion. Results: Twenty-three patients entered the phase I and 30 enrolled in phase II study. The MTD of S-1 and CPT-11 was considered to be 80 mg/m2 and 250 mg/m2, respectively. The dose-limiting toxicities (DLTs) were diarrhea and neutropenia. The recommended dose (RD) was determined at a S-1 dose of 80 mg/m2 and a CPT- 11 dose of 225 mg/m2. The overall response rate was 66.7% (95% CI, 48.7–84.6) at the RD level. Median time to progression was 7.6 months (95 % CI, 5.7–9.5). Median survival time was not reached. Grade3–4 neutropenia was observed in 53.4% of the patients. Grade 3–4 nonhematologic toxicities were diarrhea (16.7%) and asthenia (6.7%). The frequencies of UGT1A1*60, *28, and *6 allele were 25.8%, 10.3%, and 15.5%, respectively. Homozygous for *28 or *6 were not observed. All three double heterozygous for *28 and *6 experienced grade 3–4 neutropenia. The allele frequencies of CYP2A6*4, *7, and *9 were 15.5%, 8.6%, and 29.3%, respectively. There were no association between CYP2A6 genotypes and response rates or toxicities. Conclusions: The combination of S-1 and CPT-11 was effective and had manageable toxicities in patients with metastatic or recurrent colorectal cancer.

[Table: see text]

No significant financial relationships to disclose.

Phase I dose-finding study of sorafenib in combination with capecitabine and cisplatin as a first-line treatment in patients with advanced gastric cancer

4559

Background: We conducted a phase I dose-finding study of sorafenib (S) in combination with capecitabine (X) and cisplatin (P) in patients with previously untreated metastatic or inoperable advanced gastric cancer. Methods: Four dose levels of S, X, and P combination were tested. The doses of S (p.o. daily), X (p.o. on days 1–14), and P (i.v. on day 1) were escalated at the following schedule; level 1: S 400 mg/d, X 1,600 mg/m2/d, P 80 mg/m2; level 2: S 800 mg/d, X 1,600 mg/m2/d, P 80 mg/m2; level 3: S 800 mg/d, X 2,000 mg/m2/d, P 80 mg/m2; level 1A: S 800 mg/d, X 1,600 mg/m2/d, P 60 mg/m2. The cycle was repeated every 3 weeks. Dose limiting toxicities (DLTs) were evaluated only in the first cycles and a standard 3+3 dose escalation design was implemented. Results: A total 21 pts were enrolled in the study. No DLTs were observed at dose level 1 (n=3). One DLT (grade 3 diarrhea) was noted at dose level 2 (n=6), and 2 DLTs (two grade 4 neutropenias longer than 5 days in duration) were observed at dose level 3 (n=6), which made the level 3 dose the maximum tolerated dose (MTD). However, at cycle 2 and thereafter at dose level 2, the relative dose intensity (RDI) of S and X could not be maintained (mostly below 80%) due to the frequent dose reductions and cycle delays. So, we explored a new dose level (1A) between dose level 1 and 2. Since no DLTs were found in 6 patients at level 1A with RDI mostly above 80% throughout the treatment period, level 1A was determined as recommended dose (RD). Most frequent grade 3 and 4 hematologic toxicities were neutropenia (25.0% of cycles), and most frequent grade 2 and 3 non-hematologic toxicities were hand-foot syndrome (9.4%), asthenia (7.0%), and anorexia (5.5%). The objective responses were confirmed in 10 out of 16 patients with measurable lesions (62.5%; 95% CI, 38.8–86.2%). With a median follow-up of 8.1 months, estimated median progression-free survival was 10.0 months (95% CI, 1.6–18.4 months) and median overall survival has not been reached. Conclusions: Diarrhea and neutropenia were DLTs in this S, X, and P combination. The dose schedule of sorafenib 400 mg po bid daily with capecitabine 800 mg/m2 po bid on days 1–14, and cisplatin 60 mg/m2 iv on day 1 in every 3 weeks is recommended for further development in AGC.

[Table: see text]

Combination chemotherapy of irinotecan with fluoropyrimidine in taxane, anthracycline, and fluoropyrimidine-pretreated metastatic breast cancer

e12003

Background: Irinotecan (I) has some efficacy in taxane (T) and anthracycline (A)-refractory breast cancer, and combination of I and fluoropyrimidine (F) shows synergistic effects in preclinical model. We conducted this study to reveal the clinical outcomes of I and F combination therapy in T, A, and F-pretreated metastatic breast cancer. Methods: We consecutively enrolled metastatic breast cancer patients treated with I and F combination chemotherapy from 2000 to 2008 in Seoul National University Hospital. They all had been previously heavily treated with T, A, and F. We retrospectively analyzed the clinical outcomes. Results: Twenty-five patients were enrolled. The median age was 38 years (range: 30–56years). The performance status was: ECOG 1 (11 patients), 2 (13), and 3 (1). The most commonly involved site was bone (16 patients), liver (13), and lung (12). The biologic subtype was: hormone receptor (+) 17 patients, HER-2 (+) 2, triple-negative (TNBC) 6. The median time from diagnosis of metastatic breast cancer to the initiation of IF therapy was 34 months (range: 12–97 months). The used regimens were: FOLFIRI (18 patients), TS-1/ irinotecan (6), capecitabine/irinotecan (1). Response was evaluable in 24 patients. There was no CR/PR. Stable disease was shown in 29.2% and 70.8% was PD, that is disease control rate was 29.2% (95% CI:10–45%). The median duration of disease control was 3.9 months (95% CI 3.7–4.2, range 2.4–11). The progression-free survival was 1.4 months (95% CI:0.7–21, range: 0.5–11.4), and overall survival was 6 months (95% CI: 4.2–7.8, range: 1–23). According to the biologic subtypes, the median PFS was 2.0 vs. 1.3 months (p=0.895) and OS was 4 vs. 6 months (p=0.807) respectively in TNBC VS Non-TNBC. In multivariate analysis, patients with good PS showed longer OS (p = 0.035). The Gr 3/4 hematologic toxicity was: neutropenia 18.6%, anemia 1.3%, thrombocytopenia 1.3%. And the major Gr 3/4 non-hematologc toxicity was: diarrhea (4%), hand-foot syndrome (0%), fatigue (0%). No treatment-related death was occurred. Conclusions: Treatment of I combined with F might be an option in metastatic breast cancer patients heavily treated with T, A, and F, irrespective of TNBC. Further prospective studies are warranted.

No significant financial relationships to disclose.

Prognostic significance of preoperative serum tumor markers in the patients with curatively resected advanced gastric cancers

e15515

Background: We evaluated the prognostic significance of preoperative tumor markers, carcinoembryonic antigen (CEA), carbohydrate antigen 19–9 (CA19–9), and carbohydrate antigen 72–4 (CA72–4), in the patients with curatively resected advanced gastric cancers (AGC). Methods: Preoperative serum tumor markers were available for 667 patients who had been enrolled in a phase III trial of adjuvant chemotherapy (AMC0201). We compared the relapse free survival (RFS) and overall survival (OS) according to patient's pre-treatment clinical characteristics and serum tumor markers by using log rank test and Cox proportional hazard model. Results: Of total 667 patients, 3 year RFS rate and OS rate were 67.4% and 75.0%, respectively. Postoperative pathologic stage was II in 353 (52.9%), IIIA in 202 (30.3%), IIIB in 61 (9.1%), and IV (M0) in 51 (7.6%). CEA, CA19–9, CA72–4 were elevated pre-operatively in 64 of 665 patients (9.6%), 75 of 664 patients (11.3%), and 121 of 639 patients (18.9%), respectively. After the median follow-up of 38.4 months, 209 patients (31.3%) had recurrence, and 164 patients (24.6%) died. In the univariate analysis, location of tumor, type of surgery, Borrmann type, TNM stage, the elevation of CEA and CA72–4 level were significant prognostic factors for RFS and OS. In the multivariate analysis, serum CA72–4 was independent significant prognostic factor for RFS and OS as well as tumor location, Borrmann type, and stage Conclusions: Pre-operative serum CEA and CA72–4 levels were independent prognostic factors as well as clinical characteristics of pathologic stage, tumor location and Borrmann type in patients with curatively resected AGC.

No significant financial relationships to disclose.

A phase II study of BIBW 2992, a novel irreversible dual EGFR and HER2 tyrosine kinase inhibitor (TKI), in patients with adenocarcinoma of the lung and activating EGFR mutations after failure of one line of chemotherapy (LUX-Lung 2)

8013

Background: EGFR mutations are associated with exquisite sensitivity to EGFR TKIs in NSCLC. A phase II trial evaluating the efficacy of BIBW 2992 (Tovok), a novel, potent, irreversible, dual EGFR and HER2 TKI with preclinical activity in cell lines harboring activating (H3255, IC50=0.7 nM) and resistant (H1975, IC50=99 nM) EGFR mutations, is reported. Methods: Objective response rate is the primary endpoint of this 2-stage trial. Based on 16 or more unconfirmed PRs in an interim analysis of the first 40 2nd line patients (pts) completing 1 course (28 days), accrual will continue to a total of 120 1st and 2nd line pts (expected completion of accrual by May 2009. Data on 2nd line pts only are presented). Eligible pts have stage IIIB/IV lung adenocarcinoma, EGFR mutation in exons 18–21 (tested by direct sequencing), measurable disease, ECOG PS 0–2 and adequate end organ function. Pts receive 50 mg BIBW 2992 qd until progression. Tumor assessments are performed every 4 weeks for 12 weeks, then every 8 weeks. Results: Since Oct 2007, samples from 289 pts (222 from Taiwan and 67 from the US) have been sequenced. 100 had detectable EGFR mutations including del19 (n=39), L858R (n=45) and others (n=16). 69 pts have started treatment. The trial was moved to stage 2 after 21 of the first 38 treated pts had objective response at 28 days. Of 55 evaluable 2nd line pts, 29 (53%) had PR, and 23 (42%) had SD. Median follow up is 5.1 months. Most common related AEs were diarrhea and skin-related AEs, reported in 87% and 88% of pts, respectively. 27 pts (42.9 %) had dose reduction to 40 mg and 7 pts (11%) to 30 mg but only 1 pt permanently discontinued due to AEs. Diarrhea and rash were main causes of dose reduction. Conclusions: In the 2nd line setting, BIBW 2992 shows efficacy in NSCLC harboring EGFR activating mutations. Diarrhea and skin disorders, the most frequently observed AEs, are manageable with supportive care and dose reduction. Updated response and disease control rates and preliminary progression-free survival data will be presented. An international Phase III trial program investigating BIBW 2992 in NSCLC, LUX-Lung, is now recruiting.

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