Epidemic reemergence in adaptive complex networks

The dynamic nature of a system gives rise to dynamical features of epidemic spreading, such as oscillation and bistability. In this paper, by studying the epidemic spreading in growing networks, in which susceptible nodes may adaptively break the connections with infected ones yet avoid being isolated, we reveal a phenomenon, epidemic reemergence, where the number of infected nodes is incubated at a low level for a long time and then erupts for a short time. The process may repeat several times before the infection finally vanishes. Simulation results show that all three factors, namely the network growth, the connection breaking, and the isolation avoidance, are necessary for epidemic reemergence to happen. We present a simple theoretical analysis to explain the process of reemergence in detail. Our study may offer some useful insights, helping explain the phenomenon of repeated epidemic explosions.

Autologous transplantation of bone marrow-derived mesenchymal stem cells: a promising therapeutic strategy for prevention of skin-graft contraction

Hypertrophic scars result from abnormal healing of severe burns, and are characterized by loss of the original structure and function of the skin. Transplantation of autologous split skin is the preferred treatment after scar excision; however, there will be some unavoidable degree of contraction within the grafts. To our knowledge, it is very rare that bone marrow-derived mesenchymal stem cells (BM-MSCs) have been used for the treatment of skin-graft contraction. However, in our clinics, we found that during a 2-year follow-up analysis, areas treated with autologous BM-MSCs combined with transplantation of split skin were less likely to have contraction of the skin grafts than areas treated with skin grafts alone. This result indicates that BM-MSCs may be a potential and promising treatment to prevent contraction of skin grafts.

Tacrolimus enhances the invasion potential of hepatocellular carcinoma cells and promotes lymphatic metastasis in a rat model of hepatocellular carcinoma: involvement of vascular endothelial growth factor-C

PURPOSE

The purpose of this study was to elucidate the effect of tacrolimus treatment on tumor growth and metastasis of hepatocellular carcinoma (HCC).

METHODS

The effect of tacrolimus was investigated on tumor growth and lymph node metastasis in a rat model of HCC. Angiogenesis and lymphangiogenesis were assessed by CD31 and vascular endothelial growth factor receptor 3 (VEGFR-3) immunostaining. Cell proliferation and invasion were monitored in vitro using the Cell Counting Kit-8 (CCK8) and Matrigel Invasion Chambers, respectively. Levels of vascular endothelial growth factor-C (VEGF-C) expression were measured using quantitative real-time polymerase chain reaction (qRT-PCR), immunohistochemisty and Western blots.

RESULTS

Tacrolimus had no effect on the proliferation of HCC in vitro or in vivo. Treatment with tacrolimus resulted in a dose-dependent increase in the invasive potential of HCC cells in vitro, in the density of peritumoral lymphatic vessels, and in the number and volume of metastatic lymph nodes in August Copenhagen Irish (ACI) rats. qRT-PCR, immunohistochemisty, and Western blot revealed that tacrolimus increased the levels of expression of VEGF-C in HCC.

CONCLUSIONS

Tacrolimus enhanced the invasive potential of HCC cells, facilitating HCC lymphangiogenesis and promoting lymphatic metastasis in a rat model of HCC. This influence may be the result of an increase in VEGF-C expression by HCC cells. Targeting the VEGF-C/Fms-related tyrosine kinase 4 axis may be a novel treatment for HCC patients after liver transplantation.

P4-01-02: Endocrine Resistance: Mechanism, Tumorigenic Capacities, and New Therapeutic Strategies

Background

Endocrine therapy is the most effective therapies for estrogen receptor positive (ER+) breast cancer, but resistance is still a major clinical problem. Tumor initiating cells (TICs) in drug resistant tumors are believed to be part of the contributing factors for tumor relapse. Here we focused on the TICs and how they are related to HER2 expression and its downstream factors in acquired endocrine resistance models.

Materials and Methods: We have established a panel of endocrine resistant cell models through long-term treatment with tamoxifen (Tam, 10−7M, >6 months). Resistance to tamoxifen treatment in cells (TamR) was confirmed by growth curve assays (Celigo, Cyntellect Inc., San Diego, CA). In vitro mammosphere assays were applied to assess the mammosphere forming ability of parental and resistant cells. Aldefluor assays (StemCell Technology) were performed to measure the aldehyde dehydrogenase (ALDH-1) expressing cell population as a marker of TICs. Flow analysis was performed to evaluate HER2 expression in the ALDH subpopulations of both parental and TamR cells. Immunofluorescence staining was further used to detect the expression of ER, HER2, phosphorylated STAT3, and β-catenin in sorted ALDH+/− subpopulations.

Results: We found that endocrine resistant cells have a higher mammosphere forming ability than their parental counterparts. In addition, we showed that the ALDH+ subpopulation was significantly upregulated in all TamR derivative lines.

P4-01-03: Establishment and Characterization of an Endocrine Resistance Model In Vitro and In Vivo by Inducible PTEN Knockdown

Background

Growth factor receptor and estrogen receptor (ER) are two major driving pathways for initiating and sustaining breast cancer (BC) development and progression. We have previously shown that an inverse correlation exists between the PI3K pathway and ER expression/activity in luminal type BCs. High PI3K activation signaling correlates to the luminal B subtype of BC with low ER expression/activity. However, the involvement of the PI3K pathway tumor suppressor PTEN in resistance to endocrine therapy is less clear. Here we attempt to develop an experimental system to better understand the role of PTEN in this resistance.

Materials and Methods: Two luminal BC cell lines, MCF7L and ZR75-B, were stably infected with a lentivirus pINDUCER (Meerbrey et al., PNAS, 2011), containing Tet-on responsive shPTEN, turboRFP (tRFP) as an inducible tag, and enhanced GFP (eGFP) as a constitutive expressed tag for positive cells selection. Immunoblotting of PTEN, phosphorylated (p) Akt, pMAPK, pc-Jun, ER, and ER's downstream gene products (PR, IGF-1R) was performed on cells after 6 days of doxycycline (Dox) incubation. After pre-starvation for 5 days in estrogen deprivation (ED) conditions, the cells -/+ Dox were subjected to induction with estrogen (E2) or to endocrine treatment [continued ED, tamoxifen (Tam, 10–7M), or fulvestrant (Ful, 10–7M)] in 96-well plate format for 9 days. In situ cell cytometry (Celigo, Cyntellect Inc., San Diego, CA) was applied to count the cell number by scanning the same 96-well plate every other day. Ovariectomized nude mice bearing MCF7L-shPTEN xenografts, established in the presence of E2 supplementation, were randomized to minus and plus Dox groups, with each treatment group continuing E2 or endocrine therapies (ED, Tam, or Ful). The in vivo GFP/RFP imaging was performed with a home-built cooled and image intensified CCD camera system.

Results: Immunoblot analysis showed a striking loss of PTEN, and significant upregulation of pAkt, as well as pMAPK and pc-Jun in cells with +Dox. In contrast, levels of ER, PR and IGF1R were reduced in cells with +Dox compared to -Dox. In all -Dox groups, cell growth was significantly reduced in endocrine treated groups compared to the E2 group, whereas +Dox rescued the endocrine treatment growth suppression, especially in ED and Tam groups. In vivo induction of PTEN shRNA expression was confirmed by RFP imaging after feeding the mice with +Dox water. MCF7L-shPTEN xenografts randomized to +Dox under ED conditions continued to grow over 4 weeks, in contrast to the marked regression of control tumors (−Dox) under this endocrine regimen (p<0.05). Comparison between plus and minus Dox groups under E2, Tam, or Ful treatment is ongoing.

Discussion: These data further support the existence of crosstalk between PI3K and ER pathways in luminal type BC. Decreasing PTEN levels by shRNA renders the luminal type BC cells de novo resistant to endocrine therapy both in vitro and in vivo. The pINDUCER PTEN knockdown system combined with live animal imaging offers successful real-time, noninvasive tracking of endocrine sensitivity by controllably manipulating the level of target gene. Combination therapies to overcome endocrine resistance under PTEN knockdown conditions are currently underway.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-01-03.

P4-01-18: AP-1 Blockade Potentiates the Anti-Tumor Effect of Endocrine Treatment and Reverts the Resistant Phenotype in Hormone Receptor-Positive Breast Cancer

Background: Resistance to endocrine therapy is a major clinical issue. The transcription factor AP-1 is a key regulator of cell growth and survival as well as a downstream signaling component of several pathways deregulated in endocrine-resistant breast cancer. We have previously shown that acquired endocrine resistance is associated with increased AP-1 activity. AP-1 has also been shown to interact with and modulate the ER network and transcriptional program, especially under hyperactive growth factor signaling, which is commonly associated with endocrine resistance. We hypothesized that interfering with AP-1 function would circumvent endocrine resistance possibly due to its role in modulating ER transcriptional activity.

Methods and results: We inhibited AP-1 function by a genetic approach. We used two different MCF7 clones stably transfected with a Doxycycline (Dox)-inducible dominant-negative (DN) c-Jun (MCF7/Tet-Off Tam67 clones 62 and 67) and two vector-alone control MCF7 clones. Xenografts of these clones were established in ovariectomized nude mice supplemented with estrogen (E2). Mice were then randomized to continued E2 supplementation (control) or to endocrine therapy with either estrogen deprivation (ED) or tamoxifen (Tam), all in the presence or absence of Dox to induce the DN c-Jun expression. AP-1 blockade in both MCF7/Tet-Off Tam67 clones significantly enhanced sensitivity to Tam by reducing time to tumor size halving (p=.014 and p=.006 for clone 62 and 67, respectively) and time to complete tumor disappearance (p=.001 and p=.0034 for clone 62 and 67, respectively). Similar results were obtained with ED treatment. In addition, AP-1 blockade significantly delayed the onset of Tam resistance by increasing time to tumor size doubling (p=.0028). Furthermore, induction of DN c-Jun resulted in a dramatic shrinkage of growing tumors after long-term Tam treatment, suggesting reversal of endocrine resistance with AP-1 blockade. None of the above effects was observed in control clones upon Dox removal. Interestingly, no significant effect of AP-1 blockade was observed on E2-stimulated tumor growth. IHC analysis showed that AP-1 blockade induced tumor response by reducing proliferation (i.e., decreased % of Ki67- and phospho-Histone 3-positive cells) and by inducing apoptosis (i.e., increased % of cleaved caspase 3/7-positive cells). Bioinformatic analyses were conducted to intersect our MCF7 xenograft/Tam-resistant gene signature and the datasets of genes associated with ER DNA-binding sites obtained by whole-genome ER cistromic analysis under estrogen or epidermal growth factor (EGF) stimulation of MCF7 cells. A significant enrichment of the genes associated with the EGF-unique ER DNA-binding sites was observed within our Tam-resistant signature (p<2E-16). Remarkably, 90% of these DNA binding sites harbored an AP-1 motif.

Conclusions: We show that AP-1 blockade increases tumor sensitivity and circumvents resistance to endocrine therapy, thus warranting the development of AP-1-targeted therapy to improve endocrine treatment outcomes. Overall, we suggest that AP-1 is critical in induction of a switch in the ER transcriptional program and may be a new hallmark of endocrine resistance.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-01-18.

P3-03-05: Identification of miRNAs and Their Associated Target Genes Involved in Endocrine Resistance in Breast Cancer

Background: Despite the widespread use of the selective estrogen receptor modulator tamoxifen or strategies of estrogen deprivation in the treatment of estrogen receptor-positive breast cancer, tumor resistance to endocrine therapy remains a serious clinical problem. MiRNAs are a class of endogenous, single stranded RNA molecules that play a pivotal role in the regulation of gene expression. Altered expression levels of these molecules have been implicated in a number of malignancies, including breast cancer. The aim of this study was to identify those miRNAs that may be associated with endocrine resistance and to further investigate their role in development of this resistance.

Methods: MCF7L breast cancer cells were cultured in regular parental medium (Par) or in phenol-red free, 10% charcoal-stripped FBS medium treated by estrogen deprivation (ED, >6months), tamoxifen (Tam, 10−7M, >6months), or estrogen (E2, 10−9M,>1month). Cells treated by long-term Tam or ED developed resistance (TamR or EDR) and resumed cell growth, which was confirmed by growth curve assay. Parallel short-term treatment (10 days) with estrogen deprivation or tamoxifen to represent the endocrine-sensitive phase, and short-term E2 treated cells as a control was also performed. A whole-transcriptome miRNA microarray was performed by High Throughput Genomics (Tucson, AZ), using cell lysates from Par, short-term/endocrine sensitive, E2 treated cells, TamR and EDR. The expression levels of several miRNAs were validated by real-time quantitative PCR (Q-PCR). MiRNAs dysregulated in TamR cells were integrated with predicted gene targets showing anti-correlated expression patterns across human breast tumors in The Cancer Genome Atlas (TCGA) datasets.

Results: The miRNA microarray identified 23 miRNAs that are upregulated in TamR cells (>1.7 fold change, p<0.005) compared to parental cells grown in the presence of E2, and 37 miRNAs that were downregulated (>50%, p<0.005). In addition, 6 miRNAs were observed to be upregulated in EDR and 3 downregulated in EDR compared with controls. Validation of four of these upregulated miRNAs within the TamR group, miR221, miR-222, miR-301b and miR-181c, was performed using Q-PCR. Previously identified genes associated with TamR were scanned for potential binding sites of these deregulated miRNAs using miRanda and TargetScan and many potential miRNA targeted genes are downregulated in TamR. Both miR-221 and miR-181c are predicted to target estrogen receptor gene (ESR1), and downregulation of this target gene was confirmed at the mRNA level by Q-PCR. A strong negative correlation was identified between ESR1 and both miR-181c and miR-221 expression levels in breast tumor samples, according to TCGA data. Work is ongoing to identify the role of miR-181c and other miRNAs in tamoxifen resistance, using a loss-of-function approach. Parallel miRNA profiling of multiple endocrine models is underway to identify commonly deregulated miRNAs associated with endocrine resistance.

Conclusions: This study has identified those miRNAs associated with endocrine resistance in breast cancer. These miRNAs may provide potential predictive markers of resistance to endocrine therapy and modulation of these may lead to increased therapeutic sensitivity.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-03-05.

Relationships of percent body fat and percent trunk fat with bone mineral density among Chinese, black, and white subjects

We examined ethnic difference in the association of body fat and trunk fat with bone mineral density (BMD) among Chinese, white, and black subjects. We found that, with greater body and trunk fat, both white and black subjects were more likely to have a low BMD than Chinese subjects.

INTRODUCTION

Ethnic differences in body fat, abdominal fat distribution, and BMD have been found in previous studies between Chinese and white subjects. However, the associations of body fat and abdominal fat distribution with BMD have not been studied, and whether the ethnic differences have an effect on these associations is unclear.

METHODS

We evaluated 1,147 subjects aged ≥ 18 years (805 Chinese, 193 whites, and 149 blacks). Percent body fat (%BF), percent trunk fat (%TF), and total and regional BMD including that of head, arm, leg, trunk, rib, spine, and pelvis were measured by dual-energy X-ray absorptiometry. Linear regression models were developed to test the association of ethnicity, %BF, and interaction between ethnicity and %BF with BMD. The models were repeated again, replacing %BF with %TF.

RESULTS

Chinese subjects showed lower BMD in total and most regions compared with black and white subjects; however, these differences were eliminated between Chinese and whites within both sexes and between Chinese and black men when age, weight, height, and %BF were added. %BF and %TF were negatively associated with most regional body BMD. The interactions between %BF, %TF, and ethnicity were found in most regional body BMD among Chinese, white, and black subjects for both men and women.

CONCLUSION

Both %BF and %TF have negative associations with BMD. With greater accumulation of %BF and %TF, both white and black subjects may experience a higher risk of low BMD than Chinese subjects.

Uncoupling hypoxia signaling from oxygen sensing in the liver results in hypoketotic hypoglycemic death

As the ultimate electron acceptor in oxidative phosphorylation, oxygen plays a critical role in metabolism. When oxygen levels drop, heterodimeric hypoxia-inducible factor (Hif) transcription factors become active and facilitate adaptation to hypoxia. Hif regulation by oxygen requires the protein von Hippel-Lindau (pVhl) and pVhl disruption results in constitutive Hif activation. The liver is a critical organ for metabolic homeostasis, and Vhl inactivation in hepatocytes results in a Hif-dependent shortening in life span. While albumin-Cre;Vhl^F/F mice develop hepatic steatosis and impaired fatty acid oxidation, the variable penetrance and unpredictable life expectancy has made the cause of death elusive. Using a system in which Vhl is acutely disrupted and a combination of ex vivo liver perfusion studies and in vivo oxygen measurements, we demonstrate that Vhl is essential for mitochondrial respiration in vivo. Adenovirus-Cre mediated acute Vhl disruption in the liver caused death within days. Deprived of pVhl, livers accumulated tryglicerides and circulating ketone and glucose levels dropped. The phenotype was reminiscent of inborn defects in fatty acid oxidation and of fasted PPARα-deficient mice and while death was unaffected by pharmacologic PPARα activation, it was delayed by glucose administration. Ex vivo liver perfusion analyses and acylcarnitine profiles showed mitochondrial impairment and a profound inhibition of liver ketone and glucose production. By contrast, other mitochondrial functions, such as ureagenesis, were unaffected. Oxygen consumption studies revealed a marked suppression of mitochondrial respiration, which, as determined by magnetic resonance oximetry in live mice, was accompanied by a corresponding increase in liver pO₂. Importantly, simultaneous inactivation of Hif-1β suppressed liver steatosis and rescued the mice from death. These data demonstrate that constitutive Hif activation in mice is sufficient to suppress mitochondrial respiration in vivo and that no other pathway exists in the liver that can allow oxygen utilization when Hif is active precluding thereby metabolic collapse.

Associations of fat mass and fat distribution with bone mineral density in pre- and postmenopausal Chinese women

Fat mass (FM) is closely related to bone mineral density (BMD). However, the associations of FM and fat distribution with BMD in pre- and postmenopausal women are still poorly understood. The present study showed android fat mass accumulation after menopause had a negative association with BMD.

INTRODUCTION

FM is closely related to BMD. However, it is unknown whether FM and central fat distribution have different associations with BMD in pre- and postmenopausal women. The study aims to investigate the associations of FM and fat distribution with BMD in pre- and postmenopausal Chinese women.

METHODS

Two hundred sixty premenopausal and 267 postmenopausal women aged 18 to 79 years were analyzed. Lean mass (LM), FM, percent body fat (%BF), android FM, gynoid FM, and total and regional BMD were measured using dual-energy X-ray absorptiometry. Fat distribution was assessed by android to gynoid FM ratio (AOI). Multiple regression analysis was performed to examine the associations of BMD with FM, LM, and AOI.

RESULTS

FM, %BF, android FM, and AOI were significantly higher, whereas total and regional BMD were significantly lower in postmenopausal women (all р < 0.01). In premenopausal women, FM was positively associated with total and regional BMD (all р < 0.05). AOI had no significant association with BMD. In postmenopausal women, FM was significantly associated with total and regional BMD even additionally adjusting for LM (all р < 0.01). AOI had significantly negative association with total, head, arm, and leg BMD (all р < 0.05). The results remained unchanged when replacing FM with %BF.

CONCLUSIONS

There were different associations of FM and fat distribution with BMD in pre- and postmenopausal Chinese women. Increased central body fat had a negative association with BMD. Our findings may have significant implications in the prevention of menopause-related osteoporosis through reducing centralized fat deposition.

Abstract P4-02-20: Plasticity of the ER and HER2 Signaling Networks Results in Compensatory Escape Pathways Contributing to Treatment Resistance

Bidirectional crosstalk between the estrogen receptor (ER) and HER2 has been demonstrated in preclinical model systems. We have previously shown in HER2+ breast cancer cells with low ER that potent HER2- targeted therapy results in ER reactivation that functions as an escape pathway to evade therapeutic inhibition. Here we investigated the role of HER pathway components in resistance to endocrine therapies using UACC812 cells, which are endogenously amplified for HER2. Endocrine resistant (R) derivatives of the UACC812 line were developed through long-term (&gt;6 months) culturing with estrogen deprivation (ED) alone or with 4-OH-tamoxifen (Tam, 10-7M). Endocrine treatment [continued ED, estrogen (E2, 10-9M), Tam (10-7M), or fulvestrant (Ful, 10-7M)] of parental cells slowed cell growth compared to estrogen treatment (P&lt;0.01). EDR and TamR derivatives treated with any of the endocrine therapies, however, exhibited the same growth rates as with estrogen, validating the completely resistant phenotype of our clones. By immunoblot analysis, the resistant derivatives, TamR and EDR, showed a striking and complete loss of ER expression and its downstream gene products including PR, IGF-1R, and IRS-1. In contrast, both resistant lines exhibited significant upregulation of HER pathway components including marked increases in total and phosphorylated (p) EGFR, further upregulation of pHER2, and marked increases in the downstream signaling moieties pMAPK, pAkt, pFAK, pSrc, and pFOXO3a. In contrast, levels of pHER3 were markedly reduced at resistance. Since our in vitro data suggested that ER and HER2 compensate for inhibition of each other's pathways, we next examined whether simultaneous inhibition of both pathways can circumvent the development of resistance in an in vivo xenograft model. Athymic nude mice bearing UACC812 xenografts, established in the presence of E2 supplementation, were randomized to continued E2, endocrine therapies alone (ED, Tam, or Ful), anti-HER2 alone [lapatinib (L), trastuzumab (T), or L+T], or the combination of endocrine and anti-HER2 therapies (ED with L, T, or L+T). We found that tumors were stimulated by E2, as well as by Tam (as a mechanism of de novo resistance), while still being inhibited, though only temporarily (2-3 months), by ED and Ful. Anti-HER2 therapy alone only slowed down (L or T) or stabilized (L+T) tumor growth. In contrast, in the presence of both ED and anti-HER2 therapies, most tumors completely regressed. However, only the potent L+T plus ED regimen achieved continuous long term (&gt;200 days) complete regression in all mice. Our results further illustrate the plasticity of the ER and HER2 pathways and provide additional support for the role of the HER network, especially EGFR, in resistance to endocrine therapy in ER+/HER2+ breast cancer. The data emphasize the need for complete HER blockade for optimal therapy.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-02-20.

CSF neutrophils are implicated in the development of vasospasm in subarachnoid hemorrhage

BACKGROUND

Cerebral vasospasm is a significant cause of morbidity in patients after aneurysmal subarachnoid hemorrhage (aSAH). There are few effective treatments. The search for new treatments has focused predominantly on dilating cerebral blood vessels. Growing evidence supports a role for inflammation in its pathogenesis but no potential target for intervention has emerged.

METHODS

CSF and clinical information from patients with aSAH were collected. Additionally, tyrosine modifications by stable isotope dilution HPLC with online tandem mass spectrometry were quantified in CSF samples.

RESULTS

We report an association between neutrophil accumulation in the cerebrospinal fluid of patients with aSAH and the development of vasospasm. In particular, CSF neutrophil content of >62% on the third day after aSAH is an independent predictor of the later development of vasospasm (OR 6.8, 95% CI 2.0-23.3, P = 0.002). Further, activity of myeloperoxidase and NADPH oxidase is elevated in aSAH suggesting a role for modification of CSF proteins by reactive oxidant species.

CONCLUSIONS

Neutrophil percentage is an independent predictor of vasospasm in aSAH patients, days prior to its onset suggesting a role of neutrophils in vasospasm. The activity of neutrophil enzymes is also increased suggesting a mechanism for blood vessel damage. Inflammation mediated by neutrophils is a potential target for therapies in vasospasm. More study is necessary to determine the mechanism by which neutrophils damage cerebral blood vessels.

Prognostic value of different B symptoms in upper aerodigestive tract NK/T-cell lymphoma

e19544

Background: Extranodal NK/T-cell lymphoma (ENKL) is a rare disease originated from NK or toxic T cells. ENKL arising from the upper aerodigestive tract (UNKTL) is a newly recognized subtype and commonly presents with B symptoms. This study is to investigate the prognostic value of different B symptoms in UNKTL. Methods: UNKTL cases with detailed clinical, pathological and prognostic data in our center since 2001 to 2007 were retrospectively analyzed with the major study endpoint of overall survival (OS). Central pathological review was performed. Survival curves were estimated by Kaplan-Meier method and tested by Log Rank method. Statistically significant factors in univariate analysis were then included in multivariate analysis. B symptoms were defined as fever, night sweat and weight loss according to the Ann Arbor Cotswolds meeting. The predictive values of survival for each type of B symptoms were studied independently. Results: 172 cases of UNKTL with a median follow-up duration of 27.4 months were included. 45 ladies and 127 gentlemen had a median age of 43 years. 98 cases were Ann Arbor stage I, 54 were stage II and the remaining 20 cases were stage III or IV. About half of the patients present B symptoms: 82 had fever, 5 had night sweat and 6 present weight loss. Totally 18 patients had ECOG PS larger than 1. The 5-year OS rate of the whole group is 41.8%. Patients with persistent fever before treatment indicated a poor outcome in the univariate analysis (p=.033) and its prognostic value was also confirmed by the Cox regression (p=.030) whereas those of night sweat and weight loss were not (p= .960 and .824 respectively). Conclusions: B symptoms were common in UNKTL patients. Our data suggested that only fever among the three types of B symptoms was independent prognostic factor for UNKTL but it still needs further confirmation.

No significant financial relationships to disclose.

Phase I dose-escalation study of thoracic radiotherapy in combination with gefitinib in patients with IIIB/IV non-small cell lung cancer (NCT00497250)

e14581

Background: Cinical studies have confirmed that gefitinib, an EGFR-TKI, is effective for some advanced NSCLC patients. Patients with Asian ethnicity are reported to have a higher response rate with gefitinib monotherapy. However, a higher incidence of interstitial lung disease, sometimes lethal, is also found. The combination of gefitinib and radiotherapy has been observed to have a synergistic, anti-proliferative effect against NSCLC in vitro. This phase I study assessed the safety, clinical feasibility and optimally tolerated regimen (OTR) of this combination in patients with pretreated locally advanced or metastatic (IIIB/IV) NSCLC. Methods: Patients with stage IIIB or selected stage IV, failure of platinum-based chemotherapy regimen NSCLC were eligible. Four Cohorts of eight patients each were planned to be treated with escalating doses from 54 to 60 Gy of conformal or intensity- modulated radiotherapy (2Gy/Fx) administered in combination with gefitinib 250mg daily during RT and 60 days after the completion of RT to determine the OTR. Results: Since June 2007, 2 cohorts, a total of 16 patients, were enrolled and treated: 8 stage IIIB and 8 stage IV; 2 squamous-cell carcinoma and 14 adenocarcinoma; 8 smokers and 8 nonsmokers. Prior-chemotherapy regimen was consisted of NP, GP and TP for a median of 3.5 cycles (range, 1–5). Median follow-up time was seven months. Mean progression-free survival time was 5.2 months (median, 3.9; range, 1.7–12.3). Overall, adverse events were mild to moderate in severity. The most frequent grade 2 events included pneumonitis (31%) and dysphagia (19%). There were one treatment-related grade 3 event, which was nausea, and no grade 4 events. Most of the failure patterns were out-of-field (11/13) and the most common distant metastasis organ was the lungs. Three patients are progression-free to date. Conclusions: Thoracic radiotherapy up to 56 Gy concurrent with gefitinib 250 mg daily was well tolerated and clinically active in this group of pretreated Chinese NSCLC patients, including nonsmokers with adenocarcinoma. Accrual is continuing. Sponsorship: This work was partly supported by Program for New Century Excellent Talents in University (NCET), Ministry of Education.

No significant financial relationships to disclose.

Involved-field radiotherapy for patients with limited small cell lung cancer: Patterns of local-regional failure and feasibility

7554

Background: To investigate the feasibility of the involved-field radiotherapy in patients with limited-stage small cell lung cancer (LSCLC) according to the patterns of local failure, focused on the first local-regional failure. Methods: Two clinical phase II studies for patients with LSCLC treated at our institute between 1997 and 2007 were reviewed. All patients received combined chemotherapy (CHT) with cisplatin and etoposide, and thoracic RT (TRT) was generally delivered sequentially following one to three cycles of CHT and consisted of either 56 Gy in 40 fractions for 4 weeks or 55 Gy in 22 fractions for 4–5 weeks. TRT fields encompassed primary tumor volume (post-CHT) and the involved nodal areas (pre- and post-CHT) without elective node irradiation. The local-regional failure was defined as failure within thoracic cavity and supraclavicular fossa except for pleural effusion, which was then divided into two subtypes: in-field and out-field failure according to the first occurred site in the planning target volume or not. Results: There were 89 patients completed the planed regimen and eligible for evaluating patterns of failure, 54 patients (57%) in 56 Gy cohort and 35 patients(43%) in 55 Gy cohort. The media cycles of CHT were 6 (4–8). The overall survival and local progression-free survival rates for 89 patients at 2 years were 56% and 71%, respectively, with a median survival of 25.6 months. 56 patients (63%) developed distant metastases and 21 patients (24%) developed local-regional failures: 12 in-field and 9 out-field. 8 out of 9 out-field failures occurred in the ipsilateral supraclavicular fossa, and the media duration to the end of TRT was 6 mouths (5–14). Comparing the 56 Gy and 55 Gy cohorts, the rates of any thoracic, in-field and out-field failures were no difference significantly. Conclusions: Thoracic radiotherapy using involved-field technique in patients with LSCLC resulted in a high failure rate of the supraclavicular fossa. Whether improving accuracy for the initial evaluation of clinical stage could reduce out-field failure in supraclavicular fossa need to be investigated.

No significant financial relationships to disclose.

Effects of formulation factors on encapsulation efficiency and release behaviourin vitroof huperzine A-PLGA microspheres

To develop a long-acting injectable huperzine A-PLGA microsphere for the chronic therapy of Alzheimer's disease, the microsphere was prepared by using an o/w emulsion solvent extraction evaporation method based on a series of formulation design of the emulsion. The dialysis method was used for release analysis. The encapsulation efficiency and release amount of the microspheres were determined by a UV/VIS spectrophotometer. The morphology of the microspheres was observed by scanning electron microscopy. The distribution of the drug within microspheres was observed by a confocal laser scanning microscope. The results indicated that the PLGA 15,000 microspheres possessed a smooth and round appearance with average particle size of 50 microm or so. The encapsulation percentages of microspheres prepared from PLGA 15,000, 20,000 and 30,000 were 62.75%, 27.52% and 16.63%, respectively. The drug release percentage during the first day decreased from 22.52% of PLGA 30,000 microspheres to 3.97% of PLGA 15,000 microspheres, the complete release could be prolonged to 3 weeks. The initial burst release of microspheres with higher molecular weight PLGA could be explained by the inhomogeneous distribution of drug within microspheres. The encapsulation efficiency of the microspheres improved as the polymer concentration increased in the oil phase and PVA concentration decreased in the aqueous phase. The burst release could be controlled by reducing the polymer concentration. Evaporation temperature had a large effect on the drug release profiles. It had better be controlled under 30 degrees C. Within a certain range of particle size, encapsulation efficiency decreased and drug release rate increased with the reducing of the particle size.

Effects of formulation factors on encapsulation efficiency and release behaviourin vitroof huperzine A-PLGA microspheres

To develop a long-acting injectable huperzine A-PLGA microsphere for the chronic therapy of Alzheimer's disease, the microsphere was prepared by using o/w emulsion solvent extraction evaporation method based on a series of formulation design of the emulsion. The dialysis method was used for release analysis. The encapsulation efficiency and release amount of the microspheres were determined by UV/VIS spectrophotometry. The morphology of the microspheres was observed by scanning electron microscopy. The distribution of the drug within microspheres was observed by a confocal laser scanning microscope. The results indicated that the PLGA 15 000 microspheres possessed a smooth and round appearance with average particle size of 50 microm or so. The encapsulation percentages of microspheres prepared from PLGA 15 000, 20 000 and 30 000 were 62.75, 27.52 and 16.63%, respectively. The drug release percentage during the first day decreased from 22.52% of PLGA 30 000 microspheres to 3.97% of PLGA 15 000 microspheres, the complete release could be prolonged to 3 weeks. The initial burst release of microspheres with higher molecular weight PLGA could be explained by the inhomogeneous distribution of drug within microspheres. The encapsulation efficiency of the microspheres improved as the polymer concentration increase in oil phase and PVA concentration decreased in aqueous phase. The burst release could be controlled by reducing the polymer concentration. Evaporation temperature had a large effect on the drug release profiles. It had better be controlled under 30 degrees C. Within a certain range of particle size, encapsulation efficiency decreased and drug release rate increased with the reducing of the particle size.