The small quinolone derived compound HT61 enhances the effect of tobramycin against Pseudomonas aeruginosa in vitro and in vivo

HT61 is a small quinolone-derived compound previously demonstrated to exhibit bactericidal activity against gram-positive bacteria including methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA). When combined with the classical antibiotics and antiseptics neomycin, gentamicin, mupirocin and chlorhexidine, HT61 demonstrated synergistic bactericidal activity against both MSSA and MRSA infections in vitro. In this study, we investigated the individual antimicrobial activity of HT61 alongside its capability to potentiate the efficacy of tobramycin against both a tobramycin sensitive laboratory reference strain (PAO1) and tobramycin resistant clinical isolates (RP73, NN2) of the gram-negative bacteria Pseudomonas aeruginosa (P. aeruginosa). Using broth microdilution methods, the MICs of HT61 were assessed against all strains, as well as the effect of HT61 in combination with tobramycin using both the chequerboard method and bacterial time-kill assays. A murine model of pulmonary infection was also used to evaluate the combination therapy of tobramycin and HT61 in vivo. In these studies, we demonstrated significant synergism between HT61 and tobramycin against the tobramycin resistant P. aeruginosa strains RP73 and NN2, whilst an additive/intermediate effect was observed for P. aeruginosa strain PA01 which was further confirmed using bacterial time kill analysis. In addition, the enhancement of tobramycin by HT61 was also evident in in vitro assays of biofilm eradication. Finally, in vivo studies revealed analogous effects to those observed in vitro with HT61 significantly reducing bacterial load when administered in combination with tobramycin against each of the three P. aeruginosa strains at the highest tested dose (10 mg/kg).

Abstract OT1-01-03: The WinPro study: A window of opportunity study of endocrine therapy with and without prometrium in postmenopausal women with early stage hormone receptor-positive breast cancer

Background

There is bidirectional interplay between PR and ER in human breast cancers (Lim et al, Endo Rel Can 2016). There is evidence for a reprogramming of ER chromatin binding sites with 470 genes differentially regulated by dual treatment with estrogen plus progestogen compared to estrogen alone in breast cancer cell lines (Mohammed et al, Nature 2015). Functionally, there was an additive anti-cancer effect with the addition of natural progesterone to endocrine therapy in preclinical breast cancer models.

Trial Design

This is a phase II multi-site, randomised, open-label, three-arm, study in 200 postmenopausal women with early-stage ER+, PR+, HER2-negative breast cancer. Eligible patients will be randomised 1:1:1 to receive 14 days of intervention with either letrozole 2.5mg PO daily (arm 1), letrozole 2.5mg + prometrium 300mg PO daily (arm 2) or tamoxifen 20mg + prometrium 300mg PO daily (arm 3), between diagnosis of breast cancer and definite surgery.

Australian Clinical Trials Registry: ACTRN1261800092813

Eligibility Criteria

Inclusion Criteria

a) Histologically confirmed ER+ and PR+ breast cancers (≥10% positive staining cells)

b) HER2/CEP17 ratio of <2 and mean HER2 copy number <6 (ASCO CAP 2013 guidelines)

c) Tumour size ≥1cm on ultrasound and/or mammogram

d) Aged ≥18 years

Exclusion Criteria

a) Currently on hormone therapies (HRT and OCP)

b) Locally advanced/inoperable and inflammatory breast cancer

c) Clinical evidence of metastatic disease

d) Received other preoperative systemic therapies

e) Nut allergy (prometrium contains peanut oil)

f) Prior history of uterine cancer, deep vein thrombosis, pulmonary embolism or clotting disorder

g) Women who are pregnant/breast feeding

Specific Aims

a) Primary Endpoint

The geometric mean suppression of the centrally assessed proliferation marker Ki67, after two weeks of intervention, compared with baseline. This will be obtained by comparing the mean difference in Ki67 staining between pre and post-treated samples in each intervention arm.

b) Secondary Endpoint

Safety and tolerability of combination therapy (NCI-CTCAE v4.0)

c) Translational Endpoints

1. Define a gene set as a predictive biomarker for a reduction in Ki67

2. Evaluate changes in the apoptotic markers Bcl-2 and Caspase 3 in the tumors following intervention

3. Evaluate changes in ER, PR, AR, FoxA1, Cyclin D1 protein and mRNA expression in the tumors following intervention

Statistical Methods

The IMPACT study reported a geometric mean reduction in Ki67 after 2 weeks of preoperative tamoxifen of 59.5% and anastrazole of 76% (Dowsett et al, JNCI 2007). This allows estimation of power to detect differences between Arm 1 and either Arm 2 or Arm 3 with a p-value of 0.025. For the third possible comparison of Arm 2 vs Arm 3, there is no prior evidence, therefore this as a purely exploratory comparison. With a total trial recruitment of 200 and allowing 4% dropouts, this would give 80% power to detect an improvement in Ki67 suppression from 76% in the letrozole alone control arm to 92% in either experimental arm.

Accrual

Present: 5 (1 site open)

Target: 200 (8 sites total)

Contact Information

Elgene Lim, MBBS, FRACP, PhD. e.lim@garvan.com.au

Citation Format: Carson E, Segara D, Parker A, O'Toole S, Coates A, Mann B, Lindeman G, Tilley W, Lim E. The WinPro study: A window of opportunity study of endocrine therapy with and without prometrium in postmenopausal women with early stage hormone receptor-positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-01-03.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Abstract P4-22-02: Evaluation of veliparib (V) and temozolomide (TMZ) in a phase 2 randomized study of the efficacy and tolerability of V+TMZ or carboplatin (C) and paclitaxel (P) vs placebo (Plc)+C/P in patients (pts) with BRCA1 or BRCA2 mutations and metastatic breast cancer

Background: V is a potent, poly(ADP-ribose) polymerase (PARP) inhibitor that obstructs DNA damage repair. BRCA1/2 tumors are defective in homologous recombination, which leads to more error-prone mechanisms of DNA repair and increased sensitivity to PARP inhibition. V enhances the antitumor activity of alkylating agents such as TMZ in preclinical models. In addition, V+TMZ showed promising activity in a single-arm phase 2 study in pts with BRCA1/2 mutations. This phase 2 trial (NCT01506609) investigated the efficacy and tolerability of V+TMZ (or V+C/P) compared to Plc+C/P in pts with locally recurrent or metastatic breast cancer harboring a BRCA1 or BRCA2 mutation. Results from the primary analysis for the V+TMZ arm vs Plc+C/P are presented, and the V+C/P vs Plc+C/P results will be presented separately.

Methods: Male and female pts aged ≥18 years with histologically confirmed locally recurrent or metastatic breast cancer were randomized 1:1:1 to: 1) V 40 mg BID D1–7 + TMZ 150–200 mg/m2 QD D1–5, 28-D cycle; 2) V 120 mg BID D1–7 + C AUC 6, D3 and P 175 mg/m2, D3, 21-D cycle; 3) placebo BID D1–7 + C/P. Key eligibility criteria included known deleterious BRCA1/2 mutation, ≤2 prior chemotherapies for metastatic disease, no prior platinum agent, and no CNS metastases. Randomization was stratified by hormone receptor status, prior cytotoxic therapy (yes vs no), and ECOG PS (0–1 vs 2). The primary endpoint was progression-free survival (PFS) per RECIST 1.1 by independent review. Overall survival (OS), objective response rate (ORR), and safety/tolerability were also evaluated.

Results: A total of 290 pts (284 BRCA+ per central lab) were randomized (V+TMZ, n=94 [91 BRCA+]). Baseline demographics and disease characteristics were comparable among treatment arms; 41.3% of pts had triple-negative breast cancer (TNBC) and 31.7% had received &gt;2 prior regimens. Median study drug exposure was 6 cycles for the V+TMZ arm and 10 cycles for the Plc+C/P arm. Median PFS, median OS (interim), and ORR for V+TMZ were inferior to Plc+C/P (PFS 7.4 vs 12.3 mo, OS 19.1 vs 25.0 mo, and ORR 28.6% vs 61.3%). In pts with TNBC, median PFS was 5.5 (3.1–8.5) mo; 8.4 (6.8–10.6) mo for pts with non-TNBC. Treatment-emergent adverse events (AEs) of interest occurring differentially with V+TMZ are shown in Table 1. Grade ≥3 AEs in ≥30% of pts in the V+TMZ arm were thrombocytopenia (48%) and neutropenia (37%).

Conclusions: V+TMZ provided durable responses, with less neutropenia, alopecia, and neuropathy than Plc+C/P; however, PFS, OS, and ORR were inferior in the TMZ arm compared to C/P.

Table 1Treatment-Emergent AEs, n (%)V+TMZ, n=93Plc+C/P, n=96Neutropenia46 (50)71 (74)Alopecia10 (11)55 (57)Peripheral neuropathy11 (12)56 (58)Thrombocytopenia73 (79)67 (70)Nausea70 (75)56 (58)

Citation Format: Diéras V, Han HS, Robson ME, Palácová M, Marcom PK, Jager A, Bondarenko I, Citrin D, Campone M, Telli ML, Domchek SM, Friedlander M, Kaufman B, Ratajczak C, Coates A, Bonnet P, Qin Q, Qian J, Giranda VL, Shepherd SP, Puhalla S, Isakoff SJ. Evaluation of veliparib (V) and temozolomide (TMZ) in a phase 2 randomized study of the efficacy and tolerability of V+TMZ or carboplatin (C) and paclitaxel (P) vs placebo (Plc)+C/P in patients (pts) with BRCA1 or BRCA2 mutations and metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-02.

Defining dormancy in mycobacterial disease

Tuberculosis remains a threat to global health and recent attempts to shorten therapy have not succeeded mainly due to cases of clinical relapse. This has focussed attention on the importance of "dormancy" in tuberculosis. There are a number of different definitions of the term and a similar multiplicity of different in vitro and in vivo models. The danger with this is the implicit assumption of equivalence between the terms and models, which will make even more difficult to unravel this complex conundrum. In this review we summarise the main models and definitions and their impact on susceptibility of Mycobacterium tuberculosis. We also suggest a potential nomenclature for debate. Dormancy researchers agree that factors underpinning this phenomenon are complex and nuanced. If we are to make progress we must agree the terms to be used and be consistent in using them.

Collaborative case conferences in rectal cancer: case series in a tertiary care centre

BACKGROUND

In many hospitals, resource barriers preclude the use of preoperative multidisciplinary cancer conferences (mccs) for consecutive patients with cancer. Collaborative cancer conferences (cccs) are modified mccs that might overcome such barriers.

METHODS

We established a ccc at an academic tertiary care centre to review preoperative plans for patients with rectal cancer. Attendees included only surgeons who perform colorectal cancer procedures and a radiologist with expertise in cross-sectional imaging. Individual reviews began with the primary surgeon presenting the case information and initial treatment recommendations. Cross-sectional images were then reviewed, the case was discussed, and consensus on ccc-treatment recommendations was achieved. Outcomes for the present study were changes in treatment recommendations defined as "major" (that is, redirection of patient to preoperative radiation from straight-to-surgery or uncertain plan, or redirection of the patient to straight-to-surgery from preoperative radiation or plan uncertain) or as "minor" (that is, referral to a multidisciplinary cancer clinic, request additional tests, change type of neoadjuvant therapy, change type of surgery). Chart reviews provided relevant patient, tumour, and treatment information.

RESULTS

Between September 2011 and September 2012, 101 rectal cancer patients were discussed at a ccc. Of the 35 management plans (34.7%) that were changed as a result, 8 had major changes, and 27 had minor changes. Available patient and tumour factors did not predict for a change in treatment recommendation.

CONCLUSIONS

Preoperative cccs at a tertiary-care centre changed treatment recommendations for one third of patients with rectal cancer. Given that no specific factor predicted for a treatment plan change, it is likely prudent that all rectal cancer patients undergo some form of collaborative review.

Biparietal diameter at 11-13 weeks' gestation in fetuses with open spina bifida

OBJECTIVE

To ascertain the reported association between reduced biparietal diameter (BPD) at 11-13 weeks' gestation and open spina bifida and to investigate its predictive value in a single-center study.

METHODS

This was a retrospective study of fetuses in which BPD was measured at 11-13 weeks' gestation, including 27 fetuses with isolated open spina bifida subsequently diagnosed at 16-24 weeks and 7775 unaffected controls. BPD values were converted into multiples of the expected median (MoM) after adjustment for crown-rump length and maternal characteristics. Multivariable logistic regression analysis was used to determine the maternal characteristics significantly associated with spina bifida. The performance of screening was determined by receiver-operating characteristics curve analysis. BPD values at 11-13 weeks' gestation were compared with those measured in the second trimester using Z-scores.

RESULTS

BPD values at 11-13 weeks' gestation were below the 5(th) centile in 44.4% of cases of open spina bifida. In these fetuses, the median BPD MoM value was significantly smaller than that in the control group (0.930 vs 0.998 MoM; P < 0.0001). Multivariable logistic regression analysis showed a significant contribution from maternal age (P = 0.008) and BMI (P = 0.028) to the association between BPD MoM and spina bifida. The detection rate using BPD measurements in the first trimester was 55.6% with a false-positive rate of 11.6%. In fetuses with open spina bifida, the BPD Z-scores were significantly lower at 16-24 weeks compared to those recorded at 11-13 weeks (median, -1.71 (range, -3.98 to -0.20) vs -1.30 (-3.75 to 2.61); P = 0.006).

CONCLUSION

Fetuses with open spina bifida have a smaller BPD in the first trimester. This observation may be useful in early screening. It is likely that a combination of maternal characteristics such as age and BMI, fetal BPD and maternal serum alpha-fetoprotein measured in the first trimester would provide a clinically useful screening test for open spina bifida.

Abstract P5-09-01: Improving Informed Consent: Evaluating the First Decision Aid in a Clinical Trial Setting (IBIS-II Breast Cancer Prevention Trial)

Background: Recruitment to clinical trials is generally suboptimal, with both patients/consumers and clinicians reporting difficulties with the consent process. Decision Aids (DAs) are designed to facilitate doctor-patient communication and participation in decision-making, and may improve the consent process by ensuring patients/consumers make decisions that are informed and acted upon. While participant information sheets (PIS) provide information about the specific clinical trial, DAs present evidence-based information about all available management options (not just the clinical trial), including risks and benefits of each option. They also present both written and graphical forms of the information to enhance understanding, and explicit value clarification exercises to facilitate value-sensitive decisions. In screening and treatment settings, DAs have been found to reduce decisional conflict, improve patient knowledge, create more realistic expectations, and promote active decision-making without increasing anxiety. This RCT aimed to evaluate the efficacy of a DA for women at increased risk of breast cancer who are considering participation in the IBIS-II Prevention trial.

Methods: Women eligible for IBIS-II, who had not decided about participation, were invited to take part in the DA study. Participants from 12 Australian and New Zealand IBIS-II centres were randomised to receive either the standard IBIS-II information and consent materials alone (Control group, n=89), or in combination with a DA booklet (DA group, n=89). Participants completed standardised and purpose-designedmeasures 1 week and 3 months after deciding whether or not to participate in IBIS-II.

Results: In the Prevention arm, the majority of women (84%) reported the DA made it easier to understand IBIS-II compared to reading the PIS alone, and 89% recommended providing both the DA and PIS to potential IBIS-II participants. No group differences were detected in levels of decisional conflict or knowledge of IBIS-II/clinical trials in general, due to floor and ceiling effects respectively. Similarly, no group differences were found in levels of decisional regret and satisfaction at 3-month follow-up. Discussion: This is the first study to assess the effectiveness of DAs in a clinical trial setting. The use of DAs has been strongly endorsed by participating women and clinicians. Challenges of evaluating DAs in a Prevention breast cancer trial setting will be discussed. An RCT of a DA for the DCIS arm of IBIS-II is currently underway. The DAs have the potential to enhance the process of informed consent and reduce dropout rates in clinical trials.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-09-01.

Predicting Survival Time in Women Starting First Line Chemotherapy for Advanced Breast Cancer

Purpose: Women starting first line chemotherapy for advanced breast cancer have widely differing baseline characteristics and ultimate survival times. We sought to develop and validate a pragmatic prognostic index for clinical practice and research based on simple clinical and laboratory data.Methods: Prognostic models were developed in 378 women treated with CMF in the control groups of 3 randomized trials, and validated in 564 women treated with AC or mitoxantrone or capecitabine in the experimental groups of these trials. Multivariable censored linear regression of log-transformed survival times was used to select prognostic variables, which were then dichotomised to define negative prognostic features (NPFs). The effects of NPFs on survival time are expressed with hazard ratios (HR) and p-values from multivariable Cox models.Results: There were 7 independently significant NPFs (see table). In the development dataset, an elevated neutrophil count or history of brain metastasis approximately halved survival time, while the other NPFs reduced survival time by about one third. Women with 0 NPFs (15%) had a median survival of 18 months, about 1.4 times as long as those with 1 or 2 NPFs (63%, 13 months), and about 2.6 times as long as those with 3 or more NPFs (22%, 7 months). In the validation dataset, the effects of brain metastasis and elevated neutrophils were more modest, and most NPFs reduced survival by about one third. The median survivals of women with 0 NPFs (17%), 1 or 2 NPFs (60%) and 3 or more NPFs (23%) were 21 months, 13 months and 8 months respectively.Conclusions: A prognostic index using widely available baseline characteristics could improve prognostication in clinical practice. Stratification of patients using the prognostic index could improve the efficiency of randomised trials. Development (n=378)  Validation (n=564)  Negative prognostic feature% of womenHRp-value% of womenHRp-valueBrain metastasis32.410.00641.730.002Neutrophil count &gt;ULN121.910.001151.350.03ALP &gt;2 x ULN221.660.001201.380.008Age &gt;60451.490.001451.210.05Hb &lt;120g/L351.480.03291.230.05ER negative401.360.02281.52&lt;0.001ECOG 2 or 3271.320.03251.500.001ULN = upper limit of normal Development (n=378)  Validation (n=564)  Number of NPFs% of womenHRp-value% of womenHRp-value 150.850.30170.670.0021 or 2631.00-601.00-3 or more222.11&lt;0.001231.97&lt;0.001NPF = negative prognostic feature

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4066.

Outcomes of first-line chemotherapy for advanced breast cancer in women with good versus poor quality of life at baseline

1036

Background: Health-related quality of life (QL) is an established predictor of outcome in advanced breast cancer. The benefits and harms of chemotherapy in women with poor QL are unclear. Methods: We used data from 378 women receiving classical CMF in the control arms of 3 randomized trials. QL was rated at baseline by patients with linear analogue self-assessment scales (LASA) for physical well-being (PWB), mood, appetite, pain, nausea/vomiting, and overall QL; and by physicians with Spitzer's Quality-Of-Life Index (QL-I). Patients were divided into 3 groups according to their baseline QL scores: good (LASA 0–25, QL-I 5–7), intermediate (LASA 26–65, QL-I 8–10) or poor (LASA 66–100, QL-I 11–15). The main outcomes were overall survival (OS), progression-free survival (PFS), objective tumor response (OTR = CR or PR), weight loss, and grade 3 or 4 adverse events (AE). Results: All aspects of QL, except nausea/vomiting, were significant univariable predictors of OS and PFS. PWB, mood, appetite and QL-I were independently significant predictors of OS in a multivariable model with biomedical factors. Only patient's self-rated poor QL had lower rates of OTR, and higher rates of nonhematological AE than those with good QL (see Table), but rates of hematological AE were similar. Weight loss occurred more frequently in those with poor appetite (OR 5.8, p=0.05) or poor PWB (OR 4.9, p=0.05). Conclusions: Less than 25% of women with poor baseline QL responded to first line CMF but over 25% had severe non-hematological toxicity. Baseline QL predicts these outcomes beyond biomedical factors.

[Table: see text]

No significant financial relationships to disclose.

Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects

Staphylococcus aureus in the nose is a risk factor for endogenous staphylococcal infection. UK guidelines recommend the use of mupirocin for nasal decolonization in certain groups of patients colonized with methicillin-resistant S. aureus (MRSA). Mupirocin is effective at removing S. aureus from the nose over a few weeks, but relapses are common within several months. There are only a few prospective randomized clinical trials that have been completed with sufficient patients, but those that have been reported suggest that clearance of S. aureus from the nose is beneficial in some patient groups for the reduction in the incidence of nosocomial infections. There is no convincing evidence that mupirocin treatment reduces the incidence of surgical site infection. New antibiotics are needed to decolonize the nose because bacterial resistance to mupirocin is rising, and so it will become less effective. Furthermore, a more bactericidal antibiotic than mupirocin is needed, on the grounds that it might reduce the relapse rate, and so clear the patient of MRSA for a longer period of time than mupirocin.

The future of breast cancer research and practice in Asia, Latin America, and the Middle East/North Africa: a qualitative horizon scanning analysis

Abstract #5095

Objective: To conduct a horizon-scanning analysis to identify future needs, challenges and trends relating to breast cancer research and practices globally with special emphasis on emerging and understudied regions.&#x2028; Methods: Following the design and pilot of the survey instrument, data was derived from key informant interviews with 221 thought leaders in breast cancer in Asia (n=97), Latin America (n=46), Middle East/North Africa (n=39) and Australia and Canada (n=39). Thought leaders were identified using a combination of purposive and snowballing sampling and included oncologists, surgeons, other breast cancer specialists, advocacy leaders and policy makers. Transcripts and field notes were then coded and compared, and a taxonomy of 20 issues was developed. The propensity of these themes were then analyzed and compared across the four regions.&#x2028; Results: In Asia the most prevalent issues were i) building capacity for clinical research, ii) more nurses for patient care/education, iii) keeping up to date with new information and iv) increased targeted/personalized treatment. In Latin America key themes were the need to i) increase targeted/personalized treatment, ii) address disparities among the underserved, iii) high cost to third party payers, iv) increase capacity for clinical research and v) control out of pocket costs for patients. In the Middle East/North Africa key themes were the need for i) building capacity for clinical research, ii) more nurses for patient care/education, iii) increased public education on screening and iv) increased capacity for early detection. In Australia and Canada issues were i) keeping up to date with new information, ii) weighing the cost effectiveness of new treatments, iii) the need for increased data sharing and iv) improving communication between stakeholders.&#x2028; Discussion: While a number of respondents expressed observations relating to country specific etiology of disease (such as women presenting at younger ages and with more aggressive tumors) the lack of national registries and local clinical/genetic research make it hard to confirm these anecdotes scientifically. Finally, increased focus on the development of effective advocacy and policy leadership are needed in these regions to draw attention and resources towards issues of community empowerment, survivorship and quality of life which were neglected by all but a handful of respondents.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5095.

Mars environment and magnetic orbiter scientific and measurement objectives

In this paper, we summarize our present understanding of Mars' atmosphere, magnetic field, and surface and address past evolution of these features. Key scientific questions concerning Mars' surface, atmosphere, and magnetic field, along with the planet's interaction with solar wind, are discussed. We also define what key parameters and measurements should be performed and the main characteristics of a martian mission that would help to provide answers to these questions. Such a mission--Mars Environment and Magnetic Orbiter (MEMO)--was proposed as an answer to the Cosmic Vision Call of Opportunity as an M-class mission (corresponding to a total European Space Agency cost of less than 300 Meuro). MEMO was designed to study the strong interconnection between the planetary interior, atmosphere, and solar conditions, which is essential to our understanding of planetary evolution, the appearance of life, and its sustainability. The MEMO main platform combined remote sensing and in situ measurements of the atmosphere and the magnetic field during regular incursions into the martian upper atmosphere. The micro-satellite was designed to perform simultaneous in situ solar wind measurements. MEMO was defined to conduct: * Four-dimensional mapping of the martian atmosphere from the surface up to 120 km by measuring wind, temperature, water, and composition, all of which would provide a complete view of the martian climate and photochemical system; Mapping of the low-altitude magnetic field with unprecedented geographical, altitude, local time, and seasonal resolutions; A characterization of the simultaneous responses of the atmosphere, magnetic field, and near-Mars space to solar variability by means of in situ atmospheric and solar wind measurements.

Improving informed consent: pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS-II DCIS)

BACKGROUND

Patients and clinicians report difficulties with the process of informed consent to clinical trials and audiotape audits show that critical information is often omitted or poorly presented. Decision aids (DAs) may assist in improving consent.

AIMS

This study piloted a DA booklet for a high priority breast cancer prevention trial, IBIS-II DCIS, which compares the efficacy of an aromatase inhibitor (anastrozole) with tamoxifen in women who have had surgery for ductal carcinoma in situ (DCIS).

METHOD

Thirty-one Australian women participating in the IBIS-I breast cancer prevention trial and who are currently in follow-up agreed to read the IBIS-II DCIS participant information sheet and the DCIS DA booklet, complete a set of standardized questionnaires, and provide feedback on the DA via a semi-structured phone interview.

RESULTS

Women found the DA helpful in deciding about trial participation, reporting that it aided their understanding over and above the approved IBIS-II DCIS participant information sheet and was not anxiety provoking. Women's understanding of the rationale and methods of clinical trials and the IBIS-II DCIS trial was very good; with more than 80% of items answered correctly. The only areas that were not understood well were the concepts of randomization and blinding.

CONCLUSIONS

This study suggests that the DA will be acceptable to and valued by potential participants in the IBIS-II DCIS study. The revised DA is currently being evaluated prospectively in a randomized controlled trial. If successful, such DAs could transform the consent process to large clinical trials and may also reduce dropout rates.

p27 and Skp2 immunoreactivity and its clinical significance with endocrine and chemo-endocrine treatments in node-negative early breast cancer

BACKGROUND

Low p27 and high Skp2 immunoreactivity are associated with a poor prognosis and other poor prognostic features including resistant phenotypes and antiestrogen drug resistance. We investigated these proteins in two International Breast Cancer Study Group trials studying node-negative early breast cancer.

PATIENTS AND METHODS

Trial VIII compared chemotherapy followed by goserelin with either modality alone in premenopausal patients. Trial IX compared chemotherapy followed by tamoxifen with tamoxifen alone in postmenopausal patients. Central Pathology Office assessed p27 and Skp2 expression in the primary tumor by immunohistochemistry among 1631 (60%) trial patients.

RESULTS

p27 and Skp2 were inversely related; 13% of tumors expressed low p27 and high Skp2. Low p27 and high Skp2 were associated with unfavorable prognostic factors including larger size and higher grade tumors, absence of estrogen receptor and progesterone receptor, human epidermal growth factor receptor 2 overexpression and high Ki-67 (each P < 0.05). Low p27 and high Skp2 were not associated with disease-free survival (P = 0.42 and P = 0.48, respectively). The relative effects of chemo-endocrine versus endocrine therapy were similar regardless of p27 or Skp2.

CONCLUSIONS

We confirm the association of low p27 and high Skp2 with other poor prognostic features, but found no predictive or prognostic value, and therefore do not recommend routine determination of p27 and Skp2 for node-negative breast cancer.