Cancer Incidence in Merida, Mexico 2015-2018: First Report from the Population-based Cancer Registry

BACKGROUND

Cancer registries are essential for monitoring cancer burden and patterns, and document changes in time for cancer control. Hereby, we present the first results of four years of the Merida population-based cancer registry in Mexico.

METHODS

The registry collects data on all new cancers diagnosed since 2015 using both active and passive methods including a total of 104 information sources. Definitions and coding follow international standards. Using CanReg5 software, age-standardized incidence rates (ASR/100,000 person years) were computed by direct method using the world standard population.

RESULTS

A total of 5684 new cancer cases were registered during 2015-2018, 2321 in males and 3363 in females corresponding to age-adjusted incidence rates (ASR per 100,000) of 128.5, and 153.1, respectively. Most frequent cancers among males were prostate cancer (ASR 29.8), lymphomas (ASR 10.9) and colorectal cancer (ASR 9.7) while among females it was breast cancer (ASR 49.3), cervical cancer (ASR 17.5) and corpus uteri (ASR 11.5). Childhood cancers (0-14 year) represented 2.9% of all cancers, with leukemias accounting for 52% of the new cases. Overall, 87.6% of new cases were microscopically verified.

CONCLUSIONS

The data reported provide information on the cancer profile in Merida. Prostate and breast cancer are the main incident cancers. Cervical cancers present high rates among women, while lymphomas and liver cancer data merit further exploration. Efforts to support the Merida cancer registry as well as other registries in Mexico need to be pursued in order to have locally recorded data to support cancer control measures.

Detection of psychosocial distress in cancer patients: A survey of Mexican oncologists

Purpose: Identification of patients' distress is relevant for an on-time referral to psychosocial treatment. The objective was to assess the implementation of the guidelines for distress managing in Mexican oncologists based on the NCCN guidelines.Design: The study was non-experimental and cross-sectional.Sample: Two hundred thirty-one oncologists participated with an average age of 38 ± 11 years.Methods: The likelihood of distress assessment was quantitatively evaluated.Findings: A high percentage of oncologists knew and used procedures to assess psychosocial discomfort. However, a smaller percentage used a valid and reliable instrument. Factors associated with performing distress identification procedures were knowing the distress guidelines and lack of time. Factors for questionnaire usage are the availability of brief instruments and the percentage of patients suffering from stress.Implications for Psychosocial Providers: Psychosocial providers should develop strategies to educate and ensure that oncologists are familiar with guidelines on distress in oncology. More dissemination of screening procedures and referral to psychosocial programs in oncology is required. Integrating a distress screening program involving psychosocial providers and oncologists should be approached as a routine in high-quality cancer care, to reduce the stigma associated with mental health services.

Ultrastructural changes in giant cell tumor of bone cultured cells exposed to quercetin

Giant cell tumor of bone (GCTB) is a primary bone tumor that affects skeletally mature people and whose main treatment is surgical. Because there are few pharmacological alternatives for the treatment of this tumor to find other molecules or compounds that could be potential therapeutic agents is desirable. Quercetin is a flavonoid with described antitumoral effect in different types of cancer cell lines that could be a possible option in GCTB treatment. However, there is no literature about the effect of quercetin on GCTB. In the present paper, we reported the ultrastructural changes in GCTB cells exposed to quercetin and also determined the expression of RIP1K, Caspase 3 and Caspase 8 on the exposed cells. For this purpose, GCTB sample was obtained from one patient and cultured. Quercetin affected all the histological components of the GCTB. The ultrastructural changes consisted mainly in necroptosis, autophagocytosis and secondary necrosis. This is the first report about quercetin effects on giant cell tumor of bone cultured cells. Further studies in other models could be done to support the use of quercetin as a complementary treatment in giant cell tumor of bone.Abbreviations: Giant cell tumor of bone (GCTB); transmission electron microscopy (TEM); reverse transcription - polymerase chain reaction (RT-PCR); receptor interacting protein kinase 1 (RIP1K); Dulbecco's Modified Eagle's Medium (DMEM).

Clinical and functional analysis of SOX9 in colorectal cancer

519

Background: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths worldwide. CRC develops within the intestinal epithelium, which is constantly self-renewing, developmental genes could promote the initiation and progression of cancer. SOX9 transcription factor is expressed especially in intestinal stem cells and in Paneth cells, thus alterations in expression could greatly promote neoplasia. However, the clinical significance and functional role of SOX9 in CRC remains unclear. The aim of this study is to investigate the association of SOX9 expression with relapse in CRC patients and initiate functional studies by evaluating the effects of silencing SOX9 in stem cells properties such as colonospheres formation in HCT116 CRC cells. Methods: 97 FFPE biopsies from CRC patients in stage I (N = 34) and stage II (N = 63) were analyzed. Immunoreactivity of SOX9 was classified as low and high expression groups based on the percentage of positive nucleus and tissue staining intensity. SOX9 silencing was achieved using a specific siRNA and Lipofectamine-RNAiMax and confirmed by qPCR 24 h postransfection. 40,000 HCT116 and HCT116-siSOX9 cells were seeded under adherent and ultra-low attachment conditions for tumorigenesis assays. After 72 h colonospheres were seeded and quantified. ROC analysis was used to assess the clinical correlation of SOX9 with relapse. Experimental data were expressed as means and differences tested by t-Student. Results: Data showed that 12.3% of patients relapsed. Interestingly, all of them showed lower SOX9 expression (p ≤ 0.05), regardless of their relapse free survival. In functional analysis, SOX9-deficient HCT116 cells formed smaller and less-compacted spheroid when compared to non-transfected HCT116 (p ≤ 0.05). Nonetheless, cell proliferation and migration under adherent condition were similar between the groups. Conclusions: This study did not find association between SOX9 expression and relapse. So far, in vitro assays results suggest that silencing of SOX9 inhibits colonospheres formation in HCT116 cells. Further investigation will be performed in order to evaluate the functional importance of SOX9 in chemotherapy response.

Abstract 4278: Screening for BRCA1 founder mutation in Mexican population: an accessible approach

Aim: To implement an accessible strategy for detection of the Mexican founder mutation NG_005905.2:g.118973_133629del, located in BRCA1, which deletes exons 9-12 (BRCA1 ex9-12del), as part of the health care setting of patients with hereditary breast and ovarian cancer (HBOC), from the National Cancer Institute (Mexico).

Material and methods: We designed a polymerase chain reaction (PCR) based method, for the targeted detection of the deletion of exons 9 through 12, of the BRCA1 gene. The method was validated with previously verified results of the deletion by multiplex ligation-dependent probe amplification assay (MLPA), or deep sequencing of the region. Finally, the technique was used for the detection of BRCA1 ex9-12del mutation in a group of 302 HBOC patients, in whom the existence of BRCA1 and BRCA2 point mutations had been ruled by pyrosequencing.

Results: The concordance of our method, with previously reported BRCA1 ex9-12del mutation results, was 100%. Also, we provided a profile of the clinical and familial characteristics of 302 Mexican patients with clinical suspicion of HBOC, in whom the detection of BRCA1 ex9-12del mutation was performed. In this way, 21 patients (6.95%) were identified as BRCA1 ex9-12del mutation carriers. Among whom, a higher proportion of triple negative breast cancer was found (73% versus 21%, p=0.0005; two sided Fisher's exact test) .

Conclusions: A feasible molecular diagnostic strategy for the detection of BRCA1 ex9-12del mutation was established in Mexican patients, with HBOC. In this way, we identified 21 (21/302) carriers of the deletion, who represented the 6.95%. Related to the clinical features, triple negative breast cancer carriers stood out. It had been reported that large genomic rearrangements in BRCA1 are associated with an increased frequency of high risk features.

These type of approach is appropriate in populations where a founder effect is recognized. For its simplicity and effectiveness, it can be transferred to other laboratories, for the benefit of a greater number of Mexican patients and with the aim of minimize costs of testing. Because of the frequency of BRCA1 ex9-12del mutation, this method has been implemented as the first line of BRCA1 clinical genetic analysis in patients with suspected HBOC, at National Cancer Institute (Mexico ).

Citation Format: Rosa M. Alvarez, Jose Velazquez, Veronica Fragoso, Julieta Dominguez, Paulina Nuñez, Talia Wegman, Yuliana Sanchez, Silvia Vidal, Enrique Bargallo, Dolores Gallardo, Abelardo Meneses, Luis A. Herrera. Screening for BRCA1 founder mutation in Mexican population: an accessible approach [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4278. doi:10.1158/1538-7445.AM2017-4278

Abstract P4-20-04: Young women with breast cancer in Mexico: A report of the pilot phase of the “Mujer Joven y Fuerte” prospective cohort

Background: Despite high rates of breast cancer in young women from low-and-middle-income countries (LMICs), their needs and concerns are not systematically studied or addressed. Understanding the characteristics of young women with breast cancer (YWBC) and the issues they face is of great relevance to the medical community, in order to tailor clinical interventions and supportive care for this unique and understudied patient population. The Mexican cohort “Mujer Joven y Fuerte” (Young and Strong Woman) has the goal of comprehensively characterizing and assessing the needs of YWBC in Mexico using patient- and physician-based surveys. Methods: A prospective cohort of newly diagnosed YWBC was established in November 2014 at two Mexican cancer centers in Mexico City and Monterrey. Eligible women answer web-based surveys on relevant topics including physical activity, genetics, psychosocial needs, and fertility. Clinicians complete pre-specified surveys using the US NIH BOLD Task Force common data elements registering clinical/pathologic characteristics and outcomes. Patients are evaluated at diagnosis, after 6 months, and annually for 5 years. Sub-studies assessing changes in cognition, sexual function and satisfaction, quality of life and depression/anxiety are being conducted, and biologic samples are stored for future research. Results: 96 YWBC with median age at diagnosis of 34 (21-41 y) were accrued to our pilot phase. 26% were single and 25% childless. 43% had higher education and 28% were employed. 90% presented with a self-detected mass. Clinical stage at diagnosis was distributed as follows: stage 0: 2%; I: 15%; IIA: 13%; IIB: 17%; III: 47%, and stage IV: 6%. The most frequent molecular subtype was HR+/HER2- (47%), followed by HER2+ (26%) and triple negative (21%). First follow-up results will be available shortly. Conclusions: To our knowledge, this represents the first prospective cohort of YWBC in Latin America. We are expanding this project to other centers in the region. Our findings will help develop culturally tailored interventions aimed at improving the psychosocial and medical outcomes of this vulnerable patient population.

Citation Format: Villareal-Garza CM, Platas A, Castro-Sánchez A, Miaja M, Bargalló-Rocha E, Martinez-Cannon BA, Vega Y, Fonseca A, Ramos-Elias P, Márquez-Perez CJ, Bukowski A, Goss P, St. Louis J, Chapman J-A, Partridge A, Meneses A, Mohar A. Young women with breast cancer in Mexico: A report of the pilot phase of the “Mujer Joven y Fuerte” prospective cohort [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 P4-20-04.

Well-Differentiated Intramedullary Osteosarcoma

Well-differentiated intraosseous osteosarcoma (WDIOS) is a rare tumor and histologically similar to parosteal osteosarcoma. This study reports the clinicopathological features of five patients with WDIOS tumor seen at the Instituto Nacional de Cancerologia in Mexico City. The patients' ages ranged from 29 to 42 years with a median age of 32 years. Four of the five patients presented with pain and a mass that had been present for more than 3 years prior to the diagnosis. Radiologically, four of the lesions were present in the long bones and showed a predominantly trabeculated appearance with some small ill-defined lytic areas. The bony sclerosis was more prominent within the medullary cavity than in the soft tissue extension. The majority of the tumors were large, averaging 21 cm in size. Histologically, the tumors were characterized by spindle cells with areas of cytologic atypia and presence of mature bone formation. In two patients a high-grade sarcoma component was found in addition to WDIOS component: in both patients the high-grade sarcoma component was identified in the amputation specimens, and in one of these it was also recognized in the pulmonary metastasis. This study demonstrated that WDIOS is a slowgrowing malignant neoplasm that may show a histologic progression to dedifferentiation (dedifferentiated osteosarcoma) and an aggressive behavior with distant metastasis.

5-HT7 receptor activation: procognitive and antiamnesic effects

RATIONALE

The serotonin (5-hydroxytryptamine (5-HT)) 5-HT7 receptor is localized in brain areas mediating memory; however, the role of this receptor on memory remains little explored.

OBJECTIVE

First, demonstrating the associative nature of Pavlovian/instrumental autoshaping (P/I-A) task, rats were exposed (three sessions) to CS-US (Pavlovian autoshaping), truly random control, free operant, and presentations of US or CS, and they were compared with rats trained-tested for one session to the P/I-A procedure. Also, effects of the 5-HT7 receptor agonist LP-211 administered intraperitoneally after training was determined on short- (1.5 h) and long-term memory 24 and 48 h) and on scopolamine-induced memory impairment and cAMP production.

METHODS

Autoshaping and its behavioral controls were studied. Other animals were subjected to an autoshaping training session and immediately afterwards were given (intraperitoneal) vehicle or LP-211 (0.1-10 mg/kg) and/or scopolamine (0.2 mg/kg) and tested for short-term memory (STM) and long-term memory (LTM); their brains were extracted for the cAMP ELISA immunoassay.

RESULTS

P/I-A group produced the higher %CR. LP-211 did not affect STM; nonetheless, at 0.5 and 1.0 mg/kg, it improved LTM. The 5-HT7 receptor antagonist SB-269970 (SB; 10.0 mg/kg) alone had no effect; nevertheless, the LP-211 (1.0 mg/kg) LTM facilitation was reversed by SB. The scopolamine (0.2 mg/kg) induced-decrement in CR was accompanied by significant increased cAMP production. The scopolamine-induced decrement in CR and increments in cAMP were significantly attenuated by LP-211.

CONCLUSIONS

Autoshaping is a reliable associative learning task whose consolidation is facilitated by the 5-HT7 receptor agonist LP-211.

High fidelity simulation in Spain: from dreams to reality

Clinical simulation has emerged as a powerful new tool for the learning and assessment of different skills and attitudes in patient care, by using innovative technology such as high fidelity simulators (HFS).

OBJECTIVE

To describe the current state of high fidelity clinical simulation in Spain and its principal characteristics.

METHODS

Descriptive observational study that analyzes information on the clinical centers that have HFS in our country.

RESULTS

There are currently a total of 80 centers with HFS in our country, mainly distributed in university centers (43), hospital and emergency centers (27), simulation centers and institutes of simulation (5), and the rest (5) associated to entities of diverse ownership. The temporal development of HFS has been slowly progressive, with a significant growth in the last 6 years. The majority (74%) have specific facilities, auxiliary equipment (60%), and professionals with a shared commitment (80%). It is already integrated into the training programs in 56% of university centers with HFS.

CONCLUSIONS

The development of HFS has been remarkable in our country, and is mainly related to university undergraduate and postgraduate clinical medical education. It would be useful to design a network of simulation training centers of Health Sciences in Spain, which would be operational, sustainable and recognized, to optimize the use of these facilities.

Breast cancer in young women in Latin America: an unmet, growing burden

BACKGROUND

Breast cancer (BC) is the leading cause of malignancy-related deaths among women aged ≤ 45 years. There are unexplored and uncertain issues for BC in this particular group in Latin America. The aim of this study is to evaluate BC incidence and mortality among young women and related clinicopathological and survivorship aspects in this region.

MATERIALS AND METHODS

Data were obtained from Globocan 2008 and the International Agency for Research on Cancer's Cancer Incidence in Five Continents series plus databases. We requested collaboration from the 12 different national cancer institutes in Latin America through SLACOM, the Latin American and Caribbean Society of Medical Oncology, and conducted a systematic literature review to obtain local data regarding the prevalence of BC among young women and their characteristics, outcomes, and survivorship-related issues.

RESULTS

BC incidence and mortality proportions for Latin American women aged <44 years were higher when compared with those of developed countries (20% vs. 12% and 14% vs. 7%, respectively). We found only a few Latin American series addressing this topic, and prevalence varied between 8% and 14%. Stage II and III disease, high histological grade, and triple-negative and HER2 BC were features frequently observed among young Latin American BC patients.

CONCLUSION

The rising incidence and mortality of BC in young Latin American women is a call to action in the region. It is necessary to monitor the epidemiological and clinical data through reliable cancer registries and to consider the implementation of protocols for education of patients and health professionals. This unmet, growing burden must be considered as a top priority of the national programs in the fight against BC, and models of specialized units should be implemented for this particular group of patients to provide better care for this emergent challenge.

Abstract P5-12-10: Pathological characteristics and patterns of recurrence and mortality among young Mexican breast cancer patients

Background: In Mexico, it is recognized that breast cancer (BC) is diagnosed at younger ages than that reported in the US and other populations. Although national data is not available regarding BC age of diagnosis distribution, data from the INCAN, the main referral center in Mexico, showed that 17% of the total 893 newly diagnosed BC patients seen in 2012 were younger than 40 years old (which is more than twice that -7%- reported for US BC patients). We conducted a retrospective study in order to describe the frequency of BC among young Mexican BC patients, as well as their pathological characteristics at diagnosis and patters of recurrence.

Methods: Clinical and pathologic data from young pts (≤42 years old) who were newly diagnosed with invasive BC between January 2007 and December 2010 at the INCAN in Mexico and were followed for at least 2 years were identified. Clinical stage at diagnosis was recorded and estrogen receptor, progesterone receptor and HER2 expression were determined by immunohistochemistry and/or FISH. Proportion differences were tested using the Chi-square test.

Results: 445 young patients were identified from a total of 2919 BC patients (15%). A total of 320 patients met the inclusion criteria for analysis. Median age of diagnosis was 36 years (19-42). 49% of patients were very young patients (≤ 35 years). 19% were diagnosed as early disease, 67.5% as locally advanced BC and 13.5% as metastatic. 32% of patients had triple negative BC disease, while 27% were HER2 positive. From the non-metastatic patients at diagnosis, 31% developed recurrence (65% systemic, 21% loco regional and 14% both). After a median follow-up of 26 months, 18% of the 320 patients died secondary to BC disease progression.

Conclusions: Although this series corresponds to patients treated at a reference national center, the data reported in this study suggests that BC among young women is very prevalent in Mexico compared to other populations. The causes underlying the striking difference in age at diagnosis in Mexican BC patients are unknown and have not been investigated, including the genetic contributing factors. As reported in non-Hispanic population studies, BC among young women is diagnosed in more advanced stages, and triple-negative and HER2 positive diseases are more frequent. It is associated with a high proportion of systemic and loco regional recurrence, with a dismal prognosis. Due to the substantial number of BC cases among young women in Mexico, its prospective study is more than justified. In order to meet with this goal, our group is preparing the establishment of the Mexican Young Women's Breast Cancer Cohort Program at the INCAN in Mexico and to launch the related scientific projects related to this plan.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-12-10.

Breast cancer in young women in Latin America: an unmet, growing burden

Breast cancer (BC) is the leading cause of malignancy-related deaths among women aged ≤45 years. There are unexplored and uncertain issues for BC in this particular group in Latin America. The aim of this study is to evaluate BC incidence and mortality among young women and related clinicopathological and survivorship aspects in this region.

MATERIALS AND METHODS

Data were obtained from Globocan 2008 and the International Agency for Research on Cancer's Cancer Incidence in Five Continents series plus databases. We requested collaboration from the 12 different national cancer institutes in Latin America through SLACOM, the Latin American and Caribbean Society of Medical Oncology, and conducted a systematic literature review to obtain local data regarding the prevalence of BC among young women and their characteristics, outcomes, and survivorship-related issues.

RESULTS

BC incidence and mortality proportions for Latin American women aged <44 years were higher when compared with those of developed countries (20% vs. 12% and 14% vs. 7%, respectively). We found only a few Latin American series addressing this topic, and prevalence varied between 8% and 14%. Stage II and III disease, high histological grade, and triple-negative and HER2 BC were features frequently observed among young Latin American BC patients.

CONCLUSION

The rising incidence and mortality of BC in young Latin American women is a call to action in the region. It is necessary to monitor the epidemiological and clinical data through reliable cancer registries and to consider the implementation of protocols for education of patients and health professionals. This unmet, growing burden must be considered as a top priority of the national programs in the fight against BC, and models of specialized units should be implemented for this particular group of patients to provide better care for this emergent challenge.

Impact of obesity and overweight in the prognosis of women diagnosed with non metastatic breast cancer in a Mexican cohort

1607

Background: Mexico positions right up at the top with U.S. in worldwide rankings of the most obese countries. In addition, breast cancer (BrCa) is the main type of cancer among women in this country. Studies have shown inconsistent results regarding obesity as a prognostic factor for worse outcome. Methods: Our aim is to identify if overweight and obesity confer poor prognosis in non-metastasic BrCa patients (pts). We identified 1799 Hispanic women with newly diagnosed BrCa who attended the National Cancer Institute in Mexico from 2004-2008 and compared clinical and pathological features and overall survival (OS) between pts with a body mass index (BMI) > or ≤ than 25. Results: The median age at diagnosis was 51 years. A BMI>25 was found in 71% of pts. Postmenopausal women comprised 52%, and had a greater proportion of cases with a BMI>25 than premenopausal pts (75% vs. 67%, p<0.0001). Pts with BMI>25 presented with more advanced TNM stages and nodal involvement than their counterparts (73% vs. 67%, p=0.005 and 76% vs. 71%, p=0.017; respectively). Overall prevalence of hormone-receptor (HR), triple-negative (TN) and HER2 positive disease was 62%, 23%, and 27%, respectively. Differences according to receptor status between pre and postmenopausal pts and BMI are shown in table. There was no difference in disease-free survival and OS according to overweight and obesity in the overall population, but when menopausal status was considered, premenopausal pts with BMI>25 had a worse OS compared to pts with BMI<25 (HR 1.6, p=0.037). This difference was not seen in the postmenopausal group. Conclusions: Obesity may influence BrCa outcomes via several hormonal and inflammatory mechanisms. In this study, overweight and obesity confer a poor prognosis in premenopausal patients, possibly related to excess estrogen availability and higher prevalence of TN BrCa. Therefore, overweight and obesity deserve additional attention to assess possible causal relationships that potentially could be modified to improve outcomes in premenopausal patients. [Table: see text]

Treatment outcomes and prognostic factors in mexican patients with endometrial carcinoma with emphasis on patients receiving radiotherapy after surgery: an institutional perspective

Aim. To analyze the clinical characteristics and treatment outcomes in patients with endometrial carcinoma treated in a Latin American institute with emphasis in patients receiving adjuvant radiotherapy. Methods. A total of 412 patients with endometrial carcinoma admitted to our hospital between 1998 and 2008 were evaluated, retrospectively. The mean age was 55 years (28-87). Two hundred seventy patients received RT following surgery. Stage distribution was as follows: 221 patients (54%) stage I, 86 patients (21%) stage II, and 103 patients (24.5%) stage III and 2 patients (0.5%) stage IVA. Results. Overall survival rate was 95% at 2 years, 84% at 5 years, and 79% at 10 years. By the end of followup, 338 patients (82%) were disease-free, and 13 (3%) were alive with disease. Univariate and multivariate analyses identified age, grade, serosal and adnexial involvement as significant predictors for overall survival. Conclusion. The results of our study suggests that early-stage, low-grade endometrial cancer with no risk factors should not receive external beam radiotherapy, intermediate risk patients should receive only vaginal vault brachytherapy, and the use of chemotherapy with radiotherapy for patients high-risk and advanced-stage carcinoma the addition of radiotherapy is associated with a better survival being an effective therapeutic option.

Oxidative phosphorylation as a target to arrest malignant neoplasias

Since Warburg proposed in 1956 that cancer cells exhibit increased glycolysis due to mitochondrial damage, numerous researchers have assumed that glycolysis is the predominant ATP supplier for cancer cell energy-dependent processes. However, chemotherapeutic strategies using glycolytic inhibitors have been unsuccessful in arresting tumor proliferation indicating that the Warburg hypothesis may not be applicable to all existing neoplasias. This review analyzes recent information on mitochondrial metabolism in several malignant neoplasias emphasizing that, although tumor cells maintain a high glycolytic rate, the principal ATP production may derive from active oxidative phosphorylation. Thus, anti-mitochondrial drug therapy may be an adequate adjuvant strategy to arrest proliferation of oxidative phosphorylation-dependent neoplasias.

Effects of d-amphetamine on short- and long-term memory in spontaneously hypertensive, Wistar-Kyoto and Sprague-Dawley rats

Diverse studies indicate that the attention deficit hyperactivity disorder (ADHD) is associated with alterations in encoding processes, including working or short-term memory. Some ADHD dysfunctional domains are reflected in the spontaneously hypertensive rat (SHR). Here SHR-saline group showed significantly poor STM and LTM relative to SD and WKY saline rats. SD and WKY rats treated with d-amphetamine displayed better STM and LTM, compared to SD-vehicle, WKY-vehicle or SHR-d-amphetamine groups.

Biomarker analysis by tissue microarray technology of Bik, Bcl-2, Bax, ER-α, ER-β, Her2/neu, PCNA, P53, pRB proteins and apoptotic index (by TUNEL) in breast cancer Mexican biopsies

Abstract #4043

Background: &#x2028; The development and progression of epithelial cancers are the results of changes in many genetic networks. Through massive analysis techniques various prognostic factors have been studied to determine proteins implicated in cancer. A new technology used is tissue microarray (TMAs), which allows the assessment of several patients at different stages in a single slide.&#x2028; Methods:&#x2028; TMA blocks with up to 128 cylinders were made by using 1.5-mm diameter tissue cores from each paraffin block. In a series of 70 formalin-fixed carcinomas, we analyzed the immuno-expression of Bik, Bcl-2, Bax, ER-α, ER-β, Her2, PCNA, P53 and RB proteins. For apoptosis detection the TUNEL technique was used. Expression profiles for these tumors were generated with an unsupervised clustering and a T Test analysis.&#x2028; Results:&#x2028; We developed TMAs with samples from Mexican women with breast cancer at different stages (type I, II and III) and compared these with those of non affected breast tissue of the same women's samples. Through a hierarchical cluster we found three subgroups of tumors according to protein expression behavior. The apoptotic process was found in low grade 4.28%; moderate grade 90% and high grade 5.71% of samples. Statistical analysis revealed that Bax gene (p=0.000) expression was significantly increased in samples stage I and underexpressed in samples stage IIIA. The Bcl-2 gene was under-expressed in the majority of samples of the stage II. Even when the Bik gene was detected the protein level was over-expressed in 44.29% of the cases with noa significant correlation with apoptosis (TUNEL) (p=0.006). The samples where there were more alterations of the studied proteins were understood in the stages IIA (T2N0M0) and IIB (T2N1M0).&#x2028; &#x2028; Conclusions:&#x2028; The analysis of specimens of several patients in different stages of the disease turns out to be useful to establish a better diagnosis and prognosis. Differential regulation of these genes, especially Bik and Bax, may contribute to the biological nature of a clinically more aggressive and highly proliferative breast cancers.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4043.

Ex vivo study of 5-HT(1A) and 5-HT(7) receptor agonists and antagonists on cAMP accumulation during memory formation and amnesia

The cyclic adenosine monophosphate (cAMP) is a second messenger and a central component of intracellular signaling pathways that regulate a wide range of biological functions, including memory. Hence, in this work, firstly the time-course of memory formation was determined in an autoshaping learning task, which had allowed the identification of testing times for increases or decreases in performance. Next, untrained, trained and overtrained groups were compared in cAMP production. Moreover, selective stimulation and antagonism of 5-HT(1A) and 5-HT(7) receptors during memory formation and cAMP production were determined. Finally, since there is scarce information about how pharmacological models of amnesia affect cAMP production, the cholinergic or glutamatergic antagonists, scopolamine and dizocilpine, were tested. The major findings of this work showed that when the time-course was determined inasmuch as training and testing sessions occurred, memory performance was graduate and progressive. Notably, for the fourth to seventh (i.e., 48-120 h following autoshaping training session) testing session performance was significantly higher from the previous ones. When animals received 5-HT(1A) and 5-HT(7) receptor agonists and antagonists or amnesic drugs significant increases or decrements in memory performance were observed at 24 and 48 h. Moreover, when ex vivo cAMP production from trained and overtrained groups were compared to untrained ones, significant differences were observed among groups and brain areas. Trained animals treated with 8-OHDPAT, AS19, 8-OHDPAT plus AS19, WAY100635, SB-269970, scopolamine or dizocilpine were compared to similar untrained groups, and eightfold-reduced cAMP production was evident, showing the importance of cAMP production in the signaling case in mammalian memory formation.

A phase II trial of the use of 4,4’-dihydroxybenzophenone-2,4-dinitrophenyl-hydrazone (A-007) topical gel in the treatment of high-grade squamous intraepithelial lesions (HSIL) of the cervix

5593

Background: The incidence of cervical cancer is highly correlated with cervical high grade squamous intraepithelial lesions (HSIL [CIN2/3]) and human papillomavirus (HPV) infection in men and women. Approximately 70 - 80% of sexually active adolescents and adults will become infected with HPV during their lifetime. In 2003 alone, there were 50 million cases of HPV infections in the United States. Our main objective is to determine the pathological response (complete and partial, based on independent review panel of two patho the uterine cervix of women with HSIL [CIN 2/3]. Materials and Methods: Following colposcopy, pap smear and biopsy confirmation of HSIL (CIN 2/3) and HPV infection status, women are treated with gel applied to the cervix via an intravaginal applicator once daily for 5 consecutive days of a 28-day cycle for 2 cycles. At month 4 post enrollment into the trial, all women undergo the loop electrosurgical excision procedure (LEEP) procedure and repeated virology assessment. Results: 65 patients were enrolled at 2 centers and completed treatment with A-007 and 100% (65/65) were HPV positive (81.5% by Hibrid Capture II for High Risk and 100% PCR positive). All baseline and LEEP pathological specimens will be blinded read by a panel of two independent expert pathologists. A subject will be considered a complete pathological responder (CR) when the patient has regression of HSIL (CIN 2/3) without pathological evidence of HSIL, and a partial pathological responder (PR) when she has regression of HSIL (CIN 2/3) to LSIL (CIN 1). Overall response rate is defined as the percentage of patients with CR and PR. To date, no serious adverse events (SAE) has been reported during treatment in all enrolled patients, only has been reported a moderate local and transitory itching/burning sensation during the first 5–20 minutes after application in 18% (12/65) of the cases. At this moment LEEP procedures are being scheduled for all patients and the pathological response rate as well as the HPV response rate will be available and presented at the conference.

[Table: see text]

Do serotonin1–7 receptors modulate short and long-term memory?

Evidence from invertebrates to human studies indicates that serotonin (5-hydroxytryptamine; 5-HT) system modulates short- (STM) and long-term memory (LTM). This work is primarily focused on analyzing the contribution of 5-HT, cholinergic and glutamatergic receptors as well as protein synthesis to STM and LTM of an autoshaping learning task. It was observed that the inhibition of hippocampal protein synthesis or new mRNA did not produce a significant effect on autoshaping STM performance but it did impair LTM. Both non-contingent protein inhibition and 5-HT depletion showed no effects. It was basically the non-selective 5-HT receptor antagonist cyproheptadine, which facilitated STM. However, the blockade of glutamatergic and cholinergic transmission impaired STM. In contrast, the selective 5-HT(1B) receptor antagonist SB-224289 facilitated both STM and LTM. Selective receptor antagonists for the 5-HT(1A) (WAY100635), 5-HT(1D) (GR127935), 5-HT(2A) (MDL100907), 5-HT(2C/2B) (SB-200646), 5-HT(3) (ondansetron) or 5-HT(4) (GR125487), 5-HT(6) (Ro 04-6790, SB-399885 and SB-35713) or 5-HT(7) (SB-269970) did not impact STM. Nevertheless, WAY100635, MDL100907, SB-200646, GR125487, Ro 04-6790, SB-399885 or SB-357134 facilitated LTM. Notably, some of these changes shown to be independent of food-intake. Concomitantly, these data indicate that '5-HT tone via 5-HT(1B) receptors' might function in a serial manner from STM to LTM, whereas working in parallel using 5-HT(1A), 5-HT(2A), 5-HT(2B/2C), 5-HT(4), or 5-HT(6) receptors.

Memory consolidation and amnesia modify 5-HT6 receptors expression in rat brain: An autoradiographic study

Traditionally, the search for memory circuits has been centered on examinations of amnesic and AD patients, cerebral lesions and, neuroimaging. A complementary alternative might be the use of autoradiography with radioligands. Indeed, ex vivo autoradiographic studies offer the advantage to detect functionally active receptors altered by pharmacological tools and memory formation. Hence, herein the 5-HT(6) receptor antagonist SB-399885 and the amnesic drugs scopolamine or dizocilpine were used to manipulate memory consolidation and 5-HT(6) receptors expression was determined by using [(3)H]-SB-258585. Thus, memory consolidation was impaired in scopolamine and dizocilpine treated groups relative to control vehicle but improved it in SB-399885-treated animals. SB-399885 improved memory consolidation seems to be associated with decreased 5-HT(6) receptors expression in 15 out 17 brain areas. Scopolamine or dizocilpine decreased 5-HT(6) receptors expression in nine different brain areas and increased it in CA3 hippocampus or other eight areas, respectively. In brain areas thought to be in charge of procedural memory such basal ganglia (i.e., nucleus accumbens, caudate putamen, and fundus striate) data showed that relative to control animals amnesic groups showed diminished (scopolamine) or augmented (dizocilpine) 5-HT(6) receptor expression. SB-399885 showing improved memory displayed an intermediate expression in these same brain regions. A similar intermediate expression occurs with regard to amygdala, septum, and some cortical areas in charge of explicit memory storage. However, relative to control group amnesic and SB-399885 rats in the hippocampus, region where explicit memory is formed, showed a complex 5-HT(6) receptors expression. In conclusion, these results indicate neural circuits underlying the effects of 5-HT(6) receptor antagonists in autoshaping task and offer some general clues about cognitive processes in general.

Polymorphous low-grade adenocarcinoma of the parotid gland. Case report and review of the literature

Polymorphous low-grade adenocarcinoma (PLGA) is difficult to diagnose both clinically and histologically due to its indolent presentation, and because of its morphological diversity that includes several microscopic patterns. The aggressive biologic behavior seen in minor salivary glands as compared to major glands is apparently associated histologically to a predominance of the papillary pattern in the former. Biologic behavior of PLGA in the major salivary glands is uncertain, as some cases have developed recurrences and metastases independently of the presence of a papillary pattern. A case of PLGA originated de novo in parotid gland is presented a 60 year-old male, treatment was surgically excised through superficial parotidectomy and to postoperative radiotherapy (46 Gy). Forty-eight months later the patient is alive with no signs of recurrence, as well as a review of the literature, with particular emphasis in its differential diagnosis and biological behavior.

Mutational analysis of K-ras and Ras protein expression in larynx squamous cell carcinoma

The ras gene family (H, K and N-ras) encodes the Ras protein, a GTPase-activating protein that regulates several signal transduction pathways including cellular proliferation and differentiation. Mutations in codons 12, 13 and 61 of the ras genes constitute one of the most frequent alterations in human cancer. In the Western Hemisphere, a low frequency of mutations in these genes has been observed in head and neck carcinomas; a higher frequency has been found in countries such as India and Taiwan. Increased protein expression is a relatively frequent event in larynx carcinomas. This study was aimed to evaluate the participation of the k-ras gene and Ras expression in 20 Mexican patients with larynx squamous carcinoma, 2 with dysplasia and 4 with normal mucosa. Samples (of 26 patients) were embedded in paraffin and immunohistochemical analysis was performed for the Ras protein, as well as amplification of the k-ras gene exon 1 (108 bp) by laser capture microdissection. Then, DNA extraction, PCR and sequencing were performed looking for possible mutation in codons 12 and 13. All patients with larynx carcinoma were men, median age 62 years. Eighty-five percent of the patients had risk factors such as smoking and/or alcohol consumption, 25% were in clinical stages I and II, and 75% in stages III and IV; 45% of the patients presented tumor recurrence or persistence. In this study, no mutations were found in codons 12 or 13 of the k-ras gene; however, protein expression was observed in 95% of the samples and a higher expression of the protein was associated with tumor recurrence or persistence, although this was not statistically significant. Unexpectedly, well-differentiated carcinomas and dysplasias presented an increase in protein expression. These results suggest that ras may be involved in early stages of larynx carcinogenesis and may be activated by other mechanisms different from mutations, such as epigenetic events.

The Systemic Absorption of Etoposide after Intravaginal Administration in Patients with Cervical Intraepithelial Lesions Associated with Human Papillomavirus Infection

PURPOSE

The purpose of this study was to determine the systemic absorption and the release of etoposide in cervical tissue administered via a vaginal ovule to women diagnosed with cervical intraepithelial lesions associated with human papillomavirus (HPV).

METHODS

Fifteen women with low- and high-grade intraepithelial neoplasia confirmed by colposcopic test received a 50-mg intravaginal etoposide dose three times a week for 3 weeks. At the end of the study period, paralleled with the last ovule administered, blood samples were collected over a period of 24 h, and in situ cervical samples were obtained at 3 and 10 h after drug administration. Etoposide concentrations were determined in plasma and in in situ cervical samples using the high-performance liquid chromatography method with electrochemical detection.

RESULTS

Pharmacokinetic analyses of plasma data indicated low or lack of systemic exposure of etoposide after the vaginal administration. Nevertheless, high concentrations of etoposide were found in all in situ cervical samples, indicating that etoposide could be released from its pharmaceutical formulation.

CONCLUSIONS

The results of the study suggest that the etoposide administered as intravaginal ovule is safe and tolerable and apparently could be a suitable option in patients with cervical intraepithelial neoplasia. Clinical results and the true impact on HPV infection and evolution of dysplasia need to be confirmed.

5-HT1A receptor expression during memory formation

RATIONALE

It has been reported that 5-HT(1A) receptors modulate learning and memory and diverse pharmacological and genetic evidence supports this notion. Nevertheless, there are few works about expression of these receptors during memory formation.

OBJECTIVE

We aimed to determine 5-HT(1A) receptor expression in brain areas of untrained, passive, and autoshaping trained groups of rats.

METHODS

Ex vivo receptor autoradiography using the ligand agonist [(3)H]8-hydroxy-2-[di-n-propylamino]tetralin] (8-OH-DPAT) was used.

RESULTS

The trained group relative to untrained animals showed increases of 5-HT(1A) receptor expression in 14 brain areas, decrements in 7, and no changes in 12. Thus, in contrast to untrained rats, 5-HT(1A) receptor expression of autoshaping trained rats was augmented in the tubercule olfactory, septal nucleus, nucleus accumbens, caudate putamen, globus pallidus, striate, and parietal (1 and 2), temporal cortex (1 and 3), granular retrosplenial cortex (1), amygdala, and median and dorsal raphe nuclei. In contrast, in the latter group, receptors were decreased in the CA1 area, hypothalamus dorsal, frontal cortex (1 and 3), occipital cortex, cingulate cortex (1 and 2), and cuneiform nucleus. There were significant differences between passive vs trained groups, but not regarding untrained rats, in the lateral olfactory tract, dentate gyrus, CA3 area, ventromedial hypothalamic, lateral hypothalamus, preoptic medial, frontal cortex (2), granular retrosplenial cortex (2), entorhinal cortex (1 and 2), piriform cortex, and substantia nigra.

CONCLUSIONS

These data suggest that upregulated, downregulated, and "silence" of 5-HT(1A) receptors in brain areas form part of neural circuits engaged in memory formation by demonstrating a high degree of specificity and memory mapping.

Effects of the potential 5-HT7 receptor agonist AS 19 in an autoshaping learning task

This work aimed to evaluate further the role of 5-HT7 receptors during memory formation in an autoshaping Pavlovian/instrumental learning task. Post-training administration of the potential 5-HT7 receptor agonist AS 19 or antagonist SB-269970 enhanced memory formation or had no effect, respectively. The AS 19 facilitatory effect was reversed by SB-269970, but not by the selective 5-HT1A antagonist WAY100635. Amnesia induced by scopolamine (cholinergic antagonist) or dizocilpine (NMDA antagonist) was also reversed by AS 19. Certainly, reservations regarding the selectivity of AS 19 for 5-HT7 and other 5-HT receptors in vivo are noteworthy and, therefore, its validity for use in animal models as a pharmacological tool. Having mentioned that, it should be noticed that together these data are providing further support to the notion of the 5-HT7 receptors role in memory formation. Importantly, this 5-HT7 receptor agonist AS 19 appears to represent a step forward respect to the notion that potent and selective 5-HT7 receptor agonists can be useful in the treatment of dysfunctional memory in aged-related decline and Alzheimer's disease.

Modifications of 5-HT4 receptor expression in rat brain during memory consolidation

Pharmacological evidence indicates a specific role of 5-HT(4) receptors on memory function. These receptors are members of G-protein-coupled 7-transmembrane domain receptor superfamily, are positively coupled to adenylyl cyclase, and are heterogeneously located in some structures important for memory, such as the hippocampus and cortical regions. To further clarify 5-HT(4) receptors' role in memory, the expression of these receptors in passive (P3) untrained and autoshaping (A3) trained (3 sessions) adult (3 months) and old (P9 or A9; 9 months) male rats was determined by autoradiography. Adult trained (A3) rats showed a better memory respect to old trained (A9). Using [(3)H] GR113808 as ligand (0.2 nM specific activity 81 Ci/mmol) for 5-HT(4) receptor expression, 29 brain areas were analyzed, 16 areas of A3 and 17 of A9 animals displayed significant changes. The medial mammillary nucleus of A3 group showed diminished 5-HT(4) receptor expression, and in other 15 brain areas of A3 or 10 of A9 animals, 5-HT(4) receptors were increased. Thus, for A3 rats, 5-HT(4) receptors were augmented in olfactory lobule, caudate putamen, fundus striatum, CA2, retrosplenial, frontal, temporal, occipital, and cingulate cortex. Also, 5-HT(4) receptors were increased in olfactory tubercule, hippocampal CA1, parietal, piriform, and cingulate cortex of A9. However, hippocampal CA2 and CA3 areas, and frontal, parietal, and temporal cortex of A9 rats, expressed less 5-HT(4) receptors. These findings suggest that serotonergic activity, via 5-HT(4) receptors in hippocampal, striatum, and cortical areas, mediates memory function and provides further evidence for a complex and regionally specific regulation over 5-HT receptor expression during memory formation.

Expression of the 5-HT receptors in rat brain during memory consolidation

Serotonin (5-hydroxytryptamine, 5-HT) system displays more than 14 receptors subtypes on brain areas involved in learning and memory processes, and pharmacological manipulation of specific receptors selectively affects memory formation. In order to begin the search of 5-HT receptors expression during memory formation, in this work, we aimed to determine, by autoradiography (using 3H 5-HT as ligand, 2 nM, specific activity 123 Ci/mmol), 5-HT receptors (5-HTR) expression in passive (untrained) and autoshaping trained (3 sessions) adult (3 months) and old (9 months) male rats. Thus, trained adult rats had better retention than old animals. Raphe nuclei of adult and old trained rats expressed less receptors on medial and dorsal, respectively. Hippocampal CA1 area and dentate gyrus of adult trained rats expressed less 5-HTR, while dentate gyrus of old increased them. Basomedial amygdaloid nucleus in old trained rats expressed more 5-HTR; while in the basolateral amygdaloid nucleus they were augmented in both groups. Training decreased or did not change 5-HTR in caudate-putamen of adult or old animals. The above profile of 5-HTR expression is consistent with previous reports, and suggests that memory formation and aging modulates 5-HTR expression in brain areas relevant to memory systems.

8-OH-DPAT facilitated memory consolidation and increased hippocampal and cortical cAMP production

Animals were submitted to an associative learning task named Pavlovian/instrumental autoshaping (P/I-A) and treated with selective 5-HT1A and 5-HT7 receptor agonists and antagonists. Next, they were sacrificed, their brains removed, dissected and changes on cortical and hippocampal cyclic adenosine monophosphate (cAMP) production were determined. Results revealed that, the 8-OH-DPAT treatment facilitated memory consolidation of autoshaping and that effect was blocked completely by WAY100635 and partially by DR4004. WAY100635 or DR4004 alone had no effect on autoshaping. The cAMP results were complex and yielded no clear relationship to the memory results. Thus, cortical and hippocampal increased on cAMP production was observed following administration of the 5-HT(1A/7) agonist 8-OH-DPAT. The memory effect was, completely or partially, reversed by the selective antagonists WAY100635 (5-HT1A) or DR4004 (5-HT7), respectively.

Utilidad en la combinación de oligonucleótidos universales para la detección del virus del papiloma humano en cáncer cervicouterino y lesiones premalignas

OBJECTIVE

To determine the prevalence of human papillomavirus (HPV) infection at different stages of the natural history of cervical cancer. Also, to optimize its detection by means of different sets of general primers.

MATERIAL AND METHODS

A descriptive, cross-sectional study was conducted between January and December 1999. Samples were processed and analyzed at the Instituto Nacional de Cancerología (National Cancerology Institute) in Mexico City. A comparative analysis was performed using Student's t for continuous values and the chi-squared test for proportions. A contingency analysis was made between biopsy and cervical exudates with the Kappa statistic. HPV detection was done by PCR with general primers which recognize different regions of the L1 gene (MY09/11; GP5/6; L1C1/2) and with HPV16- and HPV18- specific primers, as well as direct sequencing of PCR products.

RESULTS

In total, 154 samples were analyzed: 65 (42.2%) of them showed normal cytology; 45 (29.2%) high and low grade lesions; and 44 (28.6%) invasive cervical cancer. HPV was detected in 95.5% of invasive cervical cancers, in 91.6% of high grade lesions, in 66.7% of low grade lesions, and in 23.1% of normal smears, by PCR with at least one set of oligonucleotide primers. HPV detection was more efficient in biopsy specimens than in cervical scrapes. The total percentage of HPV detection using only one set of universal oligonucleotides (37.6%) increased to 60.4% when the other two sets of universal oligonucleotides were used.

CONCLUSIONS

The frequency of high risk HPV is high even in women with reported normal cytology. HPV detection improves when different sets of general primers directed to the L1 region are used. HPV DNA screening in cervical scrapes may be a good alternative HPV diagnostic tool when the samples are appropriately taken.

Lymph node histology in head and neck cancer: impact of immunotherapy with IRX-2

OBJECTIVE

To determine if lymph nodes (LN) of patients receiving IRX-2 immunotherapy reflect changes in histology.

SETTING

National Cancer Institute, Mexico City, Mexico.

PATIENTS

Thirty patients with advanced squamous cell carcinoma of the head and neck (H and N SCC) and 10 non-cancer controls.

INTERVENTION

A 21-day cycle of preoperative immunotherapy, including a single intravenous infusion of low-dose cyclophosphamide (300 mg/M(2)), 10 or 20 daily perilymphatic injections of a natural cytokine mixture (IRX-2) (approximately 200 U interleukin-2 equivalence by enzyme-linked immunosorbent assay), daily oral indomethacin, and daily oral zinc with multivitamins, followed by surgery (20 patients); surgery only (10 patients); LN biopsy controls (10).

OUTCOME MEASURES

Pretreatment biopsies were performed to confirm the diagnosis. Clinical responses were assessed at surgery, and the specimen and a sample of lymph node were analyzed with respect to changes in morphology and lymphoid and inflammatory infiltration (T and B lymphocytes, plasma cells, macrophages, granulocytes, and giant cells). The postsurgical characteristics were ascribed percentages based on a representative section and compared.

RESULTS

All 20 H and N SCC patients treated with IRX-2 showed the changes of immune regression of their tumors, previously characterized [Arch. Pathol. Lab. Med. 122 (1998) 447]. The 10 H and N SCC controls showed no such changes. Lymph node histology of the 10 H and N SCC controls showed, compared to non-cancer controls, reduced size, decreased T cell area and density and increased sinus histiocytosis. The lymph nodes of IRX-2-treated H and N SCC patients showed increased size (over both control groups), increased T cell area and density and decreased follicles and sinus histiocytosis. The T cell and/or B cell areas of LN of IRX-2-treated patients showed a high correlation with T and/or B cell infiltration into these tumors (p<0.001).

CONCLUSION

The lymph nodes of patients with H and N SCC are distinguished by T cell depletion and sinus histiocytosis (SH). Immunotherapy reverses these changes and induces nodal expansion and lymphoid infiltration into the tumor that correlates with LN changes. The correlation of nodal expansion with tumor lymphoid infiltration and regression implies an effective immunization to host tumor antigens occurring at the level of the regional lymph node. The reversal of sinus histiocytosis, by IRX-2 treatment, in association with nodal expansion suggests that tumor antigen processing via dendritic cells is defective in cancer-bearing patients and that it is corrected by the treatment.

A trial of IRX-2 in patients with squamous cell carcinomas of the head and neck

A Phase II trial in 42 patients with squamous cell cancer of the head and neck (H and NSCC) was performed using a combination immunotherapy with 10-20 days of perilymphatic injections of a natural cytokine mixture (NCM: IRX-2; 200 units IL-2 equivalence) preceded by low dose cyclophosphamide (CY; 300 mg/m(2)) and followed by daily oral indomethacin (25 mg t.i.d.) and zinc (65 mg in a multivitamin preparation). Thirty-nine patients underwent subsequent surgical resection and 22 stage IV patients received additional radiotherapy. Forty-two percent were adjudged to have complete and partial clinical responses (>50% tumor reduction); an additional five patients had minor responses for a total of 58%. Comparison of post-treatment biopsies or surgical specimens showed 90% of patients had reduction in tumor area from 79% to 48% (over half of which was fragmented) and increased area of leukocyte infiltration from 9% to 32% (79% of which was lymphoid). The treatment with IRX-2 was not associated with significant side effects and 24 of patients showed improvement in eating, breathing or phonation or reduced pain and bleeding. Fifteen patients with lymphocytopenia (lymphocyte counts [LC] less than or equal to 1500 mm(3)) showed significant increases in LC, CD3+, CD4+ and CD8+ T lymphocytes of 401, 147, 95 and 100/mm(3), respectively. Analysis of outcome of 32 on protocol patients after 36 months versus 32 concurrent institutional H and NSCC controls showed delayed recurrences and significant increases in mean survival time (MST) and survival (p's<0.02). The data document immunotherapy induced regression of H and NSCC with delayed recurrence and improved mean survival time.

A pilot study of perilymphatic leukocyte cytokine mixture (IRX-2) as neoadjuvant treatment for early stage cervical carcinoma

Clinical and experimental data demonstrate that local cytokines are able to induce tumor regression and in some cases antitumor systemic immune response. IRX-2 is a cell-free mixture of cytokines obtained from unrelated donor lymphocytes with demonstrated ability to induce immune mediated regression of squamous cell carcinomas of head and neck. The objective of this study was to evaluate the antitumor activity and toxicity of IRX-2 in untreated early stage cervical cancer patients. Ten consecutive patients clinically staged IB1, IB2 and IIA were treated with a neoadjuvant immunotherapy regimen that consisted in a single IV dose of cyclophosphamide at 300 mg/m2 on day 1, oral indomethacin or ibuprofen and zinc sulfate were administered from days I to 21 and 10 regional perilymphatic injections of IRX-2 on days 3 to 14. All patients were scheduled for radical hysterectomy on day 21. The clinical and pathological responses, toxicity and survival were evaluated. Clinical response was seen in 50% of patients (three partial responses, two minor responses). Seven patients underwent surgery and pathological tumor reduction associated with tumor fragmentation was found in five cases. Histological studies demonstrated a rather heterogeneous cell type infiltrating pattern in the tumor which included lymphocytes, plasma cells, neutrophils, macrophages and eosinophils. Immunohistochemical analysis of the surgical specimens demonstrated an increase of tumor infiltrating CD8+ cells. The treatment was well tolerated except for mild pain and minor bleeding during injections and gastric intolerance to indomethacin. At 31 months of maximum follow-up (median 29), eight patients are disease-free. Our results suggest that the immunotherapy approach used induces tumor responses in cervical cancer patients. Further studies are needed to confirm these results as well as to elucidate the mechanisms underlying these effects.

Immunological approach in the evaluation of regional lymph nodes of patients with squamous cell carcinoma of the head and neck

In cancer, regional lymph node (LN) cells are one of the first components of the immune system to have contact with tumor cells or their products. Therefore, the phenotype and functional properties of hematopoietic cells present within the tumor-draining LN are important to understanding their role in the control of malignant cells. Based on the locoregional metastatic behavior of squamous cell carcinoma of the head and neck (SCCH&N) region, we analyzed tumor-draining lymph nodes from SCCH&N patients to obtain insights into regional tumor immunity. Using a three-color fluorescent labeling technique, surface antigen expression was visualized in mononuclear cells of lymph nodes that were obtained from head and neck cancer patients and compared to mononuclear cells of normal lymph nodes. Cell cycle analyses were performed using propidium iodide. Proliferation after phytohemagglutinin stimulation was measured by a sodium tetrazolium-based assay. LN histology was correlated with flow cytometric findings. Regional lymph nodes of head and neck cancer patients undergo morphologic and functional changes. Flow cytometry revealed a decrease in CD8(+) T cells and in some lymph nodes the presence of second or third populations of larger cells with distinct size and granularity that expressed both T (gammadelta/alphabeta) and different natural killer cell markers. Moreover, cell cycle analyses and proliferation assays showed a diminished response to mitogenic stimuli. These changes were found in both metastatic and hyperplastic lymph nodes from head and neck cancer patients; however, no alterations were found in control lymph nodes or peripheral blood mononuclear cells from noncancer patients. The immune alterations detected in lymphocytes present within the draining lymph nodes of head and neck cancer patients may improve our understanding of how tumor cells escape host immunosurveillance. However, this dysfunction in local draining lymph nodes may not be detected systemically.