POS0030 CLINICAL AND GENETIC FACTORS ASSOCIATED WITH RADIOGRAPHIC PROGRESSION IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background

Ankylosing spondylitis (AS) is a heritable inflammatory disease eventually leading to spinal fusion 1. Severity of structural damage is highly variable, some patients develop almost no change in spinal structure for long disease duration, whereas others have total ankylosis even in the early stage of disease.

Objectives

To identify clinical and genetic factors associated with severe radiographic damage in patients with AS.

Methods

We newly generated genome-wide variant data (833K, KoreanChip) of 444 AS patients. The severity of radiographic damage was assessed using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). To identify clinical and genetic factors associated with severe radiographic damage, multiple linear regression analyses were performed. Human AS osteoprogenitor cells were used for functional validation. Pathway analysis was also conducted.

Results

A total 444 AS patients (male 90.3%) were enrolled. The median mSASSS at baseline was 7.7 (5.5-16.8). The patients were observed for 9.6 (7.9-11.3) years. Within this period, the median mSASSS score increased to 14.0 (7.0-36.8). The most influential clinical factor of final mSASSS was baseline mSASSS (β = 0.818, p < 0.001). Peripheral joint involvement was associated with decreased possibility of severe radiographic damage (β = -0.221, p < 0.001). Eye involvement, longer follow up duration, and increased age at enrollment were associated with increased final mSASSS (β = 0.165, p < 0.001; β = 0.039, p < 0.001; β = 0.010, p = 0.002, respectively). Ryanodine receptor 3 (RYR3) gene was associated with severe radiographic damage (β = 1.105, p = 1.97x10-06). Treatment with Rhodamine B, a ligand of RYR3, induced extracellular matrix mineralization of AS osteoprogenitors in vitro. For the pathway analysis, PI3K-Akt signaling pathway and focal adhesion pathway were associated with severe radiographic damage in AS.

Conclusion

This study identified clinical and genetic factors that contributed to better understanding of the pathogenesis and biology associated with radiographic damage in AS.

References

[1]Li Z, Brown MA. Progress of genome-wide association studies of ankylosing spondylitis. Clinical & Translational Immunology. 2017;6(12):e163.

Disclosure of Interests

None declared

SOX9+ enthesis cells are associated with spinal ankylosis in ankylosing spondylitis

OBJECTIVE

Although cartilage degeneration and invasion of the subchondral bone plate in entheseal lesion has been considered to consequently lead bony ankylosis in ankylosing spondylitis (AS), no evident mechanisms are known.

DESIGN

To identify histopathological and physiological changes in enthesitis-related ankylosis in AS, we performed molecular characterization of transcription factors and surface markers, and transcriptome analysis with human tissues. Entheseal tissue containing subchondral bone was obtained from the facet joints of 9 patients with AS and 10 disease controls, and assessed by using differential staining techniques. Enthesis cells were isolated, characterized, stimulated with TNF and/or IL-17A, and analysed by cell-based experimental tools.

RESULTS

We found diffusely distributed granular tissue and cartilage in the subchondral bone in AS. Co-expression of SOX9, a specific transcription factor in cartilage, and matrix metalloproteinase 13 (MMP13) was found in the granular tissues within the subchondral bone from AS patients. Intriguingly, SOX9 expression was significantly higher in AS enthesis cells than controls and correlated with TNFR1 and IL-17RA expressions, which is important for high reactivity to TNF and IL-17A cytokines. Co-stimulation by TNF and IL-17A resulted in accelerated mineralization/calcification features, and increased OCN expression in AS enthesis cells. Furthermore, SOX9 overexpression in enthesis leads to promoting mineralization feature by TNF and IL-17A stimuli. Finally, OCN expression is elevated in the destructive enthesis of advanced AS.

CONCLUSION

These findings provide insight into the links between inflammation and the mineralization of entheseal tissue as the initiation of spinal ankylosis, emphasizing the importance of SOX9⁺ enthesis cells.

AB0116 DECREASED SERUM LEVEL OF IRISIN IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Irisin, exercise-mediated myokine, is one of the most recently discovered hormones. Irisin has been shown to play multifunctional roles including anti-inflammation by suppressing secretion of NF kß, TNF-α, IL-6, and other pro-inflammatory cytokines from macrophages and adipocytes [1]. Thus, several attempts have been made to investigate irisin in chronic inflammatory rheumatic diseases. And recent evidences show that serum irisin concentration is lower in patients with osteoarthritis, rheumatoid arthritis, and behcet disease than health individuals [2-4]. Furthermore, one study showed that serum irisin level was negatively correlated with radiographic severity of knee osteoarhtiritis [2]. However, no previous study has investigated irisin in patients with ankylosing spondylitis (AS).

Objectives:

To assess the serum level of irisin, and evaluate the possible relationship of irisin with disease activity in patients with AS.

Methods:

Male patients with AS fulfilled the modified New York criteria (n=119), and healthy male controls (n=30) were enrolled. Serum irisin level was measured by ELISA (Cusabio, CSB-EQ027943HU). Disease activity was assessed by acute phase reactants, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Clinical characteristics and serum irisin level of the AS group were compared with those of the control group using Student t-test for normally distributed continuous measures and Mann-Whitney U test for non-normally distributed continuous measures. To evaluate the correlations of serum Irisin level and AS disease activity, Spearman’s correlation test was used. AS patients were grouped into the high BASDAI group (BASDAI ≥ 4, n=45) and the Low BASDAI group (BASDAI < 4, n=74). And serum irisin level was also compared between two groups.

Results:

AS group had lower serum irisin concentration compared with healthy control group (60.50 [23.68-131.15] vs. 124.69 [79.58-192.90], p=0.013), while age and body mass index were not significantly different between groups. There was no significant correlation between irisin level and disease activities. However, High BASDAI group showed significantly lower irisin level than low BASDAI group (44.64 [18.13-85.89] vs. 65.68 [31.81-165.31], p=0.011).

Conclusion:

AS patients have lower serum irisin concentrations than healthy controls. AS patients with severe symptoms tend to have lower serum level of irisin than those with less severe symptoms.

References:

[1]H. Askari, et al. A glance at the therapeutic potential of irisin against diseases involving inflammation, oxidative stress, and apoptosis: an introductory review. Pharmacol Res. 2018

[2]Mao Y, et al. Association of Irisin and CRP Levels with the Radiographic Severity of Knee Osteoarthritis. Genet Test Mol Biomarkers. 2016

[3]Rania M. Gamal, et al. Preliminary study of the association of serum irisin levels with poor sleep quality in rheumatoid arthritis patients. Sleep Med. 2020

[4]A. Icli, et al. Novel myokine: irisin may be an independent predictor for subclinic atherosclerosis in Behcet’s disease. J. Investig. Med. 2016

Disclosure of Interests:

None declared

Prevalence, demographic variation and psychological correlates of exposure to police victimisation in four US cities

Aims Victimisation by the police is purported to be widespread in cities in the USA, but there is limited data on police-public encounters from community samples. This is partly due to an absence of measures for assessing police violence exposure from the standpoint of civilians. As such, the demographic distribution and mental health correlates of police victimisation are poorly understood. The aims of this study were to present community-based prevalence estimates of positive policing and police victimisation based on assessment with two novel measures, and to test the hypotheses that (1) exposure to police victimisation would vary across demographic groups and (2) would be associated with depression and psychological distress.

METHODS

The Survey of Police-Public Encounters study surveyed adults residing in four US cities to examine the prevalence, demographic distribution and psychological correlates of police victimisation. Participants (N = 1615) completed measures of psychological distress (K-6 scale), depression (Patient Health Questionnaire 9) and two newly constructed measures of civilian-reported police-public encounters. Both measures were developed to assess police victimisation based on the WHO domains of violence, which include physical violence (with and without a weapon, assessed separately), sexual violence (inappropriate sexual contact, including public strip searches), psychological violence (e.g., threatening, intimidating, stopping without cause, or using discriminatory slurs) and neglect (police not responding when called or responding too late). The Police Practices Inventory assesses lifetime history of exposure to positive policing and police victimisation, and the Expectations of Police Practices Scale assesses the perceived likelihood of future incidents of police victimisation. Linear regression models were used to test for associations between police-public encounters and psychological distress and depression.

RESULTS

Psychological violence (18.6%) and police neglect (18.8%) were commonly reported in this sample and a substantial minority of respondents also reported more severe forms of violence, specifically physical (6.1%), sexual (2.8%) and physical with a weapon (3.3%). Police victimisation was more frequently reported by racial/ethnic minorities, males, transgender respondents and younger adults. Nearly all forms of victimisation (but not positive policing) were associated with psychological distress and depression in adjusted linear regression models.

CONCLUSIONS

Victimisation by police appears to be widespread, inequitably distributed across demographic groups and psychologically impactful. These findings suggest that public health efforts to both reduce the prevalence of police violence and to alleviate its psychological impact may be needed, particularly in disadvantaged urban communities.

Multiphasic personality inventory on pneumo-or hemo-thorax: Retrospective cross-sectional analysis of military candidate in Korea

Objectives

The aim of this study was to identify association between pneumo- or hemo-thorax and psychological distress using the Military Personality Inventory (MPI).

Methods

A retrospective cross-sectional study was conducted with 19-yr-old examinees who were admitted to the Military Manpower Administration in Korea from February 2009 to January 2010. A total number of 1955 young men were enrolled in this study. The normal volunteer group (n = 1561) comprise individuals who did not have pneumo- or hemo-thorax. The pneumo- or hemo-thorax group (n = 394) included individuals with pneumo- or hemo-thorax. This group was divided into two subgroups, group A (treated with conservative care or chest tube insertion, n = 341) and group B (treated with wedge resection, n = 53).

Results

We compared each of three groups (Control group, Group A, Group B) using the analysis of covariant (ANCOVA). The somatization subscale score of the neurosis category was significantly higher for group A (P < 0.001) and showed higher tendency for Group B than the control group (P = 0.073). The other categories (validity scale; anxiety, depression, and personality disorder subscales for neurosis scale; and psychopath scale) showed no significant difference in the MPI among Group A, Group B and Control group.

Conclusion

Conservative care or chest tube insertion group had higher somatization symptoms than control group. Wedge resection group had higher somatization tendency than control group. Individuals with pneumo- or hemo-thorax history may be concerned about their body shape or their general condition. Therefore, supportive intervention and psychiatric education may be needed for them to relieve somatic distress.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The Characteristics of Alcohol Pharmacokinetics of Korean Female

Introduction

The systematized and proper sized research of alcohol pharmacokinetics in Korean has not reported ever.

Objectives and aim

Aim of this study is to measure the β value and alcohol pharmacokinetic factors in Korean adult female and the relationship between the β value and some variables including age, smoking, total body water, drinking capacity, BMI, blood cholesterol, body fat and body fat ratio.

Methods

Ninety-one subjects were randomly divided into two groups. One group was provided as much as 0.35 mg/mL/kg of alcohol and the other as much as 0.70 mg/mL/kg, and blood alcohol concentration was measured 15, 30, 45, 60, 90, 120, 180, and 240 min after the women finished drinking.

Results

The subjects’ mean alcohol elimination rate (β) was −0.002379 mg/100 mL·h, and there was no statistically significant difference in elimination rate between the two groups. The mean time to reach maximum blood alcohol concentration was 45 minutes, alcohol absorption rate was 0.1123 ± 0.1799 g/L/min, and the area under the concentration curve was 109.15 ± 62.95. Among the factors that correlated with alcohol metabolism, alcohol absorption rate and follicle-stimulating hormone were statistically significant, but age, body mass index, and body fat percentage were not significantly correlated with alcohol metabolism.

Conclusions

These results suggest that the β values for healthy Korean females can differ from the cut-offs that are currently used in Korea, which suggests that the legal limit for driving under intoxication should be adjusted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Neurokinin-1-receptor antagonism decreases anxiety and emotional arousal circuit response to noxious visceral distension in women with irritable bowel syndrome: a pilot study

BACKGROUND

Irritable bowel syndrome is characterised by chronic abdominal pain and frequent comorbid anxiety. The substance P ⁄ neurokinin-1 receptor system is implicated in the regulation of both pain and anxiety, suggesting a potential therapeutic target in IBS.

AIM

To determine whether inhibition of the neurokinin-1 receptor (NK1R) will change pain ratings and brain responses to experimental visceral pain and anxiety symptoms in women with IBS or not.

METHODS

Rome II positive IBS women were recruited for a double-blind, placebo-controlled, cross-over study of NK1R antagonist AV608. Treatment periods were 3 weeks with a 2-week washout period. Functional MRI during a visceral distension paradigm was performed before first treatment and after treatment blocks. SPM8 was used to compare brain activity during painful and nonpainful visceral stimuli in regions associated with emotional arousal and interoception. Negative affect, anxiety symptoms and pain ratings were assessed.

RESULTS

Eleven subjects completed the study and eight subjects provided fMRI data. AV608, compared with placebo, was associated with reduced anxiety, negative affect, and pain ratings. During AV608 treatment, the amygdala, hippocampus and anterior cingulate gyrus showed decreased activity during visceral distension. AV608 was also associated with decreases in activity in brain regions associated with interoception (posterior insula, anterior mid-cingulate gyrus).

CONCLUSIONS

Chronic treatment with AV608 in IBS is associated with improved mood and pain ratings and activity of emotional arousal related brain regions. This suggests that further exploration of NK1R antagonists is warranted in visceral pain disorders, particularly in patients with comorbid anxiety symptoms.

An interim analysis of a phase II study of the combination of TACE and sorafenib in patients with unresectable hepatocellular carcinoma in National Cancer Center Korea (COTSUN KOREA, NCT00919009)

253

Background: Transarterial chemoembolization (TACE) is the palliative treatment for patients with unresectable HCC. TACE-induced ischemic injury is known to increase circulating VEGF and related with poor prognosis.The aim of this study is to evaluate efficacy and safety of combined TACE with sorafenib, VEGFR inhibitor in unresectable HCC patients.

Methods: This study is a non-randomized, open-labeld, single-arm, phase II investigator-initiated clinical study. Estimated number of subjects was 50 under the assumption of 3.2 months of median time to progression (TTP) with TACE alone. All patients are Child-Pugh class A or superb B. Sorafenib begins to be administered on 3 days after the first session of TACE and will be subsequently administered up to 24 weeks. Efficacy of TACE was evaluated after 4 weeks from TACE by dynamic CT. Repeated TACE is performed “on demand” in case of PR or SD according to CT/MRI evaluation.

Results: A total of 50 patients were enrolled for this interim analysis. Male was 84% and mean age was 61.5years. Causes of underlying chronic liver disease were HBV in 28 patients (65.1%). Patients were categorized into modified UICC stage II (15, 30.0%), III (24, 48.0%) and IVA (11, 22.0%). Median follow-up period was 5.3 months (range, 1.0–13.1). The size of index lesions was ranged from 1.0 cm to 13.1 cm, and number of lesions was between 1 and 5. Number of TACE sessions was 1.0 (range, 1–4). Common adverse events (AE) during sorafenib therapy were elevation of serum AST/ALT (96.8%), hypocalcemia (90.0%), thrombocytopenia (84.0%), and hyperbilirubinemia (76.0%). Hand-foot skin reaction was most frequently observed among AE of NCI CTCAE grade 3 or higher (40.0%), followed by elevation of serum ALT (38.0%). Dose reduction of sorafenib was needed most commonly due to hand-food skin reaction (n=29). Median TTP was 5.1 months (range, 3.8–6.3).

Conclusions: Adverse events were approved as acceptable by independent monitoring system. Preliminary evidence of antitumor activity was also observed. This trial can be safely performed with close monitoring in inoperable and/or unresectable HCC patients.

No significant financial relationships to disclose.

Phase II study of irinotecan plus capecitabine in patients with anthracycline and taxane pretreated metastatic breast cancer

1093

Background: Irinotecan (I) and capecitabine (X) have demonstrated single agent activity against breast cancer by different antitumor mechanism without cross-resistance. To assess the objective response rate (RR) of IX combination in metastatic breast cancer (MBC) patients (pts) was the primary end point. Methods: Anthracycline- and taxane-pretreated pts with measurable disease, age ≥ 18 years, adequate organ functions, and ECOG performance score (PS) 0–2 were eligible. Sample size of 36 was calculated with Simon's two stage minimax design. Pts received I 80 mg/m2 intravenously on days 1 and 8 and X 1,000 mg/m2 orally twice daily on days 1–14 of every 21-day cycle. Results: Between September 2006 and April 2008, 36 pts with median age of 50 years (range, 28–71) were enrolled. Median follow-up was 17 months (range, 8.3+ - 27.7+). Among 35 evaluable pts excluding 1-consent withdrawal, 86% received at least one prior chemotherapy for MBC; 20% had stage IV disease with 66% lung/37% liver metastases; 80% had PS 0–1; 77% had hormone receptor (HR) positive tumors, 20% triple negative disease and 3% HER-2 positive tumors. Overall RR was 60% (95% CI, 43.5–74.5) with median response duration of 6.3 months (range, 1.0+-17.1+); 2 CR (6%), 19 PR (54%), 8 SD (23%), and 6 PD (17%) with similar RR between HR+ (63%) versus triple negative disease (57%). Median survival was not reached with 76% estimated survival at 1-year, and median progression free survival (PFS) was 7.3 months (range, 0.7–21.1+). Pts received a median of 8 cycles of treatment (range, 1–26+). G1, G2, and G3 hand-foot syndrome were observed in 34%, 17%, and 0%, respectively. NCI grade ≥ 3 adverse events were: neutropenia (60%); asthenia, diarrhea, and vomiting (9%, each); transaminase elevation and febrile neutropenia (6%, each); abdominal pain, anorexia, fatigue, myalgia, and nausea (3%, each). Conclusions: I and X combination by this schedule and doses is highly efficacious in anthracyline- and taxane-pretreated MBC pts with manageable toxicities. Further investigation of this combination in phase III trials is warranted.

No significant financial relationships to disclose.

Remarkable complete pathologic response rate after preoperative paclitaxel, gemcitabine, and trastuzumab chemotherapy in HER2 positive stage II/III breast cancer: a phase II multicenter study

Abstract #5105

Background: Preoperative paclitaxel (P) and gemcitabine (G) combination therapy given on D1/D8 every 3 weeks (wks) for 4 cycles was well tolerated and effective in stage II/III breast cancer (BC) in our previous phase II study, with an 18% pathological complete response (pCR) rate. Adding trastuzumab (H) to the preoperative chemotherapy increases both of the clinical and pathological response rates in HER2 positive BC patients (pts). Thus far, the highest pCR rate reported in the literature was obtained with anthracycline-based regimens in combination with trastuzumab. This study evaluated whether non-anthracycline combination chemotherapy with PGH could improve the pCR rate in HER2 positive BC. Methods: HER2 positive, stage II/III BC pts with cytologically confirmed axillary lymph node (LN), ≥ 18 years of age, with adequate organ function, and good performance status were eligible. No prior therapy was allowed. Pts received H intravenously (iv) at 4 mg/kg on D1 of the first cycle with subsequent weekly doses of 2 mg/kg in combination with P 80 mg/m2 and G 1,200 mg/m2, iv, on D1/D8 every 3 wks for 6 cycles. Within 2 wks postoperatively, patients received H 6 mg/kg every 3 wks for 11 cycles with tamoxifen or an aromatase inhibitor for 5 years if indicated. All pts received postoperative radiation therapy. Initial evaluation included sonogram and MRI of the breast, MUGA scan, or echocardiogram, and PET-CT. Results: All 53 planned pts were enrolled between April 2007 and February 2008. The median age was 43 years (range, 26–61 years), the median primary tumor size by sonogram was 5.3 cm (range, 2.0 to &gt; 12 cm) with 89 % ≥ stage IIIA, 42% T3/T4, and 28% N3. Twenty four tumors (45%) were multiple and 20 tumors (38%) were ER positive. By May 2008, 47 patients completed surgery with a 74% breast conservation rate. Twenty-eight of 47 (60%; 95% CI, 45-72) patients achieved pCR in both the tumor and lymph node, with 68% (32/47; 95% CI, 54-80) pCR in the primary tumor, and 77% (36/47; 95% CI, 63-86) pCR in the axillary LN. Median metastatic focus in 21 positive LNs (n=11 pts) was 1 mm (range, &lt;1–13mm). Grade III/IV adverse events (AE) were neutropenia (53%), febrile neutropenia (4%), and transient elevation of AST/ALT (9%). After 6 cycles of PGH chemotherapy, all patients maintained above normal LVEF. Conclusions: A remarkably high pCR was obtained by non-anthracyline based PGH combination therapy for HER2 positive stage II/III breast cancer. This combination is well tolerated with mild degree of AEs.&#x2028; Supported by NCC Grant No 0610240-3. Trastuzumab, paclitaxel, and gemcitabine were supplied by Roche, CJ Cheiljedang CO., and Eli Lilly and CO., respectively.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5105.

Comparable efficacies between premenopausal and postmenopausal metastatic breast cancer patients by letrozole with and without goserelin as first line hormone therapy: a phase II parallel group study

Abstract #6134

Background: The use of goserelin in premenopausal patients(pts) is to produce castrated level of estradiol (E2), and the remaining peripheral E2 production is inhibited by letrozole, which would accomplish comparable clinical outcomes as in postmenopausal metastatic breast cancer (MBC) pts by letrozole alone.&#x2028; Methods: Hormone receptor positive pre- and postmenopausal pts with MBC were eligible. Letrozole 2.5 mg once a day was administered with goserelin 3.6 mg every 4 weeks in premenopausal pts and serial serum E2, FSH, LH were measured. Bone mineral density (BMD) and serum bone turnover markers were also checked (n=34).&#x2028; Results: Among total 78 pts enrolled, 32 pre- and 38 postmenopausal pts were assessed for efficacy and adverse events (AE). The median age was 42 years (range, 32–52) for pre- and 53 years (range, 33–70) for postmenopausal pts. Baseline characteristics were similar in the two groups, except for significantly longer disease free interval in postmenopausal pts (22.2 months vs. 41.2 months, P=0.01). Clinical benefit (CR+ PR+ SD ≥ 24 weeks) rates (62.5% vs. 68.4%, P=0.62), and objective response (CR + PR) rates (28.1 % vs. 23.7%, P=0.79) were comparable between the two groups. Median TTP was 8.6 months vs. 9.6 months (P=0.61) with a median follow-up of 11.6 months and 14.6 months, respectively. In multivariate analysis, strong ER status was significantly associated with clinical benefit rate (P=0.01), and HER2 positivity (P&lt;0.001) and stage IV presentation (P=0.05) with shorter TTP. In premenopausal pts, the mean E2 level was dropped from 62.3 ± 81.8 pg/mL at baseline to 12.3 ± 2.2 pg/mL at week 2. AEs were mild with significantly more hot flushes in premenopausal pts. In premenopausal pts without bisphosphonate treatment, there was a trend of rising serum levels of osteocalcin (OC) (0% vs. 165%, P=0.065), bone alkaline phosphatase (bALP) (0% vs. 28%, P=0.055), and C-telopeptide (CTx) (0% vs. 108%, P=0.095), as well as a significant reduction in both lumbar spine (P=0.044) and femur (P=0.027) BMD. In contrast, in premenopausal pts with bone metastasis on bisphosphonate, there was no significant change in OC, bALP, CTx, and both BMD. In postmenopausal pts without bisphosphonate treatment, no significant change in OC, bALP, CTx, and femur BMD, while in pts with bone metastasis on bisphosphonate treatment, a significant decrease in OC (0% vs. -22%, P=0.050) and CTx (0% vs. -41%, P=0.020) and increase in both BMD (P=0.044, P=0.038 respectively) were observed.&#x2028; Conclusions: Clinical efficacies by letrozole and goserelin therapy in premenopausal MBC pts were comparable to those in postmenopausal pts by letrozole with mild AEs. While a modest increase in both bone formation and resorption especially in premenopausal pts, concurrent bisphosphonate therapy could stabilize bone metabolism in patients even with bone metastasis.&#x2028; Supported by NCC Grant No NCS-0610240-3. Letrozole for premenopausal group was supplied by Novartis.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6134.

Survival differences in patients with brain metastases according to breast cancer subtypes

11507

Background: Brain metastases (BM) occur in as many as one-third of patients with metastatic breast cancer (MBC). Incidences and prognoses by triple receptor subtypes in BM have not been well delineated. Methods: Retrospectively, prognoses were assessed according to clinical characteristics, triple receptor subtypes, and receipt of trastuzumab therapy by univariate and multivariate analyses. ER/PR/HER2 were tested by IHC with HER2 FISH for IHC 2+ and for all 118 consecutive primary BC. Results: Between 8/2001 and 4/2006, 138 of 805 pts (17.1%) with MBC presented with BM at NCC Korea. More pts with triple negative and HER2+ tumors developed BM (see table ). The median age was 47 years. They were single (9%), multiple (80%), or leptomeningeal disease with or without multiple BM (11%). As initial therapy, 104 pts received WBRT, 8, intrathecal therapy (IT), 9, WBRT with IT, and 17 others. Of 56 HER2+ pts, 45 received trastuzumab either before (n=25) or after (n=13), or continuously before and after BM diagnosed (n=7). By 10/2006, 117 pts died with a median survival of 4.5 months. Multivariate analyses indicated age, tumor receptor subtypes, leptomeningeal presentation and number of extracranial disease sites as significant factors. Receipt of trastuzumab therapy after BM was a significant variable for survival in HER2+ diseases (3.8 vs. 13.4 mo, p=0.0000). Pts with triple negative subtype lived shortest compared with other types (p=0.0035). Conclusions: More pts with triple negative and HER2+ disease developed BM. HER2+ disease gained a significant survival benefit by trastuzumab therapy. Supported by NCC Grant 0610240 and 0510520.

[Table: see text]

No significant financial relationships to disclose.

A phase II trial of radiation therapy with concurrent paclitaxel chemotherapy in high-risk endometrial cancer patients after staging operation: An interim analysis of a prospective multicenter trial (KGOG2001)

16069

Background: This is an interim report of a prospective multicenter phase II trial to evaluate 2-year disease free survival rate, toxicity, overall survival rate and recurrence rate in high-risk endometrial cancer patients who received concurrent chemoradiotherapy after staging operation. Methods: Thirty four patients with endometrial cancer from 17 medical centers in Korea have enrolled the study. The cell types were all endometrioid type and they had no prior chemotherapy. They were in either stage III or IV and all received staging operation including total hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymph node dissection and washing cytology. Concurrent chemoradiotherapy was performed with paclitaxel (60 mg/m2/weekly, 6 cycles) and external field irradiation (5 fractions/week, total 4,500–5,040 cGy). Primary end point was 2-year disease free survival rate. Overall survival rate and recurrence rate were secondary end points. Toxicity of the treatment was also evaluated. Results: The expected number of subjects to complete the trial is 56. The trial was activated on 5th June 2005 and median follow up period is 5.8 (0–11) months until December 2006. 19 patients (55.8%) have completed treatment regimen and 14 patients (41.1%) are still receiving treatment. 1 patient (2.9%) died during treatment of the disease and 1 patient (2.9%) was lost during the follow up period. Disease free survival is 94.1% (32/34) and no recurrence has occurred so far. Toxicities have occurred in 52.9% (18/34) with gastrointestinal symptoms (13/34, 38.2%) such as diarrhea and constipation being the most common ones. Conclusions: This interim report suggest a possibility that a concurrent chemoradiotherapy for high-risk endometrial cancer may be an optimal treatment option to improve disease free survival rate.

[Table: see text]

Compositional analysis of human acquired enamel pellicle by mass spectrometry

Relatively little is known about the formation of the acquired enamel pellicle other than that it involves the selective adsorption of specific proteins from oral fluids. Previous studies on the identification of pellicle components have relied largely on immunological or enzymatic detection and have been hampered by the fact that only minute quantities of pellicle can be removed from tooth surfaces. The present work describes an improved method of harvesting pellicle that combines mechanical and chemical removal; this approach was used to investigate systematically the desorption of in vitro pellicle components with different solutions. Eleven major in vitro pellicle proteins were identified by using a combination of electrophoretic separation and matrix-assisted laser desorption/ionization-reflectron time-of-flight mass spectrometry. A similar analysis of in vivo-formed pellicle revealed the presence of intact statherin, lysozyme, albumin and amylase. Further analysis of in vivo pellicle by liquid chromatography-electrospray ionization mass spectrometry suggested the presence of numerous low molecular-weight fragments of precursor proteins. The protein composition of in vitro whole-salivary pellicle adsorbed to hydroxyapatite and that of in vivo enamel pellicle differed for proline, the result of a reduction in the content of acidic proline-rich proteins in the in vivo samples. Unique features of the oral environment such as enzymatic activities or mineral surface properties may account for these differences between in vivo and in vitro pellicle formation.

Longitudinal threshold changes in older men with audiometric notches

Age-related hearing loss (presbycusis) is a multifactorial process that results chiefly from the accumulating effects of noise damage and aging on the cochlea. Noise damage is typically evidenced clinically by a discrete elevation (notch) of the auditory thresholds in the 3-6 kHz region of the audiogram whereas aging affects the highest frequencies first. To determine whether the presence of such high-frequency notches influences auditory aging, we examined the 15 year change in audiometric thresholds in 203 men from the Framingham Heart Study cohort. The mean age at the first hearing test was 64 years (range 58-80). Occupational and recreational noise exposure over the 15 years was assumed to be minimal due to the age of the subjects. The presence or absence of a notch was determined using a piecewise linear/parabolic curve fitting strategy. A discrete elevation of the pure-tone thresholds of 15-34 dB in the 3-6 kHz region was deemed a small notch (N1), and elevations of 35 dB or greater were deemed large notches (N2). Absence of a notch (N0) was encoded those ears with <15 dB elevation in the 3-6 kHz region. The presence and absence of notches correlated with the subjects' history of noise exposure. The 15 year pattern of change in age-adjusted pure-tone thresholds varied significantly by notch category. There was less change over time in the notch frequencies (3-6 kHz) and significantly greater change in the adjacent frequency of 2 kHz in the N2 group as compared to the N0 and N1 groups. The adjacent frequency of 8 kHz showed a significant, but smaller, change in the N1 group as compared to the N0 and N2 groups. The change at 2 kHz was independent of the starting hearing level at E15, whereas the changes at 4-8 kHz were influenced by the hearing level at E15. These data suggest that the noise-damaged ear does not 'age' at the same rate as the non-noise damaged ear. The finding of increased loss at 2 kHz suggests that the effects of noise damage may continue long after the noise exposure has stopped. The mechanism for this finding is unknown but presumably results from prior noise-induced damage to the cochlea.