Factors predicting lapatinib efficacy in HER-2+ metastatic breast carcinoma: Does it work better in different histologic subtypes?

CONTEXT

Introduction of trastuzumab, a recombinant monoclonal antibody against the extracellular domain of HER-2, is a cornerstone in the treatment of HER-2+ breast carcinoma. However, many cancers that have an initial response to trastuzumab will progress some time later. After progression on trastuzumab-based first-line treatment, there are several options. Although TDM-1 (Trastuzumab emtansine) has prolonged progression-free survival (PFS) and overall survival in patients previously treated with trastuzumab and taxane, it is still not available in Turkey. Patients may be switched to lapatinib (an oral tyrosine kinase inhibitor targeting both HER-1 and HER-2), or they may re-challenge with trastuzumab. There is no clear definition of the patients who should be switched to lapatinib.

AIM

In this study, we investigated the factors predicting the efficacy of lapatinib.

SUBJECTS AND METHODS

Totally, 94 patients treated with lapatinib for metastatic breast carcinoma was included in our study. Retrospective data including pathology, treatments and treatment results, metastatic sites, and laboratory tests were collected.

RESULTS

Progression-free survival was 9.1 months. Histologic subtypes other than invasive ductal carcinoma and liver metastasis were inversely related with PFS. Overall survival was 22.1 months, and patients with histologic subtypes other than invasive ductal carcinoma and who progress with brain metastasis had a worse prognosis.

CONCLUSION

Clinicians should give attention to histologic subtype and metastatic sites when choosing patients for lapatinib treatment.

Synthesis and characterization of poly(vinyl chloride-graft-2-vinylpyridine) graft copolymers using a novel macroinitiator by reversible addition-fragmentation chain transfer polymerization

Synthesis of poly(vinyl chloride-graft-2-vinylpyridine) graft copolymers was carried out by reversible addition-fragmentation chain transfer (RAFT) polymerization of 2-vinylpyridine using a novel macroinitiator (RAFT macroinitiator). For this purpose, RAFT macroinitiator was obtained from the potassium salt of ethyl xanthogenate and poly(vinyl chloride) (PVC). Then the graft copolymers were synthesized by using RAFT macroinitiator and 2-vinylpyridine. The principal parameters such as monomer concentration, initiator concentration, and polymerization time that affect the polymerization reaction were studied. The effect of the reaction conditions on the heterogeneity index and molecular weight was also investigated. The block lengths of the graft copolymers were calculated by using 1H nuclear magnetic resonance (1H NMR) spectra. The block lengths of the copolymers could be adjusted by varying the monomer and initiator concentrations. The characterizations of the samples were carried out by using 1H NMR, Fourier-transform infrared spectroscopy, gel-permeation chromatography, thermogravimetric analysis, differential scanning calorimetry, and fractional precipitation (γ value) techniques. RAFT polymerization is used to control the polymerization of 2-vinylpyridine over a broad range of molecular weights.

Diagnosing oesophagitis in children: how discriminative is histology?

BACKGROUND AND STUDY AIMS

We set out to evaluate the discriminatory value of currently available histologic criteria in the differential diagnosis of reflux oesophagitis and eosinophilic oesophagitis in children.

PATIENTS AND METHODS

We evaluated the oesophageal biopsies of 145 children and selected 28 demonstrative cases of clinically confirmed eosinophilic oesophagitis (n = 7), and reflux oesophagitis (n = 11) with a control group with normal histology (n = 10). Histological assessment was performed for the presence of papillary elongation, dilatation of intercellular spaces, basal cell hyperplasia and the number of intraepithelial eosinophils, lymphocytes and neutrophils.

RESULTS

Among 28 children, there were 3 boys and 4 girls in eosinophilic oesophagitis group, 8 boys and 3 girls in reflux group, and 5 boys and 5 girls in normal group. The mean age was 10,4 years. Basal cell hyperplasia was observed in 12 cases while papillary elongation was found in 25, and dilated intercellular spaces were present in 20 cases. Lymphocyte and neutrophil counts were significantly higher in reflux group when compared to eosinophilic oesophagitis and normal group. Eosinophil counts were significantly higher in eosinophilic group.

CONCLUSIONS

Results of the present study suggest that, basal cell hyperplasia, papillary elongation, and dilated intercellular spaces all seem to be markers of oesophagitis regardless of the underlying pathology and etiology, thereby, highlighting their rather nonspecific nature in the differential diagnosis of various types of oesophagitis. The additional information on inflammatory cell counts may help to distinguish reflux oesophagitis from other causes of oesophagitis including EoO.

Evaluation of Barrett's esophagus with CK7, CK20, p53, Ki67, and COX2 expressions using chromoendoscopical examination

Barrett's esophagus (BE) is a complication of chronic gastroesophageal reflux disease and can be diagnosed when there is an endoscopically irregular Z-line and intestinal metaplasia (IM) in a biopsy obtained lower esophagus. It is still not clear whether IM in the gastric cardia or columnar mucosa without IM in the lower esophagus have any significance as BE, which is considered as preneoplastic. The aim of the study was to determine the immunohistochemical features of BE and columnar mucosa in the distal esophagus and also to evaluate the value of chromoendoscopy in the diagnosis of BE in a prospective manner. A total of 12 chromoendoscopic biopsies (six from normal-looking unstained esophagus and six from esophageal mucosa stained with methyl blue suspicious of BE) were taken from 111 cases who underwent endoscopy because of a variety of upper gastrointestinal symptoms. Immunohistochemical analysis was performed using CK7, CK20, p53, Ki67, and cyclooxygenase 2 (COX2). Of the 111 cases, 19 cases with carcinoma (nine adeno, six squamous, four undifferentiated carcinomas) and 17 cases with normal squamous epithelium were excluded, while 75 cases showing columnar epithelium, including 46 (61.3%) with IM and 29 (38,7%) without IM, were further evaluated immunohistochemically. CK7 was observed in surface, crypt, and glandular epithelium, whereas CK20 was expressed in surface and superficial crypt epithelium. No significant difference was observed between the Barrett and non-Barrett type of CK7/20 staining pattern (P > 0,05). Expression of p53 did not show any difference between BE and columnar mucosa without IM, whereas COX2 expression was significantly increased in BE (P < 0.05) in comparison with columnar mucosa without IM. Ki67 expression was significiantly higher both in upper and lower crypts in BE (P < 0.05). The present study showed that a Barrett pattern does not seem to exist; however, the analysis of COX2 expression and the Ki67 proliferation fraction by immunohistochemistry can be used to separate BE from non-Barrett's metaplasia of the distal esophagus. In our point of view, the immunohistochemical detection of p53 expression in Barrett's metaplasia stage is useless as a marker for early detection of high-risk patients.

Does awareness of diagnosis make any difference to quality of life? Determinants of emotional functioning in a group of cancer patients in Turkey

The object of this study was to investigate how the information status with regard to diagnosis, in addition to social and clinical factors, influenced emotional functioning and quality of life in a group of cancer patients in Turkey. A consecutive sample of 100 cancer patients being treated for different diagnoses in a tertiary care centre were prospectively evaluated. Data on patient disease and social characteristics, clinical factors, and scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were analysed by logistic regression models. A significant proportion (44%) of the patients did not know of their diagnosis of cancer. The scores on functional and symptom scales and global health status/quality of life according to QLQ-C30 did not differ according to the information given or not given on diagnosis. However, the independently significant determinants of good emotional functioning were male gender (P=0.002), low serum alanine transferase levels (P=0.025), good social functioning (P=0.002), and the absence of constipation (P=0.005). In Turkey, it is still common for cancer patients not to be informed of their diagnosis, and there is a great need to improve this situation. Honest disclosure of the truth does not worsen any dimension of quality of life in general or emotional functioning in particular. On the contrary, those with hepatic dysfunction, female gender, poor social functioning and constipation are the ones at increased risk of poor emotional functioning, and these patients may benefit from psychological screening.

Predictors of distant metastasis at presentation in breast cancer: a study also evaluating associations among common biological indicators

BACKGROUND

To investigate the correlation among some of the commonly used clinical, pathological factors and newer biological indicators, and to identify the independent predictors of distant metastasis at presentation in patients with breast cancer.

METHODS

The pathological specimens from 73 patients with breast cancer were retrospectively evaluated by immunohistochemistry. Data on 13 biological indicators; ER, PR, P53, c-erbB-2, PCNA, CEA, Ki-67, Vimentin, Ulex, Nm23, Cathepsin D, Factor VIII, PS2 together with clinical and pathological factors were collected.

RESULTS

A number of highly significant correlations were found among the biological indicators studied. By logistic regression analysis, the predictors of distant metastasis at presentation in univariate tests were tumor diameter, number of lymph nodes involved, P53, c-erbB-2 and grade. In multivariate analysis, tumor diameter (P = 0.042, HR: 1.88(1.02-3.44)), c-erbB-2 expression (P=0.035, HR: 18.20 (1.23-268.66)) and grade (P=0.010, HR: 8.05(1.66-39.00)) retained their significance.

CONCLUSION

Our findings show that inactivation of suppressor genes, expression of oncogenes, loss of differentiation, augmentation of proliferative activity, metastatic potential, angiogenesis and hormone receptor status are all interrelated facets of breast cancer pathogenesis. Patients with tumors overexpressing c-erbB-2 or with bigger or higher-grade tumors probably need to be more carefully evaluated for the presence of distant metastasis, thus be better staged, at presentation. This may be a new reason to test c-erbB-2 routinely in all patients with breast cancer in addition to its well-known prognostic and predictive uses.