Real-life multi-center retrospective analysis on nivolumab in difficult-to-treat patients with advanced hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. The landscape of the systemic treatment for advanced HCC is changing quickly, and recently, the standard of care became either atezolizumab plus bevacizumab or tremelimumab plus durvalumab in the single tremelimumab regular interval durvalumab regimen. Nivolumab monotherapy has proven to be effective sometimes for advanced HCC and could be a valuable treatment option for patients outside current treatment indications and reimbursement criteria for the standard of care. This is a particular population of interest.

AIM

To evaluate the real-world effectiveness of nivolumab monotherapy in patients with advanced HCC who are not eligible for other treatment.

METHODS

We conducted a retrospective, multicentric study including 29 patients with advanced HCC from 3 Belgian tertiary hospitals. All patients had had prior chemotherapy or were intolerant or ineligible for treatments. All study subjects received nivolumab 3 mg/kg in monotherapy, administered once every two weeks intravenously. Treatment continued until disease progression, severe adverse events or death. Data were retrieved from patients’ medical records. The outcome parameters such as radiological response according to response evaluation criteria in solid tumors (RECIST) criteria, the biological response through the evolution of the alpha-fetoprotein (AFP) level, and clinical response considering both the Child–Pugh (CP) score and the World Health Organization (WHO) performance status (PS) were reported. A safety profile was also reported. Statistical analysis was performed using the SPSS Statistics 27 statistical software package.

RESULTS

The radiological overall response rate (defined as complete or partial response according to the immune RECIST and modified RECIST criteria) to nivolumab monotherapy was 24.1%. The biological overall response rate (defined as a decrease of ≥ 25% in AFP blood level) was 20.7%. Radiological and biological responses were significantly associated both with each other (P < 0.001) and with overall survival (P < 0.005 for radiological response and P < 0.001 for biological response). Overall survival was 14.5 mo (+/- 2.1), and progression-free survival was 10.9 mo (+/- 2.3). After 4 mo of treatment, 78.3% of patients remained clinically stable or even showed improvement in WHO PS. Grade 3 adverse events occurred in 17.2% of patients, none had grade 4 adverse events, and no patients ceased nivolumab due to adverse events.

CONCLUSION

Nivolumab monotherapy is a good treatment choice in frail patients with HCC who are ineligible for the standard of care or other validated systemic treatments.

The Roots of Evil: Social Conditions, Culture, Personality, and Basic Human Needs

Evil actions are defined as repeated or persistent, not commensurate with provocation and causing extreme harm, at times due to repetition. Evil develops or evolves. As individuals and groups harm others, they tend to develop characteristics that make further and more intense harmdoing probable. In this article, I explore instigating conditions (difficult life conditions in a society, group conflict); cultural characteristics; the nature of evolution, with its psychological and social processes in individuals and groups; and the passivity and complicity of bystanders that lead to genocide and other collective violence. I consider the question of whether bystanders can be regarded as evil, focusing on the genocide in Rwanda as an example. I examine the socialization and experience of children and youth that lead to aggression and the subsequent evolution of aggression toward greater violence and evil. I explore the way personal characteristics and a system of relationships can lead to sexual abuse by fathers. One organizing concept in understanding the generation of violence that causes extreme harm is the frustration of basic human needs and their subsequent destructive fulfillment.

[Bifocal lung cancer: the same histology?]

Whereas synchronous lung cancer is rare, synchronous small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are exceptional. The authors report the case of a 61-year-old man with synchronous unilateral adenocarcinoma and small cell lung cancer, raising the question as to the need for the histology of all of the lesions in the same lobe or same lung as well as the treatment. The medical history, biology, CT and (18)F-FDG TEP-CT did not support a diagnosis of synchronous lung cancer. The prognosis was poor and only surgery could improve the prognosis. This is a rare case and illustrates the difficulty in the diagnosis of multiple lung cancer and the difficulty in treating synchronous lung cancer with different histologies (SCLC and NSCLC).

Predicting the site of origin of tumors by a gene expression signature derived from normal tissues

Multiple expression signatures for the prediction of the site of origin of metastatic cancer of unknown primary origin (CUP) have been developed. Owing to their limited coverage of tumor types and suboptimal prediction accuracy on distinct tumors, there is still room for alternative CUP gene expression signatures. Whereas in past studies, CUP classifiers were trained solely on data from tumor samples, we now use expression patterns from normal tissues for classifier training. This approach potentially avoids pitfalls related to the representation of genetically heterogeneous tumor subtypes during classifier training. Two expression data sets of normal human tissues have been reanalyzed to derive an expression signature for liver, prostate, kidney, ovarian and lung tissues. In reciprocal validation, classifiers trained on either data set achieved overall accuracies greater than 97%. Classifiers trained on combined expression data from both normal tissue data sets were able to predict the site of origin in a cohort of 652 primary tumors with approximately 90% accuracy. Prediction accuracies of primary cancer-based classifiers were in the same range, as determined by cross-validation on this cohort. For individual tumor types, normal tissue-based classifiers achieved sensitivities in the range of 64-99% and specificities in the range of 92-100%. Primary origins for 12 of 20 metastases were predicted correctly, with false predictions highlighting the need for accurate sample preparation to avoid contaminations by metastases-surrounding tissue. We conclude that gene expression patterns of normal tissues harbor phenotypic information that is retained in tumors and can be sufficient to recover the type of primary tumor from expression patterns alone.

WITHDRAWN: Predicting the site of origin of tumors by a gene expression signature derived from normal tissues

Multiple expression signatures for the prediction of the site of origin of metastatic cancers of unknown primary origin (CUP) have been developed. Owing to their limited coverage of tumor types and suboptimal prediction accuracy on distinct tumors there is still room for alternative CUP gene expression signatures. Whereas in past studies CUP classifiers were solely trained on data from tumor samples, we now use expression patterns from normal tissues for classifier training. This approach potentially avoids pitfalls related to the representation of genetically heterogeneous tumor subtypes during classifier training. Two expression data sets of normal human tissues have been reanalysed to derive an expression signature for liver, prostate, kidney, ovarian and lung tissues. In reciprocal validation classifiers trained on either data set achieved overall accuracies greater than 97%. Classifiers trained on combined expression data from both normal tissue data sets were able to predict the site of origin in a cohort of 652 primary tumors with approximately 90% accuracy. Prediction accuracies of primary cancer-based classifiers were in the same range as determined by cross-validation on this cohort. For individual tumor types, normal tissue-based best-centroid classifiers achieved sensitivities ranging from 71 to 99% and specificities ranging from 91 to 99%. Primary origins for 12 of 20 metastases were predicted correctly with false predictions highlighting the need for accurate sample preparation to avoid contaminations by metastases-surrounding tissue. We conclude that gene expression patterns of normal tissues harbor phenotypic information that is retained in tumors and can be sufficient to recover the type of a primary tumor from expression patterns alone.Oncogene advance online publication, 16 November 2009; doi:10.1038/onc.2009.398.

[Erlotinib and nonsmall cell lung cancer with brain metastases: a case study with a complete and prolonged response over 17 months]

The prognosis of stage IV nonsmall cell lung cancer, in particular with brain metastases, is extremely poor. The impact of targeted therapy, in particular erlotinib, on patient survival has still not been determined. The authors report the case of a patient diagnosed with nonsmall cell lung cancer with bone and brain metastases. The patient presented a complete cerebral response for 17 months with erlotinib prescribed as a third line therapy.

[Dyspnea in lung cancer]

Dyspnea is a subjective symptom defined as an experience of uncomfortable and difficult breathing which strongly affects the quality of life. It is the most common symptom in lung cancer but its physiopathology remains unclear. Dyspnea is due to cancer itself, specific therapies or comorbidities. To evaluate intensity of dyspnea, analogue visual and verbal rating scales need to be preferred. Diagnosis of underlying cause, based on rational and non invasive strategy is needed to perform effective treatment if possible. Despite its frequency, few therapies are really effective, except nonpharmacologic measures: only morphine can be actually recommend, especially with naive patients. In palliative cases, if dyspnea is uncontrolled, benzodiazepine can be used and may represent ethic approach.

[A case of atypical pericarditis]

INTRODUCTION

An acute viral pericarditis may reveal a congenital pericardial abnormality.

CASE HISTORY

We report the case of a young man of 29 years in whom the development of rapidly progressive dyspnoea and fever led to the echocardiographic diagnosis of a pericardial tumour. The thoracic CT scan showed a mass arising in the superior mediastinum with no evidence of spread. Surgical exploration allowed the excision of a soft mutilobular mass adherent only to the aorta. Histological examination revealed an intrapericardial bronchogenic cyst.

CONCLUSION

After a review of bronchogenic cysts we point out the properties of this rare intra-pericardial localisation, one of which is the frequently observed secretion of CA 19-9.

[Positron emission tomography in the diagnosis and follow up of non-small cell lung cancer]

In the space of a few years 18F-FDG PET scanning has acquired a place in the management of all stages of the clinical care of patients with lung cancer. Its contributions are being more and more precisely understood during the assessment of mediastinal and metastatic extension and it carries the hope of better therapeutic management and surveillance.

Differential expression of genes encoding tight junction proteins in colorectal cancer: frequent dysregulation of claudin-1, -8 and -12

BACKGROUND AND AIMS

As integral membrane proteins, claudins form tight junctions together with occludin. Several claudins were shown to be up-regulated in various cancer types. We performed an expression analysis of genes encoding tight junction proteins to display differential gene expression on RNA and protein level and to identify and validate potential targets for colorectal cancer (CRC) therapy.

PATIENTS AND METHODS

Amplified and biotinylated cRNA from 30 microdissected CRC specimen and corresponding normal tissues was hybridized to Affymetrix U133set GeneChips. Quantification of differential protein expression of claudin-1, -8 and -12 between normal and corresponding tumour tissues was performed by Western blot analyses. Paraffin-embedded CRC tissue samples, colon cancer cell lines and normal tissue microarray were analysed for protein expression of claudin-1 by immunohistochemistry (IHC).

RESULTS

Claudin-1 (CLDN1) and -12 (CLDN12) are frequently overexpressed in CRC, whereas claudin-8 (CLDN8) shows down-regulation in tumour tissue on RNA level. Quantification of proteins confirmed the overexpression of claudin-1 in tumour tissues, whereas changes of claudin-8 and -12 were not significantly detectable on protein level. IHC confirmed the markedly elevated expression level of claudin-1 in the majority of CRC, showing membranous and intracellular vesicular staining.

CONCLUSIONS

Differential expression of genes encoding claudins in CRC suggests that these tight junction proteins may be associated to and involved in tumorigenesis. CLDN1 is frequently up-regulated in large proportion of CRC and may represent potential target molecule for blocking studies in CRC.

[Lymphadenopathy and absences]

A 6-year-old boy presented with deterioration of general well-being during several weeks, headache and swelling of lymph nodes in the neck. In addition, the parents reported brief episodes resembling typical absence seizures. Serological tests and the examination of cerebrospinal fluid revealed neuroborreliosis. At the same time, electroencephalography showed characteristic patterns of absence epilepsy. The boy's condition improved rapidly during a 2-week course of intravenous ceftriaxone and after initiation of antiepileptic therapy. To our knowledge, absence epilepsy has not previously been reported in association with neuroborreliosis. We consider the two conditions to be coincidental.

Genetic analysis of the LGI/Epitempin gene family in sporadic and familial lateral temporal lobe epilepsy

Mutations in the LGI1/Epitempin gene cause autosomal dominant lateral temporal lobe epilepsy (ADLTE), a partial epilepsy characterized by the presence of auditory seizures. However, not all the pedigrees with a phenotype consistent with ADLTE show mutations in LGI1/Epitempin, or evidence for linkage to the 10q24 locus. Other authors as well as ourselves have found an internal repeat (EPTP, pfam# PF03736) that allowed the identification of three other genes sharing a sequence and structural similarity with LGI1/Epitempin. In this work, we present the sequencing of these genes in a set of ADLTE families without mutations in both LGI1/Epitempin and sporadic cases. No analyzed polymorphisms modified susceptibility in either the familial or sporadic forms of this partial epilepsy.

[Low grade pulmonary sarcoma preceding the discovery of a uterine primary]

INTRODUCTION

Low grade pulmonary sarcomas are very rare tumours. We report the case of a low grade sarcoma of the lung occurring two years prior to the finding of a uterine primary.

CASE REPORT

Complete surgical excision of a low grade pulmonary sarcoma was performed. The initial search for dissemination was negative. Two years later a follow-up scan discovered a uterine mass as well as a para-aortic shadow that proved to be the primary tumour (low grade uterine sarcoma) and a metastasis.

CONCLUSION

This is the second case of a pulmonary metastasis discovered before a primary low grade uterine sarcoma. The first was found during the investigation of a pulmonary sarcoma. The main differential diagnosis to consider is metastatic leiomyosarcoma. In both cases their finding justifies the search for a uterine primary by immunohistochemical examination for oestrogen and progesterone receptors as well as pelvic ultrasound or even magnetic resonance imaging.

Inactivation of Bacillus subtilis spores and formation of bromate during ozonation

Inactivation of B. subtilis spores with ozone was investigated to assess the effect of pH and temperature, to compare the kinetics to those for the inactivation of C. parvum oocysts, to investigate bromate formation under 2-log inactivation conditions, and to assess the need for bromate control strategies. The rate of B. subtilis inactivation with ozone was independent of pH, decreased with temperature (activation energy of 42,100 Jmol(-1)), and was consistent with the CT concept. B. subtilis was found to be a good indicator for C. parvum at 20-30 degrees C, but at lower temperatures B. subtilis was inactivated more readily than C. parvum. Bromate formation increased as both pH and temperature increased. For water with an initial bromide concentration of 33 microgl(-1), achieving 2-logs of inactivation, without exceeding the 100 microg l(-1) bromate standard, was most difficult at 30 degrees C for B. subtilis and at midrange temperatures (10-20 degrees C) for C. partum. pH depression and ammonia addition were found to reduce bromate formation without affecting B. subtilis inactivation, and may be necessary for waters containing more than 50 microgl(-1) bromide.

The DAPIN family: a novel domain links apoptotic and interferon response proteins

We report the discovery of a protein domain, hereafter referred to as DAPIN, in diverse vertebrate and viral proteins that is associated with tumor biology, apoptosis and inflammation. Based on a secondary structure prediction, we suggest an all-alpha fold for DAPIN, which is also adopted by apoptotic protein domains of the CARD, death domain and death effector domain type.

Cultural-societal roots of violence. The examples of genocidal violence and of contemporary youth violence in the United States

Widespread violence in a society must have its origins in cultural characteristics, current societal conditions, or both. In this article, the cultural, societal, and psychological origins of two very different forms of violence are examined. A conception of the origins of genocide and mass killing is briefly presented, with the Holocaust and the violence in the former Yugoslavia as supporting evidence. Difficult life conditions give rise to scapegoating, destructive ideologies, and the evolution of increasing violence against a designated enemy. Cultural characteristics that make this process more or less probable are described. This is followed by a presentation of the socialization experiences of children that generate youth violence. To explain the increase in youth violence, the presence of difficult life conditions in the United States is noted (due primarily to substantial social change). The effects of difficult life conditions, cultural characteristics, and social conditions such as poverty and discrimination against minority groups on family life and parenting are described. Similarities and differences in the origins of the two forms of violence are examined. The role of unfulfilled or frustrated basic human needs in generating violence is stressed, and conditions and actions required to reduce violence are proposed.

[Lymph node metastases of unknown primary tumors. Sense and nonsense of a complicated search]

Malignant neoplasms are quite frequently (5% in our material) first diagnosed from their metastases. Detecting the site of the primary usually involves a time-consuming and costly work-up unpleasant for the patient. In a retrospective analysis of 60 cases of supraclavicular, cervical and axillary lymph node metastases, an attempt is made to establish guidelines for more economical and rational investigation. The most important but often neglected leads are provided by history and physical examination. Routine laboratory and X-ray examinations only rarely contribute to rapid detection of the primary. Histological examination of the excised lymph node is very reliable in suggesting possible primaries. A practical guide is given for the approach to a patient with lymph node metastasis of an unknown primary, based on a limited initial work-up and on the histology of the lymph node.