Ibrutinib combination therapy for advanced gastrointestinal and genitourinary tumours: results from a phase 1b/2 study

BACKGROUND

Ibrutinib, a first-in-class inhibitor of Bruton's tyrosine kinase, is approved for the treatment of various B-cell malignancies and chronic graft-versus-host disease. Based on encouraging preclinical data, safety and efficacy of ibrutinib combined with companion drugs for advanced renal cell carcinoma (RCC), gastric/gastroesophageal junctional adenocarcinoma (GC), and colorectal adenocarcinoma (CRC) were evaluated.

METHODS

Ibrutinib 560 mg or 840 mg once daily was administered with standard doses of everolimus for RCC, docetaxel for GC, and cetuximab for CRC. Endpoints included determination of the recommended phase 2 dose (RP2D) of ibrutinib in phase 1b and efficacy (overall response rate [ORR] for GC and CRC; progression-free survival [PFS] for CRC) in phase 2.

RESULTS

A total of 39 (RCC), 46 (GC), and 50 (RCC) patients were enrolled and received the RP2D. Safety profiles were consistent with the individual agents used in the study. Confirmed ORRs were 3% (RCC), 21% (GC), and 19% (CRC). Median (90% CI) PFS was 5.6 (3.9-7.5) months in RCC, 4.0 (2.7-4.2) months in GC, and 5.4 (4.1-5.8) months in CRC.

CONCLUSIONS

Clinically meaningful increases in efficacy were not observed compared to historical controls; however, the data may warrant further evaluation of ibrutinib combinations in other solid tumours.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02599324.

Real-world evidence research in metastatic colorectal cancer: raising awareness of the need for patient contributions

Real-world evidence (RWE) research helps determine whether outcomes observed in clinical trials happen in real-life clinical practice. RWE research may help patients receive more appropriate treatment, closer to their needs and wishes. RWE for metastatic colorectal cancer is currently limited. The PROMETCO RWE study is an important example of an ongoing initiative that focuses on patient-reported outcomes in metastatic colorectal cancer. Patients play an active role throughout the RWE research process, including study design, participation and results dissemination. This involvement can encourage greater patient empowerment through active engagement, potentially resulting in various benefits that can lead to improved clinical outcomes. Greater patient engagement can increase involvement in RWE, helping more patients to access the benefits of RWE research. Clinical Trial Registration: NCT03935763 (ClinicalTrials.gov).

Experimental Demonstration of the Thin-Film Liquid-Metal Jet as a Charge Stripper

For high-power heavy ion accelerators, the development of a suitable charge stripper, which can handle intense beams, is essential. This Letter describes the first experimental demonstration of a heavy ion liquid lithium charge stripper. A 10-20  μm thick liquid lithium jet flowing at >50  m/s was formed and confirmed stable when bombarded by various heavy ion beams, while increasing the charge state of the incoming beams to the desired charge state range. This demonstration proved the existing power limitation with the conventional strippers can be overcome by the liquid-metal stripper, opening completely new possibilities in high-power accelerator development.

Pain Prevalence in two Italian Hospitals. An observational study

INTRODUCTION

Pain is the most common and distressing medical symptom in hospitalized patients in all wards. Pain prevalence among hospitalized patients is an indicator of the quality of health care.

OBJECTIVE

The aim of this study is to describe pain prevalence in two Italian hospitals.

MATERIAL AND METHOD

This is an observational study. It involved hospitalized patients of both sexes, able and unable to self-report. Descriptive analysis and multivariate analysis were applied.

RESULTS

A sample of 754 inpatients were included. In Terni Ho-spital (n = 255), pain prevalence was 80.8%. The mean pain severity was 5.2 (sd ± 3.33). At Rome's San Camillo Hospital (n=499), pain prevalence was 46.9%. Acute pain is more prevalent in women (OR= 0.65; CI 95% 0.43-0.99) and increases with age (OR= 0.97; CI 95% 0.96-0.99). Chronic pain is more prevalent in men (OR= 2.34; CI 95% 1.41-3.97) and increases with age (OR= 1.04; CI 95% 1.03-1.06).

DISCUSSION AND CONCLUSION.

San Camillo Hospital presents data showing reduced pain prevalence, and describing pain even in patients unable to self-report. It is reasonable to believe that pain control by the staff at San Camillo is better, even though both hospitals are equally important regional institutions.

Social interactions impact on the dopaminergic system and drive individuality

Individuality is a striking feature of animal behavior. Individual animals differ in traits and preferences which shape their interactions and their prospects for survival. However, the mechanisms underlying behavioral individuation are poorly understood and are generally considered to be genetic-based. Here, we devised a large environment, Souris City, in which mice live continuously in large groups. We observed the emergence of individual differences in social behavior, activity levels, and cognitive traits, even though the animals had low genetic diversity (inbred C57BL/6J strain). We further show that the phenotypic divergence in individual behaviors was mirrored by developing differences in midbrain dopamine neuron firing properties. Strikingly, modifying the social environment resulted in a fast re-adaptation of both the animal's traits and its dopamine firing pattern. Individuality can rapidly change upon social challenges, and does not just depend on the genetic status or the accumulation of small differences throughout development.

Nicotinic receptors mediate stress-nicotine detrimental interplay via dopamine cells' activity

Epidemiological studies report strong association between mood disorders and tobacco addiction. This high comorbidity requires adequate treatment but the underlying mechanisms are unknown. We demonstrate that nicotine exposure, independent of drug withdrawal effects, increases stress sensitivity, a major risk factor in mood disorders. Nicotine and stress concur to induce long-lasting cellular adaptations within the dopamine (DA) system. This interplay is underpinned by marked remodeling of nicotinic systems, causing increased ventral tegmental area (VTA) DA neurons' activity and stress-related behaviors, such as social aversion. Blocking β2 or α7 nicotinic acetylcholine receptors (nAChRs) prevents, respectively, the development and the expression of social stress-induced neuroadaptations; conversely, facilitating α7 nAChRs activation specifically in the VTA promotes stress-induced cellular and behavioral maladaptations. Our work unravels a complex nicotine-stress bidirectional interplay and identifies α7 nAChRs as a promising therapeutic target for stress-related psychiatric disorders.

Co-activation of VTA DA and GABA neurons mediates nicotine reinforcement

Smoking is the most important preventable cause of mortality and morbidity worldwide. This nicotine addiction is mediated through the nicotinic acetylcholine receptor (nAChR), expressed on most neurons, and also many other organs in the body. Even within the ventral tegmental area (VTA), the key brain area responsible for the reinforcing properties of all drugs of abuse, nicotine acts on several different cell types and afferents. Identifying the precise action of nicotine on this microcircuit, in vivo, is important to understand reinforcement, and finally to develop efficient smoking cessation treatments. We used a novel lentiviral system to re-express exclusively high-affinity nAChRs on either dopaminergic (DAergic) or γ-aminobutyric acid-releasing (GABAergic) neurons, or both, in the VTA. Using in vivo electrophysiology, we show that, contrary to widely accepted models, the activation of GABA neurons in the VTA plays a crucial role in the control of nicotine-elicited DAergic activity. Our results demonstrate that both positive and negative motivational values are transmitted through the dopamine (DA) neuron, but that the concerted activity of DA and GABA systems is necessary for the reinforcing actions of nicotine through burst firing of DA neurons. This work identifies the GABAergic interneuron as a potential target for smoking cessation drug development.

Design, construction, and first commissioning results of superconducting source for ions at NSCL/MSU

A new electron cyclotron resonance ion source (ECRIS) was constructed at the NSCL/MSU to replace the existing SC-ECRIS. This ECRIS operates at 18+14.5 GHz microwave frequencies with a planned upgrade to 24-28 GHz in the second phase of commissioning. A superconducting hexapole coil system produce the radial magnetic field; the axial trapping is produced with six superconducting solenoid coils enclosed in an iron yoke to allow the optimization of the distance between the plasma electrode and the resonant zone in the plasma. We report the details of the design, construction, and initial commissioning results of this new ECRIS.

A high-current electron beam ion trap as a charge breeder for the reacceleration of rare isotopes at the NSCL

Reacceleration of low-energy rare isotope beams available from gas stopping of fast-fragment beams or from an ISOL target station to energies in the range of 0.3-12 MeV/nucleon is needed for experiments such as low-energy Coulomb excitation and transfer reaction studies and for the precise study of astrophysical reactions. The implementation of charge breeding as a first step in a reaccelerator is a key to obtaining a compact and cost-efficient reacceleration scheme. For highest efficiency it is essential that single charge states are obtained in a short breeding time. A low-emittance beam must be delivered. An electron beam ion trap (EBIT) has the potential to meet these requirements. An EBIT-based charge breeder is presently under design and construction at the NSCL as part of the construction of a reaccelerator for stopped beams from projectile fragmentation. This new facility will have the potential to provide low-energy rare isotope beams not yet available elsewhere.

[Smoking cessation with ear acupuncture. Descriptive study on patients after a smoking cessation treatment with ear acupuncture]

BACKGROUND

In complementary medicine literature studies on long-term observation of one of its methods are rare.

OBJECTIVE

The present study is an evaluation of the smoking behavior of patients treated with ear acupuncture for smoking cessation. Additionally we investigated factors that favor or impede smoking cessation.

PATIENTS AND METHODS

249 patients who had undergone ear acupuncture for smoking cessation between 1985 and 1998 in a practice in Aarau (Switzerland) were asked before the first treatment to fill in a form regarding their smoking behavior and retrospectively in autumn 1998 a questionnaire regarding the success of therapy. Ear acupuncture treatment consisted of 2 consultations at an interval of 10 days. The responder rate was 53.8% (134 questionnaires were returned). Finally the data of 126 persons could be evaluated.

RESULTS

The Kaplan Meier analysis of the abstinence time yielded a one-year success rate of 41.1%. Men gave up smoking more easily than women. Start of smoking as well as start of treatment between the age of 20 and 40 years were favorable conditions for smoking cessation. People who had smoked 20 cigarettes or more per day before treatment profited the best. For people who smoked as a way of passing the time or because of tediousness it was easier to stop smoking than for people smoking because of nervousness. People living in a non-smoker household were able to stop smoking significantly easier than persons living in a smoker household.

CONCLUSIONS

With a one-year success rate of 41.1% ear acupuncture is a competitive alternative to orthodox medicine withdrawal methods. Acupuncture treatment can be applied and adapted individually, furthermore it is economical and without side effects.

Negative-feedback regulation of CD28 costimulation by a novel mitogen-activated protein kinase phosphatase, MKP6

TCR and CD28 costimulatory receptor-cooperative induction of T cell IL-2 secretion is dependent upon activation of mitogen-activated protein (MAP) kinases. Using yeast-hybrid technology, we cloned a novel CD28 cytoplasmic tail (CD28 CYT) interacting protein, MAP kinase phosphatase-6 (MKP6), which we demonstrate inactivates MAP kinases. Several lines of evidence indicate that MKP6 plays an important functional role in CD28 costimulatory signaling. First, in human peripheral blood T cells (PBT), expression of MKP6 is strongly up-regulated by CD28 costimulation. Second, transfer of dominant-negative MKP6 to PBT with the use of retroviruses primes PBT for the secretion of substantially larger quantities of IL-2, specifically in response to CD28 costimulation. A similar enhancement of IL-2 secretion is observed neither in response to TCR plus CD2 costimulatory receptor engagement nor in response to other mitogenic stimuli such as phorbol ester and ionomycin. Furthermore, this hypersensitivity to CD28 costimulation is associated with CD28-mediated hyperactivation of MAP kinases. Third, a retroviral transduced chimeric receptor with a CD28 CYT that is specifically unable to bind MKP6 costimulates considerably larger quantities of IL-2 from PBT than a similar transduced chimeric receptor that contains a wild-type CD28 CYT. Taken together, these results suggest that MKP6 functions as a novel negative-feedback regulator of CD28 costimulatory signaling that controls the activation of MAP kinases.

T cell-specific adapter protein inhibits T cell activation by modulating Lck activity

We previously reported the isolation of a cDNA encoding a T cell-specific adapter protein (TSAd). Its amino acid sequence contains an SH2 domain, tyrosines in protein binding motifs, and proline-rich regions. In this report we show that expression of TSAd is induced in normal peripheral blood T cells stimulated with anti-CD3 mAbs or anti-CD3 plus anti-CD28 mAbs. Overexpression of TSAd in Jurkat T cells interfered with TCR-mediated signaling by down-modulating anti-CD3/PMA-induced IL-2 promoter activity and anti-CD3 induced Ca2+ mobilization. The TCR-induced tyrosine phosphorylation of phospholipase C-gamma1, SH2-domain-containing leukocyte-specific phosphoprotein of 76kDa, and linker for activation of T cells was also reduced. Furthermore, TSAd inhibited Zap-70 recruitment to the CD3zeta-chains in a dose-dependent manner. Consistent with this, Lck kinase activity was reduced 3- to 4-fold in COS-7 cells transfected with both TSAd and Lck, indicating a regulatory effect of TSAd on Lck. In conclusion, our data strongly suggest an inhibitory role for TSAd in proximal T cell activation.

LCK-phosphorylated human killer cell-inhibitory receptors recruit and activate phosphatidylinositol 3-kinase

HLA-specific killer cell inhibitory receptors (KIR) are thought to impede natural killer (NK) and T cell activation programs through recruitment of the SH2 domain-containing tyrosine phosphatases, SHP-1 and SHP-2, to their cytoplasmic tails (CYT). To identify other SH2 domain-containing proteins that bind KIR CYT, we used the recently described yeast two-bait interaction trap and a modified version of this system, both of which permit tyrosine phosphorylation of bait proteins. Using these systems, we show that KIR CYT, once phosphorylated by the src-family tyrosine kinase LCK, additionally bind the p85alpha regulatory subunit of phosphatidylinositol (PI) 3-kinase. Furthermore, we show that in an NK cell line, NK3.3, cross-linking of KIR results in recruitment of p85alpha to KIR and activation of PI 3-kinase lipid kinase activity. One consequence of KIR coupling to PI 3-kinase is downstream activation of the antiapoptotic protein kinase AKT. Therefore, in addition to providing negative signals, KIR may also contribute positive signals for NK and T cell growth and/or survival.

Abnormal levels of platelet-specific proteins and mitogenic activity in myeloproliferative disease

It has been postulated that platelet-derived growth factor and platelet factor 4 (PF4) are involved in the imbalance of the mechanism of medullar stroma maintenance which triggers off the bone marrow myelofibrotic process. In this work we compare the PF4 and the beta-thromboglobulin (beta-TG) and mitogenic activity in platelet-poor plasma (PPP) and platelet extracts (PE) from patients with myeloproliferative disorders (MPD) with those of secondary thrombocytosis (ST) and normal volunteers. Statistically significant differences were found between MPD and ST patients or controls, but none between ST and controls in all the parameters studied. Maximal differences in platelet-derived factors (PDFs) between MPD and control groups were found in polycythemia vera patients. However, the relationship between the presence of myelofibrosis and abnormal levels of beta-TG, PF4 and mitogenic activity in PPP and PE was only observed in patients with agnogenic myeloid metaplasia (AMM). These results show that PDFs are specifically decreased in MPD platelets. Furthermore, no statistical correlation was found between PDFs and the number of platelets. However, other unknown factors or conditions would be necessary to develop myelofibrosis in MPD, which is present in AMM.

Transforming growth factor release by human tumor cell lines and their interactions with other growth factors

We have studied the production of transforming growth factor (TGF) by several human tumor cell lines and their interactions with exogenously added epidermal growth factor (EGF) and insulin. TGF-like activities were present in all the conditioned media tested. The clonogenic capacity of the tumor cell lines had no correlation with the TGF-like activity production. EGF and insulin had a promoting colony-forming activity on tumor cells but this effect was not additive. Moreover, an inverse statistically significant correlation (-0.817, p less than 0.05) was found between the response to exogenous EGF and the EGF or TGF-alpha production by tumor cell lines. The EGF receptor (EGF-R) was not detected in any of the melanomas studied, nor in breast adenocarcinoma cell lines which were producers of EGF or TGF-alpha.

Artefactual low lymphocyte activity caused by platelet contamination in the mononuclear cell preparations

Platelet (PLT) contamination in preparations of mononuclear cells (MNC) produces a significant decrease (P less than 0.02) in lymphoproliferative activity and interleukin 2 (IL2) production. This effect was observed in MNC preparations from either healthy blood donors or polyglobulic patients. In a dose-response curve carried out with increasing PLT number per MNC, progressive inhibition was found, reaching to 62.6% and 49.5%, respectively, to phytohemagglutinin and IL2 lymphoproliferative response and 87.8% in IL2 production, at 80 PLTs/MNC.

[Granulomatous hepatitis caused by nomifensine]

Four patients are described who developed granulomatous hepatitis 4-6 weeks after treatment with nomifensin. The granulomas were located both in the portal tract and the liver parenchyma, and contained eosinophils and a few polynuclear giant cells. Serum alkaline phosphatase, alanine aminotransferase and bilirubin were raised in three, two and one patient respectively. After medication was discontinued all abnormalities disappeared within 6-10 weeks. After oral intake of 25-50 mg nomifensin all patients experienced paroxysms of high body temperature for several hours. Reexposure in one patient resulted in another fever spike 6 hours after ingestion. No other cause of the fever or the granulomatous hepatitis was identifiable. The clinical data, especially the simultanous occurrence of drug fever and the histologic pattern, are compatible with an allergic mechanism of the liver granulomas. In the presence of high fever and abnormal liver tests in relation to nomifensin treatment, an allergic drug reaction should be considered.