The role of anti-CENP-B and anti-SS-B antibodies in breast cancer

A close relationship between autoimmunity and malignant diseases has been supposed for a long time. In clinical practice, anti-SS-B and anti-CENP-B antibodies are used as serologic markers for autoimmune diseases. In this study, anti-SS-B and anti-CENP-B autoantibodies were studied in breast cancer patients and compared to a control group surgically treated due to benign diseases. These antibodies were evaluated by enzyme linked immunoassay and serum values >10 U/ml were accepted as positive. Fifty-five patients with breast cancer and 25 patients with benign diseases were prospectively included in the study. In the breast cancer group, both anti-CENP-B (33% vs. 8%) and anti-SS-B (44% vs. 24%) autoantibodies had higher positivity compared to the control group, but this difference reached statistical significance only for anti-CENP-B antibodies (p=0.02). Besides, anti-SS-B positivity was detected more frequently in breast cancer patients with axillary involvement (63% vs. 24%) (p=0.006) and increased as the number of involved lymph nodes increased in the axilla (p=0.03). Although the clinical significance of autoantibody detection in cancer patients is still not clear, autoantibodies especially detected in individuals without proven autoimmune diseases needs to be thoroughly evaluated for early diagnosis and treatment of various cancers.

Remaining controversies in the upfront management of advanced ovarian cancer

Ovarian cancer (OC) is one of the leading causes of cancer-related death in women. In the last decades, a lot of energy and resources have been put into a number of clinical trials, with some success. Nevertheless, the prognosis of patients diagnosed with advanced disease remains extremely poor. As research moved forward, some crucial questions with regard to the optimal upfront management of patients with advanced OC (AOC) have remained unanswered. In this article, we review the rationale behind these controversial issues, and provide the levels of evidence supporting the current recommendations for AOC management.

Remaining controversies in the upfront management of advanced ovarian cancer

Ovarian cancer (OC) is one of the leading causes of cancer-related death in women. In the last decades, a lot of energy and resources have been put into a number of clinical trials, with some success. Nevertheless, the prognosis of patients diagnosed with advanced disease remains extremely poor. As research moved forward, some crucial questions with regard to the optimal upfront management of patients with advanced OC (AOC) have remained unanswered. In this article, we review the rationale behind these controversial issues, and provide the levels of evidence supporting the current recommendations for AOC management.

The effect of exemestane on serum lipid profile in postmenopausal women with metastatic breast cancer: a companion study to EORTC Trial 10951, 'Randomized phase II study in first line hormonal treatment for metastatic breast cancer with exemestane or tamoxifen in postmenopausal patients'

BACKGROUND

The impact of aromatase inhibitors (AIs) on non-cancer-related outcomes, which are known to be affected by oestrogens, has become increasingly important in postmenopausal women with hormone-dependent breast cancer. So far, data related to the effect of AIs on lipid profile in postmenopausal women is scarce. This study, as a companion substudy of an EORTC phase II trial (10951), evaluated the impact of exemestane, a steroidal aromatase inactivator, on the lipid profile of postmenopausal metastatic breast cancer (MBC) patients.

PATIENTS AND METHODS

The EORTC trial 10951 randomised 122 postmenopausal breast cancer patients to exemestane (E) 25 mg (n = 62) or tamoxifen (T) 20 mg (n = 60) once daily as a first-line treatment in the metastatic setting. Exemestane showed promising results in all the primary efficacy end points of the trial (response rate, clinical benefit rate and response duration), and it was well tolerated with low incidence of serious toxicity. As a secondary end point of this phase II trial, serum triglycerides (TRG), high-density lipoprotein cholesterol (HDL), total cholesterol (TC), lipoprotein a (Lip a), and apolipoproteins (Apo) B and A1 were measured at baseline and while on therapy (at 8, 24 and 48 weeks) to assess the impact of exemestane and tamoxifen on serum lipid profiles. Of the 122 randomised patients, those who had baseline and at least one other lipid assessment are included in the present analysis. The patients who received concomitant drugs that could affect lipid profile are included only if these drugs were administered throughout the study treatment. Increase or decrease in lipid parameters within 20% of baseline were considered as non-significant and thus unchanged.

RESULTS

Seventy-two patients (36 in both arms) were included in the statistical analysis. The majority of patients had abnormal TC and normal TRG, HDL, Apo A1, Apo B and Lip a levels at baseline. Neither exemestane nor tamoxifen had adverse effects on TC, HDL, Apo A1, Apo B or Lip a levels at 8, 24 and 48 weeks of treatment. Exemestane and tamoxifen had opposite effects on TRG levels: exemestane lowered while tamoxifen increased TRG levels over time. There were too few patients with normal baseline TC and abnormal TRG, HDL, Apo A1, Apo B and Lip a levels to allow for assessment of E's impact on these subsets. The atherogenic risk determined by Apo A1:Apo B and TC:HDL ratios remained unchanged throughout the treatment period in both the E and T arms.

CONCLUSIONS

Overall, exemestane has no detrimental effect on cholesterol levels and the atherogenic indices, which are well-known risk factors for coronary artery disease. In addition, it has a beneficial effect on TRG levels. These data, coupled with E's excellent efficacy and tolerability, support further exploration of its potential in the metastatic, adjuvant and chemopreventive setting.

Second-line treatment in advanced colon cancer: are multiple phase II trials informative enough to guide clinical practice?

This article reviews the available data regarding the activity of second-line chemotherapy following 5-fluorouracil (5-FU), irinotecan (CPT-11) or oxaliplatin (OXA) alone or in combination. Studies undertaken in this setting, published both as full papers and in abstract form, were critically analyzed. The main conclusion is that clinical research for second and subsequent lines of treatment in advanced colon cancer (ACC) clearly needs to be optimized. A large number of small, non-randomized phase II trials have been reported without definitive conclusions. Efficient conduct of a limited number of high-quality randomized phase II trials with validation of promising regimens via phase III studies seems a preferable approach. This would not only accelerate the evaluation of new therapeutic options, but also, and more importantly, limit the number of patients receiving suboptimal treatments. The responsibility of this indispensable and urgent task lies with all researchers in this field and their partners in the pharmaceutical industry. One means to implement this approach is through strict selection of studies to be both presented and published, encouraging the spread of information provided by statistically well-designed and well-conducted trials that will eventually lead to the definition of the best standard of care for ACC patients. The conduct of repetitive phase II trials that test minor variations in dose and schedule, while commonplace, does little to advance the field.

Clinical outcome of breast cancer patients with liver metastases alone in the anthracycline-taxane era: a retrospective analysis of two prospective, randomised metastatic breast cancer trials

Liver metastases have long been known to indicate an unfavourable disease course in breast cancer (BC). However, a small subset of patients with liver metastases alone who were treated with pre-taxane chemotherapy regimens was reported to have longer survival compared with patients with liver and metastases at other sites. In the present study, we examined the clinical outcome of breast cancer patients with liver metastases alone in the context of two phase III European Organisation for Research and Treatment of Cancer (EORTC) trials which compared the efficacy of doxorubicin (A) versus paclitaxel (T) (trial 10923) and of AC (cyclophosphamide) versus AT (trial 10961), given as first-line chemotherapy in metastatic BC patients. The median follow-up for the patients with liver metastases was 90.5 months in trial 10923 and 56.6 months in trial 10961. Patients with liver metastases alone comprised 18% of all patients with liver metastases, in both the 10923 and 10961 trials. The median survival of patients with liver metastases alone and liver plus other sites of metastases were 22.7 and 14.2 months (log rank test, P=0.002) in trial 10923 and 27.1 and 16.8 months (log rank test, P=0.19) in trial 10961. The median TTP (time to progression) for patients with liver metastases alone was also longer compared with the liver plus other sites of metastases group in both trials: 10.2 versus 8.8 months (log rank test, P=0.02) in trial 10923 and 8.3 versus 6.7 months (log rank test, P=0.37) in trial 10961. Most patients with liver metastases alone have progression of their disease in their liver again (96 and 60% of patients in trials 10923 and 10961, respectively). Given the high prevalence of breast cancer, improved detection of liver metastases, encouraging survival achieved with currently available cytotoxic agents and the fact that a significant portion of patients with liver metastases alone have progression of their tumour in the liver again, a more aggressive multimodality treatment approach through prospective clinical trials seems worth exploring in this specific subset of women.

The pipeline of new anticancer agents for breast cancer treatment in 2003

In recent years, strategy in cancer therapy in general, and breast cancer in particular, has been the use of maximum tolerated doses of toxic non-specific agents as well as the investigation of a range of new agents that specifically target tumor-related molecules, in a variety of biological pathways. The trial of chemotherapy (CT) versus chemotherapy+trastuzumab (Herceptin) in HER-2-overexpressing metastatic breast cancer (MBC) was one of the first to use a biological agent in combination with chemotherapy with success and, together with some trials of taxanes in anthracycline-resistance patients one of the few to demonstrate an overall survival (OS) advantage in MBC. Five main molecular pathways are of particular interest in terms of new drug development in breast cancer: the estrogen receptor (ER) pathway, the tyrosine kinase signal transduction pathway, the cell cycle regulation pathway, the apoptosis pathway and the angiogenesis pathway. This review will focus on new agents, cytotoxic, hormonal and molecular-targeted, which are in advanced clinical stages of development for the treatment of MBC.

Serum Helicobacter pylori IgG and IgA levels in patients with gastric cancer

The association between Helicobacter pylori and gastric cancer has been debated in the last decade and evidence for such a causal relationship has been claimed. This study aimed to detect the seroprevalence of Helicobacter pylori in patients with gastric cancer and compare it to the other cancer patients. In addition, the value of IgG and IgA in Helicobacter pylori detection was compared in patients with gastric cancer. Consecutive gastric and other cancer patients treated between 1999-2001 were prospectively studied. Serum Helicobacter pylori IgG and IgA levels were determined. Serological tests revealed IgA and IgG positivity as 53.9% and 50.9%, respectively, while 74.5% had positive results for either IgA or IgG. Serum IgA positivity was significantly higher in gastric cancer group compared to control group (p=0.02). In contrast, serum IgG positivity did not show a significant difference in both groups and either IgG or IgA seropositivity was significantly higher in patients with gastric cancer compared to control patients (p=0.04). This study revealed a higher seroprevalence of Helicobacter pylori in gastric cancer patients and IgA was a better predictor of Helicobacter pylori seropositivity in gastric cancer patients.

Novel therapeutic strategies targeting the epidermal growth factor receptor (EGFR) family and its downstream effectors in breast cancer

From the early experience with tamoxifen to the current use of Herceptin, targeted therapy has been proven to be an important part of breast cancer (BC) treatment. In the last decade, advances in molecular biology have allowed scientists to design highly individualized, 'smart' pharmaceuticals, capable of manipulating the growth factor pathways and the genes that are involved in the development and maintenance of the malignant phenotype. The epidermal growth factor receptor (EGFR) family, as one of the best studied growth factor pathways in cancer, resembles a 'treasure island' by providing a wide range of biologically relevant targets involved in breast carcinogenesis. While a large number of new agents targeting this pathway are continuingly being tested in preclinical experiments, clinicians are witnessing the migration of some of these agents to daily practice. The aim of this review is to provide clinicians with an updated synopsis of the most advanced anti-erbB therapeutic strategies with activity against BC.

An EORTC phase I study of capecitabine (Xeloda) in combination with fixed doses of cyclophosphamide and epirubicin (cex) as primary treatment for large operable or locally advanced/inflammatory breast cancer

In breast cancer, chemotherapy regimens that include infusional 5-fluorouracil (5-FU) lead to high response rates, but require central venous access and pumps. To avoid these inconveniences, we substituted infusional 5-FU with capecitabine. The main objective of this study was to determine the maximum tolerated dose (MTD) of capecitabine when given in combination with fixed doses of epirubicin and cyclophosphamide (100 and 600 mg/m(2) day 1 every (q) 3 weeks) as primary treatment for large operable or locally advanced/inflammatory breast cancer without distant metastasis. Capecitabine was escalated from 750 mg/m(2) twice a day (bid) to 1250 mg/m(2) bid from day 1 to day 14 in four dose levels. Dose escalation was permitted if 0/3 or 1/6 patients experienced dose-limiting toxicity (DLT). A total of 23 patients were included and 117 courses were administered. At dose level 4, 2 of 2 patients presented DLTs defining the MTD. A high rate of capecitabine treatment modification was required with capecitabine 1050 mg/m(2) bid (dose level 3). 19 patients achieved an objective response (83%). In conclusion, we believe that capecitabine 900 mg/m(2) bid (dose level 2) is the recommended dose in combination with epirubicin 100 mg/m(2) and cyclophosphamide 600 mg/m(2). The acceptable toxicity profile and encouraging activity of this regimen warrant further evaluation.

Neoplastic diseases prevalence in a turkish university hospital

PURPOSE

The purpose of this study was to register the different cancer cases diagnosed in our hospital with an aim to define the most common and treatable cancer types and help define accurate targets for the allocation of the already limited resources of the Ministry of Health.

MATERIALS AND METHODS

We surveyed 12 months of the hospital's pathology records to determine the prevalence of various cancer types.

RESULTS

Out of 9720 biopsy and cytology samples, 662 were cancer cases. Breast and gastric cancers were higher and colorectal cancers were lower than the series reported from the United States. Of the pulmonary malignancies, lung cancer in general was not particularly higher in proportion to other cases, something interesting for a country with smoking rates exceeding 60% of the adult population. Squamous cell lung cancer was more common compared to the rates reported in the western world statistics.

CONCLUSION

Although biases may exist, as certain cancers are more amenable to surgical intervention and physician groups may have special interest toward a particular cancer, distribution of cancer cases in Turkey is probably similar to the western world.

The effects of nitric oxide donors and inhibitors on neutrophil functions in Behçet's disease

OBJECTIVE

The effects of nitric oxide donor SNAP and nitric oxide inhibitors L-NMMA and AG on the functions of neutrophils in patients with Behçet's Disease (BD) were investigated in vitro.

METHODS

Oxidative burst and phagocytosis of neutrophils were evaluated by flow cytometry in patients with Behçet's disease (n = 32), inflammatory (n = 17) and healthy controls (n = 14), in the presence of L-NMMA, AG and SNAP.

RESULTS

The stimulation index of oxidative burst was found to be significantly decreased following PMA stimulation in patients with active BD compared to inflammatory and healthy controls. Oxidative function of neutrophils were inhibited in all 3 groups in the presence of L-NMMA, AG and SNAP L-NMMA inhibited the oxidative burst of neutrophils obtained from healthy controls more than inflammatory controls and BD (80% vs 52% and 53% respectively, p = 0.001). No significant difference of phagocytosis inhibition was found with L-NMMA, AG and SNAP and there were also no differences between the groups (% 9-39).

CONCLUSION

Nitric oxide donors and inhibitors may have a therapeutic role in Behçet's disease by suppresing neutrophil activity.