Somatostatin neuron contributions to cortical slow wave dysfunction in adult mice exposed to developmental ethanol

Introduction

Transitions between sleep and waking and sleep-dependent cortical oscillations are heavily dependent on GABAergic neurons. Importantly, GABAergic neurons are especially sensitive to developmental ethanol exposure, suggesting a potential unique vulnerability of sleep circuits to early ethanol. In fact, developmental ethanol exposure can produce long-lasting impairments in sleep, including increased sleep fragmentation and decreased delta wave amplitude. Here, we assessed the efficacy of optogenetic manipulations of somatostatin (SST) GABAergic neurons in the neocortex of adult mice exposed to saline or ethanol on P7, to modulate cortical slow-wave physiology.

Methods

SST-cre × Ai32 mice, which selectively express channel rhodopsin in SST neurons, were exposed to ethanol or saline on P7. This line expressed similar developmental ethanol induced loss of SST cortical neurons and sleep impairments as C57BL/6By mice. As adults, optical fibers were implanted targeting the prefrontal cortex (PFC) and telemetry electrodes were implanted in the neocortex to monitor slow-wave activity and sleep-wake states.

Results

Optical stimulation of PFC SST neurons evoked slow-wave potentials and long-latency single-unit excitation in saline treated mice but not in ethanol mice. Closed-loop optogenetic stimulation of PFC SST neuron activation on spontaneous slow-waves enhanced cortical delta oscillations, and this manipulation was more effective in saline mice than P7 ethanol mice.

Discussion

Together, these results suggest that SST cortical neurons may contribute to slow-wave impairment after developmental ethanol.

7-Steps medication reviews: analysis of medicine changes in acute medical wards

Introduction

In Northern Ireland, medication errors cause 20 patient deaths, lead to around 800 non-elective hospital admissions and cost £1.9 million annually.1 The iSIMPATHY (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years) project is an EU-funded partnership between Scotland, Ireland and Northern Ireland delivering medication reviews using the 7-Steps medication review tool and asking ‘what matters to you?’ 2 The iSIMPATHY 7-Steps review is a new research study in Northern Ireland.

Aim

To identify medicine changes made by an independent prescribing pharmacist during 7-Steps medication reviews.

Method

Medication reviews were delivered on acute medical wards in the Northern Health and Social Care Trust. No patients were excluded from reviews, however reviews were targeted at patients aged 50 years and older and resident in a care home, approaching the end of their lives, prescribed 10 or more medicines or on high-risk medication. Data on medication changes made during 192 medication reviews was collected and analysed to identify the numbers and types of medicines stopped, started and doses altered. Ethical approval was not required, an approved Data Protection Impact Assessment was in place.

Results

Mean number of medicines per patient pre- and post-review were 12.2 and 12.3 respectively. Medicines were stopped in 49% of patients, dose decreased in 36%, changed to a more appropriate medicine in 15%, dose increased in 15% and new medicines started in 55%. Medicines stopped included opioids and gabapentenoids (18%), nutritional and electrolyte supplements (15%), items for comfort (9%), antidepressants (including amitriptyline for pain) (10%), antihypertensives and diuretics (8%), bladder anticholinergics and mirabegron (5%), laxatives (4%), betahistine (3%), quinine (2%). Dose decreases were made for analgesics including opioids (28%), PPI/H2RA (23%), anticoagulants (13%), statins and fibrates (6%), antihypertensives (6%), benzodiazepines and z-drugs (5%), antidiabetics (3%). Dose increases were made for anticoagulants and items for comfort (both 26%), laxatives (24%), pancreatin (15%), nutritional and electrolyte supplements (9%). Medicines started included nutritional and electrolyte supplements (45%), medicines for comfort (19%), laxatives (15%), nicotine replacement (7%), PPI/H2RA (2%), bisphosphonates (2%).

Discussion/Conclusion

The 7-STEPS medicine reviews led to important medicine changes while the number of medicines following review remained the same. The person-centred, holistic approach facilitated identification and actioning of the medicine changes that mattered to individual patients. Stopped and decreased dose medicines included high risk medicines, those likely to cause adverse effects or high anticholinergic burden and medicines no longer needed or effective for the individual. Medicine doses were increased for high risk medicines, to ensure sufficient nutritional, electrolyte and enzyme replacement and items for comfort for example constipation. Importantly, unmet therapeutic needs were identified and new medicines were prescribed to address these needs, for example, acid suppressants, bisphosphonates, anticoagulants, statins, antidiabetics, nicotine replacement therapy and for patient’s comfort including pain relief. Limitations include results may not be reflective of all hospital patients as set in an acute setting and through the iSIMPATHY project.

References

1. Transforming medication safety in Northern Ireland, Department of Health 2022. Available from: https://www.health-ni.gov.uk/sites/default/files/publications/health/Transforming-medication-safety-in-Northern-Ireland_1.pdf

2. iSimpathy. Making Medication Personal. 2022. Available from: https://www.isimpathy.eu/

Using co-design to develop an online intervention for families after a sudden cardiac death in the young

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of Australia / NHMRC Co-funded Post Graduate Scholarship

Introduction

Sudden cardiac death (SCD) is a devastating complication of many genetic heart diseases. The psychological impact on surviving family members is significant and lifelong. Previous needs analysis found medical and psychological needs are of high importance but remain unmet in some cases. Co-design is an increasingly popular research method for the development of interventions and services that include users as contributing members of the research team. Previous research has shown co-design leads to innovative ideas that better address user needs.

Purpose

To use co-design to develop an online support intervention for families after SCD.

Methods

Semi-structured moderated online focus groups were held with key stakeholders, including family members who had experienced young SCD, healthcare professionals and researchers. Guided discussions were used to co-design an online support intervention. Thematic analysis of discussions and iterative feedback on draft materials guided content development.

Results

Four focus groups were held (average 11 participants per group). Stakeholder involvement facilitated development of high-level ideas and priority issues. Key benefits included creative content and materials developed based on user preference for stories, narratives and information reflecting everyday experience of families navigating the legal and medical processes surrounding SCD, normalising and supporting grief responses in the context of family relationships, and fostering hope.

Conclusion

Co-design supported creative presentation, tailoring of information and development of psychosocial interventions to meet the needs of SCD families. Further work is needed to pilot and trial the intervention, prior to it becoming a key resource in the care of these families.

Magnetic sulfur-doped carbons for mercury adsorption

Mercury pollution is a significant threat to the environment and health worldwide. Therefore, effective and low-cost absorbents that are easily scalable are needed for real-world applications. Enlarging the surface area of the materials and doping with heteroatoms are two of the most common strategies to cope with this problem. Sulfur-doped activated carbon synthesized from the carbonization of inverse vulcanized thiopolymers makes it possible to combine both large specific surface area and doping of heteroatoms, resulting in outperformance in mercury uptake against commercial activated carbons. Convenient recovery of mercury absorbents after treatment should be beneficial in mercury collecting and recycling. Therefore, magnetic sulfur-doped carbons (MSCs) were prepared by functionalizing sulfur doped carbons through chemical precipitation with magnetic iron oxides. Besides the characterisations of materials, mercury uptake experiments, such as stactic test, capacity test, impact of solution pH, and mixed ions interferences were performed. These MSCs exhibit high specific surface area (1,329 m²/g), high sulfur content (up to 14.8 wt%), porous structure, low cost, and are convenient for retrieval. MSCs are demonstrated high uptake capacity (187 mg g^-1) and efficiency in mercury solution and multifunctional absorption in mixed ions solution, showing their potential to be applied in water purification and environmental remediation.

Nitric Oxide Releasing Titanium Surfaces for Antimicrobial Bone-Integrating Orthopedic Implants

Titanium implants in orthopedic applications can fail due to infection and impaired integration into the host. Most research efforts that facilitate osseointegration of the implant have not considered infection, and vice versa. Moreover, most infection control measures involve the use of conventional antibiotics which contributes to the global epidemic of antimicrobial resistance. Nitric oxide (NO) is a promising alternative to antibiotics, and while researchers have investigated NO releasing coatings, there are few reports on the function/robustness or the mechanism of NO release. Our comprehensive mechanistic study has allowed us to design, characterize, and optimize NO releasing coatings to achieve maximum antimicrobial efficacy toward bacteria with minimum cytotoxicity to human primary osteoblasts in vitro. As the antibiotic era is coming to an end and the future of infection control continues to demand new alternatives, the coatings described herein represent a promising therapeutic strategy for use in orthopedic surgeries.

Investigating the Antibacterial Properties of Inverse Vulcanized Sulfur Polymers

More than 60 million tons of sulfur are produced as a byproduct of the petrochemical industry annually. Recently, the inverse vulcanization process has transformed this excess sulfur into functional polymers by stabilization with organic cross-linkers. These interesting new polymers have many potential applications covering diverse areas. However, there has been very little focus on the potential of these high-sulfur polymers for their antibacterial properties. These properties are examined here by exposing two common bacteria species, Escherichia coli (E. Coli) and Staphylococcus aureus (S. aureus), to two structurally different, inverse vulcanized sulfur polymers: sulfur-co-diisopropenyl benzene (S-DIB) and sulfur dicyclopentadiene (S-DCPD). We report the highest bacteria log reduction (>log 4.3) of adhered bacterial cells (S. aureus) to an inverse vulcanized sulfur polymer to date and investigate the potential pathways in which antibacterial activity may occur.

Abstract P4-14-01: Estrogen levels in premenopausal patients (pts) with hormone-receptor positive (HR+) early breast cancer (BC) receiving adjuvant triptorelin (Trip) plus exemestane (E) or tamoxifen (T) in the SOFT trial: SOFT-EST substudy final analysis

Background: Optimal endocrine therapy for premenopausal pts with early HR+ BC may depend on complete estrogen suppression with GnRH analog, which is crucial when using concurrent aromatase inhibitors (AIs). SOFT-EST is a prospective substudy of the phase 3 SOFT trial aiming to describe estradiol (E2), estrone (E1) and estrone sulphate (E1S) during the first 4 years (y) of monthly Trip+E/T and to assess if there were suboptimally estrogen suppressed (SES) pts in the E+Trip group. Secondary objectives included associations of baseline (BL) factors with SES, early SES with later SES, and SES with disease-free survival (DFS; exploratory objective).

Methods: Patients from select centers who consented and enrolled in SOFT, selected Trip as ovarian function suppression method, and were randomized to E+Trip or T+Trip were eligible for SOFT-EST until the accrual goal (120 pts: 90 E+Trip; 30 T+Trip). Prem status for SOFT eligibility was based on local E2. Blood sampling timepoints were 0, 3, 6, 12, 18, 24, 36 & 48 months (m) until Trip stopped. Serum estrogens were measured centrally by high specificity/sensitivity GC/MSMS and were not available during the study. For 4y analyses, SES was defined as E2 levels >2.72 pg/mL in ≥2 post-BL samples (E2 levels not consistent with postmenopausal (PM) status on AIs [Smith IE, JCO 2006]), or vaginal bleeding >3m after Trip start, or pregnancy. We explored 2 additional cutoffs: >10 pg/mL (clearly inconsistent with PM status on AIs) and >20 pg/mL (inconsistent with GnRH analog-related PM status). The analysis is intention-to-treat based on E/T assignment; as-treated analyses are forthcoming.

Results: From Mar 2009 to Jan 2011,109 pts (E/T=83/26) started Trip and had ≥2 samples drawn. In pts assigned E+Trip, median reductions from BL in E1, E2 and E1S were >95% at all timepoints and significantly lower than in T+Trip. Post-BL E2 geometric mean ranged 0.8-1.3 pg/mL in E+Trip and 16.5-18.3 pg/mL in T+Trip. 21 (25%), 11 (13%) and 6 (7%) pts assigned to E+Trip had E2>2.72, >10, and >20 pg/mL in ≥2 post BL samples or vaginal bleeding (n=3), respectively. Early SES [(≥1 E2 value >2.72 pg/mL or vaginal bleeding in the firsty] predicted later SES [≥1 E2 value >2.72 or vaginal bleeding thereafter (n=1); p<0.001]. BL factors related to SES were higher E2, lower FSH and lower LH values (p=0.02, p<0.01, p<0.01 respectively). 12m FSH levels were not related to SES. In pts assigned E+Trip, after 6y median follow-up, DFS events were seen in 0 of 21 pts with SES vs 5 of 62 pts without SES.

Conclusions: Most pts on E+Trip had a profound E2 drop consistent with postmenopausal status on AI, but >20% assigned to E+Trip had ≥2 E2 values >2.72 pg/mL and 4% had vaginal bleeding, with those having higher E2, lower FSH/LH at BL being at higher risk. SES at 12m predicted subsequent SES. Few DFS events limit the ability to assess clinical relevance of SES with disease outcomes.

BL characteristicsN-109Prior chemo60 (55%)Amenorrhea39 (36%)Age <35y8 (7%) Median (range)Age, y44 (25-53)BMI, kg/m224 (22-28)Estrogen (pg/mL) E252 (7-119)E141 (24-70)E1S894 (304-1320)FSH/LH (IU/L) FSH15 (7-47)LH11 (6-26)

Citation Format: Bellet M, Gray K, Francis P, Láng I, Ciruelos E, Lluch A, Ángel Climent M, Catalán G, Avella A, Bohn U, González-Martin A, Zaman K, Ferrer R, Azaro A, Rajasekaran A, De la Peña L, Fleming G, Regan MM. Estrogen levels in premenopausal patients (pts) with hormone-receptor positive (HR+) early breast cancer (BC) receiving adjuvant triptorelin (Trip) plus exemestane (E) or tamoxifen (T) in the SOFT trial: SOFT-EST substudy final analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-14-01.

Abstract GS4-03: Randomized comparison of adjuvant tamoxifen (T) plus ovarian function suppression (OFS) versus tamoxifen in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): Update of the SOFT trial

Background: The primary results of SOFT at 5.6 years median follow-up found adding OFS to T did not provide a significant benefit in the overall study population of premenopausal women with HR+ BC (Francis et al, NEJM 2015). For those women at sufficient risk for recurrence to warrant adjuvant chemotherapy (CT) and who remained premenopausal, the addition of OFS improved disease outcomes. Follow-up was immature for overall survival (OS). We report a planned update with visit cut-off of 31Dec16 after 8 yrs median follow-up.

Methods: SOFT randomized premenopausal women with HR+ BC from Nov 2003 to Jan 2011 to 5 yrs of T vs T+OFS vs Exemestane(E)+OFS. OFS was by choice of GnRH agonist triptorelin, oophorectomy or ovarian irradiation. SOFT was stratified by the use of prior CT; 47% received no CT and 53% remained premenopausal after prior CT, determined by premenopausal estradiol level within 8 months of CT completion. The primary endpoint was invasive disease-free survival (DFS; randomization until invasive local, regional, distant recurrence or contralateral breast; invasive second malignancy; death). Secondary endpoints included invasive breast cancer-free interval (BCFI), distant recurrence-free interval (DRFI) and OS. NCT00066690.

Results: DFS for patients assigned T+OFS (n=1015) was significantly improved over T (n=1018; HR=0.76 [95%CI 0.62-0.93]) and 8yr DFS was 83.2% vs 78.9%, respectively; BCFI and DRFI results were supportive (see Table). Hazard ratios for these 3 endpoints showed no heterogeneity by use of prior CT. For patients with prior CT, 8yr DFS was 76.7% with T+OFS vs 71.4% with T (Δ=5.3%); in those without CT, 8yr DFS was 90.6% vs 87.4% (Δ=3.2%). E+OFS (n=1014) improved outcomes relative to T (Table); 8yr DFS for E+OFS was 85.9% (80.4% with use of prior CT and 92.5% for those without CT). OS was improved with T+OFS vs T (8yr OS 93.3% vs 91.5%). 8yr OS was 92.1% with E+OFS. 201/225 deaths occurred in women with prior CT. For women without CT there have been 10, 5 and 9 deaths in the T+OFS, T and E+OFS groups (total n=1419), respectively, only half of these deaths after breast cancer event.

N. EventsHazard Ratio (95% CI)Endpoint(3 arms)T+OFS vs TE+OFS vs TDFS5180.76 (0.62-0.93) P=0.0090.65 (0.53-0.81)BCFI4370.76 (0.61-0.95)0.64 (0.51-0.81)DRFI3060.86 (0.66-1.13)0.73 (0.55-0.96)OS2250.67 (0.48-0.92)0.85 (0.62-1.15)

Overall toxicity was worse with T+ OFS than with T, including 32% vs 25% grade 3+ targeted AEs. Early cessation of tamoxifen occurred for 19% assigned T+OFS and 22% of women assigned T; the cumulative incidence of early cessation of triptorelin on the T+OFS arm was 23% by 4yrs. Early cessation of exemestane occurred for 28% and of triptorelin for 21% by 4yrs on the E+OFS arm.

Conclusions: With additional follow-up to a median of 8yrs, SOFT further supports the value of OFS for some premenopausal women. Follow-up continues, which will further clarify the safety and the benefit of OFS for late recurrence and overall survival. Oncologists appear to be able to select a low risk group (no chemotherapy) for whom treatment escalation is unlikely to improve survival.

Citation Format: Fleming G, Francis PA, Láng I, Ciruelos EM, Bellet M, Bonnefoi HR, Climent MA, Pavesi L, Burstein HJ, Martino S, Davidson NE, Geyer Jr CE, Walley BA, Coleman RE, Kerbrat P, Buchholz S, Ingle JN, Rabaglio-Poretti M, Colleoni M, Regan MM. Randomized comparison of adjuvant tamoxifen (T) plus ovarian function suppression (OFS) versus tamoxifen in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): Update of the SOFT trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS4-03.

Nitric Oxide Releasing Polymeric Coatings for the Prevention of Biofilm Formation

The ability of nitric oxide (NO)-releasing polymer coatings to prevent biofilm formation is described. NO-releasing coatings on (poly(ethylene terephthalate) (PET) and silicone elastomer (SE)) were fabricated using aminosilane precursors. Pristine PET and SE were oxygen plasma treated, followed by immobilisation of two aminosilane molecules: N-(3-(trimethoxysilyl)propyl)diethylenetriamine (DET3) and N-(3-trimethoxysilyl)propyl)aniline (PTMSPA). N-diazeniumdiolate nitric oxide donors were formed at the secondary amine sites on the aminosilane molecules producing NO-releasing polymeric coatings. The NO payload and release were controlled by the aminosilane precursor, as DET3 has two secondary amine sites and PTMSPA only one. The antibacterial efficacy of these coatings was tested using a clinical isolate of Pseudomonas aeruginosa (PA14). All NO-releasing coatings in this study were shown to significantly reduce P. aeruginosa adhesion over 24 h with the efficacy being a function of the aminosilane modification and the underlying substrate. These NO-releasing polymers demonstrate the potential and utility of this facile coating technique for preventing biofilms for indwelling medical devices.

Abstract P2-16-05: Efficacy of ABT-888 (veliparib) in patients with BRCA-associated breast cancer

Background: The potential for exploiting BRCA deficiencies with DNA repair inhibitors has both pre-clinical and clinical support. ABT-888 (veliparib), a DNA repair inhibitor initially thought to target Poly(ADP-Ribose) Polymerases (PARP), has demonstrated in vitro inhibition of BRCA1 and BRCA2 deficient mouse embryonic stell cells, with a larger effect on BRCA1 cells. We report on the pre-planned interim analysis of the efficacy of single agent veliparib in patients with either BRCA1 or BRCA2-associated stage IV breast cancer. Methods: BRCA 1 or 2 carrier patients with stage IV breast cancer, with measurable disease, without prior exposure to a PARP inhibitor or a platinum compound in the metastatic setting, were eligible. Velapirib was administered orally, at doses of 400 mg twice daily. Dose adjustments based on toxicity were permitted. Patients progressing on velapirib alone received carboplatin at an AUC of 5, IV, given Q 21 days, and velapirib 150 mg twice daily (the maximum tolerated dose [MTD] of the combination from our completed Phase I study: J Clin Oncol 30, 2012 [suppl; abstr 1024]). Patients were to be accrued from 7 NCI NO1- supported consortia. Initially 10 patients were to be accrued to each stratum (BRCA1 and BRCA2) to provide evidence of single agent activity. If there was sufficient activity to warrant consideration of velapirib as single agent therapy (defined as 2 or more confirmed partial [PR] or better responses out of 10 per stratum), an additional 12 patients would be accrued per stratum. Results: 20 evaluable patients (11 BRCA1 and 9 BRCA2 [1 in screening]) have been accrued, the majority with lung or liver as visceral metastatic sites of disease. Median age (range) is 46 (29-68) years. Tumors from 9 patients were hormone receptor positive. BRCA1 cohort: 4 of 11 patients are off treatment at a median of 2 months (1-4); 1 patient stopped velapirib due to toxicity (grade 2 rash/pruritus, grade 2 vomiting), 3 stopped for progressive disease (one with an unconfirmed PR). Seven patients are still on single agent veliparib with 1 unconfirmed PR, and 1 patient with two evaluations showing stable disease. BRCA2 cohort: 2 patients are off treatment at 2 months for progressive disease, 7 are still on treatment with 1 confirmed PR, and 3 unconfirmed PRs. Data on patients receiving combination of velapirib and carboplatin after progression is too early. Treatment-related toxicity is being updated and has so far been reported from 14 patients: 1 patient had grade 3 fatigue, 1 patient with liver metastasis had both grade 3 alanine aminotransferase elevation and grade 3 abdominal pain. Grade 2 toxicities occurring in more than 1 patient included nausea/vomiting (6 patients), chills (2 patients), and fatigue (2 patients). Conclusion: Velapirib has single agent activity in both BRCA1 and BRCA2-associated stage IV breast cancer patients, and is well-tolerated. Mature response, treatment, and toxicity data will be presented.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-16-05.

Abstract OT2-2-01: SOFT and TEXT: Trials of tamoxifen and exemestane with and without ovarian function suppression for premenopausal women with hormone receptor-positive early breast cancer

Background: The SOFT and TEXT randomized phase 3 trials address two primary questions for endocrine treatment of premenopausal women with hormone receptor-positive breast cancer. 1) In combination with ovarian function suppression (OFS), does an aromatase inhibitor (exemestane, E) improve outcome compared with tamoxifen (T)? 2) Does addition of OFS to T improve outcome compared with T alone?

Trial Designs: SOFT compares 5y of T to OFS+T or OFS+E. OFS can be GnRH analog (triptorelin) × 5y, oophorectomy or ovarian irradiation. Median age was 43y (11% <35y); 35% had N+ disease. Prior neo/adjuvant chemotherapy (CT) given in 53%.

TEXT compares 5y of OFS+T to OFS+E. Patients were enrolled prior to CT (if planned). Median age was 43y (9% <35y); 48% had N+ disease. Adjuvant CT was planned in 60%.

Major Eligibility Criteria – Premenopausal, confirmed by estradiol levels– ER≥10% and/or PgR≥10%– Invasive early breast cancer

Specific Aims: Evaluate the role of aromatase inhibitors and the addition of OFS to T in this population.

Statistical Methods (amended 2011): The primary analysis will be intention-to-treat of all randomized patients. The primary endpoint, invasive disease-free survival (DFS), is defined as time from randomization to invasive local, regional, or distant relapse, contralateral breast cancer, appearance of a second non-breast malignancy, or death. DFS will be compared using a 2-sided stratified logrank test with an overall experiment-wise alpha level equal to at most 0.05.

In the original protocol, anticipated 5y DFS was 67% with T alone, 74% with OFS+T, and 79.8% with OFS+E, and required a total of 396 DFS events in TEXT and 783 DFS events in SOFT to reach 80% power. Because the enrolled population had more favorable characteristics and the event rates were lower than anticipated (2%/yr vs 8%/yr), the revised analysis plan is ‘time-driven’ rather than ‘event-driven.’

The comparison of OFS+E to OFS+T across both trials (n = 4717) is planned at median follow-up (MFU) >5y. The estimated power to detect a 20%, 25%, or 30% reduction in the hazard with OFS+E vs OFS+T is 63%, 84%, and 95%, respectively.

The comparison of OFS+T to T alone is planned at 5y MFU (SOFT, n=2045). The estimated power to detect a 20%, 25%, 30%, or 33.5% reduction in the hazard is 34%, 52%, 69%, and 80%, respectively.

Accruals

SOFT Target: 3000; Final: 3066

TEXT Target: 2639; Final: 2672

Enrollment 2003–2011; primary analyses expected late 2013/early 2014.

Related Research

Quality of Life (QL) component evaluates QL, menopausal symptoms and sexual impairment.

TEXT Translational Research investigates patient and tumor features that may contribute to treatment effectiveness and side effects.

TEXT-Bone investigates changes in bone mineral density and the role of serial serum markers of bone remodeling as predictors of bone side effects.

Co-SOFT evaluates changes in cognitive function during the first year.

SOFT-EST evaluates estrogen levels during the first 4y of GnRH analogue and whether there is a suboptimally estrogen-suppressed subgroup.

North American Pharmacogenetics study investigates whether genetic variations that affect T and E metabolism influence efficacy.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr OT2-2-01.

Measuring clinical competence in preregistration trainees by OSCEs

Focal points

Bloodspot acylcarnitine and amino acid analysis in cord blood samples: efficacy and reference data from a large cohort study

BACKGROUND

In order to test the feasibility of cord blood screening for inherited metabolic disease, a two-year cohort study of births in six obstetric units from five towns in the north of England was undertaken. These towns have a high prevalence of consanguineous marriages, largely among the immigrant Asian community. The purpose of the study was to determine whether early detection of metabolic disease was possible and whether early intervention would improve prognosis.

METHODS

Following parental consent, cord blood samples were collected at birth and analysed for acylcarnitine and amino acid profiles by tandem mass spectrometry in one of two laboratories. One laboratory used butylated derivatives, the other used underivatized samples. The same laboratories performed routine blood spot neonatal screening at 5-7 days of age on these babies. Patients with positive results were investigated and treated by a metabolic paediatrician as soon as possible.

RESULTS

24,983 births were examined. 12,952 samples were analysed as butyl derivatives, 12,031 samples were analysed underivatized. The following disorders were detected: medium-chain acyl-CoA dehydrogenase (MCAD) deficiency (1 case), 3-methylcrotonyl-CoA carboxylase (MCC) deficiency (2 cases), maternal carnitine transporter defect (2 cases), maternal MCC (1 case). The following disorders were diagnosed subsequently but were not detected by the cord blood screening: phenylketonuria (PKU) (1 case), maple syrup urine disease (MSUD) (2 cases), argininosuccinic aciduria (1 case), methylmalonic acidaemia (MMA) (1 case), glutaric aciduria type 2 (1 case), MCAD deficiency (2 cases), 3-hydroxy-3-methylglutaryl-CoA lyase deficiency (1 case). Comprehensive reference data for all analytes by both methods were obtained.

CONCLUSIONS

Cord blood testing is of limited value in detecting inherited metabolic disease. The metabolites associated with most disorders examined were not elevated in cord blood. Some maternal disorders, carnitine transporter defect and 3-methlycrotonyl-CoA carboxylase deficiency, are detected. These remain of uncertain clinical significance. Comprehensive reference data have been obtained that will facilitate future interpretation of studies in cord blood.

Phase I study of preoperative chemoradiation therapy in unresectable locally advanced breast cancer (LABC)

11097

Introduction: Therapy of unresectable LABC is challenging due to the need to resect local disease and prevent distant metastases. We conducted a phase I trial to determine the maximum tolerated dose of preoperative vinorelbine (VIN) combined with paclitaxel (P) and radiation (XRT). Methods: Eligible patients (pts) had unresectable LABC, ECOG performance 0–2 and adequate organ function. Prior chemotherapy and metastatic disease were permitted. All pts received weekly bolus P 80 mg/m2 and concurrent XRT at 2.0 Gy daily for 5 days in a week-on/week-off (WO/WO) schedule for 12 weeks. A planned 59 -70 Gy were delivered to the breast, chest wall and supraclavicular regions. In dose level 2, VIN 15 mg/m2 /week was added. Results: Twenty-six pts were enrolled from July 1999-July 2005 with a median age of 51 years (range 24–69); 9 pts had stage IV disease, 17 pts had stage IIIB disease, and 13 pts had received prior chemotherapy. VIN was not tolerated due to grade (G) 4 neutropenia despite GCSF; however single-agent P and concurrent XRT was well-tolerated. Thus, 7 pts in the final cohort received P/XRT without GCSF. This regimen was well-tolerated; toxicities seen included: G3 in-field skin desquamation 4/7; G4 lymphopenia 7/7, G3 infection 1/7; G3 wound dehiscence 1/7. After therapy, 20/26 pts underwent mastectomy: 6 pts had a pathologic complete response (no invasive disease), 12 had a pathologic partial response (scattered microscopic disease), and 2 pts had no response. Overall pathologic response rate was 90% for pts undergoing mastectomy; only 3 of the 20 resectable pts are alive without relapse a mean of 19.5 months after mastectomy. Conclusions: Neoadjuvant P 80 mg/m2 with full dose XRT in a WO/WO schedule is tolerable and effective allowing 20/26 unresectable pts to undergo successful mastectomy. Pts do not require routine GCSF support. Although most pts eventually relapse distantly, this regimen does render some pts not responding to initial doxorubicin-based therapy resectable.

[Table: see text]

No significant financial relationships to disclose.

A phase II trial of trastuzumab and low dose interleukin-2 in patients with metastatic breast cancer who have previously failed trastuzumab

3028

Background: Trastuzumab (TZB) mediates lysis of Her2-pos. breast cancer cells by interleukin-2 (IL2) primed natural killer (NK) cells. We hypothesized that IL2 would augment the effects of TZB. The objective of this study was to determine the response rate to and toxicity of low dose IL2 plus TZB in patients with Her2-pos. metastatic breast cancer who had progressed within 12 months of receiving TZB. Also, we measured the ability of patient (pt) peripheral blood mononuclear cells (PBMC) to produce cytokines and conduct antibody-directed cellular cytotoxicity (ADCC) against Her2-pos. target cells. Methods: Pts received low (1 million IU/m2) and intermediate dose (12 million IU/m2) IL2 plus TZB (4 mg/kg) in each cycle. Low dose IL2 was given on days 2–7 and days 12–21 of cycle 1, and days 4–14 of later cycles. Intermediate dose IL2 was given on days 9–11 of cycle 1, and on days 1–3 of later cycles. TZB was given on day 1 and 8 of cycle 1, and on day 1 of later cycles. Pt plasma and PBMCs were analyzed for levels of serum cytokines and ADCC against a TZB-coated cell line, respectively. Results: Thirteen pts with median age of 52 (range 30–71), and a median of 1 (range 1–2) prior TZB-containing regimens were enrolled. The median number of cycles completed was 4. Five pts had grade 3 or greater toxicities, including fever, nausea, vomiting, diarrhea, dyspnea, and hypercalcemia. Twelve pts had progression of disease, and 1 pt withdrew consent. ADCC of pt PBMCs against a TZB-coated cell line was enhanced in only 1 pt. Two pts had elevated plasma levels of interferon-gamma (IFNg), and one of these pts had a 20-fold increase in IFNg transcript levels. The antiangiogenic chemokines MIG and IP-10 rose significantly over baseline in 11 pts. Conclusions: TZB given with low and intermediate pulse-dose IL2 did not produce a robust immune or clinical response in this pt population. A clinical trial in a TZB-naive population may help to determine the immune effects of this combination of IL2 plus TZB.

No significant financial relationships to disclose.

Validation and reduction of FACT/GOG-Ntx subscale for platinum/paclitaxel-induced neurologic symptoms: a gynecologic oncology group study

The FACT/GOG (Gynecologic Oncology Group) Neurotoxicity (Ntx) subscale for assessing platinum/paclitaxel-induced neurologic symptoms was evaluated. The 11-item questionnaire was administered to patients with advanced endometrial cancer treated with doxorubicin/cisplatin (AP) or doxorubicin/cisplatin/paclitaxel (TAP) prior to 1-7 cycles of treatment in GOG 177. The subscale was evaluated in 134 patients in the TAP group for internal reliability, construct validity, criteria validity, sensitivity to treatment differences, and change over time. Cronbach coefficients for internal consistency prior to cycles 1-7 were 0.85, 0.80, 0.84, 0.82, 0.82, 0.85, and 0.84, respectively. The area under the receiver operating characteristic curve was 0.81 for the Ntx score prior to cycle 3. The TAP arm Ntx scores increased significantly from 3.67 at baseline to 8.13 prior to cycle 7; these were higher than the AP arm Ntx scores, which increased from 3.54 at baseline to 4.72 prior to cycle 7. The four sensory items accounted for 80% of treatment differences and 63% of longitudinal changes in the observed subscale score. The 11-item Ntx subscale reliably and validly assesses platinum/paclitaxel-induced peripheral neuropathy. A reduced four-item version is an efficient alternative in measuring this toxicity in clinical trials without compromising its performance.

Study participants’ perceptions of the process and impact of receiving results of N9831

518

Background: There has been growing interest in providing clinical trial participants with study results. We sought to evaluate the process of sharing results from a large cooperative group trial in an effort to guide clinicians and clinical investigators. Methods: We mailed surveys to a subset of women who participated in NCCTG 9831, Phase III Trial of Adjuvant Chemotherapy with or without Trastuzumab for Women with HER2+ Breast Cancer, after the preliminary study results were mailed to participants. Surveys were sent to all trial participants enrolled through 9 CALGB/ECOG institutions. Results: Of 228 surveys sent, 160 (70%) have been returned. Average age of respondents was 51 years (range 26–76); 84% were white; 61% were college graduates; 4% reported recurrent disease. Women reported receiving results by mail (84%), from a health care provider in person or by phone (43%), and/or from the media (47%); 2% reported that they were not informed of the results. 29% heard the results first from the media; 27% first heard by mail. 35% of women might have preferred to be offered results, with the option of not receiving them, but only 4% of women indicated that they would have declined results had they been offered first. 89% of women found the results information easy to understand; 69% correctly interpreted the results of the study; 31% either had an incorrect interpretation or were unsure of the findings. 81% of women were satisfied with how results were shared; 63% of women felt that learning results had an impact on their lives, 24% were more anxious after learning the results; 36% were less anxious. Multivariable analyses evaluating factors associated with greater satisfaction and increased anxiety will be presented. Conclusions: Sharing results is met with overwhelmingly favorable responses from patients, although a substantial proportion of patients may not initially understand the findings. Some patients desire to be offered results first, but few would decline them. The potential for increased anxiety should be considered, and psychosocial support may be required by some. A plan to share results should be routinely and prospectively included in the design of clinical trials. (Supported in part by an ASCO Career Development Award (AHP)

No significant financial relationships to disclose.

Angiogenesis pathway gene polymorphisms associated with clinical outcome in recurrent ovarian cancer treated with low dose cyclophosphamide and bevacizumab: A California Consortium Trial

5017

Background: Despite advances in chemotherapy, ovarian cancer remains a major cause of cancer mortality worldwide. It has therefore become essential to identify novel therapeutic targets, such as angiogenesis which is a complex process regulated by the delicate balance between various local proangiogenic and antiangiogenic proteins. Bevacizumab, a monoclonal antibody binding to VEGF, has shown significant activity in colon, breast, lung and ovarian cancer. There are no established molecular markers to predict response or time to tumor progression for Bevacizumab based chemotherapy. The key enzymes of the VEGF pathway are: Vascular Endothelial Growth Factor (VEGF), VEGF Receptor (VEGFR), Hypoxia Inducible Factor1 (HIF α and β-subunit), Neuropilin1 (NRP), Interleukin-8 (IL-8), Adrenomedullin (AM) and Leptin. Methods: Seventy patients with refractory ovarian cancer were enrolled in a Phase II clinical trial and treated with Cyclophoshamide 50 mg po/Bevacizumab 10 mg/kg IV every 14 days. From 52 patients blood samples were available for gDNA extraction and PCR-RFLP assays. Results: 13 patients had a PR (25%) and 39 were non responders. 31 pts had progressed. Median follow-up of 8.3 months with a median progression-free survival of 6.6 months. Patients who were homozygous A/A or heterozygous A/T genotype at the −251 locus in the IL-8 gene had a lower response rate than those who were T/T (P = 0.047 Fisher’s exact test). Patients with Vegf936 C/C had a median TTP of 6.5 months, pts with any T (T/T, C/T) had a median TTP of 17.2 months. Pts carrying both AM 3’end alleles <14 CA repeats had 3.4 months median TTP, patients with at least one allele >14 showed a median TTP of 6.6 months; for both alleles >14 patients showed 8.7 months of median TPP (P = 0.0006 Log-rank test) Conclusions: Our data suggest for the first time, that IL-8 may be a potential molecular predictor of response to Bevacizumab based chemotherapy. We also demonstrate that both VEGF 936 and the AM 3’ dinucleotide repeat polymorphisms are potential molecular markers for time to tumor progression. A larger prospective study is needed to validate and confirm our preliminary findings. This study was supported by NCI grant NO1 CM 17101.

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Does adjuvant chemotherapy (CT) exacerbate cognitive impairment in elderly breast cancer (BC) patients? Results of a prospective, longitudinal study

10530

Background: Over the last few years, several retrospective studies documented cognitive impairment in post-chemotherapy BC patients. This decline was hypothesized to be related to CT (“chemo-brain”). More recently, a prospective study (Wefel et al. 2005) documented significant cognitive impairment at baseline, which may impact response to CT, along with treatment related effects. While all previous studies focused on the cognitive response of young BC women, older patients may be much more susceptible to any CT related neurotoxicity. Thus, the current study investigated the incidence and course of cognitive impairment in older, post-menopausal BC patients undergoing CT. Methods: 19 postmenopausal women (≥50 yrs) with no prior chemo or hormonal cancer treatment, and baseline MMSE >23 completed a comprehensive neurocognitive battery of tests along with anxiety and depression measures, prior to treatment. At 6 months, 12 patients returned for post-chemotherapy evaluation, with 8 evaluated at 2 years. Ten DCIS patients were also evaluated at baseline and 6 months. Results: Mean age at baseline was 67 yrs with 14 years of education. Prior to treatment, 37% displayed significant cognitive impairment not accounted for by other variables. At six months, within and between group analyses revealed only improved fine motor speed (Finger tapping, p.01) related to practice effects, but no decline in cognitive functions. There were no significant differences across measures between BC and DCIS groups. However, RCI revealed 3 of 12 BC patients improved on memory tasks. Two year longitudinal analyses again revealed improved motor speed and possible cognitive flexibility (TMT-A, p.02), along with decreased anxiety (STAI-S, p = .03). Conclusion: This small study does not support a finding of treatment-associated cognitive impairment among elderly women receiving standard CT for breast cancer. However, like Wefel’s sample, we documented significant cognitive impairment prior to initiation of treatment. Studies addressing the etiologic mechanism related to this cognitive dysfunction are warranted. Limitations of the current study will be discussed.

No significant financial relationships to disclose.

A phase I and pharmacokinetic study of irinotecan in patients with hepatic or renal dysfunction or with prior pelvic radiation: CALGB 9863

BACKGROUND

To ascertain if hepatic or renal dysfunction or prior pelvic radiation (XRT) leads to increased toxicity at a given dose of irinotecan and to characterize the pharmacokinetics of irinotecan and its major metabolites in patients with hepatic or renal dysfunction.

PATIENTS AND METHODS

Adults with tumors appropriate for irinotecan therapy and who had abnormal liver or renal function tests or had prior radiation to the pelvis were eligible. Patients were assigned to one of four treatment cohorts: I, aspartate aminotransferase (AST) > or = 3x upper limit of normal and direct bilirubin <1.0 mg/dl; II, direct bilirubin 1.0-7.0 mg/dl; III, creatinine 1.6-5.0 mg/dl with normal liver function; IV, prior pelvic XRT with normal liver and renal function. Starting with reduced doses of either 145 or 225 mg/m(2), irinotecan was administered every 3 weeks to at least three patients within each cohort. Irinotecan and its metabolites in the blood were measured in all patients.

RESULTS

Thirty-five patients were evaluable for toxicity. No dose-limiting toxicity was seen in cohort I, although only three patients were treated and at a dose of 225 mg/m(2). Patients with elevations of direct bilirubin had dose-limiting toxicities, even though the starting dose was 145 mg/m(2). These same patients appeared to have comparable exposure to the active metabolite SN-38 as normal patients treated with full-dose irinotecan. Patients with elevations of creatinine or with prior pelvic radiotherapy did not appear to have increased risk of toxicity at the doses explored in this study.

CONCLUSIONS

Patients with elevated bilirubin treated with irinotecan have an increased risk of toxicity and a dose reduction is recommended. Patients with elevated AST, creatinine or prior pelvic radiation do not appear to have increased sensitivity to irinotecan, but the data are not adequate to support a specific dosing recommendation.

Fertile transgenic pearl millet [ Pennisetum glaucum (L.) R. Br.] plants recovered through microprojectile bombardment and phosphinothricin selection of apical meristem-, inflorescence-, and immature embryo-derived embryogenic tissues

Pearl millet [ Pennisetum glaucum (L.) R. Br.] is a drought-tolerant cereal crop used for grain and forage. Novel traits from outside of the gene pool could be introduced provided a reliable gene-transfer method were available. We have obtained herbicide-resistant transgenic pearl millet plants by microprojectile bombardment of embryogenic tissues with the bar gene. Embryogenic tissues derived from immature embryos, inflorescences and apical meristems from diploid and tetraploid pearl millet genotypes were used as target tissues. Transformed cells were selected in the dark on Murashige and Skoog medium supplemented with 2 mg/l 2,4-D and 15 mg/l phosphinothricin (PPT). After 3-10 weeks in the dark, herbicide-resistant somatic embryos were induced to germinate on MS medium containing 0.1 mg/l thidiazuron and 0.1 mg/l 6-benzylaminopurine. Plants were transferred to the greenhouse after they were rooted in the presence of PPT and had passed a chlorophenol red assay (the medium turned from red to yellow). Transgenic plants were recovered from bombardments using intact pAHC25 plasmid DNA, a gel-purified bar fragment, or a mixture of pAHC25 plasmid or bar fragment and a plasmid containing the enhanced green fluorescent protein ( gfp) gene (p524EGFP.1). Analyses by the polymerase chain reaction, Southern blot hybridization, GFP expression, resistance to herbicide application, and segregation of the bar and gfp genes confirmed the presence and stable integration of the foreign DNA. Transformed plants were recovered from all three explants, although transformation conditions were optimized using only the tetraploid inflorescence. Time from culture initiation to rooted transgenic plant using the tetraploid inflorescence ranged from 3-4 months. Seven independent DNA/gold precipitations were used to bombard 52 plates, 29 of which produced an average of 5.5 herbicide-resistant plants per plate. The number of herbicide-resistant plants recovered per successful bombardment ranged from one to 28 and the frequency of co-transformation with gfp ranged from 5% to 85%.