[Trisomy 18: how lethal is 'lethal'?]

Should active treatment be available for children with trisomy 18? In the Netherlands, trisomy 18 is described as a lethal condition leading to death during or immediately after birth. The Dutch course of action for trisomy 18 is termination of pregnancy, almost without exception, or passive treatment without medical interventions. But that approach might be outdated. We present a case that inspired physicians and parents to rethink the perception of trisomy 18.

A randomised phase II trial of the Polo-like kinase inhibitor BI 2536 in chemo-naïve patients with unresectable exocrine adenocarcinoma of the pancreas - a study within the Central European Society Anticancer Drug Research (CESAR) collaborative network

BACKGROUND

BI 2536, a novel Polo-like kinase 1 inhibitor, was assessed in patients with unresectable advanced exocrine adenocarcinoma of the pancreas.

METHODS

The study employed a two-stage design. Randomised first-line patients received BI 2536 200 mg on day 1 (n=43) or 60 mg on days 1-3 (n=43) every 21 days. Recruitment of second-line patients was planned for a second stage dependent on an interim analysis demonstrating ≥ 2 responses in the first 18 evaluable patients following 12 weeks of treatment and/or tumour control ≥ 12 weeks in 5 patients per schedule. Primary end point was objective response rate (ORR).

RESULTS

By independent review, ORR was 2.3% (all partial) and 24.4% had stable disease as confirmed best response. The second stage was not initiated. Median overall and progression-free survivals were 149 (95% confidence interval (CI), 91-307) and 46 days (95% CI, 44-56). Most common drug-related adverse events were neutropenia (37.2%), leukopenia (29.1%), fatigue (29.1%) and nausea (22.1%); most common grade 3/4-related events were neutropenia (36.0%), leukopenia (27.9%) and thrombocytopenia (8.1%).

CONCLUSION

Given the low ORR and poor survival, further development of BI 2536 monotherapy is not warranted in this population.

Twelve versus 36 months of adjuvant imatinib (IM) as treatment of operable GIST with a high risk of recurrence: Final results of a randomized trial (SSGXVIII/AIO)

LBA1

Background: Adjuvant IM administered for 12 months (mos) after surgery improves recurrence-free survival (RFS) of patients (pts) diagnosed with operable GIST. We compared 12 vs 36 mos of adjuvant IM as treatment of pts with a high risk for GIST recurrence after surgery. Methods: Pts with histologically diagnosed KIT-positive GIST were entered to this prospective, open-label, multicenter, randomized Phase III study (identifier NCT00116935 ). The risk of recurrence was estimated according to the modified Consensus Criteria. The primary objective was RFS. The secondary objectives included survival (OS) and treatment safety. The key exclusion criteria were ECOG PS >2, metastatic or inoperable GIST, and >12 wks from surgery to the study entry. IM was administered orally 400 mg/d. The sample size (n =200 in each group to obtain ≥110 events) was estimated by simulating log-rank tests assuming an overall hazard ratio (HR) of 0.44, a 20% drop-out rate, 2-sided type-I error rate of .05 and power 0.80. Analysis was based on the intention-to-treat population (ITT). Tumor histology was centrally reviewed. Results: 400 pts were entered to the study from Feb 2004 to Sep 2008. Three pts were excluded due to lack of consent from the ITT, which includes 15 pts who did not have GIST at a central review. The median FU time was 54 mos. RFS was longer in the 36-mo group compared to the 12-mo group (HR 0.46, 95% CI 0.32-0.65; p <.0001; 5-y RFS 65.6% vs 47.9%, respectively). Pts assigned to 36-mo of IM had longer OS (HR 0.45, 0.22-0.89; p =.019; 5-y OS 92.0% vs 81.7%). IM was generally well tolerated. The proportion of pts who discontinued IM during the assigned treatment period for reasons other than GIST recurrence was 25.8% in the 36-mo group and 12.6% in the 12-mo group. Exploratory efficacy subgroup analyses including KIT and PDGFRA mutation analysis data from 366 tumors will be presented. Conclusions: IM administered for 36 mos improves RFS and OS compared to 12 mos of administration as adjuvant treatment of GIST pts who have a high estimated risk of recurrence after surgery.

Loss of expression of the DRR 1 gene at chromosomal segment 3p21.1 in renal cell carcinoma

Consistent deletion of DNA sequences in chromosomal band 3p21 observed in a variety of human tumors suggests the presence of one or more tumor suppressor genes within this region. Previously, we reported on the construction of two distinct cosmid contigs and our identification of several new genes within 3p21.1. In our search for tumor suppressor genes from this region, we have cloned a gene that we have called DRR 1 (downregulated in renal cell carcinoma). The gene was first mapped to 3p21.1 by fluorescence in situ hybridization analysis. Further analysis of yeast artificial chromosome clones in 3p14.2-p21.1 refined its localization. DRR 1 spans about 10 Kb of genomic DNA with a 3.5-Kb mature transcript. The putative protein encoded by this gene is 144 amino acids and includes a nuclear localization signal and a coiled domain. The gene showed loss of expression in eight of eight renal cell carcinoma cell lines, one of seven ovarian cancer cell lines, one of one cervical cancer cell line, one of one gastric cancer cell line, and one of one non-small-cell lung cancer cell line. Southern blot analysis did not show any altered bands, indicating that gross structural changes or deletions did not cause the loss of expression. This gene was also found to have reduced expression in 23 of 34 paired primary renal cell carcinomas. Mutational analysis detected three polymorphic sites within the gene, but no point mutations were identified in the 34 primary tumors. However, we did detect base substitutions in 4 of 12 cell lines that had undetectable expression of the gene. We also transfected the gene into DRR 1-negative cell lines and observed clear growth retardation. Our results suggest that loss of expression of the DRR 1 gene may play an important role in the development of renal cell carcinoma and possibly other tumors. Genes Chromosomes Cancer 27:1-10, 2000.

Precise localization of aphidicolin-induced breakpoints on the short arm of human chromosome 3

The common fragile site at 3p14.2 (FRA3B) has been described as the most active fragile site in the human genome. This locus may predispose chromosome 3 to specific losses due to deletions and translocations that have been associated with several malignancies, including hereditary renal cell carcinoma. We have previously described induction of breakage around FRA3B using aphidicolin in a somatic cell hybrid whose only human component was a single intact chromosome 3. That work led to the isolation of hybrids with breakpoints in the 3p13-p21.1 region with loss of all sequences distal to their respective breakpoints. In this report we describe the further characterization of the breakpoints in many of these cell lines using newly available molecular markers. We also report the identification of YAC clones that span the breakpoints present in many of these hybrids.

Effect of pneumonectomy on the remaining lung in dogs

To determine the magnitude of functional compensation after pneumonectomy and whether compensation is related to maturity of the animal at the time of resection, we performed left pneumonectomy in either adult or 10-wk-old beagles. Studies were performed in adults 7-9 mo after surgery and in puppies 18-23 mo after surgery when the dogs reached full maturity. Results were compared with those in age- and sex-matched unoperated controls. Measurements included pressure-volume relationships, pulmonary hemodynamics, rebreathing studies of lung volume, diffusing capacity and its components, lung tissue volume, and pulmonary blood flow. Computerized-tomographic scans were performed in the puppy groups to determine changes in thoracic shape and size. Morphometric analysis of the lungs was performed under light microscopy. There was partial compensation for loss of one lung by functional improvement in the remaining lung. Compensation was greater in those pneumonectomized as puppies than as adults. Volume of the remaining lung was larger than predicted for a given transpulmonary pressure in both groups. Diffusing capacity, pulmonary capillary blood volume, and lung tissue volume were larger than expected for the normal right lung. After pneumonectomy, compliance of the rib cage was greater in puppies than in adults. Weight of the costal diaphragm was reduced in pneumonectomized puppies. Pulmonary hypertension at rest did not develop, and pulmonary vascular reactivity to hypoxia was unchanged after pneumonectomy in both groups. Significant correlations were obtained between physiological and morphometric measurements.

Review of the clinical trials activity of the Soft Tissue and Bone Sarcoma Group of the European Organization for Research and Treatment of Cancer

Despite the low incidence of sarcomas, the Soft Tissue and Bone Sarcoma Group has established itself as one of the more active cooperative groups of the European Organization for Research and Treatment of Cancer. Performing over a 10 yr period three phase III protocols (total entry 750 patients), three randomized phase II studies (464 patients), a pilot combination study (185 patients), and 12 phase II studies (406 patients). The new randomized phase III protocol for advanced soft-tissue sarcoma will provide an interesting test of the validity of the current membership policy, which has not discouraged the participation of enthusiastic new members. For extremity sarcomas, improved surgical techniques have increased the number of patients retaining functional limbs but have maintained excellent rates of local control. However, systemic metastasis remains a significant problem and presents a challenge for future adjuvant studies.

Interactions between surface cooling and LBNP-induced central hypovolemia

The interaction between whole body surface cooling (WBSC) and progressive lower body negative pressure (LBNP) to -50 torr was evaluated in nine healthy male volunteers, mean age 29 +/- 1.7 years. WBSC, accomplished by circulating 16 degrees C water through an Apollo cooling garment, produced a significant drop in mean skin temperature of 1.96 degrees C (p less than 0.001). Cardiac output (Q) was measured by the C2H2 rebreathing technique. Changes in leg volume (LgV) were monitored by a Whitney strain gauge. WBSC at rest produced a significant decrease in leg volume of 0.27 I (p less than 0.01). Heart rate decreased (-7 bpm, p less than 0.01) and systolic arterial blood pressure was increased (+6 torr, p less than 0.02). The hemodynamic effects of cooling were maintained throughout progressive levels of LBNP with consistently lower leg volumes and heart rates and higher stroke volumes and systolic pressure (p less than 0.01 for all measurements). The data suggest that WBSC produces a central displacement of cutaneous venous volume resulting in an increase in stroke volume.