MAGNIFY phase IIIb interim analysis of induction R2 followed by maintenance in relapsed/refractory indolent NHL

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Background: Patients (pts) with relapsed iNHL have limited standard treatment options. The immunomodulatory agent lenalidomide shows enhanced activity with rituximab (ie, R2), which recently reported 39.4-mo median PFS in R/R iNHL pts (AUGMENT; J Clin Oncol. 2019;37:1188). Methods: MAGNIFY is a multicenter, phase IIIb trial in pts with R/R FL gr1-3a, MZL, or MCL (NCT01996865) exploring optimal lenalidomide duration. Lenalidomide 20 mg/d, d1-21/28 + rituximab 375 mg/m2/wk c1 and then q8wk c3+ (R2) are given for 12c followed by 1:1 randomization in pts with SD, PR, or CR to R2 vs rituximab maintenance for 18 mo. Data presented here focus on induction R2 in efficacy-evaluable FL and MZL pts (MCL not included) receiving ≥ 1 treatment with baseline/post-baseline assessments to analyze the primary end point of ORR by 1999 IWG criteria. Results: As of June 16, 2019, 393 pts (81% FL gr1-3a; 19% MZL) were enrolled with a median follow up of 23.7 mo (range, 0.6-57.8) for censored pts (n = 335). Median age was 66 y (range, 35-91), 83% had stage III/IV disease, with a median of 2 prior therapies (95% prior rituximab-containing). ORR was 69% with 40% CR/CRu (Table). Median DOR was 39.0 mo, and median PFS was 40.1 mo. 199 pts (51%) have completed 12c of R2, and 188 (48%) have been randomized and entered maintenance. 139 pts (35%) prematurely discontinued both lenalidomide and rituximab, primarily due to AEs (n = 52, 13%) or PD (n = 45, 11%). Most common all-grade AEs were 48% fatigue, 43% neutropenia, 36% diarrhea, 31% nausea, and 30% constipation. Grade 3/4 AE neutropenia was 36% (9 pts [2%] had febrile neutropenia); all other grade 3/4 AEs occurred in < 7% of pts. Conclusions: R2 is active with a tolerable safety profile in pts with R/R FL and MZL, including rituximab-refractory, double-refractory, and early relapse pts. Clinical trial information: NCT01996865 . [Table: see text]

Temperature dependence of the electronic structure of two-dimensional Na gas on the Si(111)-7 × 7 surface

The temperature dependence of the irreversible phase transition from a two-dimensional gas to an ordered zero-dimensional solid on the Si(111)-7 × 7 surface was studied using photoemission spectroscopy. With increasing Na coverage, the two-dimensional Na gas, which is a state of highly mobile Na atoms, undergoes a phase transition into ordered zero-dimensional magic nanoclusters at room temperature. The critical Na coverage of the phase transition was found to increase with reduced temperature. This was used to develop a gas-solid phase diagram of Na atoms on the Si(111)-7 × 7 surface as a function of Na coverage and sample temperature based on the electronic structure. The temperature dependence of the phase transition can be ascribed to the suppression of the thermal energy that is required to overcome the energetic barrier between the two-dimensional gas and the zero-dimensional solid at low temperature, where three different hopping mechanisms are related to the phase transition.

The impact of cigarette smoking on the frequency of and qualitative differences in KRAS mutations in Korean patients with lung adenocarcinoma

PURPOSE

This study was designed to determine the relationship of cigarette smoking to the frequency and qualitative differences among KRAS mutations in lung adenocarcinomas from Korean patients.

MATERIALS AND METHODS

Detailed smoking histories were obtained from 200 consecutively enrolled patients with lung adenocarcinoma according to a standard protocol. EGFR (exons 18 to 21) and KRAS (codons 12/13) mutations were determined via direct-sequencing.

RESULTS

The incidence of KRAS mutations was 8% (16 of 200) in patients with lung adenocarcinoma. KRAS mutations were found in 5.8% (7 of 120) of tumors from never-smokers, 15% (6 of 40) from former-smokers, and 7.5% (3 of 40) from current-smokers. The frequency of KRAS mutations did not differ significantly according to smoking history (p=0.435). Never-smokers were significantly more likely than former or current smokers to have a transition mutation (G→A or C→T) rather than a transversion mutation (G→T or G→C) that is known to be smoking-related (p=0.011). In a Cox regression model, the adjusted hazard ratios for the risk of progression with epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) were 0.24 (95% CI, 0.14-0.42; p<0.001) for the EGFR mutation and 1.27 (95% CI, 0.58-2.79; p=0.537) for the KRAS mutation.

CONCLUSION

Cigarette smoking did not influence the frequency of KRAS mutations in lung adenocarcinomas in Korean patients, but influenced qualitative differences in the KRAS mutations.

Abstract B34: Receptor tyrosine kinases (RTKs) profiling and its role in advanced gastric cancer

Background: Receptor tyrosine kinase (RTK) activation is the starting point of intracellular signaling cascades that control cellular process such as proliferation, differentiation, migration and survival and aberrant RTK activation may promote cancer initiation and progression. The purpose of this study was to determine the frequency and the influence of major RTKs including EGFR, HER-2, c-MET, and FGFR-2 expression on the outcomes of gastric cancer patients.

Methods: Between January 2000 and December 2004, 122 patients with advanced gastric cancer in our institute were selected. All patients underwent gastrectomy and D2 lymph node dissection with a curative aim and pathologically confirmed N3 stage without distant metastasis. Formalin-fixed paraffin-embedded (FFPE) tissue specimens were examined for the expression of EGFR, HER-2, c-MET, FGFR-2 by immunohistochemistry (IHC). The score for expression was assessed by the independent pathologist with weighted histoscore method. We defined positive result as the expression of 3+ in IHC for each RTK.

Results: Among 4 RTKs, c-MET expression showed highest frequency as 31 patients (25.4%) followed by FGFR-2 (13; 11.2%), HER-2 (10; 8.5%) and EGFR (6; 5.0%). The majority of samples (58.2%) were negative (wild type) for all four markers. Fourteen patients (11.5%) showed co-expression for these RTKs; one patient was quadruple positive, and the others showed double positivity for c-MET and one of 3 other markers. There were no significant correlations between each biomarker and clinic-pathologic parameters such as patient's gender, differentiation, T stage, lymphovascular invasion, Lauren classification or the number of LN metastasis. With the follow-up period of 21.5 months (0.5–115.7), median overall survival of all patients was 20.9 months (95% CI, 15.2–26.6) and median disease-free survival (DFS) was 17.1 months (95% CI, 9.4–24.8). Based on the status of each receptor, survival outcome was only associated with c-MET over-expression; median DFS of 10.8 months in c-MET positive patients and 22.0 months in c-MET negative patients (p=0.04). Median DFS in patients with co-expression of RTKs showed poorer trend than single marker positive group and wild type group (10.8m, 15.7m, and 19.4m, respectively; p=0.27).

Conclusion: We evaluated the expression pattern with four major RTKs in relatively homogenous subgroup of gastric cancer patients with pathologic N3. c-MET over-expression could be a prognostic biomarker for DFS in these patients, suggesting the significant role of c-met in gastric cancer progression.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr B34.

Efficacy and feasibility of radiofrequency ablation for liver metastases from gastric adenocarcinoma

PURPOSE

Optimal treatment for liver metastases from gastric cancer remains a matter of debate. The aim of our study is to evaluate the efficacy of radiofrequency ablation (RFA) for the treatment of liver-only metastases from gastric adenocarcinoma.

MATERIALS AND METHODS

We retrospectively reviewed medical records of 29 patients who developed liver-only metastases from gastric adenocarcinoma and subsequently underwent gastric resection and RFA (n = 20) or gastric resection and systemic chemotherapy (n = 9) between January 1995 and February 2008. Overall survival was estimated using the Kaplan-Meier method, and was compared using the log rank test to evaluate RFA efficacy.

RESULTS

Twenty patients who underwent RFA showed a median overall survival of 30.7 months (range: 2.9 to 90.9 months), a median progression-free survival of 6.8 months (range: 0.8 to 45.2 months), and median overall one-, three-, and five-year survival rates were 66.8%, 40.1%, and 16.1% respectively. The RFA group showed a 76% decreased death rate compared to the chemotherapy-only group (30.7 months versus 7 months, hazard ratio, 0.24; p = 0.004). Most patients tolerated RFA well, and complications were found to be minor (transient fever (20%) and/or right upper quadrant pain (25%)). One case of treatment-related death occurred due to sepsis that originated from a liver abscess at the ablation site.

CONCLUSIONS

The data suggest that a use of RFA as a liver-directed treatment may provide greater survival benefit than chemotherapy and is an alternative option for the treatment of liver-only metastases from gastric cancer.

Abstract 525: ADAM-9 expression in gastric cancer and its association with invasiveness

The ADAMs (a disintegrin and metalloproteinase) comprise a family of multidomain transmembrane and secreted proteins. Accumulating evidence associates an increased expression of individual ADAM family members with various types of cancer including prostate, breast, skin and lung cancers. However, little is known about its role in gastric cancer. Herein, we investigated the expression of ADAM-9 in gastric cancer, and its implication as a potential therapeutic target for anti-metastaasis therapy.

First, we evaluated the expression of ADAM-9 on protein by immunoblotting and transcript level in 24 gastric cancer cell lines by RT-PCR. ADAM-9 protease activity was also measured using ADAM-9 fluorogenic substrate (R&D systems, Minneapolis, MN, USA). We then conducted invasion assay using transwell coated with matrigel in the presence or absence of ADAM-9-specific inhibiting antibody (kindly supplied from Raven Biotechnologies, Inc., South San Francisco, CA). The mRNA expression of ADAM-9 was observed in all the gastric cancer cell lines while the protein expressions of pro- and active-form and protease activities were variable. We selected the cell lines of high baseline ADAM-9 expression (SNU-638, MKN-28 and AGS) and of low baseline expression (SNU-216, MKN-1 and HS-746T) to continue further experiment. Baseline level of ADAM-9 is little correlated with invasion activity though matrigel. Treatment of anti-ADAM-9 antibody does not influence the cytotoxicity. However, it reduced its protease activity and invasiveness, which was dependent on baseline ADAM-9 activity. Actually, protease activity reduced 64.5±0.3% when the specific antibody to ADAM-9 was treated to high expressed cell lines, but 9.6±0.4% were decreased in low expressed cell lines at the 20ug/ml of the antibody. Anti-ADAM-9 antibody inhibited the invasion activity dose dependently, and its effect was more prominent in high ADAM-9-expressing cell lines (67.7±1.9% vs 5.9±4.3% at the 20 ug/ml antibody). Anti-ADAM-9 treatment did not influence on the cell-matrix adhesion, which implies this anti-invasive effect is through its inhibition of protease function. In the hypoxic condition (1% oxygen), invasion was increased along with elevation of both active form of ADAM-9 and its protease activity, suggesting that increased ADAM-9 could have a role of enhancing invasiveness of gastric cancer. To conclude, we presented that ADAM-9 has a role in invasiveness of gastric cancer and would be one of the putative targets for anti-metastasis therapy.

This work was supported by the Brain Korea 21 Project for Medical Science, Yonsei University.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 525.

Abstract B8: A phase I pharmacokinetic (PK) study of TSU-68 plus S-1 and oxaliplatin (SOX) in patients with metastatic colorectal cancer (mCRC) treated with prior chemotherapy

Background: TSU-68 is a novel oral multiple tyrosine kinase inhibitor that inhibits VEGFR-2, FGF and PDGF receptors. Since TSU-68 inhibit angiogenesis pathway which is important to tumor growth and metastasis in human colorectal cancer, we conducted a phase I study to evaluate the safety, tolerability and PK of TSU-68 plus S-1 and oxaliplatin (SOX) in patients with metastatic colorectal cancer (mCRC) treated with prior chemotherapy. Methods and Materials: ECOG PS 0 or 1 patients with mCRC were treated with TSU-68 400 mg/day (Level 1) or 800 mg/day (Level 2) on Days 1–21, S-1 70 mg/m2 on Days 1–14 with one week rest and oxaliplatin 130 mg/m2 IV on Day 1 repeated every 3 week. The dose escalation of TSU-68 was not done more than Level 2 based on the results of phase I studies of TSU-68 alone in Japan.

Results: Eleven patients were enrolled in the study. Of 11 patients, 2 patients were excluded from DLT assessment because both patients withdrew the written informed consent (IC) without a DLT during cycle 1. Of 9 evaluable patients, initial 3 patients in Level 1 experienced no DLT. Of 3 patients in Level 2, two patients experienced a DLT (one patient: grade 3 hiccup and grade 3 rash, another one: grade 2 neutropenia which prevented the initiation of the next cycle within 14 days). According to the protocol, additional 3 evaluable patients were enrolled in Level 1, and experienced no DLT. The MTD and RD of TSU-68 in combination with SOX was 400mg. Common adverse drug reactions (ADRs) in cycle 1 included peripheral sensory neuropathy (91%), nausea (82%), anorexia (82%), fatigue (46%), vomiting (36%) and diarrhoea (36%). No patient exhibited grade 4 ADR and treatment related death. Partial response was observed in 2 patients treated with prior chemotherapy. Median PFS was 218 days. TSU-68 plasma concentrations, Cmax and AUC0-t in Level 1 were higher than those in Level 2. There was no appreciable effect of administered TSU-68 on the PK of S-1 components (FT, CDHP and Oxo) and oxaliplatin-derived platinum.

Conclusions: Administration of TSU-68 in combination with SOX is generally well tolerated. The MTD and RD of TSU-68 in this study was 400mg. A multi-institutional phase II study of TSU-68 at 400mg/day in combination with SOX is planned.

Citation Information: Mol Cancer Ther 2009;8(12 Suppl):B8.

Clinical value of ezrin expression in primary osteosarcoma

PURPOSE

Ezrin is a membrane cytoskeletal linker protein and it is known to be associated with metastasis of primary osteosarcoma. The aim of this study is to determine the relationship between an ezrin expression and several key clinical parameters and to elucidate its potential prognostic value for patients with osteosarcoma.

MATERIALS AND METHODS

Seventy patients with histologically confirmed osteosarcoma and who had no distant metastasis were enrolled between 1995 and 2005 at Yonsei Cancer Center, Severance Hospital, Korea. The clinical parameters were retrospectively reviewed and immunohistochemical staining (IHC) for ezrin was performed using the surgically resected specimens.

RESULTS

Of the 70 tumor specimens, 39 (55.7%) revealed an ezrin expression. More of an osteoblastic histology and an elevated initial ALP level were observed in the ezrin positive patients than in the ezrin negative patients (p=0.008 and 0.001, respectively). The proportion of patients who favorably responded to neoadjuvant chemotherapy (≥or=90% necrosis) was significantly higher in the group of ezrin positive patients than that in the group of ezrin negative patient (72.2% vs 45.2%, respectively, p=0.024). The ezrin positive patients showed more frequent recurrence than did the ezrin negative patients (64.1% vs 35.5%, respectively, p=0.017). The patients with an ezrin expression also demonstrated poorer survival than did those patients without ezrin expression (5-year EFS: 31.7% vs 61.3%, respectively, p=0.023, 5-year OS: 53.4% vs 71.0%, respectively, p=0.022). When comparing EFS according to both an ezrin expression and chemoresponsiveness, there were trends that the ezrin negative/chemoresponsive group showed the best 5-year EFS (71.4%), followed by the ezrin negative/chemoresistant group (52.9%), the ezrin positive/chemoresponsive group (38.1%) and the ezrin positive/chemoresistant group (13.6%). These trends were statistically significant (p=0.036).

CONCLUSION

The expression of ezrin by IHC staining was found in 55.7% of the patients with metastasis-free osteosarcoma. Immunoreactivity to ezrin is a negative prognostic factor for survival for the patients suffering with osteosarcoma. Identifying an ezrin expression might offer a valuable piece of information when treating patients with primary osteosarcoma.

Prognosis of pN3 stage gastric cancer

PURPOSE

The aim of this study was to determine the prognosis of pN3 stage gastric cancer patients after they have undergone curative resection, and we also wanted to identify the prognostic factors according to the clinico-pathologic features.

MATERIALS AND METHODS

Between January 2000 and December 2004, we retrospectively reviewed the medical records of the patients with histologically confirmed pN3 stage gastric cancer. They underwent both gastrectomy and lymphadenectomy with a curative aim. We categorized the pN3 stage patients into 2 groups; one with pN3 only (pN3M0) and the other with pN3 combined with M1 stage (pN3M1) that included peritoneal seeding, hepatic metastasis or para-aortic LN metastasis.

RESULTS

Out of 467 patients with stage IV gastric adenocarcinoma who received surgery, 260 patients underwent curative resection and they were pathologically staged as N3. Among these 260 patients, 78 patients were classified as the pN3/M1 stage. For all the patients, the median follow-up period was 19 months (range: 1~108 months) and the median overall survival time was 16.2 months (95% CI, 14.1~18.3%). The 5-year survival rate of the pN3/M0 group was significantly higher than that of the pN3/M1 group (12.6% vs. 2.6%, respectively, p<0.0001). The identified predictor for a worse prognosis was an advanced T4 stage (HR: 3.38, 95% CI, 1.4~8.3, p=0.008) for the pN3 patients.

CONCLUSION

The survival for the pN3 gastric cancer patients after curative gastrectomy was significantly longer in the pN3/M0 group as compared to that of the pN3/M1 group. An advanced T stage was a predictor for a poor prognosis for the pN3 patients. Therefore, diverse treatment strategies for these heterogeneous pN3 gastric cancer patients are needed for improving their survival.

Treatment outcomes of sunitinib treatment in advanced renal cell carcinoma patients: a single cancer center experience in Korea

PURPOSE

The retrospective study was performed to assess the efficacy and toxicity profiles of sunitinib in Korean patients with metastatic renal cell carcinoma (RCC).

MATERIALS AND METHODS

Between January 2005 and December 2008, 76 Korean patients with recurrent/metastatic RCC who received sunitinib were retrospectively reviewed. The primary end point was progression-free survival and the secondary end points were overall survival and response rate. We also assessed the toxicities associated with sunitinib treatment.

RESULTS

Of the 76 patients, 69 (90.1%) were diagnosed with clear cell RCC. The median progression-free survival and overall survival were 7.2 and 22.8 months, respectively in overall patients. Sixty-two patients (81.6%) received 50 mg 4 week and 2 week off schedule, and 14 patients (18.4%) received 37.5 mg daily on a daily continuous schedule. The objective response rate and disease control rate were 27.6% and 84.2%, respectively. A dose reduction or reduction in dose due to adverse events occurred in 76% of the patients, whereas 11% of the patients had discontinued treatment. Other common laboratory abnormalities were increased serum creatinine (75.6%), elevated alanine aminotransferase (71.0%), neutropenia (61.8%), anemia (69.7%), and increased aspartate aminotrasferase (53.3%). Grade 3/4 toxicities occurred as follows: thrombocytopenia (38.2%), fatigue (10.5%), stomatitis (10.5%), and hand-foot syndrome (9.2%).

CONCLUSION

Our results indicate that sunitinib treatment is effective and tolerable for ecurrent/metastatic RCC patients in Korea. Further studies with prognostic or biochemical factors are needed to clarify the different toxicity profiles of this study.

Coexistence of two different Peierls distortions within an atomic scale wire: Si(553)-Au

The ground state property of a Au-induced atomic wire array on a stepped Si(553) surface with interesting 1D metallic bands was investigated. Electron diffraction and scanning tunneling microscopy reveal an intriguing coexistence of triple- and double-period lattice distortions at low temperature. Angle-resolved photoemission observes both the nearly 1/3- and 1/2-filled bands to gradually open energy gaps upon cooling. We explain these unusual findings as due to the occurrence of Peierls distortions of triple and double periods on the two different atomic-scale chain elements, respectively, within a single unit wire. The two Peierls distortions are suggested to have different transition temperatures and little lateral correlation between each other.

Atomic-scale phase coexistence and fluctuation at the quasi-one-dimensional metal-insulator transition

Scanning tunneling microscopy of a quasi-one-dimensional (1D) metal-insulator transition in an In nanowire array on the Si(111) surface reveals unprecedented details in the transition dynamics. The transition proceeds in microscopic first order, namely, through the domain-by-domain conversion at the nanoscale, from the metallic to the insulating phase or vice versa. The definition of domains and their effective transition temperatures (Tc) are strongly correlated with the distribution of defects. Below Tc, the condensation and the fluctuation of 1D charge density waves are observed within the isolated metallic domains, as well as at the domain boundaries. The appearance of such isolated condensates suggests a strong intrawire coupling: a manifestation of the 1D nature of the critical fluctuation, as well as the origin of the first-order transition.

Mechanism of gap opening in a triple-band Peierls system: in atomic wires on Si

One dimensional (1D) metals are unstable at low temperature undergoing a metal-insulator transition coupled with a periodic lattice distortion, a Peierls transition. Angle-resolved photoemission study for the 1D metallic chains of In on Si(111), featuring a metal-insulator transition and triple metallic bands, clarifies in detail how the multiple band gaps are formed at low temperature. In addition to the gap opening for a half-filled ideal 1D band with a proper Fermi surface nesting, two other quasi-1D metallic bands are found to merge into a single band, opening a unique but k-dependent energy gap through an interband charge transfer. This result introduces a novel gap-opening mechanism for a multiband Peierls system where the interband interaction is important.

Metal-insulator transition in Au atomic chains on Si with two proximal bands

One-dimensional atomic chains on Au/Si(557) feature two proximal 1D bands near the Fermi level, which were controversially attributed as a spinon-holon pair of a Luttinger liquid. Angle-resolved photoemission shows that only one band is metallic with the neighboring one gapped at room temperature. Furthermore, even the metallic branch is found to undergo a metal-insulator transition upon cooling, which follows a mean-field-type behavior. Scanning tunneling microscopy observes two apparently unequivocal chains on the surface, one of which exhibits periodicity doubling accompanying the metal-insulator transition. The surface 1D structure is thus concluded to be insulating at low temperature with a Peierls-type instability.

Adsorbate-induced pinning of a charge-density wave in a quasi-1D metallic chains: Na on the In/Si(111)-(4x1) surface

We find that foreign adsorbates acting as local impurities can induce a metal-insulator transition by pinning a charge-density wave (CDW) on the quasi-1D metallic In/Si(111)-(4x1) chain system. Our scanning tunneling microscopy image clearly reveals the presence of a new local 4x2 structure nucleated by Na adatoms at room temperature, which turns out to be insulating with a doubled periodicity along the chains. We directly determine a CDW gap energy Delta = 105+/-8 meV by identifying a characteristic loss peak in our high-resolution electron-energy-loss spectra. We thus report the first observation of a local impurity-derived Peierls-like reconstruction of a quasi-1D system.

Observation of disorder-induced 2D mott-hubbard states of the alkali-earth metal (Mg,Ba)-adsorbed Si(111) surface

We report evidence of a disorder-driven Mott-Hubbard-type localization on the alkali-earth metal (AEM) (Mg,Ba)-adsorbed Si(111)-(7x7) surface. The clean metallic Si(111) surface is found to undergo a two-dimensional (2D) metal-insulator transition as randomly distributed AEM adsorbates cause disorder on the surface. A well-defined electron-energy-loss peak unique to the insulating phase is attributed to an interband excitation between the split Hubbard bands originated from a metallic surface band at Fermi energy. A quantitative analysis of the loss peak reveals that the AEM-induced insulating surfaces are of a Mott-Hubbard type driven essentially by disorder.