Systemic immunity markers are associated with clinical outcomes of atezolizumab treatment in patients with triple-negative advanced breast cancer: a retrospective multicenter observational study

Immune checkpoint inhibitors (ICI) are reportedly efficacious against triple-negative breast cancer (TNBC) and are now recommended as first-line therapy. Systemic immunity markers, the absolute lymphocyte count (ALC) and the neutrophil-to-lymphocyte ratio (NLR), have been identified as predict ICI efficacy in patients with various cancers. We retrospectively enrolled 36 TNBC patients who received atezolizumab treatment between September 2019 and May 2021 at eight Japanese medical institutions. We evaluated systemic immunity markers, including dynamic changes in these markers, as predictors of survival benefit derived from atezolizumab treatment. Median time-to-treatment failure (TTF) and overall survival (OS) were 116 days and "not reached", respectively. Patients with low NLR at baseline and decreased NLR at the start of the second cycle (SO2nd) had significantly longer OS than those with high NLR at baseline and increased NLR (SO2nd) (log-rank P < 0.001 and log-rank P = 0.049, respectively). Multivariate analyses identified high ALC at baseline and decreased NLR (SO2nd) as independent predictive markers for longer TTF (P = 0.043 and P = 0.002, respectively), and low NLR at baseline and decreased NLR (SO2nd) as independent predictive markers for longer OS (P < 0.001 and P = 0.013, respectively). The safety profile was consistent with those of previous trials. This retrospective multicenter observational study showed the clinical efficacy and safety of atezolizumab treatment. Furthermore, systemic immunity markers, including their dynamic changes, were found to be associated with clinical outcomes of atezolizumab treatment in patients with advanced or metastatic TNBC.

[Three Cases of Orbital Metastasis from Breast Cancer Treated with Radiotherapy]

Orbital metastasis from breast cancer is relatively uncommon and is not the dominant prognosis. While it can reduce a patient's QOL through symptoms such as diplopia, visual impairment, and exophthalmos, evidence suggests that radiotherapy might improve these symptoms in a relatively short period. We report 3 cases of orbital metastasis from breast cancer treated with radiotherapy. All 3 patients were diagnosed with stage Ⅳ breast cancer and underwent chemotherapy and endocrine therapy for several years. When they were diagnosed with orbital metastasis, their life expectancy was only a few months with debilitating illness. They received radiotherapy, which caused slight side effects including skin disorders. The cancer symptoms rapidly improved in 2 patients, suggesting that radiotherapy can be an efficacious choice for improving the QOL for patients with orbital metastasis from breast cancer, especially for patients in terminal status.

A case report of fibroadenoma of the breast with characteristic cystic change on a cut surface

Fibroadenoma with remarkable cystic change is very unusual. Opinions differ as to the interpretation of this lesion. Furthermore, there have been few reports focusing on its macroscopic view. We herein report a case of fibroadenoma in a 43-year-old woman. The patient presented herself to a medical doctor's office due to a rapidly growing breast tumor. Based on a core needle biopsy, a benign lesion was suspected, and the tumor was surgically resected. On a macroscopic study, the cut surface of the tumor revealed a remarkably cystic and well-circumscribed lesion with an intracystic polypoid component. Microscopically, a variety of findings of epithelial and stromal proliferation were observed. This is an interesting case not only because a fibroadenoma with prominent cystic change is unusual but also because the breast tumor showed a characteristically cystic appearance on its macroscopic view.

[Two Cases of Endobronchial Metastases from Breast Cancer]

Endobronchialmetastasis(EBM)is a rare complication in breast cancer patients. Herein, we report 2 cases of EBM in breast cancer patients. Patient 1 had pulmonary metastases that were treated with hormone therapy and showed long survival after achieving a CR, while patient 2 had multi-organ metastases and died 42 months after the diagnosis of EBM. If bronchial obstruction is observed in a breast cancer patient, early diagnosis of EBM via a bronchoscopic examination is recommended. EBM may not indicate a poor prognosis, and appropriate anti-cancer therapy with palliative intrabronchial therapies can prolong the survival in selected EBM patients.

[Three Cases of Intrathecal Chemotherapy with Ventricular Catheter for the Treatment of Leptomeningeal Metastasis from Breast Cancer]

Leptomeningeal metastasis(LM)is a rare complication in patients with breast cancer. We report 3 cases of LMs in patients with breast cancer who were treated with intrathecal methotrexate via an Ommaya reservoir. In 2 patients, a significant neurological improvement was observed, whereas in 1 patient there was no response. The overall survivals for the patients who experienced improvements were 22 and 9 months. Although we have no evidence for the efficacy of intrathecal chemotherapy for LMs in patients with breast cancer, its effects for some patients could be promising, after reservoir management and drug selection establishment.

[A Case of Skull Base Metastasis of Breast Cancer with Dysphasia, Odynophagia and Dysarthria]

While skull base metastases from breast cancer are not uncommon, there are relatively few reported cases in the literature. We report a case of skull base metastasis of breast cancer that resulted in dysphasia, odynophagia, and dysarthria. The case involved a woman in her 50 s who was diagnosed with cancer of the right breast(cT4N1M0, cStage III B)at another medical institution 9 years previously and who underwent a partial mastectomy and an axillary lymph node dissection following neoadjuvant chemotherapy. She began experiencing neck pain 6 months previously, followed by dysphasia, odynophagia, and dysarthria 1 month previously. The patient was referred to our hospital for detailed examination and treatment. PET-CT and cranial MRI was conducted and detected metastatic lesion from the skull base to the upper cervical vertebrae. An orthopedic surgeon performed a posterior decompression and fusion surgery on the occipital bone, cervical vertebra, and thoracic vertebra. A histological examination of bone tissue extracted during surgery revealed that the breast cancer had metastasized. We then performed irradiation of the cervical vertebra from the cranial base and initiated treatment with zoledronic acid and anastrozole. Symptoms such as dysphasia, odynophagia and dysarthria lessened, and the patient is currently being followedupas an outpatient.

High resolution x-ray absorption and emission spectroscopy of Li x CoO2 single crystals as a function delithiation

The effect of delithiation in Li _x CoO₂ is studied by high resolution Co K-edge x-ray absorption and x-ray emission spectroscopy. Polarization dependence of the x-ray absorption spectra on single crystal samples is exploited to reveal information on the anisotropic electronic structure. We find that the electronic structure of Li _x CoO₂ is significantly affected by delithiation in which the Co ions oxidation state tending to change from 3+  to 4+. The Co intersite (intrasite) 4p-3d hybridization suffers a decrease (increase) by delithiation. The unoccupied 3d t _2g orbitals with a _1g symmetry, containing substantial O 2p character, hybridize isotropically with Co 4p orbitals and likely to have itinerant character unlike anisotropically hybridized 3d e _g orbitals. Such a peculiar electronic structure could have significant effect on the mobility of Li in Li _x CoO₂ cathode and hence the battery characteristics.

Isolation and characterization of dental epithelial cells derived from amelogenesis imperfecta rat

OBJECTIVE

Disruption of the third zinc finger domain of specificity protein 6 (SP6) presents an enamel-specific defect in a rat model of amelogenesis imperfecta (AMI rats). To understand the molecular basis of amelogenesis imperfecta caused by the Sp6 mutation, we established and characterized AMI-derived rat dental epithelial (ARE) cells.

MATERIALS AND METHODS

ARE cell clones were isolated from the mandibular incisors of AMI rats, and amelogenesis-related gene expression was analyzed by reverse transcription polymerase chain reaction (RT-PCR). Localization of wild-type SP6 (SP6WT) and mutant-type SP6 (SP6AMI) was analyzed by immunocytochemistry. SP6 transcriptional activity was monitored by rho-associated protein kinase 1 (Rock1) promoter activity with its specific binding to the promoter region in dental (G5 and ARE) and non-dental (COS-7) epithelial cells.

RESULTS

Isolated ARE cells were varied in morphology and gene expression. Both SP6WT and SP6AMI were mainly detected in nuclei. The promoter analysis revealed that SP6WT and SP6AMI enhanced Rock1 promoter activity in G5 cells but that enhancement by SP6AMI was weaker, whereas no enhancement was observed in the ARE and COS-7 cells, even though SP6WT and SP6AMI bound to the promoter in all instances.

CONCLUSION

ARE cell clones can provide a useful in vitro model to study the mechanism of SP6-mediated amelogenesis imperfecta.

De novo expression of Nav1.7 in injured putative proprioceptive afferents: Multiple tetrodotoxin-sensitive sodium channels are retained in the rat dorsal root after spinal nerve ligation

Tetrodotoxin-sensitive (TTX-s) spontaneous activity is recorded from the dorsal roots after peripheral nerve injury. Primary sensory neurons in the dorsal root ganglion (DRG) express multiple TTX-s voltage-gated sodium channel α-subunits (Navs). Since Nav1.3 increases, whereas all other Navs decrease, in the DRG neurons after peripheral nerve lesion, Nav1.3 is proposed to be critical for the generation of these spontaneous discharges and the contributions of other Navs have been ignored. Here, we re-evaluate the changes in expression of three other TTX-s Navs, Nav1.1, Nav1.6 and Nav1.7, in the injured 5th lumbar (L5) primary afferent components following L5 spinal nerve ligation (SNL) using in situ hybridization histochemistry and immunohistochemistry. While the overall signal intensities for these Nav mRNAs decreased, many injured DRG neurons still expressed these transcripts at clearly detectable levels. All these Nav proteins accumulated at the proximal stump of the ligated L5 spinal nerve. The immunostaining patterns of Nav1.6 and Nav1.7 associated with the nodes of Ranvier were maintained in the ipsilateral L5 dorsal root. Interestingly, putative proprioceptive neurons characterized by α3 Na+/K+ ATPase-immunostaining specifically lacked Nav1.7 mRNA in naïve DRG but displayed de novo expression of this transcript following SNL. Nav1.7-immunoreactive fibers were significantly increased in the ipsilateral gracile nucleus where central axonal branches of the injured A-fiber afferents terminated. These data indicate that multiple TTX-s channel subunits could contribute to the generation and propagation of the spontaneous discharges in the injured primary afferents. Specifically, Nav1.7 may cause some functional changes in sensory processing in the gracile nucleus after peripheral nerve injury.

[Effectiveness of skin icing for reducing pain associated with luteinizing hormone-releasing hormone agonist injection]

We evaluated the effect of using the cooling method on pain at the site of luteinizing hormone-releasing hormone(LH-RH) agonist injection in 181 prostate cancer or premenopausal breast cancer patients by using a numerical rating scale(NRS)and a questionnaire survey with open-ended questions. According to the NRS, 38.1% of the patients experienced a reduction in pain, 37.5% experienced no change, and 24.4% experienced an increase in pain. Therefore, use of the cooling method did not have a statistically significant effect in terms of pain reduction(p=0.123). However, on analyzing pain reduction according to the answers in the questionnaire survey, 53.2% of the patients experienced a reduction in pain, 38.5% experienced no change, and 8.3% experienced an increase in pain. These findings were different from those obtained on using the NRS. In addition, irrespective of using the cooling method, needle thickness and patient obesity strongly influenced the pain experienced. The skin icing method was effective in reducing pain at the site of LH-RH agonist injection. This method is simple, inexpensive, and safe, and is hence recommended.

CYP2C19 genotype-based phase I studies of a c-Met inhibitor tivantinib in combination with erlotinib, in advanced/metastatic non-small cell lung cancer

Background:

A previous clinical study in non-small cell lung cancer (NSCLC) patients in Western countries suggested the potential for combination of a first-in-class non-ATP-competitive c-Met inhibitor tivantinib with an epidermal growth factor receptor-tyrosine kinase inhibitor erlotinib. Polymorphisms of CYP2C19, the key metabolic enzyme for tivantinib, should be addressed to translate the previous Western study to Asian population, because higher incidence of poor metabolisers (PMs) is reported in Asian population.

Methods:

Japanese patients with advanced/metastatic NSCLC received tivantinib in combination with erlotinib to evaluate safety and pharmacokinetics. Doses of tivantinib were escalated separately for extensive metabolisers (EMs) and PMs.

Results:

Tivantinib, when combined with erlotinib, was well tolerated up to 360 mg BID for EMs and 240 mg BID for PMs, respectively. Among 25 patients (16 EMs and 9 PMs), the adverse events (AEs) related to tivantinib and/or erlotinib (>20%, any grade) were rash, diarrhoea, dry skin and nausea. Grade ⩾3 AEs were leukopenia, anaemia and neutropenia. No dose-limiting toxicity was observed. Pharmacokinetics profile of tivantinib was not clearly different between the combination and monotherapy. Three partial response and three long-term stable disease (⩾24 weeks) were reported.

Conclusion:

Two doses of tivantinib in combination with erlotinib were recommended based on CYP2C19 genotype: 360 mg BID for EMs and 240 mg BID for PMs.

Impact of lithium-ion ordering on surface electronic states of Li(x)CoO2

Li(x)CoO(2) exhibits intriguing electronic properties due to a strong electron correlation and complex interplay between Co and Li ions. However, fundamental understanding of the nanoscale distribution of Li ions and its effect on the electronic properties remains unclear. We use scanning tunneling microscopy and density functional theory to elucidate the degree of Li(x)CoO(2) surface electronic state modification that can be achieved by Li ordering. The surface Li ions are highly mobile and preferentially form a (1 × 1) hexagonal lattice, whereas the surface CoO(2) layer shows metallic and insulating phases, indicating the coexistence of ordered and disordered Li ions in the subsurface layer. These results provide evidence of novel electronic properties produced by spatially inhomogeneous Li-ordering patterns.

Role of oxygen holes in Li(x)CoO(2) revealed by soft X-ray spectroscopy

The fundamental electronic structure of the widely used battery material Li(x)CoO(2) still remains a mystery. Soft x-ray absorption spectroscopy of Li(x)CoO(2) reveals that holes with strong O 2p character play an essential role in the electronic conductivity of the Co(3+)/Co(4+) mixed valence CoO(2) layer. The oxygen holes are bound to the Co(4+) sites and the Li-ion vacancy, suggesting that the Li-ion flow can be stabilized by oxygen hole back flow. Such an oxygen hole state of Li(x)CoO(2) is unique among the various oxide-based battery materials and is one of the key ingredients to improving their electronic and Li-ion conductivities.