Quaternary ammonium-based coating of textiles is effective against bacteria and viruses with a low risk to human health

While the global healthcare system is slowly recovering from the COVID-19 pandemic, new multi-drug-resistant pathogens are emerging as the next threat. To tackle these challenges there is a need for safe and sustainable antiviral and antibacterial functionalized materials. Here we develop an 'easy-to-apply' procedure for the surface functionalization of textiles, rendering them antiviral and antibacterial and assessing the performance of these textiles. A metal-free quaternary ammonium-based coating was applied homogeneously and non-covalently to hospital curtains. Abrasion, durability testing, and aging resulted in little change in the performance of the treated textile. Additionally, qualitative and quantitative antibacterial assays on Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumanii revealed excellent antibacterial activity with a CFU reduction of 98-100% within only 4 h of exposure. The treated curtain was aged 6 months before testing. Similarly, the antiviral activity tested according to ISO-18184 with murine hepatitis virus (MHV) showed > 99% viral reduction with the functionalized curtain. Also, the released active compounds of the coating 24 ± 5 µg mL-1 revealed no acute in vitro skin toxicity (IC50: 95 µg mL-1) and skin sensitization. This study emphasizes the potential of safe and sustainable metal-free textile coatings for the rapid antiviral and antibacterial functionalization of textiles.

Release and toxicity assessment of carbon nanomaterial reinforced polymers during the use and end-of-life phases: A comparative review

The research on carbon-based nanomaterial (C-NM) composites has increased in the last two decades. This family of functional materials shows outstanding mechanical, thermal and electrical properties, and are being used in a variety of applications. An important challenge remains before C-NM can be fully integrated in our production industries and our lives: to assess the release of debris during production, use, and misuse of composites and the effect they may have on the environment and on human health. During their lifecycle, composites materials can be subjected to a variety of stresses which may release particles from the macroscopic range to the nanoscale. In this review, the release of debris due to abrasion, weathering and combustion as well as their toxicity is evaluated for the three most used C-NM: Carbon Black, Carbon Nanotubes and Graphene-related materials. The goal is to stimulate a Safe-By-Design approach by guiding the selection of carbon nano-fillers for specific applications based of safety and performance.

Advanced and Smart Textiles during and after the COVID-19 Pandemic: Issues, Challenges, and Innovations

The COVID-19 pandemic has hugely affected the textile and apparel industry. Besides the negative impact due to supply chain disruptions, drop in demand, liquidity problems, and overstocking, this pandemic was found to be a window of opportunity since it accelerated the ongoing digitalization trends and the use of functional materials in the textile industry. This review paper covers the development of smart and advanced textiles that emerged as a response to the outbreak of SARS-CoV-2. We extensively cover the advancements in developing smart textiles that enable monitoring and sensing through electrospun nanofibers and nanogenerators. Additionally, we focus on improving medical textiles mainly through enhanced antiviral capabilities, which play a crucial role in pandemic prevention, protection, and control. We summarize the challenges that arise from personal protective equipment (PPE) disposal and finally give an overview of new smart textile-based products that emerged in the markets related to the control and spread reduction of SARS-CoV-2.

Cellular and molecular features related to exceptional therapy response and extreme long-term survival in glioblastoma

Glioblastoma Multiforme (GBM) remains the most common malignant primary brain tumor with a dismal prognosis that rarely exceeds beyond 2 years despite extensive therapy, which consists of maximal safe surgical resection, radiotherapy, and/or chemotherapy. Recently, it has become clear that GBM is not one homogeneous entity and that both intra-and intertumoral heterogeneity contributes significantly to differences in tumoral behavior which may consequently be responsible for differences in survival. Strikingly and in spite of its dismal prognosis, small fractions of GBM patients seem to display extremely long survival, defined as surviving over 10 years after diagnosis, compared to the large majority of patients. Although the underlying mechanisms for this peculiarity remain largely unknown, emerging data suggest that still poorly characterized both cellular and molecular factors of the tumor microenvironment and their interplay probably play an important role. We hereby give an extensive overview of what is yet known about these cellular and molecular features shaping extreme long survival in GBM.

P01.09.A Prevalence and predictors of cognitive impairment in adult glioma survivors after multimodal therapy

Background

Long-term survival can be achieved in an increasing number of glioma patients after treatment. Therefore, safeguarding these survivors’ quality of life (QoL) is essential. Neurocognitive decline arises in many young patients, placing a heavy burden on the social and economic aspects of the patients’ lives. A lot of debate is currently ongoing regarding the prevalence of neurocognitive impairment and individual predictors of whom is susceptible for such side effect.

Material and Methods

In this cross-sectional study, 37 WHO grade 2-3 adult glioma survivors, at least one year after multimodal therapy, were tested using a comprehensive neurocognitive test battery covering multiple cognitive domains. Neurocognitive test scores were converted into z-scores using country-specific normative data. Cognitive impairment was defined as a z-score lower or equal to -1.50 for each subtest. Age, time since multimodal therapy, radiotherapy treatment and tumour location were included as predictors in a linear regression model per outcome (n=12).

Results

In this cohort, 29 patients (78%) showed a test score below the predefined cutoff on at least one cognitive test. The percentage of patients who showed test-specific cognitive impairment ranged from 8.1% to 56.76% per test. Fine motor skills, verbal memory, processing speed and executive functioning were the most commonly affected cognitive domains. In this study, the variability in processing speed performance was associated with age (TMT A, p=0.03), time since therapy (WAIS-IV coding, p=0.02) and tumour location. In these measures, poorer outcomes were observed with increasing age, longer time since therapy and in patients with gliomas located in the left frontal lobe. Moreover, age showed to be a significant predictor of verbal memory, with poorer outcomes on the HVLT-R delayed recall task with increasing age (p=0.04). Tumour location predicted working memory performance, as patients with right parietal tumours (p=0.03) showed significantly worse on the WAIS-IV digit span task.

Conclusion

These preliminary data underline the various alterations of neurocognitive functioning in glioma survivors after multimodal therapy. Therefore, future research needs to shift towards a patient-tailored approach. The next step in this study will be to link these neurocognitive data to advanced neuroimaging data to explore the potential predictive value of imaging markers for neural damage and cognitive outcomes, paving the path to innovative treatment planning techniques.

Community Masks - from an Emergency Solution to an Innovation Booster for the Textile Industry

The COVID-19 pandemic resulted in shortages of personal protective equipment and medical devices in the initial phase. Agile small and medium-sized enterprises from regional textile industries reacted quickly. They delivered alternative products such as textile-based community masks in collaboration with industrial partners and research institutes from various sectors. The current mask materials and designs were further improved by integrating textiles with antiviral and antimicrobial properties and enhanced protection and comfort by novel textile/membrane combinations, key factors to increase the acceptance and compliance of mask wearing. The innocuity and sustainability of masks, as well as taking into account particular needs of vulnerable persons in our society, are new fields for textile-based innovations. These innovations developed for the next generation of facemasks have a high adaptability to other product segments, which make textiles an attractive material for hygienic applications and beyond.

Features of durable response and treatment efficacy for capecitabine monotherapy in advanced breast cancer: real-world evidence from a large single-centre cohort

PURPOSE

In metastatic breast cancer (MBC) population treated with capecitabine monotherapy, we investigated clinical-pathological features as possible biomarkers for the oncological outcome.

METHODS

Retrospective study of consecutive MBC patients treated at University Hospitals Leuven starting capecitabine between 1999 and 2017. The primary endpoint was the durable response (DR), defined as non-progressive disease for > 52 weeks. Other main endpoints were objective response rate (ORR), time to progression (TTP) and overall survival (OS).

RESULTS

We included 506 patients; mean age at primary breast cancer diagnosis was 51.2 years; 18.2% had de novo MBC; 98.8% were pre-treated with taxanes and/or anthracycline. DR was reached in 11.6%. Patients with DR, as compared to those without DR, were more likely oestrogen receptor (ER) positive (91.5% vs. 76.8%, p = 0.010) at first diagnosis, had a lower incidence of lymph node (LN) involvement (35.6% vs. 49.9%, p = 0.039) before starting capecitabine, were more likely to present with metastases limited to ≤ 2 involved sites (54.2% vs. 38.5%, p = 0.020) and time from metastasis to start of capecitabine was longer (mean 3.5 vs. 2.7 years, p = 0.020). ORR was 22%. Median TTP and OS were 28 and 58 weeks, respectively. In multivariate analysis (only performed for TTP), ER positivity (hazard ratio (HR) = 0.529, p < 0.0001), HER2 negativity (HR = 0.582, p = 0.024), absence of LN (HR = 0.751, p = 0.008) and liver involvement (HR = 0.746, p = 0.013), older age at capecitabine start (HR = 0.925, p < 0.0001) and younger age at diagnosis of MBC (HR = 0.935, p = 0.001) were significant features of longer TTP.

CONCLUSION

Our data display relevant clinical-pathological features associated with DR and TTP in patients receiving capecitabine monotherapy for MBC.

OS10.6 Infigratinib (BGJ398) in patients with recurrent gliomas with fibroblast growth factor receptor (FGFR) alterations: a multicenter phase II study

BACKGROUND

FGFR mutations and translocations occur in approximately 10% of glioblastomas (GBMs). FGFR3-TACC3 fusion has been reported as predictive of response to FGFR tyrosine kinase inhibitor therapy both pre-clinically and clinically. Infigratinib (BGJ398) is a selective small-molecule pan-FGFR kinase inhibitor that has demonstrated anti-tumor activity in several solid tumors with FGFR genetic alterations. Therefore, we conducted a phase II trial to test the efficacy of infigratinib in FGFR-altered recurrent GBM (NCT01975701).

METHODS

This open-label trial accrued adults with recurrent high-grade gliomas following failure of initial therapy that harbored FGFR1-TACC1 or FGFR3-TACC3 fusions; activating mutations in FGFR1, 2 or 3; or FGFR1, 2, 3, or 4 amplification. Oral infigratinib was administered 125 mg on days 1–21 every 28 days. Prophylaxis for hyperphosphatemia, a common toxicity, was recommended. The primary endpoint was the 6-month progression-free survival (6mPFS) rate by RANO (locally assessed, estimated by K-M method), with a goal of >40%.

RESULTS

As of the Sep 2017 data cut-off, 26 patients (16 men, 10 women; median age 55 years, range 20–76 years; 50% with ≥2 prior regimens) were treated, and 24 (92.3%) discontinued for disease progression (n=21) or other reasons (n=3). All patients had FGFR1 or FGFR3 gene alterations, and 4 had >1 gene alteration. The estimated 6mPFS rate was 16% (95% CI 5.0–32.5%); median PFS was 1.7 months (95% CI 1.1–2.8 months); median OS was 6.7 months (95% CI 4.2–11.7 months); ORR was 7.7% (95% CI 1.0–25.1%). The best overall response was: partial response 7.7% (FGFR1 mutation n=1; FGFR3 amplification n=1); stable disease 26.9%; progressive disease 50.0%; missing/unknown 15.3%. The most common (>15%) all-grade treatment-related adverse events (AEs) were hyperphosphatemia, fatigue, diarrhea, hyperlipasemia, and stomatitis. There were no grade 4 treatment-related AEs. Eleven patients (42.3%) had treatment-related AEs requiring dose interruptions or reductions (most commonly hyperphosphatemia).

CONCLUSIONS

Infigratinib induced partial response or stable disease in approximately one-third of patients with recurrent GBM and/or other glioma subtypes harboring FGFR alterations. Most AEs were reversible and manageable. Further potential combinations are being explored in patients with proven FGFR-TACC fusion genes and analysis of biomarker data is ongoing.

P11.08 Defining EGFR amplification status for clinical trial inclusion

BACKGROUND

Precision medicine trials targeting the epidermal growth factor receptor (EGFR) in glioblastoma patients require selection for EGFR-amplified tumors. However, there is currently no golden standard in determining the amplification status of EGFR or EGFRvIII expression. Here, we aimed to determine which technique and which cut-offs are suitable to determine EGFR amplification status.

MATERIAL AND METHODS

We compared fluorescent in-situ hybridization (FISH) and RT-qPCR data from patients screened for trial inclusion into the Intellance 2 clinical trial, with data from a panel-based next generation sequencing (NGS) platform (both DNA and RNA).

RESULTS

By using data from >1000 samples, we show which cut-offs are optimal to determine EGFR gene amplification by FISH. Our data also show that gene amplification (as determined by FISH) correlates with EGFR expression levels (as determined by RT-qPCR) with ROC analysis showing an under the curve area of up to 0.902. EGFR expression as assessed by RT-qPCR therefore may function as a surrogate marker for EGFR amplification. Our NGS data shows that EGFR copy numbers can strongly vary between tumors with levels ranging from 2 to more than 100 copies per cell. Levels exceeding 5 gene copies can be used to define EGFR-amplification by NGS; below this level FISH detects very few (if any) EGFR amplified nuclei and none of the samples express EGFRvIII.

CONCLUSION

Our data from central laboratories and diagnostic sequencing facilities, using material from patients eligible for clinical trial inclusion, help defining the optimal cut-off for various techniques to determine EGFR amplification for diagnostic purposes.

Early integrated palliative care in chronic heart failure and chronic obstructive pulmonary disease: protocol of a feasibility before-after intervention study

Background

Patients with chronic heart failure (CHF) and patients with chronic obstructive pulmonary disease (COPD) are amenable to integrated palliative care (PC); however, despite the recommendation by various healthcare organizations, these patients have limited access to integrated PC services. In this study, we present the protocol of a feasibility prospective study that aims to explore if an “early integrated PC” intervention can be performed in an acute setting (cardiology and pulmonology wards) and whether it will have an effect on (i) the satisfaction of care and (ii) the quality of life and the level of symptom control of CHF/COPD patients and their informal caregivers.

Methods

A before-after intervention study with three phases, (i) baseline phase where the control group receives standard care, (ii) training phase where the personnel is trained on the application of the intervention, and (iii) intervention phase where the intervention is applied, will be carried out in cardiology and pulmonology wards in the University Hospital Leuven for patients with advanced CHF/COPD and their informal caregivers. Eligible patients (both control and intervention group) and their informal caregivers will be asked to complete the Palliative Outcome Scale, the CANHELP Lite, and the Advance Care Planning Questionnaire at the inclusion moment and 3 months after hospital discharge.

Discussion

The present study will assess the feasibility of carrying out PC-focused studies in acute wards for CHF/COPD patients and draw lessons for the further integration of PC alongside standard treatment. Further, it will measure the quality of life and quality of care of patients and thus shed light on the care needs of this population. Finally, it will evaluate the potential efficacy of the “early integrated palliative care” by comparing against existing practices.

Trial registration

Current Controlled Trials ISRCTN24796028 (date of registration August 30, 2018).

Professionals' perceptions and current practices of integrated palliative care in chronic heart failure and chronic obstructive pulmonary disease: a qualitative study in Belgium

Background

Patients with Chronic Heart Failure (CHF) and patients with Chronic Obstructive Pulmonary Disease (COPD) share similar symptom burden with cancer patients, however, they are unlikely to receive palliative care (PC) services. This article examines the perceptions of health care professionals and the current practices of integrated palliative care (IPC) in Belgium.

Methods

Cardiologists and pulmonologists, working in primary care hospitals in Belgium, participated in this study with semi-structured interviews based on IPC indicators. One researcher collected, transcribed verbatim the interviews and carried out their thematic analysis. To increase the reliability of the coding, a second researcher coded a random 30% of the interviews.

Results

A total of 22 CHF/COPD specialists participated in the study. The results show that IPC and its potential benefits are viewed positively. A number of IPC components like the holistic approach (physical, psychological, social, spiritual aspects) via multidisciplinary teams, prognosis discussion and illness limitations, patient goals assessment, continuous goal adjustment, reduction of suffering and advanced care planning are partially implemented in several health centers. However, PC specialists are absent from such implementations and PC is still an end-of-life care.

Conclusions

Misconceptions about PC and its association to death and end-of-life appear to be decisive factors for the exclusion of PC specialists and the late initiation of PC itself. The implementation of IPC components is not associated to PC, and as such, leads to suboptimal results. Improved education and enhanced communication is expected to alleviate existing challenges and thus improve the quality of life for the patients.

Medullary thyroid cancer: prognostic factors for survival and recurrence, recommendations for the extent of lymph node dissection and for surgical therapy in recurrent disease

BACKGROUND

We reviewed our experience with MTC (medullary thyroid cancer), focusing on recurrence and survival, recommendations for the extent of lymph node (LN) dissection and surgery for recurrent disease.

METHODS

Of 51 MTC patients treated between 1988 and 2008 at the University Hospitals Leuven, 38 previously untreated patients were analysed.

RESULTS

Overall and disease-specific (DSS) five-year survival rates were 75% and 82%. Variables univariately associated with DSS were age, pN, stage, vascular invasion, pre-operative recurrent laryngeal nerve function and last calcitonin level. Recurrence occurred in 10 patients (26%). For recurrence, age was no longer a prognostic factor and post-operative calcitonin, number of positive LN and of positive compartments proved to be prognostic factors. Of 21 clinical NO patients, 2 out of 6 (33%) undergoing a prophylactic central neck dissection (ND) based on per-operative palpatory suspicion proved pN+, and 2 out of 9 patients (22%) undergoing a prophylactic lateral ND were pN+. Five patients surgically treated for recurrence did not achieve long-term normalisation of calcitonin, but remained alive with locoregional control.

CONCLUSION

Overall survival and DSS rates are within the range reported in the literature. The results confirm that (1) total thyroidectomy and central compartment dissection is the treatment of choice in the cN0 patients, (2) additional ipsilateral lateral ND is needed for cN+ disease in the ipsilateral lateral compartment, and (3) in the clinically uninvolved contralateral lateral neck, per-operative inspection should serve as a basis for a decision about further ND. Locoregional control and prolonged survival is achieved in surgically treated locoregionally recurrent MTC.

P5-14-24: The Long Term Prognostic Impact of Real-Time Quantitative RT-PCR Detection of Cytokeratin 19 mRNA in Preoperative Bone Marrow Aspirates of Early Breast Cancer Patients

Purpose: Several studies have evaluated the prognostic effect of bone marrow micrometastases at the time of surgery in early breast cancer, but few studies have long term outcome data. We report here a cohort with more than ten years follow-up.

Materials and methods: 131 patients with primary operable invasive breast cancer were enrolled in the protocol from February 1998 to September 1999. Bone marrow aspirates, obtained from the iliac crest or the sternum, were analyzed with real-time quantitative reverse-transcription polymerase chain reaction (RT-PCR) for the presence of cytokeratin 19 (CK19) mRNA. All patients received standard therapy and follow-up. After a median follow-up of 133 months, data about disease recurrence (invasive disease free survival, IDFS) and survival (breast cancer specific survival (BCSS) and overall survival (OS)) were collected. A control group consisted of archived cDNA samples from 38 patients with hematological malignant antecedents in complete remission and without known gene arrangements. The upper limit of the 95% confidence interval of the level of CK19 positive cells is this group was used as cut-off (260 cytokeratin 19+ cells / 5 × 106 leucocytes) to determine bone marrow status in breast cancer patients.

Results: 69 bone marrow samples from breast cancer patients (52,7 %) were considered CK19 positive. IDFS was 60.9 % and 79 % for CK19+ and CK19- patients, respectively (log-rank p-value = 0,036). When CK19 was evaluated as a continuous variable, IDFS also correlated significantly with the level of CK19 mRNA in bone marrow aspirates (p-value = 0,019). Except for lymph node status (ANOVA linear regression p-value = 0.022), there was no significant correlation between the level of CK19+ cells in the bone marrow and classical prognostic factors (pathological tumor stage, tumor size, differentiation grade, hormonal receptor status).

In multivariate Cox-regression analysis correcting for tumor size, differentiation grade, lymph node status, hormone receptor status, tumor stage and treatment modalities (surgical procedure, chemotherapy, radiotherapy and antihormonal therapy), the CK19 bone marrow status still was a significant predictor of IDFS. (p-value = 0.042)

Differences in BCSS (78 % of CK19 + patients and 84 % of CK19 — patients) and OS (75 % in CK 19 + patients and 74 % in CK 19 — patients) were not statistically significant. (log rank p-values 0.087 and 0.883, respectively).

Conclusion: This study demonstrates the long term (&gt;ten years) prognostic effect of CK19 mRNA detection with RT-PCR in the bone marrow of operable breast cancer patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-14-24.

Is there any relationship between nCPAP therapy and signs of sinus hyperpneumatization?

OBJECTIVES

Both nasal continuous positive airway pressure (nCPAP) therapy and nose blowing can generate high pressures in the nose and sinuses. Nose blowing generates higher pressures than nCPAP therapy, but the duration of nCPAP therapy is considerably longer than the duration of nose blowing. Therefore, nCPAP could cause bone deformation. The aim of this study was to document the influence of the pressure generated by nCPAP therapy on the structure and dimensions of the sinuses and on the nose-blowing patterns of the patients.

METHODOLOGY

The study included nine patients, who had recently been diagnosed with obstructive sleep apnea syndrome (OSAS) and had not received any previous treatment for OSAS. Before nCPAP therapy was started, they all underwent computer tomography (CT) in the prone position with sequential coronal slices followed by pressure measurements during nose blowing. After the initial measurements, nCPAP therapy commenced. All of the patients were treated with a fixed-pressure device and nasal mask for 6 mo. nCPAP therapy compliance was checked after 6 mo. At the end of the 6 mo treatment with nCPAP, coronal CT scans of the sinuses and pressure measurements during nose blowing were repeated.

RESULTS AND CONCLUSION

Although CPAP therapy provides continuous positive pressure for several hours at night, bone structure and sinus dimensions appeared to be unchanged after 6 mo of therapy. However, CPAP therapy seemed to have an effect on the nose-blowing pattern of the patients, with a significant decrease in nose blowing pressure after 6 mo of CPAP treatment.

Multicentre phase II studies evaluating imatinib plus hydroxyurea in patients with progressive glioblastoma

Background:

We evaluated the efficacy of imatinib mesylate in addition to hydroxyurea in patients with recurrent glioblastoma (GBM) who were either on or not on enzyme-inducing anti-epileptic drugs (EIAEDs).

Methods:

A total of 231 patients with GBM at first recurrence from 21 institutions in 10 countries were enrolled. All patients received 500 mg of hydroxyurea twice a day. Imatinib was administered at 600 mg per day for patients not on EIAEDs and at 500 mg twice a day if on EIAEDs. The primary end point was radiographic response rate and secondary end points were safety, progression-free survival at 6 months (PFS-6), and overall survival (OS).

Results:

The radiographic response rate after centralised review was 3.4%. Progression-free survival at 6 months and median OS were 10.6% and 26.0 weeks, respectively. Outcome did not appear to differ based on EIAED status. The most common grade 3 or greater adverse events were fatigue (7%), neutropaenia (7%), and thrombocytopaenia (7%).

Conclusions:

Imatinib in addition to hydroxyurea was well tolerated among patients with recurrent GBM but did not show clinically meaningful anti-tumour activity.

Administration of 24-hour intravenous infusions of trabectedin every 3 weeks in ambulatory patients with mesenchymal tumors via disposable elastomeric pumps

e13530

Background: Patients (pts) with sarcoma whose disease progresses after standard chemotherapy have poor outcome. In this setting, DNA- transcription-interacting cytotoxic agent trabectedin (TRA) is efficacious and marketed in Europe. It is administered as 24-h i.v. infusion q3w with steroid co-medication. To overcome the inconvenience of hospitalization for drug delivery TRA is now given in Leuven via disposable elastomeric pumps, which facilitate ambulatory treatment and are compatible with the drug. Material and Methods: Heavily pre-treated pts with sarcoma were offered chemotherapy with TRA 1.5 mg/m2 as 24-h i.v. infusion via port catheter, either during hospitalization using electronic pumps or as outpatients using the Baxter LV10 disposable pump (drug dissolved in 267 ml NaCl 0.9%). Co-medication consisted of antiemetics and dexamethasone 2x4 mg days -1,1,2,3. Results: Between 09/07–12/08 28 pts were treated, and 21 (75%) elected outpatient therapy (9 F, 12 M, med. age 49 yrs, range 19–68). Common diagnoses included leiomyo- (5), lipo- (4), synovial (2) and myxofibrosarcomas. Pts had previous primary surgery (17), adjuvant RT (4) and surgery for relapse/metastasis (7). They had local relapse (2), distant metastasis (12) or both (7) when starting TRA, 19 had received previous chemotherapy with a med. number of 2 prior lines (range, 0–5). We administered 130 cycles of TRA in 21 pts, with a med. number of 3 cycles/patient (range, 1–24). Dose reductions were done in 60 cycles, mainly due to laborabory events. Best response (RECIST) was 3 confirmed PR, 1 PR pending confirmation, 6 SD, 11 PD. Grade 3/4 (CTC) AEs were limited to one case each of hemorrhage and lung embolism, other AEs were in line with published TRA experience. One port catheter contamination required replacement, one catheter tip thrombosis occurred and one extravasation due to needle dislocation was observed. Conclusions: Outpatient administration of TRA as 24-h infusion via port catheter using Baxter LV10 pumps is preferred by 3/4 pts, is feasible, safe, effective, cost-efficient and should be considered routine practice in this clinical setting.

[Table: see text]

Hypogonadism in male cancer patients treated with the tyrosine kinase inhibitors sunitinib (SUN) or sorafenib (SOR)

3565

Background: SUN and SOR are multi-targeted tyrosine kinase inhibitors (TKIs) inhibiting several kinases (VEGFR- 1,2; c-kit; PDGFR-α,β; flt-3; RET). SUN is approved for treatment of imatinib-resistant gastrointestinal stromal tumors (GIST) and metastatic renal cell carcinoma (RCC), SOR is used for RCC and hepatocellular carcinoma. We observed in some pts with fatigue under TKI treatment low testosterone (T) levels and started assessing the incidence and severity of gonadal dysfunction prospectively in male pts receiving these TKIs. Methods: Gonadal status (serum total testosterone (TT), free testosterone (FT), sex-hormone binding globulin (SHBG), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were evaluated in pts with RCC or GIST under SUN or SOR. SUN was given at a daily dose of 50 mg p.o. 4 weeks on, 2 weeks off, SOR at a daily oral dose of 800 mg. Results: We identified 27 pts (median age 63, range: 27–77), for which data on gonadal function were available, 23 RCC (85 %), 4 GIST (15%), with 22 (85.5%) receiving SUN and 5 (18.5%) SOR. Median treatment duration was 48 (2–202) weeks, 13 (48%) underwent dose reductions, in 4 (15%) pts due to grade 3 fatigue. All pts had at least once during TKI treatment T levels lower than normal (TT < 300 ng/dL and/or FT < 5 ng/dL), 17 (63%) had a low T with normal LH/FSH, 4 (15%) a low T with an elevated LH/FSH and 6 (22%) a low T and elevated FSH, but normal LH. The median TT level in the whole group was 194 ng/dL (21–477, normal range: 300–1,000 ng/dL), the median FT level in the whole group was 4.01 (0.45–9.07, normal range: 5–20 ng/dL). In the SUN cohort the median levels for TT and FT were slightly lower on day 28 in comparison to day 1 (184.5 vs 206 ng/dL for TT and 3.935 vs 4.225 ng/dl for FT). Pts with information available on testosterone at baseline (n = 8) tended to have slightly diminished baseline T levels (median: 222.5 [61–319] ng/dL), but 50% of these pts had been treated with other TKIs before. Two pts with grade 3 fatigue under SUN had very low T levels shortly after starting SUN (21 and 28 ng/dL, respectively). Conclusions: We observed a high incidence of hypogonadism in male RCC and GIST pts under treatment with SUN or SOR. Hypogonadism may likely contribute to the fatigue associated with these agents.

[Table: see text]

[Long-term results of facial palsy's rehabilitation by end-to-end hypoglossal-facial anastomosis]

OBJECTIVE OF THE STUDY

To evaluate the long term functional and esthetical results of the patients who underwent a facial palsy rehabilitation surgery by a hypoglossal-facial anastomosis.

PATIENTS AND METHODS

In this retrospective study, 11 patients (8 males and 3 females) with a complete facial palsy (grade VI House-Brackmann) due to an otoneurosurgery performed between 1985 and 2006 (6 vestibular schwannomas, 1 facial schwannoma of the geniculate ganglion and 4 meningiomas) were evaluated (with the help of an auto-questionnary, a physical exam and electromyography) between July and september in 2008.

RESULTS

The voluntary palpebral closure was obtained in 8 cases out 11 (grade III of House-Brackmann). The lingual hemiatrophy was constant. It was major for the patients who didn't take part in a specific re-education. In these cases patients had troubles during feeding and elocution.

CONCLUSION

The hypoglossal-facial is a dynamic surgical rehabilitation of choice for the facial palsy. It nearly achived 80% of good palpebral results. The end-to-end anastomosis gives a lingual hemiatrophy which is not the case with a side to end anastomosis. This atrophy can be reduced with an intensive and specific reeducation. Moreover this re-education improves the functionnal and the esthetical results for the patients who underwent an hypoglossal-facial anastomosis. This lingual hemiatrophy was then responsible for troubles for feeding and elocution.

[Cat scratch disease: a diagnosis to be aware of!]

Subacute cervical lymphadenopathy among young adults may be of an infectious or malignant aetiology. We report two cases of young males with chronic cervical lymphadenopathy. A diagnosis of Cat scratch disease (CSD) was made by serological and molecular studies. CSD is one of the most frequent infectious lymphadenopathies among young people. Diagnosis of CSD is dependent on clinical, epidemiological, molecular and histological criteria. The detection of antibodies to Bartonella Henselae and the amplification of its DNA by Polymerase Chain Reaction (PCR) are the two main methods of laboratory diagnosis. The evolution of CSD is usually benign; however therapeutic management remains problematic, particularly in atypical forms.

Randomized phase II trial of erlotinib (E) versus temozolomide (TMZ) or BCNU in recurrent glioblastoma multiforme (GBM): EORTC 26034

2005

Background: In 40–50% of GBM epidermal growth factor receptor (EGFR) is amplified, and often constitutively activated (EGFRvIII mutant). EGFR is therefore a potential therapeutic target. Previous studies suggested activity of EGFR tyrosine-kinase inhibitors in recurrent GBM, particularly in specific molecular subsets. This study explored erlotinib (E) activity in recurrent GBM. Methods: Randomized phase II trial. Eligibility criteria: histologically proven GBM, recurrent >3 months after radiotherapy, Karnofsky performance status (KPS) =70, no prior chemotherapy for recurrent disease, tissue sample for EGFR studies. Patients (pts) received E 150mg/day (300mg/day if on enzyme inducing anti-epileptic drugs [EIAEDs]), or control (TMZ 150–200mg/m2, day 1–5 q4wk or BCNU 60–80mg/m2 i.v., day 1–3 q8wk). If no significant toxicity, E was escalated to 200mg (500mg in patients on EIAEDs). The primary endpoint was 6 months’ PFS in =10/50 pts on E (20%); P0 was set at 15%, and P1 at 30%. Response was assessed with Macdonald’s criteria. EGFR amplification (FISH) and expression of EGFR, EGFRvIII and PTEN (immunohistochemistry [IHC]) were assessed. Results: 110 patients were randomized (54 E, 56 control: 27 TMZ; 29 BCNU). Median age 55 years; median KPS 90. All but 1 patient started treatment; median number of cycles was 2 for E, 4 for TMZ and 1 for BCNU. Grade 3/4 toxicities likely related to E: dermatological (5); hemorrhage (1). Grade 3/4 toxicities for control were mainly hematological (3 TMZ, 13 BCNU). Three pts discontinued E due to toxicity. Six-month PFS was 12% for E, 24% for control. Six and 12-month survival were 61% and 24% for E, and 63% and 26% for control. Two responses were seen on control; the best response on E was SD (n=6). Patients with EGFRvIII mutations (13 in E arm, 8 in control arm) had shorter PFS (p=0.007) and OS (p=0.004) regardless of treatment. Response to E was not correlated with EGFR expression, EGFR amplification or EGFRvIII mutation. Conclusions: This randomized, controlled phase II study did not find sufficient activity for erlotinib in the general population of recurrent GBM. The presence of EGFRvIII mutations was not predictive for response.

No significant financial relationships to disclose.

Phase I/IIa trial of cilengitide (EMD121974) and temozolomide with concomitant radiotherapy, followed by temozolomide and cilengitide maintenance therapy in patients (pts) with newly diagnosed glioblastoma (GBM)

2000

Background: To evaluate safety, toxicity, and efficacy of the combination of the cyclic RGD pentapeptide cilengitide (EMD121974), an inhibitor of integrins avβ3 and avβ5, in addition to standard temozolomide (TMZ) and radiotherapy (RT). Methods: 52 pts (PS 0–1: 92%, 2: 8%; median age 57 yrs) after tumor resection (n=43/83%) or biopsy (n= 9/17%) were treated with standard TMZ/RT (Stupp et al. NEJM 2005). In addition cilengitide (500 mg i.v., 2x/week) was started one week before TMZ/RT and given throughout for the duration of chemotherapy or until progression. The primary endpoint was progression free survival rate at 6 months (target: 65%). Pts were followed with MRI every 2 months. Histopathologic diagnosis and MRI imaging were independently reviewed, O6-Methylguanine- DNA methyltransferase (MGMT) promotor methylation status was assessed in 45 (86.5%) pts. Results: 46 pts (92%) completed RT, = 90% of concomitant TMZ was received by 42 pts and cilengitide by 45 pts. 20 pts (3 ongoing) completed 6 cycles of maintenance TMZ and cilengitide. Observed hematological grade 3 and 4 toxicities were: lymphopenia (28/52, 53.8%), thrombocytopenia (7/52 pt. 13.4%) and neutropenia (5/52, 9.6%). Treatment related non-hematologic grade 3/4 toxicities were reported for n=3/52 (5.7%) patients: constitutional symptoms (asthenia, fatigue, anorexia, n=3); elevated liver function tests (n=1), deep venous thrombosis and pulmonary embolism (n=1). One patient with a history of sigmoid diverticulosis experienced sigmoid perforation (grade 2). In total, 34/52 (65.4% [95% CI, 50.9–78.0%]) of the pts were progression free at 6 months. Pts with MGMT gene-promotor methylation in the tumor were more likely to reach 6 months PFS endpoint. Conclusions: The study reached its primary endpoint. The combination of the integrin inhibitor RGD peptide Cilengitide and TMZ/RT was well tolerated, PFS at 6 months is encouraging. MGMT gene promoter methylation correlates with outcome. At the time of ASCO, updated results and survival estimates after a minimum follow-up of at least 1 year will be available.

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Analysis of paranasal sinus development and anatomical variations: a CT genetic study in twins

OBJECTIVE

To determine if anatomical variations in the paranasal sinuses of twins are the result of genetic or environmental influences.

STUDY DESIGN

A prospective, observational study.

SETTING

An academic hospital in Brussels, Belgium.

PARTICIPANTS

Twenty-five volunteer twins (17 identical twins and eight non-identical twins). Of the identical twins, six were both female and 11 both male. The mean age was 40.6 years (18-49). Of the non-identical twins, one pair was female and seven were male. The mean age was 39.6 years (25-48).

MAIN OUTCOME MEASURES

The CT-scan similarity in anatomical structures (frontal cells, agger nasi cells, concha bullosa, infraorbital cells and changes in the shape of the lamina orbitalis), and the intranasal and paranasal sinus morphology was compared between the twins.

RESULTS

Among the studied variables, there was no statistically significant difference between the two twin groups (Fisher's exact test, P > 0.05). Regarding combine-studied parameters, there were no identical CT scans in the twins. However, a tendency of non-genetic influence existed in the development of frontal cell type III and IV, and infraorbital cells, as well as a liability of genetic influence in the presence of concha bullosa.

CONCLUSION

In this study, the differences in anatomical structure of the paranasal sinuses between identical and non-identical twin pairs were not statistically significant. This indicates that environmental factors are more significant than genetic ones in the development of anatomical variations in paranasal sinus anatomy.

The effect of MK-0524, a prostaglandin D2 receptor antagonist, on prostaglandin D2-induced nasal airway obstruction in healthy volunteers

INTRODUCTION

Nasal congestion in allergic rhinitis results from tissue edema and vasodilatation in the nasal mucosa. Of the mediators released by mast cells in response to allergens, prostaglandin (PG) D(2) is regarded as the most potent inducer of nasal congestion. Intranasal administration of PGD(2) reproduces the nasal blockade experienced by patients with seasonal allergic rhinitis (SAR) via its action on the PGD(2) (DP) receptor to induce nasal vasodilatation. Intranasal challenge with PGD(2) can be a useful tool for evaluating DP-receptor antagonists.

OBJECTIVE

The main purpose of this study was to examine the ability of MK-0524, a DP receptor antagonist in development for the treatment of SAR, to block PGD(2) induced nasal congestion in healthy volunteers.

METHODS

To this end, a double-blind, placebo-controlled, randomized, 3-period study was performed in 15 healthy subjects. During each period, subjects received MK-0524 25 mg, MK-0524 100 mg or placebo qd for 3 days. Twenty-four hours following the last dose, nasal provocations with PGD(2) were performed to determine the PD(75), which is the intranasal dose of PGD(2) that provokes a 75% increase in baseline total nasal airway resistance as performed by active anterior rhinomanometry.

RESULTS

Following treatment with MK-0524, the PD(75) (mean+/-SD) was significantly shifted from 15.8 +/- 18.3 mug/nostril during the placebo period to more than 512 mug/nostril both following the 25- and 100-mg (maximum challenge dose tested) dose regimen.

CONCLUSION

Whether this >45 fold increase in PD(75) will induce a clinically meaningful effect of MK-0524 will require clinical study in participants with SAR.

Emerging role of tyrosine kinase inhibitors in the treatment of advanced renal cell cancer: a review

Advanced and metastatic renal cell cancer (RCC) is resistant to conventional chemotherapy. Only a very small number of patients survive long term after immunotherapy. However, any effect of interleukin-2 (IL-2) and/or interferon on median overall survival is small, and treatment-associated toxicities may be severe. The disease is therefore an area of high unmet medical need. Activation of the VEGF and EGF/RAS/RAF/MAP kinase pathways is frequent in solid tumours such as RCC. Such activation is implicated in tumour angiogenesis and proliferation. VEGF and EGF receptors and molecules (such as RAF kinase) involved in downstream signalling are therefore potential appropriate targets for drug therapy. Several antibodies and low molecular weight tyrosine kinase inhibitors (TKIs) have completed phase II clinical trials. Phase II studies of multitargeted agents, which include inhibition of VEGFR tyrosine kinase in their repertoire (sorafenib, sunitinib and AG 013736), show clear second-line activity in metastatic RCC. The same is true of the anti-VEGF antibody, bevacizumab. In a randomised phase III comparison against placebo in pretreated patients, sorafenib doubled median progression free survival (24 versus 12 weeks). Studies now in progress will determine whether benefits seen second-line will also be evident first-line, and whether the activity of novel agents can be increased by combining them with each other, with cytokines, or with chemotherapy.

A single institution retrospective analysis of basosquamous carcinoma of the head and neck

15530

Background: Basosquamous Cell Carcinoma (BSCC) of the larynx, hypopharynx and base of tongue represents 1% of all head and neck tumours. It is considered a more aggressive disease than squamous cell carcinoma, based on higher incidence of advanced stage disease (60% lymph node-involvement and 40% metastases at diagnosis). Therefore, a treatment regimen including chemotherapy is often recommended in addition to surgery and/or radiotherapy in the literature. Methods: We retrospectively analyzed the data of all patients diagnosed with BSCC of the head and neck at the University Hospital of Leuven between 1993 and 2003, and report here the stage at diagnosis, treatment modality, disease evolution, progression free and overall survival. Results: Seven patients where diagnosed with BSCC in the head and neck region. Six patients were male. Three of the tumours were localised in the larynx, two at the base of tongue, and two in the oral cavity. The AJCC stages of disease ranged from I to IVa. Three patients had lymph node involvement at diagnosis. Six patients were treated with surgery in combination with radiotherapy. One patient was treated with cryotherapy before brachytherapy was applied. Five patients have no evidence of disease with a follow up of 4, 5, 6, 10 and 11 years, respectively. One patient died of an unknown cause 18 months after treatment. Only one of the seven patients, developed metastases during follow up. This patient had BSCC of the base of tongue, and was diagnosed with lungmetastases 16 months after surgery and radiotherapy. He was treated with the combination of Doxorubicine, Cisplatin and Fluorouracil. A partial response was confirmed after six cycles. Eight months after the last treatment cycle, there is still no evidence of disease progression. Conclusions: BSCC is a rare tumour of the head and neck. Seven patients were treated at the University hospital of Leuven in the period between 1993 and 2003 with a median progression free and overall survival of more than 5 years. Only one patient developed metastases, and was consequently treated with chemotherapy, inducing a continuing partial remission 8 months after treatment. In contrast to what is reported in the literature we do not confirm a high incidence of metastases at diagnosis nor a high mortality rate.

No significant financial relationships to disclose.

Intrahepatic mitomycin C as treatment of breast cancer hepatic metastasis

10690

Background: Because of increasing survival due to improving systemic treatment, liver metastasis represents a major and increasing cause of death in women with metastatic breast cancer. Regional treatment is an attractive option in the treatment of liver metastases. We reviewed the tolerability and efficacy of intrahepatic administration of mitomycin C (MMC) performed in our institution. Patients with only or predominant liver metastasis were eligible, independent of previous chemotherapy for metastatic breast cancer. Methods: In a unicentric protocol we reviewed retrospectively all patients (n = 11) who received intrahepatic MMC for liver metastasis of breast cancer between January 2000 and July 2005 in the University Hospital Leuven. MMC was administered as a bolus of 6 mg in 50 ml saline directly into the right and left hepatic arteries by transcatheter technique. The procedure was performed by an interventional radiologist. Patients were hospitalised for 24 hours. In patients with severe liver function disturbances or more than six administrations of MMC a dose reduction was applied. Results: All treated patients were reviewed. The median age was 52 years (range, 36–61). Most patients were heavily pre-treated with a median of 4 systemic chemotherapy regimens (range, 1–5). Treatment was well tolerated, no grade 3 or 4 adverse events were reported. Only one patient had persistent thrombocytopenia for which interruption of treatment was required. One patient had fatigue. There were no procedure-related complications. Six patients received only 1 or 2 administrations because of rapid disease progression within the first two months. Among the remainders, 4 patients had 6 and 1 had 11administrations. When evaluatde by RECIST criteria one patient had a complete remisson, two patients had a partial remission and 2 patients remained stable for at least 6 months. Conclusions: In this retrospective analysis intrahepatic administration of MMC was well tolerated and provided clincal benefit (respons or at least disease stabilization for 6 months) in 45% of heavily pre-treated patients. This treatment represents a valid therapeutic option for patients with predominant liver metastases of breast cancer after failure of standard systemic treatment.

No significant financial relationships to disclose.

Comparison of decongestive capacity of xylometazoline and pseudoephedrine with rhinomanometry and MRI

Topical and systemic sympathicomimetics have been used for many years as a treatment of nasal congestion in diseases such as coryza and sinusitis. The aim of this study was to perform an objective measurement of the decongestive capacity of topical xylometazoline and oral pseudoephedrine in normal subjects and patients with chronic sinusitis. Ten healthy subjects and 10 patients with chronic sinusitis were included in this study. Xylometazoline (0.1%) and pseudoephedrine (120 mg) were each administered to 5 healthy subjects and to 5 patients with chronic sinusitis. Decongestion was measured with active anterior rhinomanometry before, 15 minutes, 30 minutes and 1, 2, 4, 6 and 8 hours after administration. Before and about 90 minutes after drug administration a MRI was performed to visualize the decongestive effect on the turbinates and the mucosa of the sinuses. Xylometazoline reduces the nasal airway resistance for an average 37.3% in all patients and healthy subjects during 8 hours. Pseudoephedrine does not show a clear and long lasting decongestive effect on the turbinates. Important interindividual differences are also noted. MRI clearly shows a clear cut superiority of xylometazoline over pseudoephedrine concerning decongestion of the nasal mucosa. However, there was no decongestive effect whatsoever on the mucosa of the sinuses with either sympathicomimetic.

International Consensus on Nasal Polyposis 2002–2004

Seventeen well-known experts in rhinosinusology from various countries tried to achieve consensus on the etiology, conservative approach and surgical approach to nasal polyposis. A Digi-Vote electronic system was used for an immediate computer analysis of expert answers to 23 questions related to the problem of nasal polyposis.

Array comparative genomic hybridization profiling of first-trimester spontaneous abortions that fail to growin vitro

OBJECTIVES

Cytogenetic analysis of spontaneous abortion samples can be limited by culture failure. Failure to grow in vitro has traditionally been suspected to be due to in vivo death of tissue associated with spontaneous abortion (SAB) or simply technical factors of growth in culture.

METHOD

We used array comparative genomic hybridization (array CGH) to investigate chromosomal imbalances in products of conception that failed to grow in vitro.

RESULTS

Our data on 26 cases of SABs that failed to grow in culture are compared and contrasted with published data on cytogenetic findings following in vitro culture. The results revealed abnormalities uncommonly seen by classic cytogenetic methods. These abnormalities include high rates of double aneuploidy and autosomal monosomy. The data taken together suggest that classic cytogenetics of spontaneous abortion may yield normal karyotypes or selected abnormal karyotypes that permit cell proliferation in vitro while Array CGH detects other abnormalities.

CONCLUSION

Array CGH is becoming an important clinical assay for unbalanced chromosome abnormalities whether cells grow in culture or not and in cases of analysis on one or few cells.