Participation in research improves overall patient management: insights from the Global Rheumatic Heart Disease registry (REMEDY)

Background

Rheumatic heart disease (RHD) is a major public health problem in low– and middle–income countries (LMICs), with a paucity of high–quality trial data to improve patient outcomes. Investigators felt that involvement in a recent large, observational RHD study impacted positively on their practice, but this was poorly defined.

Aim

The purpose of this study was to document the experience of investigators and research team members from LMICs who participated in a prospective, multi–centre study, the global Rheumatic Heart Disease Registry (REMEDY), conducted in 25 centres in 14 countries from 2010 to 2012.

Methods

We conducted an online survey of site personnel to identify and quantify their experiences. Telephone interviews were conducted with a subset of respondents to gather additional qualitative data. We asked about their experiences, positive and negative, and about any changes in RHD management practices resulting from their participation in REMEDY as a registry site.

Results

The majority of respondents in both the survey and telephone interviews indicated that participation as a registry site improved their management of RHD patients. Administrative changes included increased attention to follow–up appointments and details in patient records. Clinical changes included increased use of penicillin prophylaxis, and more frequent INR monitoring and contraceptive counselling.

Conclusions

Our study demonstrates that participation in clinical research on RHD can have a positive impact on patient management. Furthermore, REMEDY has led to increased patient awareness and improved healthcare workers’ knowledge and efficiency in caring for RHD patients.

Abstract P4-08-04: The clinical utility of oncotype Dx for patients with recurrence scores of 10 or less: A value based pathology study of tumor histopathology and outcomes analysis in an integrated delivery and finance health system

Introduction

The majority of publications regarding breast cancer GEPTs rarely supply detailed breast tumor histopathology in their outcome studies. As a result, the cost effective role of clinical risk assessment with histopathology of breast carcinomas tends to be minimized. The aims of this study are to characterize the details of breast tumor histopathology of patients with Oncotype Dx Recurrence Scores (RS) of 10 or less, and determine if Oncotype Dx offers value and clinical utility for patients with these low grade tumors

Methods

A total of 459 patients (18%) with Oncotype Dx RS of 10 or less were retrieved from a registry of 2558 patients with Oncotype Dx results. Patients had five years of follow-up with tumor registry and were treated with endocrine therapy alone. Tissue slides were available to review on 441/459 patients. Recorded details included (1) histopathologic type of carcinoma (2) mitotic score (MS), tubule formation, nuclear pleomorphism and Notttingham histologc (NG) grade. (3) Estrogen (ER) and progesterone (PgR) semiquantitated by Allred Score and Histologic Score (H Score: strong 200-300, moderate 100-199, weak <100). (4) Lymph node status. (5) overall survival and breast cancer specific survival.

Results

Patient ages were 33-92, with mean/median age of 60, and all had endocrine therapy alone. 148 of 441(34%) patients had carcinomas of “special types”, notable for low grade/good prognosis including tubular 22(15%), cribriform 15 (10.1%), papillary 17 (11.5%), and mucinous 28 (21%), along with 63 (42.5%) low grade classic lobular carcinomas and 3 (2%) low grade mixed ductal and lobular carcinomas. All 148 tumors had a MS of 1, were NG1 and had high ER HScores (280 median/263 mean) (Allred Scores 7-8) and high PR HScores (210 median/201 mean) (Allred Scores 6-8). The remaining 293 tumors were ductal carcinomas of no special type (NST), and 261/293 (89%) of these had a MS of 1/NG2. Of the remaining cases, 10 (3%) had a MS of 2/NG2, 18 (6%) had MS of 2/NG3 and four (1%) were MS3/NG3. Estrogen receptor H Score/Allred Score was strong (Allred Score 7-8) in 395/441 (89.6%), moderate in 45 (10.2%) and weak in 1 patient (0.2%). Progesterone HScores were strong in (Allred Score 6-8) 269/441 (76%) and moderate in the remainder. Strong and moderate ER comprised 99.8% of tumors. Thus, tumors with MS1, and NG1, all with ER HScore >200 (Allred Score of 7-8) were enriched in the RS <10, and these features distinguished this group from other tumors with a MS1.

At 5 years, 433 patients (98%) were alive, 8 were dead, 1 from breast cancer due to distant recurrence. The 5-year breast cancer specific survival for this group was 99.7%. [95%CI 98.5-99.9.] 87 cases were accrued in the ongoing prospective study to date. There were 15/87 (17%) cases, 95% of which were correctly identified by pathologists as having an RS <10 using the criteria defined, with sensitivity 95%, specificity 86%, PPV 63% 95% CI(49.76-75.08), NPV 99% 95% CI(90.7-99.78). No patient had a recurrence score >22.

Conclusions

Pathologists can identify these low risk tumors with high accuracy. Oncotype Dx lacks clinical value and utility in this setting.

Citation Format: Dabbs DJ, Serdy K, Onisko A, Clark BZ, Bhargava R, Smalley S, Perkins S, Brufsky AM. The clinical utility of oncotype Dx for patients with recurrence scores of 10 or less: A value based pathology study of tumor histopathology and outcomes analysis in an integrated delivery and finance health system [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-08-04.

Abstract P6-08-02: Disruption of the estradiol-regulated NTN1-UNC5A dependence receptor signaling axis causes a hybrid basal/luminal molecular phenotype in estrogen receptor-positive breast cancer cells

Luminal subtype of breast cancers that express the estrogen receptor alpha (ERα) represents approximately two-thirds of all breast cancer cases. ER+ tumors tend to have the most favorable prognoses when treated with endocrine therapy. However, a relapse or endocrine therapy resistance is often seen in ER+ breast tumors. UNC5A belongs to the dependence receptor family which can mediate two different intracellular signals: cell survival, differentiation or migration when engaged with its ligand (such as Netrin-1; NTN1) or cell death/apoptosis in the absence of the ligand. Here we demonstrate that, depending upon the cell type, UNC5A and NTN1 are estradiol (E2)-inducible genes. Using shRNA or CRISPR knockdown strategies, we show that the disruption of the NTN1-UNC5A signaling axis in ER+ (MCF7 and T-47D) cells generates a mixed basal-like/luminal phenotype with stem cell-like characteristics. RNA-seq of UNC5A knockdown cells showed deregulated expression of several E2-target genes in both cell lines. Moreover, knockdown of UNC5A resulted in increased cell proliferation, and elevated expression of the E2-inducible anti-apoptotic, BCL2. Furthermore, the expression of ΔNp63 was enhanced in UNC5A knockdown cells. ΔNp63 is a TP53 family transcription factor that promotes breast epithelial stem cell maintenance and basal-like breast cancer. Accordingly, UNC5A knockdown cells displayed cancer stem cell phenotype as evident from ~3-fold increase in the number of CD44+/CD24+, CD44+/EPCAM+ and ITGA6+/EPCAM+ subpopulation compared with control cells. In addition, the expression of NTN4, a pro-angiogenic and lymphangiogenic factor, was increased upon UNC5A knockdown. In vivo, UNC5A knockdown cells implanted in nude mice were able to form tumors in the mammary fat pad independent of E2 supplementation and were able to colonize and develop into overt metastasis in multiple organs such as lungs, ovaries and adrenal glands. Consequently, analysis of mammary fat pad tumors from animals that received UNC5A knockdown cells revealed an increased expression of PECAM1 (CD31), a marker for endothelial cells used to evaluate tumor angiogenesis. In contrast to UNC5A, knocking down NTN1, decreased the expression of BCL2 and TP63 in both cell lines. Thus, knockdown of UNC5A resulted in deregulated expression of E2-regulated genes, E2-independent and anti-estrogen-resistant growth in vitro, and E2-independent tumor formation in xenograft models. Consistent with results of in vitro studies, analysis of tissue samples from breast cancer patients (n=196) revealed that lower expression of UNC5A is associated with lower overall survival (P < 0.05). Thus, loss or mutational inactivation of UNC5A could lead to unrestricted E2:ERα signaling and anti-estrogen resistant growth while simultaneously enabling ERα-positive luminal breast cancer cells to acquire basal-like and cancer stem cell-like features.

Citation Format: Padua MB, Bhat-Nakshatri P, Anjanappa M, Hao Y, Liu Y, McElyea K, Sandusky G, Althouse S, Perkins S, Nakshatri H. Disruption of the estradiol-regulated NTN1-UNC5A dependence receptor signaling axis causes a hybrid basal/luminal molecular phenotype in estrogen receptor-positive breast cancer cells [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-08-02.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Abstract P3-08-05: The use of chemoprevention increases significantly with oncology trained providers and with application of a risk assessment model

BACKGROUND

Large clinical trials have proven the efficacy of selective estrogen receptor modulators in reducing the risk of breast cancer in high risk women. However, despite these studies the use of chemoprevention in high risk women remains low. The goal of this study was to determine in a clearly identified high risk population, the utilization rate of chemoprevention and factors that affect its use, notably, surgeon training and the Gail model.

METHODS

This was a retrospective chart review of all women diagnosed with Atypical Ductal Hyperplasia (ADH) at our institution from 2008 to 2013. We examined the use of chemoprevention and screening recommendations after diagnosis. Other factors evaluated included family history, Gail model, surgeon specialty and menopausal status.

RESULTS

Ninety-four women with ADH were treated at our facility in the study time frame. The overall use of chemoprevention in our study population was 41.5%. Of those who were not on chemoprevention, 56.4 % were offered chemoprevention and declined. In addition, after the diagnosis of ADH, annual mammography was recommended for 75% of women. However, this was preferentially seen in women on chemoprevention (95% vs. 65%). Menopausal status and use of the Gail model were statistically significant in predicting annual screening after a diagnosis of ADH. The Gail score was calculated preferentially in women who chose chemoprevention. Prior breast biopsy, family history of cancer, first degree relative with cancer, age and menopausal status were not found to be statistically significant in the use of chemoprevention. Oncology training and use of the Gail model were found to be statistically significant in chemoprevention use.

CONCLUSION

The use of chemoprevention in high risk women is significantly improved with oncology training and the use of the Gail model. Concern regarding side effects continues to result in low utilization of selective estrogen receptor modulators. Education regarding newer agents for chemoprevention with minimal side effects may result in increased utilization of chemoprevention.

Table 1: Patient CharacteristicsFactorsChemoprevention n (%)No Chemoprevention n (%)p valueMedian age (range)58 (37-78)52 (30-77)0.07Race  0.790Caucasian18 (46.1 %)33 (60.0 %) Asian/PCI6 (15.4 %)5 (9.1 %) African American2 (5.1 %)2 (3.6 %) Hispanic2 (5.1 %)1 (1.8 %) Family history10 (25.6 %)18 (32.7 %)0.358First degree26 (66.7 %)32 (58.1 %)1.000Gail score calculated29 (74.3 %)20 (36.3 %)<0.001Gail score median (range)3.4 % (0.8-17.7)2.7% (0.2-8.6)0.169Menopausal status17 (43.6 %)19 (34.5 %)0.796Specialty provider37 (94.9 %)38 (69.1 %)0.002Prior breast biopsy13 (33.3 %)16 (29.1 %)0.438

The views expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

Citation Format: Oseni T, Perkins S, Deutsch E, Soballe P. The use of chemoprevention increases significantly with oncology trained providers and with application of a risk assessment model. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-08-05.

Pediatric T- and NK-cell lymphomas: new biologic insights and treatment strategies

T- and natural killer (NK)-cell lymphomas are challenging childhood neoplasms. These cancers have varying presentations, vast molecular heterogeneity, and several are quite unusual in the West, creating diagnostic challenges. Over 20 distinct T- and NK-cell neoplasms are recognized by the 2008 World Health Organization classification, demonstrating the diversity and potential complexity of these cases. In pediatric populations, selection of optimal therapy poses an additional quandary, as most of these malignancies have not been studied in large randomized clinical trials. Despite their rarity, exciting molecular discoveries are yielding insights into these clinicopathologic entities, improving the accuracy of our diagnoses of these cancers, and expanding our ability to effectively treat them, including the use of new targeted therapies. Here, we summarize this fascinating group of lymphomas, with particular attention to the three most common subtypes: T-lymphoblastic lymphoma, anaplastic large cell lymphoma, and peripheral T-cell lymphoma-not otherwise specified. We highlight recent findings regarding their molecular etiologies, new biologic markers, and cutting-edge therapeutic strategies applied to this intriguing class of neoplasms.

Investigations and control measures following a non-travel-associated case of toxigenic Cornyebacterium diphtheriae, London, United Kingdom, December 2009-January 2010

Binary file ES_Abstracts_Final_ECDC.txt matches

Investigations and control measures following a non-travel-associated case of toxigenic Cornyebacterium diphtheriae, London, United Kingdom, December 2009-January 2010

This article reports the investigation and control measures undertaken following the identification of a toxigenic strain of Cornyebacterium diphtheriae var gravis, designated ribotype Minsk , in a partially vaccinated teenager born in the United Kingdom with no recent history of travel or known contact with a case of diphtheria or a carrier. This case highlights the need for ongoing work to improve vaccine uptake rates to ensure children receive all scheduled vaccinations.

Prevalence of gastric squamous ulceration in horses with abdominal pain

REASONS FOR PERFORMING STUDY

Prevalence of gastric ulcerations differs widely according to breed and circumstances of management. Further study of the biological variables involved is required in order to identify more exactly the reasons for the reported range.

OBJECTIVES

The objectives of this present study, which do not appear to have been addressed previously in the literature, were 1) the prevalence of gastric ulceration in horses with abdominal pain. 2) difference in prevalence in horses responding to medical therapy and those requiring surgical intervention. 3) whether gastric ulceration is associated with any particular gastrointestinal tract lesion.

METHODS

Horses were included in the study if gastroscopy was performed within 24 h of presentation. The presence and grade of gastric ulceration was recorded together with the medical records. Data were analysed categorically using a Fisher's exact test or Chi-squared test.

RESULTS

One hundred horses met the selection criteria. Forty-nine percent (49/100) of horses had gastric ulceration, 63% (63/100) responded to medical therapy and 37% (37/100) to surgical intervention, and prevalence was higher in the former (59%) than the latter (32%). Horses with duodenitis-proximal jejunitis (DPJ) had a trend towards higher prevalence of gastric ulceration compared to those with other GI lesions. Sixty-eight percent (13/19) of horses diagnosed with DPJ, 32% (8/25) with a large colon impaction and 14% (1/7) with large colon volvulus had gastric ulceration.

CONCLUSIONS

The presence of gastric ulceration in all horses with abdominal pain was moderate. Horses responding to medical therapy had a higher prevalence of gastric ulceration compared to horses requiring surgery and there was a trend towards higher prevalence in cases of DPJ compared to other GI lesions. There was not a statistically significant difference in gastric ulceration detected between specific lesions, including large colon impactions and large colon volvulus.

POTENTIAL RELEVANCE

The clinical relevance of ulceration is still unclear and further studies are required to differentiate between incidental and clinically important gastric ulceration.

An Exploratory Study of the Biological Activity of Sunitinib as a Component of Neoadjuvant Therapy for Breast Cancer

Background: The neoadjuvant setting provides an ideal opportunity to explore the impact of sunitinib alone and in combination with paclitaxel on the functional status of tumor vasculature as indicated by changes in tumor interstitial pressure (IFP) and circulating progenitor cell (CPC) subsets.Methods: Patients(pts.) with newly diagnosed stage Ic-IIIc breast cancer were treated with sunitinib monotherapy (100 mg Day 1; 37.5 mg D2-14) prior to the initiation of paclitaxel (80 mg/M2 D1,8,15 every 28 days x 4 cycles) with sunitinib (25 mg/d). IFP and CPC subsets were assessed at baseline and after sunitinib monotherapy. IFP was measured in three separate areas of the tumor using a micropressure transducer catheter; mean and highest IFP recorded were analyzed. Improvements in poly-chromatic flow cytometry allowed distinction of pro-angiogenic (pCPC = Live/AC133+CD34bright/CD31+CD45dim\), from non-angiogenic (nCPC = Live/AC133-CD34bright/CD31+/CD45dim\), CPCs that cannot be quantified separately using previously reported protocols1. Baseline CPC subsets were also compared to age and gender matched healthy controls.Results: From July 2008 to May 2009, 14 pts were enrolled; baseline and post-sunitinib IFP and CPC data are available for 12 and 11 pts respectively. The median age was 48 (range 32-69). Mean pretreatment tumor diameter was 3.2 cm. Sunitinib monotherapy was generally well tolerated; two patients developed grade III toxicities including hypertension (n=1) and hand-foot syndrome (n=1). Sunitinib significantly decreased mean IFP (18.87 mmHg vs. 6.38 mmHg; p=0.002); similar results were obtained when only the maximum IFP was considered (22.32 mmHg vs. 8.36 mmHg; p=0.003). pCPC frequency was not different between pts and healthy controls (0.099% vs. 0.076%, p=0.24) but the p:nCPC ratio was significantly higher in pts compared to healthy controls (3.26 vs. 1.46; p=0.001) suggesting a shift toward vascular damage and/or active angiogenesis. Both pCPC frequency (0.099 vs. 0.022; p=0.001) and p:nCPC ratio (3.26 vs. 0.78; p=0.001) significantly decreased after sunitinib monotherapy. Analysis of paclitaxel + sunitinib is too early (n=4).Conclusion: Sunitinib, through its effects on VEGF-mediated vascular permeability, markedly reduces tumor IFP. In addition sunitinib profoundly reduces pCPCs that are thought to be important for angiogenesis in human cancers. Accrual is ongoing (planned N=40). Analysis of IFP and CPC subsets after paclitaxel + sunitinib as well as additional correlates will be presented.1 Duda et al. (2007). Nat. Protocol 2, 805-810.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 202.

mTOR Inhibition and Diet Induced Obesity in a Mouse Model of Postmenopausal Breast Cancer

Background:Breast cancer is the most common type of noncutaneous cancer among white women. It is more frequently diagnosed after menopause, and the majority of cases are estrogen receptor positive (ER+). Obesity is associated with poor prognosis, increasing risk by 50% in post-menopausal women, and correlates with shorter disease-free and overall survival. Unfortunately, the mechanism underlying the poorer outcomes in obese breast cancer patients is not known. The majority of ER+ tumors present with genomic ER activity; however, nongenomic ER activity can also occur, resulting in interaction with growth factor (GF) receptors.In the obese state nongenomic activity may be especially enhanced, promoting ER and GF signaling crosstalk, breast tumor cell growth and survival. Since Akt/mTOR signaling has been implicated in breast cancer, and obesity (through activation of GF signaling pathways) can activate this pathway, we hypothesized that the enhancement of tumor growth in response to obesity can be offset by mTOR inhibition. To test this we used a mouse model of postmenopausal breast cancer and investigated the effects of obesity (relative to lean and overweight phenotypes) with and without pharmacologic mTOR inhibition by RAD001.Methods:Ovariectomized C57BL/6 mice were randomized to diet regimens that induce either a lean, control (overweight), or a diet-induced obesity (DIO) phenotype. After 17 weeks on the diets, DIO mice were switched to the control diet and acclimated for 3 weeks. To determine diet-induced changes in adiposity, quantitative magnetic resonance (qMR) was performed at wk 18. At wk 21 mice were injected with syngeneic MMTV-Wnt-1 mammary tumor cells in the 4th mammary fat pad. Two weeks after tumor injection, the mice received RAD001 (10 mg/kg) or vehicle by oral gavage twice a week for 6 weeks.Tumor growth was measured weekly.Results:At week 17, mice in the DIO group were significantly heavier (42.8 g) than control (34.5 g) and lean mice (24.6 g) (p <0.001) and % fat was also higher (p<0.001) in DIO (54.5%) when compared to the control (42.2%) and lean (30.7%) groups.Tumor growth was different between the three diet regimens, confirming that dietary modulation directly influences MMTV-Wnt-1 tumor growth in a postmenopausal mouse model of breast cancer. DIO mice displayed significantly enhanced tumor growth (p<0.05) when compared to the control and lean mice. Overall, RAD001 was effective at decreasing tumor growth in all diet groups (p<0.01). However, the relative effect of RAD001 versus placebo was diminished in DIO mice compared to control and lean mice, suggesting obese mice may be partially resistant to RAD001. This resistance was overcome in the DIO mice by increasing the RAD001 dose to 15 mg/kg.Conclusion:Our results confirm that DIO increases tumor growth in the context of postmenopausal breast cancer. In addition, treatment with the mTOR inhibitor RAD001 reversed the mammary tumor enhancing effects of obesity (particularly at the higher dose of RAD001), further supporting mTOR as an important molecular target for breaking the obesity-breast cancer link.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5077.

A pilot study of vascular endothelial growth factor inhibition with bevacizumab in patients with lymphedema following breast cancer treatment

9523

Background: Lymphedema is a significant long-term complication of primary therapy for breast cancer. Anecdotally, several patients (pts) with metastatic disease treated with bevacizumab monotherapy noted improvement in long-standing lymphedema. This pilot study was conducted to explore these observations prospectively. Methods: We used an existing biospecimen bank to conduct a case-control study to compare VEGF-A, -C, -D and VEGFR-3 serum concentrations in breast cancer pts with and without lymphedema (matched for age and LN status). In a separate pilot trial, pts with significant unilateral lymphedema receive bevacizumab, 15 mg/kg every 3 weeks. Baseline assessments include arm volume, interstitial fluid pressure (IFP), extracellular fluid volume by lymphometer (ECF), quality of life (QOL) and plasma VEGF-C, -D, and R3. IFP is measured serially for 24 hours after the first treatment; arm volume, ECF, QOL, and plasma VEGF-C/D/R3 are assessed at 3 and 6 weeks. Results: Samples were available for 16 pts with chronic lymphedema and 31 matched controls. Median VEGF-C levels were significantly increased in pts with lymphedema (6895 pg/ml vs. 5349 pg/ml, p=0.001). Twelve pts have been enrolled in the pilot trial. Median duration of lymphedema was 6.3 years (0.5–16.6) Median time since surgery was 5.5 years (1.9–17.6); median time since radiation (n=10) was 5.1 years (1.3–8.3). Complete IFP data is available in 9 pts. Baseline IFP was significantly higher in the affected compared to unaffected arm (7.63 vs. -0.87 mmHg; p=0.0023). Mean IFP in the affected arm decreased an average of 41.9% 24 hours after bevacizumab infusion (7.63 vs. 4.88 mmHg; p=0.07). ECF, VEGF-1, and VEGF-R3 levels all significantly decreased three weeks after initial treatment. Two patients met the definition of response with a ≥ 25% reduction in excess arm volume though the mean difference in excess arm volume did not significantly change (p=0.19). Conclusions: Preliminary data supports the hypothesis that VEGF plays a central role in the development and persistence of lymphedema after local therapy for breast cancer. Bevacizumab acutely decreases IFP, leading to a decrease in ECF and modest improvement in arm volume.

[Table: see text]

Apparent absence of Parahaemoproteus lophortyx and other hematozoa in North Florida populations of bobwhite quail (Colinus virginianus)

Parahaemoproteus lophortyx (formerly Haemoproteus lophortyx) is known to infect populations of bobwhite quail (Colinus virginianus) in California and to lead to considerable mortalities in these birds. Populations of bobwhite quail in Florida have never been surveyed for the presence of this parasite. The goal of this study was to determine whether P. lophortyx is present in populations of bobwhite quail in north Florida. To achieve this goal, blood was drawn from 294 bobwhite quail from 4 study sites in north Florida from 19 June 2007 to 1 August 2007. Blood smears were made, stained with Giemsa, and examined under x1,000 magnification for the presence of Parahaemoproteus lophortyx. No gametocytes were noted in any of the blood smears. Thirty randomly chosen samples were examined via polymerase chain reaction (PCR). This procedure may detect parasitemias too low to detect by microscopy. No PCR-positive samples were detected, however, adding support to the absence of hematozoa in Florida populations of bobwhite quail.

Effects of obesity on anastrozole response in a mouse model of postmenopausal breast cancer

Abstract #1146

Background: The prevalence of obesity, an established breast cancer risk factor for postmenopausal women, has risen rapidly in the US in recent decades. The majority of postmenopausal breast tumors are estrogen receptor-α positive (ER-α+) and responsive to the mitogenic effects of estrogen. Tamoxifen, a selective estrogen receptor modulator, has been the endocrine agent of choice for the treatment and prevention of ER-α+ breast cancer. Unfortunately, resistance to tamoxifen develops in the majority of cases. Akt activation in breast tumors is associated with poor prognosis and resistance to tamoxifen and other forms of endocrine therapy. Akt activation in the mammary epithelium is also enhanced by obesity, possibly due to elevated growth factor and hormone levels known to activate the PI3K/Akt/mTOR pathway. Aromatase inhibitors, such as anastrozole, are emerging as the treatment of choice for the postmenopausal patient, yet little is known as to how obesity may modulate response to these agents. In this study we examined the effect of obesity on tumor growth response to anastrozole and local tumor aromatase expression. We also assessed the correlation between obesity, Akt activation and tumor growth.
 Methods: To mimic postmenopausal obesity, ovariectomized C57BL/6 mice (n=80) were randomized to a control diet (10 Kcal% fat; ∼10.2 kcal/day) or a diet-induced obesity (DIO) regimen (60 Kcal% fat; ∼14.4 kcal/day). After 14 wk on the diets mice were injected with isogenic MMTV-Wnt-1 mammary tumor cells (5x104 cells/mouse) in the 4th mammary fat pad. After tumors became palpable mice were injected with the AI anastrozole (10 μg/day s.c.) or vehicle control (0.3% hydroxypropylcellulose) for 4 wk. Serum leptin and resistin were measured at the end of the study, RT-PCR and western blot analyses were used to determine aromatase gene expression and total and phosphorylated protein levels in the tumors.
 Results: Mice on the DIO regimens were significantly heavier (39.2 g ±0.7) than controls (29.7 g ±1.23), with significantly higher circulating levels of the obesity-related adipokines leptin and resistin. Tumors from DIO mice, relative to controls, displayed increased aromatase expression. Anastrozole had no effect on food consumption or body weight but intriguingly increased aromatase expression in tumors from both control and DIO mice. Importantly, DIO mice, relative to controls, were much less responsive to the tumor inhibitory effect of anastrozole. Akt protein expression correlated positively with tumor weight, regardless of dietary or hormonal treatment.
 Conclusion: In the context of postmenopausal breast cancer, our results suggest that obese mice compared to controls are less responsive to the effects of anastrozole on tumor growth and that aromatase expression in tumors is higher in obese mice regardless of anastrozole treatment. We also found a strong correlation between Akt activation and tumor growth, irrespective of diet or hormonal treatment.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1146.

Multi-site, multi-country evaluation of analytical and operational performance of a low-mid volume chemiluminescent immunoassay analyzer

BACKGROUND

A new automated immunoassay low-mid volume (< or = 250 immunoassays/day) chemiluminescent analyzer, Abbott Architect i1000sR, was evaluated by seven laboratories around the world (4 in Europe, one each in Canada, Japan, and the U.S.A.) to demonstrate equivalent performance for key operating characteristics (e.g., precision, turn around time, limit of detection, functional sensitivity, and linearity).

METHODS

The laboratories followed standard protocols to assess precision, limit of detection (LoD), functional sensitivity, assay linearity, method comparison, and sample carryover. Turn around time for three stat assays (beta-hCG, BNP, and CK-MB) and the time required to complete workloads of 50 and 100 tests with a mixture of 75% routine tests and 25% stat tests was also evaluated.

RESULTS

Total precision was typically < 5% CV for nine immunoassays. Analytical performance met design goals and demonstrated equivalency to package insert data for assays on market and in use for an existing high volume immunoassay system. Stat turn around times were consistent with the fixed analytical time of 15.6 minutes and met the expectations of the laboratories. Measured test throughput ranged from 47 - 54 tests per hour and demonstrated that the analyzer was fit for the intended purpose of supporting a laboratory that performs < or = 250 immunoassays per day.

CONCLUSIONS

A multisite, international analyzer familiarization study is a practical means of confirming that a new instrument meets both a manufacturer's design specifications and users' real world expectations and provides a pragmatic test for the system. The experience of investigators at seven sites around the world indicates that a new fully automated chemiluminescent system is suitable for use.

Randomised controlled trial of CD-ROM-based cognitive-behavioural self-care for bulimia nervosa

BACKGROUND

Cognitive-behavioural self-care is advocated as a first step in the treatment of bulimia nervosa.

AIMS

To examine the effectiveness of a CD-ROM-based cognitive-behavioural intervention in bulimia nervosa and eating disorder not otherwise specified (NOS) (bulimic type) in a routine setting.

METHOD

Ninety-seven people with bulimia nervosa or eating disorder NOS were randomised to either CD-ROM without support for 3 months followed by a flexible number of therapist sessions or to a 3-month waiting list followed by 15 sessions of therapist cognitive-behavioural therapy (CBT) (ISRCTN51564819). Clinical symptoms were assessed at pre-treatment, 3 months and 7 months.

RESULTS

Only two-thirds of participants started treatment. Although there were significant group x time interactions for bingeing and vomiting, favouring the CD-ROM group at 3 months and the waiting-list group at 7 months, post hoc group comparisons at 3 and 7 months found no significant differences for bingeing or vomiting. CD-ROM-based delivery of this intervention, without support from a clinician, may not be the best way of exploiting its benefits.

Motivation to change in recent onset and long-standing bulimia nervosa: are there differences?

REASON FOR THE STUDY: Little is known about how motivation to change evolves over the course of an eating disorder. The present study compared 'stage of change' and motivation, confidence and readiness to change in two groups of patients with bulimia nervosa (BN), adolescents with a short duration of illness and adults with a long duration of illness.

METHOD

Patients completed the Severity of eating disorder symptomatology scale, Hospital Anxiety and Depression Scale and measures of stage of change and motivation, readiness and confidence to change their bulimic symptomatology at pre-treatment.

MAIN FINDINGS

Short- and long duration groups did not differ in illness severity, comorbidity, stage of change, motivation, readiness, and confidence to change. There were, however, some differences between groups in terms of the relationship between motivational measures, illness severity, duration and comorbidity.

CONCLUSIONS

There seem to be more similarities than differences between adolescents with short duration of illness and those with well-established BN in terms of their motivation to change.