IDH mutations in G2-3 conventional central bone chondrosarcoma: a mono institutional experience

BACKGROUND

Heterozygous isocitrate dehydrogenase (IDH) mutations occur in about half of conventional central bone chondrosarcomas (CCBC). Aim of this study was to assess the frequency and prognostic impact of IDH mutations in high grade CCBC patients.

METHODS

64 patients with G2 and G3 CCBC were included. DNA extraction, PCR amplification of IDH1/2 exon 4s, and sequencing analysis with Sanger were performed.

RESULTS

IDH mutations were detected in 24/54 patients (44%): IDH1 in 18, IDH2 in 4, and both IDH1/2 in 2 patients. The frequency of mutations was 37% in G2 vs. 69% in G3 (p = 0.039), and 100% in three Ollier disease associated chondrosarcoma. 5-year overall survival (OS) at 124 months (range 1-166) was 51%, with no significant difference based on the IDH mutational status: 61% in IDHmut vs. 44% in IDH wild type (IDHwt). The 5-year relapse free survival (RFS) was 33% (95% CI:10-57) for IDHmut vs. 57% (95%CI: 30-77) for IDHwt. Progression free survival (PFS) was 25% (95%CI:1-65) IDHmut vs. 16% (95%CI: 0.7-52) IDHwt. 55% (5/9) of IDHmut G2 became higher grade at the recurrence, as compared with 25% (3/12) of G2 IDHwt.

CONCLUSIONS

This study shows a higher frequency of IDH mutations in G3 CCBC as compared with G2. No significant differences in OS, RFS, and PFS by mutational status were detected. After relapse, a higher rate of G3 for IDH mutated CCBC was observed.

Multivisceral Transplant in a Patient With Portopulmonary Hypertension: A Case Report

Portopulmonary hypertension, a type of pulmonary arterial hypertension in the setting of cirrhotic or noncirrhotic portal hypertension, is associated with elevated morbidity and mortality during and after transplantation. Uncontrolled portopulmonary hypertension may prevent or delay listing for transplant candidates, and the prognosis without treatment and ultimately transplant is extremely poor. We present a 29-year-old White woman, who had a post-liver transplant at infancy due to biliary atresia. Later on, she developed extensive portal vein thrombosis and portopulmonary hypertension and underwent a multivisceral transplant (liver, stomach, pancreaticoduodenal complex, and small and large intestine). Preoperative mean pulmonary artery pressure was <30 mm Hg with a pulmonary vascular resistance of <300 dynes^.s/cm⁵ on oral sildenafil and intravenous epoprostenol. Intraoperatively, management required comprehensive transfusion protocols, a careful balance between correcting blood loss and preventing thrombosis. Intravenous epoprostenol, sildenafil, milrinone, and inhaled nitric oxide were used to reduce elevated mean pulmonary artery pressure and right ventricular strain associated with vascular clamping, reperfusion, and massive fluid shifts. Nitric oxide and epoprostenol use unleashed antiplatelet effects on a patient already susceptible to coagulopathy. A multimodal and multidisciplinary approach continued throughout the surgery and in the postoperative period, which led to a successful outcome.

Pulsed Laser Deposited Zeolite Coatings on Femtosecond Laser-Nanostructured Steel Meshes for Durable Superhydrophilic/Oleophobic Functionalities

Ultrafast laser structuring has proven to alter the wettability performance of surfaces drastically due to controlled modification of the surface roughness and energy. Surface alteration can be achieved also by coating the surfaces with functional materials with enhanced durability. On this line, robust and tunable surface wettability performance can be achieved by the synergic effects of ultrafast laser structuring and coating. In this work, femtosecond laser-structured stainless steel (SS-100) meshes were used to host the growth of NaAlSi₂O₆-H₂O zeolite films. Contact angle measurements were carried on pristine SS-100 meshes, zeolite-coated SS-100 meshes, laser-structured SS-100 meshes, and zeolite-coated laser-structured SS-100 meshes. Enhanced hydrophilic behavior was observed in the zeolite-coated SS-100 meshes (contact angle 72°) and in laser-structured SS-100 meshes (contact angle 41°). On the other hand, superior durable hydrophilic behavior was observed for the zeolite-coated laser-structured SS-100 meshes (contact angle 14°) over an extended period and reusability. In addition, the zeolite-coated laser-structured SS-100 meshes were subjected to oil-water separation tests and revealed augmented effectuation for oil-water separation.

Integrative analysis of hybrid PET/MR improves recovery prediction of left ventricular contractility after percutaneous revascularisation of coronary chronic total occlusions

Background

The clinical indication to revascularization of coronary chronic total occlusions (CTO) is set on viability assessment through well-established imaging methods. Precise characterization of the myocardium allows a better interventional risk stratification before revascularization. Hybrid positron emission tomography/magnetic resonance (PET/MR) scanners allow the combination of image based biomarkers through simultaneous acquisition and may potentially improve the prediction of therapy response. This study aims to evaluate the accuracy in recovery prediction after CTO revascularization by combining information of myocardial viability and wall motion abnormalities (WMA) from PET/MR exams.

Methods

Viability was assessed with PET/MR imaging in 22 patients before percutaneous revascularization of a CTO. A cardiac MR imaging was performed at follow-up after 6 months. Segmental WMA was assessed on the AHA 17-segments model from cine images at baseline and follow-up with a 5-point scale. Recovery of WMA was predicted using six different models combining parameters from fluorodeoxyglucose (FDG) uptake, transmural extent of the scar with late gadolinium enhancement image (LGE), T1 mapping, and WMA at baseline. From 374 myocardial segments, we considered only 82 that were completely characterized and presented at least hypokinetic WMA at baseline. 46 of them were supplied by the treated CTO artery (CTO-subtended), wherefrom 16 segments recovered the contractility.

A Random Forest classifier was applied for recovery prediction. Training and testing data were selected through stratified random sampling (50 iterations) with replacement from the two sets: CTO-subtended and non-CTO-subtended segments. To compensate for class imbalance and limited sample size, SMOTE oversampling was applied to the training data. Prediction assessment was based on balanced accuracy (bAcc), sensitivity, specificity, ROC AUC, and Precision-Recall AUC (PR AUC), while Wilcoxon test with a Bonferroni's correction was used for comparison between the proposed models and LGE+FDG, which has shown the best performance in previous studies [1,2].

Results

The best model for the prediction of recovery after revascularisation was the combination of LGE+FDG+WMA+T1mapping (bAcc 0.62±0.11, sensitivity 0.72±0.18, specificity 0.70±0.19, ROC AUC 0.67±0.12, PR AUC 0.60±0.12), followed by LGE+FDG+WMA, LGE+FDG+T1mapping, LGE+FDG, LGE, and FDG, respectively. The first model statistically significantly (p-value&lt;0.01) outperformed the reference model LGE+FDG (bAcc 0.54±0.11, sensitivity: 0.67±0.18, specificity 0.55±0.19, ROC AUC 0.56±0.13, PR AUC 0.47±0.10).

Conclusion

This study documents the benefits of a hybrid PET/MR multiparametric assessment beyond the standard analysis based on FDG uptake and LGE for the prediction of contractility recovery after revascularization of CTO of the coronary arteries.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 764458 PETMR protocolROC AUC comparsion

Peptide receptor radionuclide therapy in patients with metastatic progressive pheochromocytoma and paraganglioma: long-term toxicity, efficacy and prognostic biomarker data of phase II clinical trials

BACKGROUND

Pheochromocytoma and paraganglioma (PPGL) have currently only limited treatment options available for patients in the metastatic phase (mPPGL) in either post-surgery or inoperable settings. However, these rare tumors overexpress somatostatin receptors and can thus be treated with peptide receptor radionuclide therapy (PRRT). We present data about our 10-year experience treating 46 consecutive mPPGL patients with 90Y-DOTATOC or 177Lu-DOTATATE.

PATIENTS AND METHODS

All patients (20 men and 26 women, median age 52 years) showed positive scintigraphic imaging at 111In-octreotide or 68Ga-DOTATOC positron emission tomography/computed tomography (PET/CT). 90Y-DOTATOC was administered in 12 patients, with cumulative dosages ranging from 7.4 to 11 GBq, while 34 patients received 18.5 or 27.5GBq of 177Lu-DOTATATE. We used Southwest Oncology Group Response Evaluation Criteria in Solid Tumors criteria to evaluate treatment efficacy and Common Terminology Criteria for Adverse Events criteria to assess toxicity. The prognostic role of primary tumor site, hormone secretion, succinate dehydrogenase (SDHx) mutation, and metastatic involvement was also evaluated.

RESULTS

Both 90Y-DOTATOC and 177Lu-DOTATATE PRRT were well tolerated by patients without significant renal or bone marrow toxicity. The median follow-up was 73 months (range 5-146 months). The overall disease control rate (DCR) was 80% [95% confidence interval (CI) 68.9% to 91.9%] with a mean five cycles of therapy. However, 177Lu-DOTATATE patients showed a longer median overall survival (mOS) than those receiving 90Y-Dotatoc and a better DCR when higher dosages were administered, even if a direct comparison was not carried out. Syndromic patients had a poorer mOS. SDHx mutations did not interfere with treatment efficacy.

CONCLUSIONS

PRRT is safe and effective for the treatment of patients with progressive mPPGL, especially at higher dosages. The longer mOS of 177Lu-DOTATATE-treated patients in our protocols indicates the former radiopharmaceutical as the better candidate for further clinical application.

Development and validation of an in-silico tool for the study of therapeutic agents in 3D cell cultures

Computational models constitute a fundamental asset for cancer research and drug R&D, as they provide controlled environments for testing of hypotheses and are characterized by the total knowledge of the system. These features are particularly useful for 3D cell culture models where a complex interaction among cells and their environments ensues. In this work, we present a programmable simulator capable of reproducing the behavior of cells cultured in 3D scaffolds and their response to pharmacological treatment. This system will be shown to be able to accurately describe the temporal evolution of the density of a population of MDA-MB-231 cells following their treatment with different concentrations of doxorubicin, together with a newly described drug-resistance mechanism and potential re-sensitization strategy. An extensive technical description of this model will be coupled to its experimental validation and to an analysis aimed at identifying which variables and behaviors account for differences in the response to treatment. Comprehensively, this work contributes to the growing field of integrated in-silico/in-vitro analysis of biological processes which has great potential for both the increase of our scientific knowledge and the development of novel, more effective treatments.

P4707Incidence and outcome of endovascular therapy in subclavian occlusive disease involving the vertebral artery origin

Background

Endovascular revascularization represents the treatment option of choice in symptomatic steno-occlusive disease of the subclavian artery (SA). While the majority of lesions are localized in the proximal segment of the subclavian artery, studies in regards to the medial segment involving the vertebral artery (VA) origin are scarce.

Purpose

The aim of this study was to analyze the technical approaches and outcome of endovascular therapy of subclavian artery disease with a special focus on medial lesions involving the VA origin.

Methods

We retrospectively analyzed all patients who underwent percutaneous revascularization of the subclavian or innominate artery with a special focus on medial lesions involving the VA origin.

Results

In total 196 patients with subclavian or innominate artery intervention were analyzed. The majority of lesions (83%) were located in the proximal, whereas 28 patients (14%) presented with lesions in the medial segment of the SA, and only 3% involved the distal segment. Overall procedural success was high for both stenosis (96%) and occlusion (89%) and did not differ according to the lesion location. Revascularization techniques in the medial segment included stenting of the SA only (13 patients), additional VA balloon-dilatation (6 Patients), and bifurcational stenting of the SA and VA using T-stenting technique (9 patients). Overall periprocedural complication rate was low (6%) and comparable between different SA segments (6% in proximal segment vs. 7% in medial segment vs. 0% in distal segment; p=0.81). Outcome assessed after a median of 12 months (interquartile range 4–30) showed no significant differences in terms of Kaplan-Meier estimated freedom from restenosis between proximal and medial lesions despite the technically demanding approach in the medial segment (90% vs. 95%; p=0.67).

Long-term patency

Conclusion

Endovascular revascularization of medial subclavian artery lesions involving the vertebral artery origin shows comparable safety and efficacy in terms of long-term patency rates compared to lesions located within the proximal subclavian artery. However, more complex endovascular techniques with bifurcational ballooning or stenting is required in a considerable number of patients with medial subclavian artery disease.

5964Hybrid PET/MR imaging for the prediction of left ventricular (LV) recovery after revascularisation of chronic total occluded coronaries

Background

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents one of the major challenges in interventional cardiology. Physicians are still reluctant in referring for PCI, assuming non viability of the myocardium subtended by the CTO. Data are controversial in assessing the improvement of left ventricular (LV) wall motion after revascularisation and the prognostic value of viability testing to guide patient selection.

Purpose

The aim of this study was to determine, whether hybrid fluorodeoxyglucose positron emission tomography/magnetic resonance (FDG PET/MR) imaging allows a more accurate prediction of LV regional wall motion recovery after successful PCI of CTOs in comparison to PET or MR alone.

Methods

We enrolled 49 consecutive symptomatic patients with CTO and evidence of wall motion abnormality in the corresponding CTO-territory. All patients underwent hybrid FDG PET/MR imaging as semi-quantitative assessment of myocardial viability - glucose metabolism in PET and late gadolinium enhancement (LGE) transmurality in MR – prior of PCI of the CTO. Follow-up MRI was performed in 23 patients 3–6 months after successful revascularisation to evaluate wall motion changes.

Results

We assessed viability in 124 myocardial segments subtended by a CTO in 23 patients with successful PCI who underwent serial imaging. Segments with wall motion abnormality at baseline (n=80) were analysed. Most of these segments (n=54, 68%) were concordantly assessed viable by PET and MR, conversely only 2 (2%) segments were assessed non-viable by both imaging techniques. However, almost one third of the segments showed discordant patterns of viability either PET not viable/ MR viable (3 (4%) segments) or PET viable/ MR not viable (21 (26%) segments): particularly the latter revealed a significant wall motion improvement (p=0.033).

The combination of PET and MR showed a fair accuracy in predicting myocardial segments with wall motion improvement after CTO revascularisation (PET/MR area under ROC curve (AUC) 0.72, SE 0.07, p=0.002), which was superior to MR-LGE (AUC=0.66, SE 0.09) and FDG-PET (AUC=0.58, SE 0.10) alone (Figure).

Comparisons of ROC curves

Conclusion

Hybrid PET/MR imaging prior to successful CTO showed a better performance than PET or MR alone in predicting regional improvement of disturbed wall motion.

The complimentary information derived from both modalities may particularly help to identify small amounts of viable epicardial myocardium within large scars which can improve contractility after CTO-revascularisation.

OS7.3 Health-related quality of life (HRQoL) evaluation in the REGOMA trial: a randomized, phase II clinical trial analyzing regorafenib activity in relapsed glioblastoma patients

BACKGROUND

REGOMA trial showed that regorafenib (REG) significantly improved OS and PFS in patients (pts) with relapsed GBM with respect to lomustine (LOM). REG showed a different toxicity profile compared to LOM. Here, we report final results of the HRQoL assessment, a secondary end point.

MATERIAL AND METHODS

HRQoL was measured using the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30) and brain module (QLQ-BN20) administered before any MRI assessments, every 8 weeks (+/- 2 weeks) until disease progression. To evaluate treatment impact on HRQoL, questionnaires at progression were excluded. Mixed-effect linear models were fitted for each of the HRQOL domain to examine the change over progression-free time within and between arms. The models included the time of questionnaire assessment, the treatment group and their interaction, as fixed effects, and a compound symmetry covariance structure for the random effects. Differences of at least 10 points were classified as a clinically meaningful change. To correct for multiple comparisons and to avoid type I error, the level of significance was set at P=0.01 (2-sided).

RESULTS

Of 119 randomized pts, 117 partecipated in the HRQoL evaluation, and 114 had a baseline assessment (n=56 REG; n=58 LOM). No statistically significant differences were observed in any generic or cancer specific domain during treatment in the REG and LOM arms, or between the two arms, except for the appetite loss scale which was significantly worse in PTS treated with REG (Global mean 14.7 (SD=28.6) vs 7.6 (SD=16.0); p=0.0081). The rate of pts with a clinically meaningful worsening for appetite loss was not statistically different between the two arms (9 out of 24 and 0 out of 13 in the REG and LOM arm, respectively;p=0.02).

CONCLUSION

In the REGOMA trial, HRQoL did not change during regorafenib treatment. Pts treated with regorafenib and lomustine reported no significant difference in HRQoL.

Extended-Spectrum Beta-Lactamase-production in Escherichia coli isolated from door handles in Nasarawa State University, Keffi, Nigeria

Serious clinical concern has been raised globally over the continual evolution of pathogenic microorganisms that are resistant to several chemotherapeutic agents, especially the beta-lactam antibiotics. This study investigated ESBL-production in Escherichia coli isolated from door handles in Nasarawa State University, Keffi-Nigeria. A total of 200 door handles were sampled and 34 (17.0%) E. coli isolates were identified. The bacterial resistance profile to tested antibiotics was: tetracycline 31 (91.18%), cotrimoxazole, ceftazidime, and augmentin with 28 (82.35%). Streptomycin and ampicillin had 26 (76.47%), while ciprofloxacin, chloramphenicol, ceftriaxone, and gentamicin had 16 (47.06%), 14 (41.18%), 12 (35.29%) and 7 (20.59%) resistance profile respectively. Multiple antibiotics resistance index (MARI) ≥ 0.3 was recorded in 33 (97.06%) of the isolates. A total of 23 resistant phenotypes were observed in this study. The most common resistant phenotype was AMP-AUG-CAZ-CRO-S-CIP-SXT-TE-C with 4 appearances. Fourteen (14) of the isolates were Multidrug resistant (MDR), while 9 were extensively resistant (XDR) isolates. Fifteen (15) ESBL-producers were identified out of which bla _TEM was identified in 7 of the isolates, while 10 were carriers of bla _SHV, and bla _CTX-M gene was not detected in any of the test isolates. This study recommends prompt action by all stakeholders in public health to prevent a potential disease burden from a superbug.

Real-world efficacy and safety of lenvatinib: data from a compassionate use in the treatment of radioactive iodine-refractory differentiated thyroid cancer patients in Italy

BACKGROUND

Lenvatinib is a multi-kinase inhibitor approved for patients with radioactive iodine (RAI)-resistant differentiated thyroid cancer (DTC). Before the drug approval from the Italian National Regulatory Agency, a compassionate use programme has been run in Italy. This retrospective study aimed to analyse data from the first series of patients treated with lenvatinib in Italy.

METHODS

The primary aim was to assess the response rate (RR) and progression-free survival (PFS). Secondary end-points include overall survival (OS) and toxicity data.

RESULTS

From November 2014 to September 2016, 94 patients were treated in 16 Italian sites. Seventeen percent of patients had one or more comorbidities, hypertension being the most common (60%). Ninety-eight percent of patients were treated by surgery, followed by RAI in 98% of cases. Sixty-four percent of patients received a previous systemic treatment. Lenvatinib was started at 24 mg in 64 subjects. Partial response and stable disease were observed in 36% and in 41% of subjects, respectively; progression was recorded in 14% of patients. Drug-related side-effects were common; the most common were fatigue (13.6%) and hypertension (11.6%). Overall, median PFS and OS were 10.8 months (95% confidence interval [CI], 7.7-12.6) and 23.8 months (95% CI, 19.7-25.0) respectively.

CONCLUSION

Lenvatinib is active and safe in unselected, RAI-refractory, progressive DTC patients in real-life setting. RR and PFS seem to be less favourable than those observed in the SELECT trial, likely due to a negative selection that included heavily pretreated patients or with poor performance status.

Flexible intramedullary nailing versus nonoperative treatment for paediatric displaced midshaft clavicle fractures

PURPOSE

The treatment of displaced midshaft clavicle fractures in children remains controversial. The purpose of our study was to compare the outcome of displaced midshaft clavicle fractures in children who were managed operatively by flexible intramedullary nailing (FIN) with nonoperative treatment.

METHODS

A prospective review of 31 children (mean age 10.5 years) with displaced midshaft clavicle fractures treated either by FIN or nonoperatively and with at least a six-month follow-up was undertaken. In all, 24 children underwent FIN and seven underwent nonoperative treatment. The patient outcomes included the Constant-Murley score, Customer Satisfaction Questionnaire (CSQ-8), numeric pain rating scale, time to union and time to return to activity. Surgical complications were recorded.

RESULTS

The two groups were comparable with regards to age, gender and mechanism of injury. At six months of follow-up, the Constant-Murley (97.8 versus 94.7, p < 0.001) and CSQ-8 (29.1 versus 19.1, p < 0.001) scores were higher in the FIN group. Time to union and return to activity were significantly shorter in the FIN group (7.3 and 9.2 weeks versus 10.4 and 16.6 weeks respectively, p < 0.01). The only surgical complication was a FIN exchange for skin irritation due to nail prominence.

CONCLUSION

FIN is a minimally invasive procedure for children with displaced midshaft clavicle fractures associated with shorter time to union, quicker return to activity and higher Constant-Murley and CSQ-8 scores when compared with nonoperative treatment. However, the difference in Constant-Murley scores was not clinically significant. Furthermore, the advantages of FIN are at the expense of an increased complication rate of 12.5% (upper 95% confidence interval 33.3%).

LEVEL OF EVIDENCE

Therapeutic, II.