Outcomes of a Phase II Study of Intraperitoneal Paclitaxel plus Systemic Capecitabine and Oxaliplatin (XELOX) for Gastric Cancer with Peritoneal Metastases

BACKGROUND

Adding intraperitoneal paclitaxel (IP-PTX) to paclitaxel/5-fluoropyrimidine has shown promising results in patients with gastric cancer peritoneal metastases (GCPM) but has not been studied with standard-of-care platinum/fluoropyrimidine combinations. Our goal to was evaluate IP-PTX with capecitabine/oxaliplatin (XELOX) in GCPM.

METHODS

Forty-four patients with GCPM received IP PTX (40 mg/m², Days 1, 8), oral capecitabine (1000 mg/m² twice daily, Days 1-14) and intravenous oxaliplatin (100 mg/m², Day 1) in 21-day cycles. Patients with synchronous GCPM underwent conversion surgery if they had good response after chemotherapy, conversion to negative cytology, no extraperitoneal metastasis, and no peritoneal disease during surgery. The primary endpoint was overall survival and secondary endpoints were progression-free survival and safety. Outcomes from the trial were compared against a matched cohort of 39 GCPM patients who received systemic chemotherapy (SC) comprising platinum/fluoropyrimidine.

RESULTS

The median OS for the IP and SC groups was 14.6 and 10.6 months (hazard ratio [HR] 0.44; 95% confidence interval [CI], 0.26-0.74; p = 0.002). The median PFS for the IP and SC group was 9.5 and 4.4 months respectively (HR 0.39; 95% CI 0.25-0.66; p < 0.001). Patients in the SC group were younger (IP vs. SC, 61 vs. 56 years, p = 0.021) and had better performance status (ECOG 0, IP vs. SC, 47.7% vs. 76.9%, p = 0.007) compared with the IP cohort. In IP group, conversion surgery was performed in 36.1% (13/36) of patients, with a median OS of 24.2 (95% CI 13.1-35.3) months and 1-year OS of 84.6%.

CONCLUSIONS

IP PTX with XELOX is a promising treatment option for GCPM patients. In patients with good response, conversion surgery was feasible with favourable outcomes.

Clinics in diagnostic imaging (204). Gastro-gastric intussusception due to gastric gastrointestinal stromal tumour (GIST)

A 95-year-old woman presented with abdominal bloating and anorexia of one week's duration. Contrast-enhanced computed tomography (CT) revealed features in keeping with gastro-gastric intussusception with a lead mass. Oesophagogastroduodenoscopy demonstrated a large 5-cm pedunculated fundal mass intussuscepted into the distal stomach. The patient subsequently underwent endoscopic polypectomy and open gastrostomy. Histological evaluation of the gastric mass revealed a gastrointestinal stromal tumour. Her postoperative course was uneventful. We herein describe the radiological features of adult intussusception and illustrate the usefulness of CT in the detection and characterisation of lead masses.

A Novel Wind Speed Estimation Based on the Integration of an Artificial Neural Network and a Particle Filter Using BeiDou GEO Reflectometry

Oceanographic remote sensing, which is based on the sensitivity of reflected signals from the Global Navigation Satellite Systems (GNSS), so-called GNSS-Reflectometry (GNSS-R), is very useful for the observation of ocean wind speed. Wind speed estimation over the ocean is the core factor in maritime transportation management and the study of climate change. The main concept of the GNSS-R technique is using the different times between the reflected and the direct signals to measure the wind speed and wind direction. Accordingly, this research proposes a novel technique for wind speed estimation involving the integration of an artificial neural network and the particle filter based on a theoretical model. Moreover, particle swarm optimization was applied to find the optimal weight and bias of the artificial neural network, in order to improve the accuracy of the estimation result. The observation dataset of the reflected signal information from BeiDou Geostationary Earth Orbit (GEO) satellite number 4 was used as an input for the estimation model. The data consisted of two phases with I and Q components. Two periods of BeiDou data were selected, the first period was from 3 to 8 August 2013 and the second period was from 12 to 14 August 2013, which corresponded to events from the typhoon Utor. The in situ wind speed measurement collected from the buoy station was used to validate the results. A coastal experiment was conducted at the Yangjiang site located in the South China Sea. The results show the ability of the proposed technique to estimate wind speed with a root mean square error of approximately 1.9 m/s.

A novel long-acting glucose-dependent insulinotropic peptide analogue: enhanced efficacy in normal and diabetic rodents

AIM

Glucose-dependent insulinotropic peptide (GIP) is an incretin hormone that is released from intestinal K cells in response to nutrient ingestion. We aimed to investigate the therapeutic potential of the novel N- and C-terminally modified GIP analogue AC163794.

METHODS

AC163794 was synthesized by solid-phase peptide synthesis. Design involved the substitution of the C-terminus tail region of the dipeptidyl peptidase IV (DPP-IV)-resistant GIP analogue [d-Ala(2) ]GIP(1-42) with the unique nine amino acid tail region of exenatide. The functional activity and binding of AC163794 to the GIP receptor were evaluated in RIN-m5F β-cells. In vitro metabolic stability was tested in human plasma and kidney membrane preparations. Acute insulinotropic effects were investigated in isolated mouse islets and during an intravenous glucose tolerance test in normal and diabetic Zucker fatty diabetic (ZDF) rats. The biological actions of AC163794 were comprehensively assessed in normal, ob/ob and high-fat-fed streptozotocin (STZ)-induced diabetic mice. Acute glucoregulatory effects of AC163794 were tested in diet-induced obese mice treated subchronically with AC3174, the exendatide analogue [Leu(14) ] exenatide. Human GIP or [d-Ala(2) ]GIP(1-42) were used for comparison.

RESULTS

AC163794 exhibited nanomolar functional GIP receptor potency in vitro similar to GIP and [d-Ala(2) ]GIP(1-42). AC163794 was metabolically more stable in vitro and displayed longer duration of insulinotropic action in vivo versus GIP and [d-Ala(2) ]GIP(1-42). In diabetic mice, AC163794 improved HbA1c through enhanced insulinotropic action, partial restoration of pancreatic insulin content and improved insulin sensitivity with no adverse effects on fat storage and metabolism. AC163794 provided additional baseline glucose-lowering when injected to mice treated with AC3174.

CONCLUSIONS

These studies support the potential use of a novel GIP analogue AC163794 for the treatment of type 2 diabetes.

Davalintide (AC2307), a novel amylin-mimetic peptide: enhanced pharmacological properties over native amylin to reduce food intake and body weight

OBJECTIVE

The current set of studies describe the in vivo metabolic actions of the novel amylin-mimetic peptide davalintide (AC2307) in rodents and compares these effects with those of the native peptide.

RESEARCH DESIGN AND METHODS

The anti-obesity effects of davalintide were examined after intraperitoneal injection or sustained peripheral infusion through subcutaneously implanted osmotic pumps. The effect of davalintide on food intake after lesioning of the area postrema (AP) and neuronal activation as measured by c-Fos, were also investigated.

RESULTS

Similar to amylin, davalintide bound with high affinity to amylin, calcitonin and calcitonin gene-related peptide receptors. Acutely, davalintide displayed greater suppression of dark-cycle feeding and an extended duration of action compared with amylin (23 versus 6 h). Davalintide had no effect on locomotor activity or kaolin consumption at doses that decreased food intake. Davalintide-induced weight loss through infusion was dose dependent, durable up to 8 weeks, fat-specific and lean-sparing, and was associated with a shift in food preference away from high-fat (palatable) chow. Metabolic rate was maintained during active weight loss. Both davalintide and amylin failed to suppress food intake after lesioning of the AP and activated similar brain nuclei, with davalintide displaying an extended duration of c-Fos expression compared with amylin (8 versus 2 h).

CONCLUSION

Davalintide displayed enhanced in vivo metabolic activity over amylin while retaining the beneficial properties possessed by the native molecule. In vitro receptor binding, c-Fos expression and AP lesion studies suggest that the metabolic actions of davalintide and amylin occur through activation of similar neuronal pathways.

Mast cell desensitization to IgE fails to induce a parallel adenosine receptor desensitization

Desensitization induced by challenge of mast cells with antigen is specific for IgE-dependent signals. During the secretory process mast cells release adenosine, which can induce a desensitization of adenosine receptors. To determine whether adenosine receptors may be desensitized from a previous antigen challenge, mast cells were sensitized with anti-DNP IgE antibody, challenged with DNP-BSA antigen, returned to culture overnight, resensitized, and rechallenged. Previously challenged cells exhibited increased spontaneous beta-hexosaminidase release, but adenosine retained its ability to augment beta-hexosaminidase release. Adenosine enhanced A23187-stimulated release of beta-hexosaminidase in control and previously challenged cells. Leukotriene C4 generation followed a similar pattern. Mastoparan, a direct G protein activator and mast cells secretagogue, produced a doubling of beta-hexosaminidase release in previously challenged cells. Results using other G protein activators were equivocal. Degranulation alone is insufficient to induce adenosine receptor hyposensitization. Whether the hyperresponsiveness to mastoparan is a consequence of uncoupling of IgE receptors from G proteins remains uncertain.