[A case of lymphatic vessel abnormality with chylous pneumonia]

Chylous pneumonia is a rare respiratory disease. The main clinical manifestation is coughing up chylous sputum with a variety of causes which can be clarified by lymphangiography. The lack of understanding of the disease, and infrequent lymphangiography have led to a high rate of misdiagnosis and missed diagnosis. Here, we reported a case of bronchial lymphatic fistula caused by lymphatic abnormality that led to the diagnosis and treatment of chylous pneumonia, with the aim of improving clinicians' understanding of this disease.

Catalytic Asymmetric [3 + 2] Annulation of Hantzsch Esters with Racemic N-Sulfonylaziridines

Hantzsch esters (HEs) served as two-carbon partners in a copper(I)-catalyzed enantioselective [3 + 2] annulation with racemic 2-(hetero)aryl-N-sulfonyl aziridines via kinetic resolution to provide pyrrolo[2,3-b]tetrahydropyridines containing multiple contiguous stereogenic centers including all-carbon quaternary centers in excellent yields and enantiopurities and moderate-to-excellent diastereoselectivities. Mainly dependent upon the structures of the aziridines, a competitive hydrogenolysis process with HEs as the hydrogen source was also observed in some cases.

[Application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing destructive wounds]

Objective: To explore the application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing various destructive wounds. Methods: The retrospective observational study method was applied. From January 2015 to December 2020, 28 patients (21 males and 7 females, aged 25 to 66 years) with destructive wounds in various body parts were admitted to Beijing Jishuitan Hospital. The wound areas of patients ranged from 17 cm×8 cm to 35 cm×22 cm after debridement. Pedicled or free paraumbilical perforator flaps with inferior epigastric vessels were used to repair the wounds respectively. The areas of flaps were from 18 cm×10 cm to 37 cm×24 cm, and the lengths of vascular pedicles were 13.0-17.0 (15.1±2.3) cm. For type Ⅲ high-voltage electric burn wounds of wrist, two methods were used to reconstruct the blood flow of hand, one is to bridge the radial artery with saphenous vein grafting and the other one is to design blood flow-through flap. The strength of abdominal wall in the donor site was strengthened by polypropylene patch, and then the wounds were directly sutured. If the wounds could not be sutured directly, then allogenic acellular dermal matrix (ADM) was applied to strengthen the abdominal wall first, and then autologous medium-thickness skin graft was taken from the thigh to cover the wounds. The flap transplantation, hand blood flow reconstruction, the repair of donor site, the flap survival, the wound and donor site healing after operation, the appearance of flaps, and the wound and donor site recovery during follow-up were observed. Results: Among the patients in this group, 13 patients were treated with pedicled flap grafting, while 15 patients were treated with free flap grafting. The hand blood flow of 7 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed by bridging radial artery with saphenous vein grafting. The hand blood flow of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed with blood flow-through flap. In 16 patients, the strength of abdominal wall was strengthened using patch in the donor site,and then the donor sites were sutured directly. In 12 patients, the strength of abdominal wall was strengthened using allogenic ADM, and then the donor sites were covered by skin grafting. All the transplanted flaps survived completely. The wounds of 24 patients were healed, while the wounds of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist and 1 patient with chronic radiation ulcer of ilium failed to heal because of there were still some necrotic tissue and purulent secretion under the flaps. The wounds were healed eventually after debridement and dressing changes. During the follow-up of 6 months to 3 years, the flap survived well with good appearance in all patients, and there was no recurrence, or no abdominal wall hernia occurred in the donor site. Conclusions: Paraumbilical perforator flap with inferior epigastric vessels has flexible design, long vascular pedicle, large area for cut. It can be pedicled or freely transplanted, which is a good choice for repairing destructive wounds in various areas.

Abstract SP012: Convergent evolution of resistance pathways during early stage breast cancer treatment with combination cell cycle (CDK) and endocrine signaling inhibitors

Combining cyclin-dependent kinase (CDK) inhibitors with endocrine therapy improves outcomes for metastatic estrogen receptor positive (ER+), HER2 negative, breast cancer patients. However, the value of this combination in potentially curable earlier stage patients is not clear. Using single cell transcriptomic profiling, we examined the evolutionary trajectories of early stage breast cancer tumors using serial tumor biopsies from a clinical trial of preoperative endocrine therapy alone (letrozole) or in combination with the cell cycle inhibitor ribociclib. Applying hierarchical regression and Gaussian process mathematical modelling, we classified each tumor by whether it shrinks or persists with therapy and determined cancer phenotypes related to evolution of resistance and cell cycle transcriptional rewiring. We found that all patients’ tumors undergo subclonal evolution during therapy, irrespective of the clinical response. However, tumors subjected to endocrine therapy alone showed reduced diversity over time, those facing combination therapy exhibited increased diversity. Despite different diversity, single nuclei RNA sequencing uncovered common phenotypic changes in tumor cells that persist following treatment. In these tumors, accelerated loss of estrogen signaling is convergent with up-regulation of the JNK pathway, while persistent tumors that maintain estrogen signaling during therapy show potentiation of CDK4/6 activation consistent with ERBB4 and ERK signaling up-regulation. Cell cycle reconstruction identified that these tumors can rebound during combination therapy treatment, indicating stronger selection and promotion of a proliferative state. These results indicate that combination therapy in early stage ER+ breast cancers with ER and CDK inhibition drives rapid evolution of resistance via a shift from estrogen signaling to alternative growth factor receptor mediated proliferation and JNK signaling activation, concordant with a bypass in the G1 checkpoint.

Citation Format: JI Griffiths, J Chen, PA Cosgrove, A O'Dea, P Sharma, CX Ma, M Trivedi, K Kalinsky, KB Wisinski, R O'Reagan, I Makhoul, LM Spring, A Bardia, FR Adler, AL Cohen, JT Chang, QJ Khan, AH Bild. Convergent evolution of resistance pathways during early stage breast cancer treatment with combination cell cycle (CDK) and endocrine signaling inhibitors [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SP012.

[Limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation]

Objective: To explore the limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation. Methods: From January 2003 to March 2019, 61 patients with high voltage electric burns of extremities on the verge of amputation were treated in our hospital. All of them were male, aged 15-58 years, including 49 cases of upper limbs and 12 cases of lower limbs. The wound area after thorough debridement ranged from 15 cm×11 cm to 35 cm×20 cm. Emergency surgery for reconstruction of the radial artery with saphenous vein graft under eschar was performed in 5 cases. The arteries of 36 patients (including 7 cases with simultaneous ulnar artery and radial artery reconstruction) were reconstructed with various forms of blood flow-through after debridement, among them, the radial artery of 13 cases, the ulnar artery of 8 cases, the brachial artery of 8 cases, and the femoral artery of 2 cases were reconstructed with saphenous vein graft; the radial artery of 3 cases and the ulnar artery of 7 cases were reconstructed with the descending branch of the lateral circumflex femoral artery graft; the radial artery of 2 cases were reconstructed with greater omentum vascular graft; the reflux vein of 3 cases with wrist and forearm annular electric burns were reconstructed with saphenous vein graft. According to the actual situation of the patients, 12 cases of latissimus dorsi myocutaneous flap, 6 cases of paraumbilical flap, 28 cases of anterolateral thigh flap, 10 cases of abdominal combined axial flap, 5 cases of greater omentum combined with flap and/or skin grafts were used to repair the wounds after debridement and cover the main wounds as much as possible. Some cases were filled with muscle flap in deep defect at the same time. The area of tissue flaps ranged from 10 cm×10 cm to 38 cm×22 cm. For particularly large wounds and annular wounds, the latissimus dorsi myocutaneous flap, the paraumbilical flap, the abdominal combined axial flap, and the greater omentum combined with flap and/or skin grafts were used more often. Donor sites of three patients were closed directly, and those of 58 patients were repaired with thin and medium split-thickness skin or mesh skin grafts. The outcome of limb salvage, flap survival, and follow-up of patients in this group were recorded. Results: All the transplanted tissue flaps survived in 61 patients. Fifty-six patients had successful limb salvage, among them, 31 limbs were healed after primary surgery; 20 limbs with flap infection and tissue necrosis survived after debridement and flap sutured in situ; 5 limbs with flap infection, radial artery thrombosis, and hand blood supply crisis survived after debridement and radial artery reconstruction with saphenous vein graft. Five patients had limb salvage failure, among them, 3 patients with wrist electric burns had embolism on the distal end of the transplanted blood vessels, without condition of re-anastomosis, and the hands gradually necrotized; although the upper limb of one patient was salvaged at first, due to the extensive necrosis and infection at the distal radius and ulna and the existence of hand blood supply under flap, considering prognostic function and economic benefits, amputation was required by the patient; although the foot of one patient was salvaged at first, due to the repeated infection, sinus formation, extensive bone necrosis of foot under flap, dullness of sole and dysfunction in walking for a long time, amputation was required by the patient. During the follow-up of 6 months to 5 years, 56 patients had adequate blood supply in the salvaged limbs, satisfied appearance of flaps, and certain recovery of limb function. Conclusions: Timely revascularization, early thorough debridement, and transplantation of large free tissue flap, combined tissue flap, or blood flow-through flap with rich blood supply are the basic factors to get better limb preservation and recovery of certain functions for patients with high voltage electric burns of limbs on the verge of amputation.

[Effects of 18β-sodium glycyrrhetinic acid on TNF-α expression in rats with allergic rhinitis]

Objective:To observe the effect of 18β-sodium glycyrrhetinic acid(18β-SGA) on the expression of TNF-α in nasal mucosa of rats with allergic rhinitis（AR）, and explore the intervention mechanism of 18β-SGA on AR. Method:One hundred and six SPF-level Wistar rats were randomly divided into control group, AR group, budesonide group, 18β-SGA low dose group and high dose group. After the AR rat model was constructed by ovalbumin, the rats were given drug intervention and sacrificed after 2 and 4 weeks of intervention. The nasal mucosa of the rats was taken for immunohistochemical staining, RT-qPCR and Western-blotting to localize and quantify the expression of TNF-α. Result:By immunohistochemistry, Western-blotting and RT-PCR, TNF-α was mainly found in the columnar epithelium, vascular endothelium, glandular and some inflammatory cytoplasm of nasal mucosa. And the expression of TNF-α in the nasal mucosa of AR rats was significantly increased than the normal group at the protein and mRNA levels (P<0.01). After intervention with different doses of 18β-SGA, the expression of TNF-α was significantly decreased (P<0.01), especially after 4 weeks of 18β-SGA low dose group(P<0.01). Conclusion:Different doses of 18β-SGA have therapeutic effects on AR, and its mechanism of action may be related to the inhibition of TNF-α expression.

[Effects of perforator flaps in the reconstruction of hypertrophic scar contracture deformities in the large joints of extremities of patients after severe burns]

Objective: To explore the clinical effects of perforator flaps in the reconstruction of hypertrophic scar contracture deformities in the large joints of extremities after severe burns. Methods: From January 2008 to January 2018, 72 patients (53 males and 19 females, aged 5 to 63 years) with hypertrophic scar contracture deformities and functional disorder in the large joints of extremities after severe burns were admitted to the Department of Burns of Beijing Jishuitan Hospital. Scar hyperplasia and contracture deformity were located at shoulder joints of 28 patients, elbow joints of 15 patients, hip joints of 7 patients, knee joints of 17 patients, and ankle joints of 5 patients. The wound area of patients after the scars were excised and released ranged from 7 cm×6 cm to 34 cm×12 cm. The wounds were repaired with corresponding unexpanded perforator flaps or expanded perforator flaps according to the joint location and existing soft tissue conditions. The size of flaps ranged from 7 cm×6 cm to 35 cm×14 cm. The donor sites of 51 patients were sutured directly; the donor sites of 21 patients were repaired by segmented grafts or mesh grafts. The adopted surgeries, the survival of flaps after surgery, and the functional recovery of the joints during follow-up were recorded. Results: Among the 72 patients, 53 patients had perforator flap repairing surgery only; 19 patients had perforator flap repairing surgery and skin grafting. Among them, 12 patients had expanded perforator flaps, 60 patients had unexpanded perforator flaps. The perforator flaps were performed free transplantation in 9 patients, pedicled transplantation in 61 patients, and groin transplantation in 2 patients. At last, 67 flaps survived completely, while 5 flaps had distal-end necrosis which were healed after dressing change or skin grafting after debridement. During follow-up of 6 months to 3 years, the joint function of all the patients was obviously improved. The abduction angles of shoulder joints were over 110°; the hip, knee, and elbow joints could reach the straight position, and the flexion was normal; the foot drop deformity was corrected, and the appearance of flaps was good with obvious extension compared with the original state. Conclusions: Perforator flaps are suitable for reconstruction of hypertrophic scar contracture deformities in the large joints of extremities of patients after severe burns. They can restore the joint function to the greatest extent as well as repair the wounds.

[Application and prospect of fecal DNA test in colorectal cancer screening]

Effective early screening and primary prevention is one of the major initiatives to decrease the morbidity and mortality of colorectal cancer in China. As a new non-invasive screening method for colorectal cancer in recent years, fecal DNA test detects colorectal cancer by analyzing gene mutations from intestinal tumor cells in the feces. The most widely used method among fecal DNA test is multi-target stoolDNA test (MT-sDNA). Many studies abroad on this emerging technique have been carried out to verify its high sensitivity, and it is gradually used in the clinic with continuous improvement and development of technology. Meanwhile, domestic MT-sDNA is still in the prototype stage, and more researches from Chinese population are needed. Compared with traditional screening methods, MT-sDNA technology has the advantages of non-invasiveness, painlessness and convenience. But its defects exist, such as high cost and low specificity. MT-sDNAis in accordance with precision medicine, and can largely make up for the shortcomings of traditional screening methods for colorectal cancer. It also holds a great promise for promoting the screening for colorectal cancer. This paper is aimed to discuss the application value of fecal DNA test by introducing its related researches at home and abroad,and summarizing its merits and demerits.

Abstract P1-15-05: Is absolute lymphocyte count associated with platinum-sensitivity? A phase II single arm study evaluating the efficacy of neoadjuvant carboplatin and docetaxel in triple negative breast cancer

Background: Platinum-based chemotherapy is still considered investigational for the treatment of sporadic triple negative breast cancer (TNBC). Since patients with TNBC have a high rate of chemotherapy resistance, it is critical to identify platinum-sensitive individuals prior to initiating therapy. Higher absolute lymphocyte count (ALC) is associated with improved clinical response to anthracycline-based chemotherapy, the current standard of care in TNBC. We report the initial results of a phase II single arm study evaluating the efficacy of neoadjuvant carboplatin and docetaxel in TNBC. We also report results of an exploratory analysis assessing whether ALC can be used to predict pathologic complete response (pCR) after treatment with platinum-based chemotherapy.

Patients and Methods: 78 patients with clinical stage II or III TNBC have been enrolled in this ongoing study evaluating the efficacy of neoadjuvant carboplatin and docetaxel (NCT201404107). Patients received docetaxel 75 mg/m2 and carboplatin AUC 6 every three weeks for a total of 6 cycles. Blood samples were collected prior to each cycle, and a posttreatment sample was collected &gt; 3 weeks after completing cycle 6. pCR was defined as no residual invasive disease in the breast, with or without ductal carcinoma in situ, and no tumor deposits in sampled lymph nodes. Baseline characteristics of patients were summarized with descriptive statistics. Univariate and multivariate logistic regression analyses were used to identify factors associated with pCR.

Results: Out of the 78 enrolled patients, 60 have completed all 6 treatment cycles and surgery. The preliminary pCR rate is 46.7%. Age, race, clinical stage, and tumor grade determined at time of diagnosis were not significantly different between pCR patients and non-pCR patients. In univariate analyses, patients with higher ALCs at the posttreatment time point were more likely to have pCR than those who had lower ALCs (OR 5.5, 95% CI 1.5-20.7, p=0.011). Additionally, patients who had higher minimum ALCs were also more likely to have pCR (OR 9.1, 95% CI 1.5-54.9, p=0.016). Baseline ALC values were not associated with pCR. The associations of posttreatment and minimum ALCs to pCR remained statistically significant even after controlling for age and clinical stage at time of diagnosis (posttreatment ALC OR 7.6, 95% CI 1.7-34.8, p=0.009; minimum ALC OR 9.0, 95% CI 1.5-55.2, p=0.018).

Conclusion: The pCR rate of our cohort is similar to that of other trials evaluating neoadjuvant platinum-based chemotherapy in TNBC. Baseline ALC did not predict which patients would achieve pCR. However, the associations of posttreatment and minimum ALCs with pCR indicate patients who are able to maintain a robust population of circulating lymphocytes throughout treatment with platinum-based chemotherapy are more likely to respond favorably. The link between patient immunity and platinum-based chemotherapy suggests addition of immunotherapy agents to neoadjuvant chemotherapy may improve patient outcomes.

Citation Format: Chen I, Guo F, Summa T, Luo J, Ellis MJ, Ma CX, Weilbaecher KN, Naughton MJ, Suresh R, Peterson LL, Cherian MA, Bose R, Frith AE, Hernandez-Aya LF, Gillanders WE, Ademuyiwa FO. Is absolute lymphocyte count associated with platinum-sensitivity? A phase II single arm study evaluating the efficacy of neoadjuvant carboplatin and docetaxel in triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-05.

Abstract P5-21-30: Retrospective review of palbociclib (Pal) efficacy and benefit from subsequent treatments following Pal progression in patients (pts) with hormone receptor positive (HR+) and HER2 negative (HER2-) metastatic breast cancer (MBC)

Background

The cyclin-dependent kinase (CDK) 4/6 inhibitor Pal is approved for HR+ HER2- MBC. However, the optimal therapy following Pal progression is unknown. Therefore we conducted this retrospective study to review Pal efficacy and summarize the practice pattern and responses to subsequent treatments post Pal progression.

Methods

We performed a chart review of pts with HR+ HER2- MBC who began Pal treatment at Washington University Siteman Cancer Center between Feb 16, 2015 and July 13, 2016 and collected information on pts demographics, diagnosis, and treatment history. Duration of therapy was used to calculate the progression free survival (PFS) for each regimen. Treatment was considered first-line if administered without any prior systemic therapy or at least 1 year from completion of adjuvant hormonal therapy (HT). Treatments received after progression on 1st line therapy or upon relapse during or within 1 year from the completion of adjuvant HT were considered second-line regimens.

Statistical analyses were performed on SAS software, version 9.4. The Kaplan-Meier method was used to generate time-to-event curves, from which median PFS was calculated. A stratified log-rank test was used for all comparisons, and the P value derived from the comparison was reported.

Results

We completed a chart review for 81 pts (78 female and 3 male; 63 Caucasian, 14 African American, and 4 other races) with HR+ HER2- MBC (68 were ER+PR+, 13 were ER+PR-) who received Pal plus letrozole (n=65) or fulvestrant (n=15) or anastrozole (n=1), with a median age of 62.0 years (range 28.1 - 85.6) at the start of Pal.

The median follow up was 20.0 months (mos) (range 10.8 – 27.9). 25 pts were still on Pal treatment. The median PFS on Pal was 19.9 mos in the first-line setting (n=20), compared to 12.1 mos and 4.4 mos in the second-line (n=14) and subsequent lines (n=47), respectively (p=0.0287). Among the 54 pts who progressed on Pal, 38 moved on to the next treatment. 20 pts received chemotherapy and 16 pts received HT or a HT combination. 2 pts received fulvestrant plus Pal upon progression on letrozole plus Pal, and treatment was still ongoing at 4 mos and 7 mos of follow up, respectively. The most common treatments post Pal were single-agent capecitabine (Cape) (n=9) and the combination of exemestane (Exe) and everolimus (Eve) (n=8). The median PFS was 4.7 mos with Cape compared to 8.4 mos with Exe and Eve (p=0.60). The median PFS was 4.7 mos for the 20 pts who received chemo, whereas the median PFS was 4.9 mos with subsequent HT (n=16) (p=0.75).

Conclusion

Pal plus letrozole or fulvestrant is effective for the treatment of HR+ HER2- MBC, with activity observed beyond the 1st and 2nd line treatment settings. The PFS of Pal observed in this single center retrospective study is consistent with that of published data. Single-agent cape or the Exe and Eve combination were common treatment choices following progression on Pal. Although the study is limited by its small sample size, the median PFS of 8.4 mos with Exe and Eve indicates its potential efficacy in the setting of Pal progression. Additional pts and followup data will be presented.

Citation Format: Xi J, Oza A, Thomas S, Naughton M, Ademuyiwa F, Weilbaecher KN, Suresh R, Bose R, Cherian MA, Hernandez-Aya L, Frith A, Peterson LL, Krishnamurthy J, Ma CX. Retrospective review of palbociclib (Pal) efficacy and benefit from subsequent treatments following Pal progression in patients (pts) with hormone receptor positive (HR+) and HER2 negative (HER2-) metastatic breast cancer (MBC) [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 P5-21-30.

Abstract P2-09-19: Genomic biomarker for resistance to palbociclib in the NeoPalAna trial

Background: Cyclin-dependent kinase (CDK) 4/6 inhibitors are being evaluated in the adjuvant setting for patients with resected early stage hormone receptor positive (HR+) and HER2 negative (HER2-) breast cancer (BC). However, biomarkers that predict benefit from this class of agents are unknown. We have recently reported results from the phase II neoadjuvant NeoPalAna trial which demonstrated that palbociclib (Pal) enhanced the anti-proliferative activity when added upon anastrozole (Ana) monotherapy in estrogen receptor (ER) positive and HER2 negative breast cancers. Interestingly, a small group of patients was resistant to Pal, exhibiting persistent tumor cell proliferation (Ki67 &gt;2.7%) on the combination of Ana and Pal. In this study, we evaluated the utility of a research algorithm for the 70-gene signature (70-GS) in identifying Pal resistant versus sensitive patients. Methods: Serial biopsies were collected from patients at four treatment timepoints: baseline (BL), cycle 1 day 1 (C1D1) following 28 days of Ana monotherapy, cycle 1 day 15 (C1D15) at 2 weeks post the addition of Pal, and at surgery (Surg). RNA was extracted from frozen tumor biopsies at each timepoint and run on Agilent full genome microarrays (GSE93204) at Washington University. As an exploratory analysis, genes from the GPL8253 array that match the 70-GS were used to calculate a research approximation of the 70-GS index (r-GS). The distribution of the r-GS across Ki67 response groups was evaluated. Results: Ki67 had previously been measured at each timepoint, and used to classify patients as being either Ana-sensitive (C1D1 Ki67 ≤2.7%), Pal-sensitive (C1D1 Ki67 &gt;2.7%, C1D15 Ki67 ≤2.7%), or Pal-resistant (C1D15 Ki67 &gt;2.7%). The r-GS was differentially regulated between sensitive (AI or Pal) and Pal-resistant groups at BL (p=0.012), C1D1 (p=0.039), and C1D15 (p=0.022). The r-GS values varied widely across patients at BL, and generally became more positive (more low risk) with treatment. There was no correlation between Ki67 levels and r-GS. Furthermore, gene expression analysis was performed to elucidate the difference between Pal-sensitive vs. Pal-resistant patients, and Ana-sensitive vs. Pal-sensitive patients. Conclusions: While on-treatment Ki67 indicated drug responsiveness, baseline r-GS significantly stratified patients into sensitive (Ana or Pal) versus Pal-resistant groups in the neoadjuvant setting. This preliminary finding suggests that the 70-GS may have clinical utility in identifying patients resistant to Pal for future studies. Additionally, results of the gene expression analysis may help to further develop genomic biomarkers for Pal and Ana sensitivity and resistance.

Citation Format: Hoog JW, Treece T, Blumencranz L, Audeh W, Sanati S, Ellis MJ, Ma CX. Genomic biomarker for resistance to palbociclib in the NeoPalAna trial [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 P2-09-19.

[The influence of EphA2 overexpression on proliferation and apoptosis of human lens epithelial cells exposed to high-concentration dexamethasone in vitro]

Objective: To construct lentiviral-mediated EphA2 overexpression vectors, transfect them into human lens epithelial cells (HLE-B3) in vitro, and investigate the effect of EphA2 gene overexpression on the proliferation and apoptosis of HLE-B3 exposed to high-concentration dexamethasone. Methods: Experimental Study. The pCDH-CMV- MCS-EF1-RFP plasmid was set up by the digestion of NOTⅠand XbaⅠ double restriction enzyme and ligation of CE ligase, and then the plasmid was transformed into DH10B cells. Seven clons were picked for enzymatic digestion and the clons with correct results were chosen for sequencing. The 293 T/17 cells were co-transfected with the pCDH-CMV-MCS-EF1-RFP-EphA2 and the packaging mixture by Lipofectamine 2000. At different multiplicities of infection (MOI=20, 50, 100, and 200) after 72-hour infection, we observed the expression of RFP and morphological changes of HLE-B3 by an inverted fluorescence microscope, and calculated the transfection efficiency through the flow cytometry. EphA2 protein expression was detected by Western blot. The following experiments were divided into four groups: normal control group (group A), EphA2 overexpression vector transfection group (group B), HLE-B3 cells exposed to dexamethasone group (group C) and EphA2 overexpression vector transfection HLE-B3 cells exposed to dexamethasone group (group D). Statistical analysis method was single factor or two factors variance analysis. Cell survival rate was detected by the Cell Counting Kit-8 assay. Cell apoptosis index was detected by Tunel. Results: Restriction enzyme digestion and sequencing indicated that EphA2 cDNA fragment was successfully inserted in the vector. The infection efficiency was up to 38.6%±3.9%, 49.2%±4.2%, 79.5%±5.5% and 80.2%±6.0% when the MOI was 20, 50, 100 and 200, respectively. There was statistically significant difference (F=2 600.8, P=0.001) among the four groups and between any two groups except between the MOI=100 group and MOI=200 group (P=2.507) . The relative quantity of EphA2 protein of the normal control group, empty vector transfection group and EphA2 gene overexpression vector transfection group was (0.561 2±0.031 7) , (0.559 7±0.012 8) and (3.032 0±0.041 9) , respectively. There was statistically significant difference (F=2 646.0, P=0.001) among the three groups and between any two groups except between the normal control group and empty vector transfection group (P=0.868) . The survival rate of groups A, B, C and D was 98.18%±1.85%, 122.01%±3.89%, 52.32%±1.99% and 76.18%±3.74%, respectively. There was statistically significant difference among the four groups (F=497.6, P=0.001) . The survival rate of group B was greater than group A (P=0.001) . The survival rate of group D was greater than group C (P=0.001) . Tunel results showed that the apoptosis index of groups A, B, C and D was 5.4%±1.5%, 5.0%±1.3%, 23.0%±3.9% and 14.4%±2.7%, respectively. There was statistically significant difference among the four groups (F=397.6, P=0.001) . The apoptosis index of group B was lower than group A, but there was no statistically significant difference between them (P=0.415) ; the apoptosis index of group D was lower than group C (P=0.018). Conclusions: The lentiviral vector carrying human EphA2 gene has been successfully constructed and efficiently expressed in HLE-B3 cells. EphA2 gene overexpression could increase the HLE-B3 cell survival rate and protect HLE-B3 cells from high-concentration dexamethasone-induced reduction of the cell survival rate. EphA2 gene overexpression could protect HLE-B3 cells from high-concentration dexamethasone-induced apoptosis, but it has no remarkable effect on apoptosis of HLE-B3 cells under physiological conditions. (Chin J Ophthalmol, 2018, 54: 125-132).

[Effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients]

Objective: To investigate the effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients. Methods: From January 2014 to June 2016, 5 patients with high-voltage electrical burn of unilateral wrist were hospitalized in our burn ward, with extensive necrosis of skin soft tissue of burn wrist. Five patients were transferred to our burn ward 6 to 12 days post injury after undergoing emergency dermotomy of wrist to reduce tension in other hospitals. In 2 to 3 days after admission, operation was performed by two surgeon group at the same time, when patients' general condition were stable. One group underwent debridement and the other group designed and dissected flap according to the range of skin soft tissue defect of wrist. Wrist wounds after debridement ranged from 15 cm×10 cm to 24 cm×15 cm. Three patients were treated with flow-through descending branch of lateral circumflex femoral artery flap and great saphenous vein for repairing wounds of wrist and reconstruction of ulnar and radial artery. Two patients were treated with flow-through descending branch of lateral circumflex femoral artery flap for repairing wounds of wrist and reconstruction of ulnar artery. The dissected flaps ranged from 16 cm×12 cm to 26 cm×16 cm and the length of bridging vessel ranged from 15 to 21 cm. Results: The flow-through descending branch of lateral circumflex femoral artery flaps of five patients survived well. Wounds of 4 patients healed and wounds of 1 patient with infection under the flap on 3 days after operation healed after changing wound dressing and undergoing debridement for 2 weeks. After the operation, wrists and hands of 5 patients had adequate blood supply and ulnar and radial artery recovered patency. Follow-up of patients for 6 months to 1 year showed good flap appearance and adequate blood supply of burn hands. Conclusions: The flow-through descending branch of lateral circumflex femoral artery flap can repair wrist wounds and recover blood supply of hands and it is a good method for repairing high-voltage electrical burns of wrist.

Abstract P1-07-11: Tumor genomic profiling of triple negative breast cancer during neoadjuvant chemotherapy: Results from a prospective trial of carboplatin and docetaxel

Background-The clonal evolution and effect of neoadjuvant chemotherapy on the mutational landscape of triple negative breast cancer (TNBC) is unknown. Inability to eradicate TNBC may be due to clonal progression and selection of cells fundamentally resistant to chemotherapy.In this study, we sought to decipher the genomic architecture of TNBC serially during neoadjuvant chemotherapy to distinguish pre- versus post-chemotherapy genotypes.

Methods-Tumor specimens were obtained from patients with stages II and III TNBC enrolled on an ongoing prospective neoadjuvant co-clinical trial (NCT02124902). Patients have a research biopsy at baseline, cycle 1 day 3 (optional), and at definitive surgery for those with residual disease. Patients are treated with docetaxel 75mg/m2 and carboplatin AUC6 cycled every 3 weeks X six cycles. Definitive surgery is 3-5 weeks after chemotherapy. The primary endpoint is pathologic complete response rate. Correlative studies include development of patient derived xenografts, evaluation of genomic signatures of resistance and response, and comparison of chemotherapy responses between xenografts and host patients. Five patients' serial tumor samples and germline DNA were studied by exome and transcriptome sequencing. Three of these patients had an additional on-treatment sample at cycle 1 day 3. Two patients lacked residual disease samples- one was not banked and the other could not be accurately genotyped due to low cellularity. The median sequencing depth was 90.13x. Sequencing was performed on either fresh frozen or formalin-fixed paraffin-embedded samples with high cellularity (≥50%). After identifying somatic mutations in each tumor series, we evaluated whether each mutation was persistent, emergent, or cleared by comparing pre- and post-treatment (and when possible, on-treatment) samples.

Results-All five patients had response to neoadjuvant chemotherapy based on caliper-based and pathologic (residual cancer burden I or II) measurements. All residual disease remained TNBC by standard immunohistochemistry and all samples were basal-like from PAM50 gene expression analysis. We identified 908 somatic mutations, including the expected variants in TP53 which persisted in all post-treatment samples. Non-silent somatic variants were identified in other breast cancer-related genes, including GATA1, FBXO11, PIK3R1, AXIN2, ARID1B, BRCA2, and RBCC1. In spite of the clinico-pathologic evidence of response, we observed little change in clonal architecture, as derived from the purity-corrected variant allele fractions between baseline, cycle 1 day 3, and post-chemotherapy samples. Copy number alterations were likewise stable and transcriptional-based assessment indicated that patterns of mutant allele expression in driver genes were retained throughout the course of treatment.

Conclusion-In TNBC patients undergoing neoadjuvant platinum-based chemotherapy, there were no apparent shifts in the prevalence of known breast cancer specific somatic variants during or after chemotherapy. Despite pathologic response, core genomic features appear to be preserved in TNBC patients with residual disease following chemotherapy, likely accounting for high rates of relapse in these patients.

Citation Format: Ademuyiwa FO, Miller CA, Li T, Sanati S, Ma CX, Weilbaecher K, Ellis MJ, Mardis ER. Tumor genomic profiling of triple negative breast cancer during neoadjuvant chemotherapy: Results from a prospective trial of carboplatin and docetaxel [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 P1-07-11.

[Clinical analysis of aphakic glaucoma following infantile congenital cataract surgery]

OBJECTIVE

To investigate the incidence, occurrence time and types of aphakic glaucoma following infantile congenital cataract surgery.

METHODS

The records of children who underwent surgery for congenital cataract within the first 24 months of life between January 2010 and January 2014 at the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed.Children with preoperative conditions associated with glaucoma were excluded.The following parameters were ascertained: age received cataract surgery, operation method, the incidence, occurrence time and types of glaucoma.

RESULTS

A total of 205 patients (324 eyes) with an average surgery age of 13.9 months were included, and the mean follow-up time was 47.6 months.The operation method was cataract extraction combined with posterior continuous circular capsulorhexis and anterior vitrectomy.Twenty-nine patients (37 eyes, 11.42%) had subsequent development of aphakic glaucoma, 9 eyes of which (2.78%) developed early onset angle closed glaucoma, and the occurrence time was (4.2±2.6) months after cataract surgery; 28 eyes (8.64%) developed late onset open angle glaucoma, 26 of which was angle open glaucoma, and the rest two was angle closed glaucoma.The occurrence time was (37.5±11.0) months after cataract surgery. Twenty-nine patients (37 eyes) developed aphakic glaucoma had cataract surgery within 2 to 12 months (6.8 months on average). The rest 176 patients (287 eyes) who did not develop glaucoma had cataract surgery at 10 to 24 months (14.1 months on average).

CONCLUSIONS

The incidence of aphakic glaucoma following infantile congenital cataract surgery is 11.42%.Aphakic glaucoma is divided into two types of early onset angle closed glaucoma and late onset open angle glaucoma.The occurence time of glaucoma was 2 months to 64 months after cataract surgery.Late onset open angle glaucoma is the most common type.

Abstract S6-05: A phase II trial of neoadjuvant palbociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor, in combination with anastrozole for clinical stage 2 or 3 estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC)

Background

ER+ BC is associated with activated CDK4/6. The CDK4/6 inhibitor palbociclib (P) markedly improves time to progression in advanced ER+HER2- BC. We conducted a neoadjuvant phase II trial to determine the activity of P in primary breast cancer as a prelude to adjuvant studies.

Methods

To assess molecular changes induced by anastrozole (A) or P+A, patients (pts) were treated initially with A alone (1mg PO daily) for 28 days in cycle 0 (C0) before the addition of P (125mg PO daily on D1-21 each cycle) on C1D1. P+A was administered for 4 28-day cycles followed by C5 with A alone for 2-4 weeks (wks) before surgery. P was added in C5 for 10-12 days immediately prior to surgery in the last 20 pts enrolled to assess molecular changes induced by A, either alone or in combination with P immediately prior to surgery, in resected tumor. Goserelin was added in premenopausal pts.

Research tumor biopsies were obtained at baseline, C1D1, and C1D15. Central Ki67 analysis was performed at all timepoints, those with Ki67 &gt;10% at C1D15 went off study treatment.

The primary endpoint was complete cell cycle arrest (CCA), defined as Ki67 &lt;2.7%, at C1D15. Patient stratification was based on PIK3CA mutation status with an initial focus on PIK3CA wild type (WT) disease. Pts with PIK3CA mutant (Mut) tumors enrolled to a separate cohort. A sample size of 33 pts in the PIK3CA WT cohort was chosen based on the Fleming's single-stage phase II design to test the hypothesis that P+A leads to &gt; 50% improvement over A in CCA rate on C1D15 biopsy (44% with A alone based on historical data, vs 66% with P+A, power = 0.8, alpha=0.05). The primary endpoint is met if &gt;20 pts achieved CCA in this cohort.

Correlative endpoints included assessment of markers of proliferation, apoptosis, senescence, Rb, gene expression microarray, intrinsic subtype, and next generation sequencing of 83-gene panels, which will be reported at the meeting.

Results

Between 4/23/2013 and 4/24/2015, 50 pts (33 PIK3CA WT, 11 PIK3CA Mut, 2 pending, 4 tissue quantity or quality not sufficient for sequencing (QNS)) were enrolled to the study. Median age was 57.5 (range: 34.1–79.6) years. Four pts, all with WT PIK3CA, went off study due to Ki67 &gt;10% on C1D15 biopsy, 26 pts completed treatment and surgery, 1 refused surgery, 3 withdrew study treatment in C1, and 16 continued to receive study drug (2 in C0, 3 in C1, 4 in C2, 5 in C3, 1 in C4, and 1 in C5). Among the 40 pts currently evaluable for the primary endpoint (C1D15 Ki67), CCA occurred in 34 (85%) pts, including 9 of 9 (100%) PIK3CA Mut, 22 of 28 (78.5%) WT, and 3 of 3 QNS pts. Preliminary analysis of available data indicated a significantly lower Ki67 value after 2 wks of P+A (C1D15) compared to that on A alone (C1D1) (p=0.034, n=18).

Conclusion

This study met the primary endpoint demonstrating that P+A is a highly effective anti-proliferative combination. The sequential biopsy design clearly demonstrated that P+A increased cell cycle control over A alone. P+A was effective regardless of PIK3CA mutation status and these results support the evaluation of this combination in the adjuvant setting for ER+HER2- BC.

Citation Format: Ma CX, Gao F, Northfelt D, Goetz M, Forero A, Naughton M, Ademuyiwa F, Suresh R, Anderson KS, Margenthaler J, Aft R, Hobday T, Moynihan T, Gillanders W, Cyr A, Eberlein TJ, Hieken T, Krontiras H, Hoog J, Han J, Guo Z, Vij K, Mardis E, Al-Kateb H, Sanati S, Ellis MJ. A phase II trial of neoadjuvant palbociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor, in combination with anastrozole for clinical stage 2 or 3 estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). [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 S6-05.

Abstract P5-13-04: A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC)

Background

Activating mutations in PIK3CA occur in approximately 40% ER+BC. MK-2206 (M), a pan-AKT inhibitor, induced apoptosis of ER+ BC under estrogen deprivation in preclinical studies. We conducted this neoadjuvant trial to determine the pathologic complete response (pCR) rate of M plus anastrozole (A) for PIK3CA mutant (Mut) ER+ BC.

Methods

This single arm open label study of M+A used a 2-stage Simon phase II design (stage 1, n=16; stage 2, n=13, alpha=0.10, power=0.90) to test whether pCR rate &lt;1% (based on historical data with A alone), against the alternative that pCR rate ≥15% in PIK3CA Mut ER+ BC. At least 1 pCR in stage 1 was required to proceed to stage 2.

Eligible patients (pts) with clinical stage II or III ER+HER2- BC were pre-registered and proceeded to a research tumor biopsy for PIK3CA sequencing, followed by treatment with daily A monotherapy for 28 days (cycle 0). Pts with PIK3CA Mut BC were subsequently registered, underwent a second biopsy, and started M (150mg PO weekly) with daily A on cycle 1 day 1 (C1D1) for a maximum of four 28-day cycles followed by surgery. Goserelin was added for premenopausal pts. A tumor biopsy on C1D17, 17 days post the start of M, was performed. Those with C1D17 Ki67 &gt;10% discontinued study treatment. pCR was defined as no invasive cancer in the breast and the lymph nodes. Tumor specimens collected at all timepoints are being analyzed for markers of proliferation, apoptosis, and PI3K pathway activity, gene expression microarray, intrinsic subtypes, and next generation sequencing of 83 genes.

Results

Of the 51 pts pre-registered, 35 pts did not register due to no PIK3CA mutation (n=22), inadequate specimen for testing (n=6), physician/pt decision (n=7). The remaining 16 pts (median age: 58, range: 40-77 years) received combination therapy. Three pts did not complete 4 cycles due to C1D17 Ki67 &gt;10% (n=2) and intolerability (grade (Gr) 4 transaminase elevation in C1, n=1). Other severe toxicities possibly related to M included Gr 3 rash (25%) and pruritus (12.5%). Of the 13 pts completed study therapy and underwent surgery, all had residual disease in the breast and 7 also had positive nodes. Table 1 summarized changes in Ki67 during treatment.

ComparisonsnAbsolute changes in Ki67 median (range)Wilcoxon signed rank p-valueC1D1 relative to pre-registration11-17.0% (-49.8 to 4.1%)0.0020C1D17 relative to pre-registration14-16.4% (-51.4 to 4.1%)0.0004C1D17 relative to C1D112-1.5% (-18.6 to 15.8%)0.9697C1D1, biopsy post 28 days of A alone; C1D17 biopsy post 17 days on combination therapy

Although Ki67 levels post A monotherapy (C1D1) or M+A (C1D17) were significantly lower than that of pre-registration samples, Ki67 did not differ between C1D17 and C1D1 samples. Other correlative studies are ongoing and results will be presented.

Conclusion

Despite the small sample size, biomarker analysis on serial biopsy specimens demonstrated that M+A is unlikely to be more effective than A alone in PIK3CA Mut ER+ BC. This trial demonstrated the feasibility of genomic sequencing for pt selection and the value of a small, well-designed proof-of-principle neoadjuvant trial for the evaluation of targeted agents.

Citation Format: Ma CX, Suman VJ, Goetz M, Northfelt D, Burkard M, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tavaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Hoog J, Guo Z, Han J, Vij K, Mardis E, Sanati S, Al-Kateb H, Doyle L, Erlichman C, Ellis MJ. A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). [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 P5-13-04.

Abstract ES7-1: Neoadjuvant endocrine therapy

Neoadjuvant endocrine therapy has become a standard approach in clinical practice to improve the chance of breast conservation in postmenopausal women with locally advanced estrogen receptor positive breast cancer based on results from several neoadjuvant endocrine trials. Although data is limited, neoadjuvant endocrine therapy appears to as effective as chemotherapy in converting mastectomy to lumpectomy. In addition, neoadjuvant endocrine therapy allows an early assessement of tumor responsiveness to endocrine therapy so that adjuvant treatments could be tailored accordingly. Persistent cell proliferation on neoadjuvant endocrine therapy predicts a high risk of early relapse, for whom novel treatment strategies are in great need. In contrast, the Preoperative Endocrine Prognostic Index score of 0 (pathologic T2/3 N0 Ki67 &lt;2.7% ER+) in response to neoadjuvant endocrine therapy is being prospectively evaluated in the ongoing Alliance A011106 (ALTERNATE) as a marker of endocrine sensitive disease, for whom chemotherapy could be avoided. Furthermore, neoadjuvant endocrine trials provide a unique research platform for biomarker studies and the testing of novel therapeutic hypothesis.

Citation Format: Ma CX. Neoadjuvant endocrine therapy. [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 ES7-1.

Abstract PD1-4: A phase I study of BKM120 and fulvestrant in postmenopausal women with estrogen receptor positive metastatic breast cancer

Background

BKM120, a pan-Phosphatidylinositol-3-kinase (PI3K) inhibitor, in combination with fulvestrant (F) induced synergistic apoptotic effect in preclinical studies of estrogen receptor positive (ER+) breast cancer. We therefore conducted a phase I trial of BKM120 and F in postmenopausal women with ER+ metastatic breast cancer (MBC) to determine the maximum tolerated dose (MTD) and the tolerability of this combination.

Methods

A standard 3+3 phase I design was chosen for phase IA to determine the MTD. Upon completion of phase 1A, an expansion cohort phase IB was initiated to further assess the tolerability and efficacy. Patients (pts) with ER+ MBC with measurable disease were eligible. No more than 3 lines of systemic therapy in the metastatic setting were allowed in phase 1B. Cycle (C) length was 28 days. Adverse events (AEs) were assessed using CTCAE 4.0. Tumor measurement occurred every 3 cycles.

Results

Since November 2011, 18 pts (median age: 60 (range 48-71) years) were treated at 3 dose levels (DL) of BKM120 [Table 1]. Since none of the 3 pts enrolled at the starting dose of BKM120 (DL1: 80mg daily) experienced any DLT during C1, 3 pts were then enrolled at DL2 (BKM120 100 mg daily). No DLT was observed in C1, however 2 experienced grade (G) 3 ALT elevation during C2. Therefore, 3 pts were treated with BKM120 100mg 5 days on and 2 days off schedule (DL2b), without any significant AEs. Subsequently Phase IB enrolled 9 pts at this dose level.

Across different DLs, most AEs were G1. MTD was not reached based on C1 toxicity. However, asymptomatic ALT elevations occurred frequently during C2, resulting in dose interruption and dose reductions of BKM120 [Table 1]. Other AEs led to dose interruption and reductions include G2 confusion, G2 hyperglycemia and G3 rash. However, only 2 pts discontinued treatment due to AEs.

Table 1 Dose Level and Adverse EventsPhase IANBKM120No. pts dose reduced (AE, Cycle)No. pts discontinued (AE, Cycle)DL1380mg daily1 (G3 ALT, C2)1 (G2 confusion, C2)DL23100mg daily1 (G3 ALT, C2), 1 (G3 ALT, C2; G3 Rash, C7)0DL2b3*100mg daily, 5/700Phase IB (DL2b)9100mg daily, 5/71 (G3 ALT, C2; G3 Rash, C4), 1 (G2 ALT, G3 hyperglycemia, C2)1 (G4 ALT, C2)* 1 pt started DL2 in C1, then switched to DL2b following an amendment

Eleven pts with a median of 2 prior endocrine therapy (range 1-9) and 0-1 chemotherapy regimens in the metastatic setting were evaluable for response [Table 2]. Among these pts, 6 had prior disease progression on F. Clinical benefit was observed in 6 (54.5%) pts, including 1 partial response (PR) and 5 prolonged SD lasting for at least 6 cycles. Eight pts continue to receive treatment to date. Data will be updated at the time of presentation.

Table 2 ResponsePhaseDLEval. pts (N)Best responseDuration on study (mon)IA11PD3  1SD19+ 21PD1  2SD9, 7 2b1PR12IB2b5SD4+, 6, 6, 10+, 11++ treatment ongoing

Conclusion

BKM120 100mg, administered daily or intermittently, plus F was tolerable without DLT during C1. Grade 2/3 ALT elevation was common in C2, especially with daily dosing, but most pts continued treatment with reduced dose of BKM120. Promising activity was observed in this Phase I trial. Phase III studies of this combination have been started in ER+ MBC.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD1-4.

Neoadjuvant endocrine therapy in primary breast cancer: indications and use as a research tool

Neoadjuvant endocrine therapy has been increasingly employed in clinical practice to improve surgical options for postmenopausal women with bulky hormone receptor-positive breast cancer. Recent studies indicate that tumour response in this setting may predict long-term outcome of patients on adjuvant endocrine therapy, which argues for its broader application in treating hormone receptor-positive disease. From the research perspective, neoadjuvant endocrine therapy provides a unique opportunity for studies of endocrine responsiveness and the development of novel therapeutic agents.

Targeted therapies for triple negative breast cancer based on TP53 status

Abstract #403

Background: Triple negative breast cancer (TNBC: negative for ER, PR and HER2) presents a significant clinical challenge. The frequent occurrence of mutations in TP53, the gene encoding the p53, in TNBC provides an opportunity for therapeutic intervention. p53 is required for cells to respond to DNA damage in the G1 phase of the cell cycle. Tumors with a defective p53 pathway fail to arrest (or undergo apoptosis) in G1 and rely on p53-independent pathways at S and G2 for their survival following DNA damage. Therefore, a potential therapeutic strategy for TP53 mutant tumors is to inhibit the S- and G2-checkpoints. Chk1 is a key regulator of both the S- and G2- checkpoints as such, p53 mutant cells are absolutely dependent on Chk1 activity to respond to DNA damage. This property makes Chk1 a potential therapeutic target in p53 defective tumors. Therefore, we tested the combination of irinotecan (DNA damaging agent) and UCN-01 (non-specific Chk1 inhibitor) in a preclinical model of TNBC. This combination was chosen based on preliminary results obtained in patients with TNBC on a Phase I trial conducted at our institution. UCN-01 is also a potent inhibitor of PDK1 and therefore inhibits the PI3K pathway. Given that PTEN is frequently deficient in TNBC, we also monitored components of the PI3K pathway in our preclinical model of TNBC.&#x2028; Material and Method: Tumor biopsies from patients with TNBC were engrafted into the humanized mammary fat pad of immunodeficient NOD/SCID mice. TP53 was sequenced in each engrafted tumor explant and the integrity of the p53 pathway was determined by monitoring p53 stabilization and p21 induction following DNA damage. Three independent TNBC tumor explants, one wild-type and two mutant for TP53 were analyzed for their response to irinotecan and UCN-01 either as single agents or in combination. UCN-01 was administered 24h post irinotecan in mice treated with the combination. Mice were sacrificed 48 h later and tumors were harvested and analyzed for cell cycle arrest (geminin, pCdk1), DNA damage (pChk1, gamma H2AX), apoptosis (cleaved caspase 3), checkpoint bypass (pHistone H3) and the PI3K pathway (pS6) by Western blotting and immunohistochemistry.&#x2028; Results: Expression profiling revealed that the characteristics of the tumor are preserved in the tumor explants suggesting this is a valid model system to study experimental therapy for TNBC. Irinotecan induced similar levels of DNA damage in TP53 wild-type and TP53 mutant TNBCs. UCN-01 potently inhibited levels of pS6 independent of p53 status. Strikingly, the combination of irinotecan and UCN-01 selectively induced checkpoint bypass and apoptosis in p53 mutant TNBCs.&#x2028; Conclusion: p53 status is a significant predictor of response to combination therapies involving DNA damage followed by Chk1 inhibition. Tumors, like TNBC, that frequently lack a functional p53 pathway may be effectively treated using this strategy. Studies are underway to test different chemotherapy agents and more selective Chk1 and PI3K inhibitors in this preclinical model of TNBC.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 403.

Characterization of phytoene synthase 1 gene (Psy1) located on common wheat chromosome 7A and development of a functional marker

Phytoene synthase (Psy), a critical enzyme in the carotenoid biosynthetic pathway, demonstrated high association with the yellow pigment (YP) content in wheat grain. Characterization of Psy genes and the development of functional markers for them are of importance for marker-assisted selection in wheat breeding. In this study, the full-length genomic DNA sequence of a Psy gene (Psy-A1) located on chromosome 7A, was characterized by in silico cloning and experimental validation. The cloned Psy-A1 comprises six exons and five introns, 4,175 bp in total, and an ORF of 1,284 bp. A co-dominant marker, YP7A, was developed based on polymorphisms of two haplotypes of Psy-A1, yielding 194 and 231-bp fragments in cultivars with high and low YP content, respectively. The marker YP7A was mapped on chromosome 7AL using an RIL population from cross PH82-2/Neixing 188, and a set of Chinese Spring nullisomic-tetrasomic lines and ditelosomic line 7AS. Psy-A1, co-segregating with the STS marker YP7A, was linked to SSR marker Xwmc809 on chromosome 7AL with a genetic distance of 5.8 cM, and explained 20-28% of the phenotypic variance for YP content across three environments. A total of 217 Chinese wheat cultivars and advanced lines were used to validate the association between the polymorphic band pattern and grain YP content. The results showed that the functional marker YP7A was closely related to grain YP content and, therefore, could be used in wheat breeding programs targeting of YP content for various wheat-based products.

A phase II trial of a combination of pemetrexed and gemcitabine in patients with metastatic breast cancer: an NCCTG study

PURPOSE

This phase II study was undertaken to define the efficacy and toxicity of pemetrexed in combination with gemcitabine in patients with metastatic breast cancer.

PATIENTS AND METHODS

Patients with measurable metastatic breast cancer who had previously received an anthracycline and a taxane in either the adjuvant or metastatic setting were treated with gemcitabine 1250 mg/m2 (intravenous; days 1 and 8) and pemetrexed 500 mg/m2 (intravenous; day 8) every 21 days.

RESULTS

Fifty-nine patients received a median of five cycles (range one to 22) of treatment and were followed until death or for a median of 28 months (range 19.4-36.6) among living patients. Fourteen partial responses for an overall response rate of 24% [95% confidence interval (CI) 16% to 39%] were documented. Nine (15%; CI 5% to 32%) patients had stable disease for >6 months. The median survival time was 10.3 months (95% CI 8.3-18.9) and the 1 year survival rate was 49% (95% CI 38% to 64%). The median time to progression was estimated to be 3.7 months (95% CI 2.3-5.3). The most common grade 3 or 4 toxicities were neutropenia and thrombocytopenia in 83% and 27% of patients, respectively. Fourteen percent of patients experienced febrile neutropenia. Other common grade 3 or 4 non-hematological toxicities included fatigue (17%), dyspnea (15%), rash (7%) and anorexia (5%).

CONCLUSIONS

The combination of pemetrexed and gemcitabine is clinically active, with an overall response rate of 24% in patients with metastatic breast cancer who have previously been treated with an anthracycline and a taxane. Myelosuppression (66% grade 4 neutropenia and 14% febrile neutropenia) was the major treatment-related toxicity observed for this combination.

Starch properties of mutant rice high in resistant starch

As the staple food of over half the world's population, hot cooked rice high in resistant starch (RS) is of particular interest, which will have greater impact in the dietary prevention of diabetes and hyperlipidemia. A mutant rice high in RS in hot cooked rice, described as RS111, was comparatively studied with the wild type and common rice. Despite obviously low RS content in the raw milled rice, the RS content in the hot cooked rice of mutant RS111 was significantly higher than that of the wild type and common rice and, correspondingly, in vitro starch hydrolysis by porcine pancreatic alpha-amylase tends to be incomplete with low hydrolysis extent for the cooked mutant rice high in RS. Obvious differences in physicochemical properties, starch granule morphology, pasting properties, thermal properties, and X-ray diffraction pattern were observed among the mutant RS111, wild type, and common indica rice. The high-RS mutant was characterized by significantly higher apparent amylose content and crude lipid content, higher percentage of oval-shaped granules and bigger oval size, reduced paste viscosity, and low onset temperature, peak temperature, final temperature, enthalpy of gelatinization, and crystallinity.

A multivalent pairing model of linkage analysis in autotetraploids

Polyploidy has been recognized as an important step in the evolutionary diversification of flowering plants and may have a significant impact on plant breeding. Statistical analyses for linkage mapping in polyploid species can be difficult due to considerable complexities in polysomic inheritance. In this article, we develop a novel statistical method for linkage analysis of polymorphic markers in a full-sib family of autotetraploids. This method is established on multivalent pairings of homologous chromosomes at meiosis and can provide a simultaneous maximum-likelihood estimation of the double reduction frequencies of and recombination fraction between two markers. The EM algorithm is implemented to provide a tractable way for estimating relative proportions of different modes of gamete formation that generate identical gamete genotypes due to multivalent pairings. Extensive simulation studies were performed to demonstrate the statistical properties of this method. The implications of the new method for understanding the genome structure and organization of polyploid species are discussed.

[Application of skin and soft tissue expansion in treatment of burn injury]

OBJECTIVE

To evaluate the application of skin and soft tissue expansion in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.

METHODS

From 1988, 83 cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe burn of large area and with whole nasal defect, soft tissue expander was used under the forehead skin graft and venter frontalis, followed by reconstruction of nose with the expanded vascularized skin flap and carved cartilago costalis as nasal frame. In patients of severe deep electrical burned scalp and skull with fresh wound, skin and soft tissue expansion were used to repair the wound simultaneously with scalp burn alopecia, anesthetics and antibiotics injected into the extracapsular space of the expander in case of pain and infection.

RESULTS

All of the cases were successfully treated with little pain and minimized infection.

CONCLUSION

Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.

Experimental study of early diagnosis and treatment of fat embolism syndrome

An experimental animal model has been established using i.v. fat injection to mimic fat embolism syndrome (FES). Fourteen healthy mongrel dogs who were administered 0.7 ml/kg of fluid marrow fat obtained from the long bone marrow cavity of mongrel dogs were divided into control and therapeutic groups. The therapeutic group (n = 7) was given dexamethasone (1.0 mg/kg) and repeated every 6 h i.v. During 48 h of observation, blood gas analysis and frozen sections were performed on blood samples collected from the pulmonary vessels by a floating catheter and from a peripheral vein at different time intervals. The frozen sections were stained with Oil Red O. Positive results were seen 2 h after fat injection in both pulmonary and peripheral blood samples of both control and therapeutic groups. By computer image analysis, the average median number of fat droplets per section and the average median diameter of fat droplets in pulmonary blood of the control group were found to be significantly higher and larger than were those of the therapeutic group. The average median number and diameter of fat droplets in pulmonary blood were significantly higher and larger than were those of peripheral blood in both control and therapeutic groups. These findings correlated well with blood gas changes and the clinical appearance of the experimental animals. The fat droplets from pulmonary or peripheral blood as demonstrated by Oil Red O staining in combination with blood gases changes [PaO2 < 7.99 KPa, difference between the alveolar and arterial oxygen tension (P(A - a)O2) > 6.09 KPa] may be a rapid method for screening of an earlier diagnosis of FES.(ABSTRACT TRUNCATED AT 250 WORDS)

Langerhans cells in nasopharyngeal carcinoma in relation to prognosis

Langerhans cells (LC) and macrophages in 119 cases of nasopharyngeal carcinoma and 19 cases of nasopharyngeal mucosa obtained from non-cancer patients were studied by SPA immunohistochemical methods with the use of antibodies against S-100 protein and lysozyme, respectively. The distribution of LC in the tumor tissue was different from that in macrophages. Patients with dense infiltration of LC in the tumor tissue survived longer than those without such infiltration (mean survival times, 26.9, 51.7 and 72.6 months in the patients with -, + and ++ density, respectively: P < 0.005). There was no relationship between patient prognosis and density of macrophages (P > 0.25). LC may play an important role in tumor immunity and may be taken as one of the criteria of prognosis.

[The effects of injection salviae miltiorrhizae in preventing and treating fat embolism syndrome]

This study was to examine the effects and mechanisms of injectio salviae miltiorrhizae (ISM) in preventing and treating fat embolism syndrome (FES), which was simulated by intravenous injection of homologous bone marrow fat in 16 dogs. PaO2, free fatty acids (FFAs), TXA2/PGI2, SOD/MDA were measured in different times combined with X-ray, conjunctiva microcirculation observation, radioisotope scanning and histologic examination. It was found that in the control group there were a significant fall in PaO alpha and rise in FFAs and MDA; blood clot stained with oil red O showed many fat droplets; radioisotope scanning revealed mild hypoperfusion or perfusion defects. In the treatment group, arterial oxygen levels were maintained, serum level of FFAS and MDA was reduced significantly. It is concluded that there is damage induced by oxygen-derived radicals in FES, LSM is an effective therapy for the FES, and 99mTc radioisotope scanning is a promising technique for noninvasive identification of FES in the early stage.

Electron microscopic observations on the synaptonemal complex of spermatocytes of the giant panda (Ailluropoda melanoleuca)

Surface-spread and silver-stained preparations of spermatocytes from a giant panda were observed by electron microscopy for synaptonemal complex karyotyping. Ten pachytene spermatocyte nuclei were selected for length quantitation of SC. The mean relative lengths and centromeric indices of each SC agreed closely with those of the mitotic chromosomes. The pairing between lateral elements of autosomal chromosomes starts at early zygotene and leads progressively along their length to complete pairing at pachytene. The whole Y is paired with 1/3 length of X at mid-pachytene. The morphology of X and Y chromosome axes and the nonhomologous pairing of X and Y is discussed.