[A case of hereditary diffuse leukoencephalopathy with spheroids and pigmented glia presenting with long-term mild psychiatric symptoms]

A 64-year-old woman visited our hospital with early-onset dementia and progressive gait disturbance. She had demonstrated a mild communication disorder at the age of ~40 years; however, her psychiatric symptoms at that time were mild and were not accompanied by social problems. At the age of 59, she presented with memory loss, visual hallucinations, and delusions. Over the following five years she developed gait difficulties that gradually deteriorated and suffered frequent falls. On admission, neurological examinations revealed severe pyramidal and extrapyramidal signs of akinetic mutism. MRI of the brain showed cerebral atrophy, enlarged lateral ventricles, thinning of the corpus callosum, and leukoencephalopathy in the frontal-parietal lobes. Additionally, CT revealed a small spotty calcification in the frontal subcortical white matter. Genetic analysis revealed a single-base substitution (c.2330G>A/p.R777Q) in exon 18 of the colony stimulating factor 1 receptor (CSF1R) gene, encoding the CSF1R protein. She was diagnosed with hereditary diffuse leukoencephalopathy with spheroids (HDLS). HDLS is included in the differential diagnosis of early-onset dementia and should be considered in patients with mild personality change and abnormal behavior in the early course of the illness.

Outcome of pitavastatin versus atorvastatin therapy in patients with hypercholesterolemia at high risk for atherosclerotic cardiovascular disease

BACKGROUND

There has been no report about outcome of pitavastatin versus atorvastatin therapy in high-risk patients with hypercholesterolemia.

METHODS

Hypercholesterolemic patients with one or more risk factors for atherosclerotic diseases (n = 664, age = 65, male = 54%, diabetes = 76%, primary prevention = 74%) were randomized to receive pitavastatin 2 mg/day (n = 332) or atorvastatin 10 mg/day (n = 332). Follow-up period was 240 weeks. The primary end point was a composite of cardiovascular death, sudden death of unknown origin, nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, or heart failure requiring hospitalization. The secondary end point was a composite of the primary end point plus clinically indicated coronary revascularization for stable angina.

RESULTS

The mean low-density lipoprotein cholesterol (LDL-C) level at baseline was 149 mg/dL. The mean LDL-C levels at 1 year were 95 mg/dL in the pitavastatin group and 94 mg/dL in the atorvastatin group. There were no differences in LDL-C levels between both groups, however, pitavastatin significantly reduced the risk of the primary end point, compared to atorvastatin (pitavastatin = 2.9% and atorvastatin = 8.1%, HR, 0.366; 95% CI 0.170-0.787; P = 0.01 by multivariate Cox regression) as well as the risk of the secondary end point (pitavastatin = 4.5% and atorvastatin = 12.9%, HR = 0.350; 95%CI = 0.189-0.645, P = 0.001). The results for the primary and secondary end points were consistent across several prespecified subgroups. There were no differences in incidence of adverse events between the statins.

CONCLUSION

Pitavastatin therapy compared with atorvastatin more may prevent cardiovascular events in hypercholesterolemic patients with one or more risk factors for atherosclerotic diseases despite similar effects on LDL-C levels.

Abstract P4-16-13: Prospective study of scalp cooling for hair loss prevention in Japanese breast cancer women receiving (neo)adjuvant chemotherapy

Introduction

Recently scalp cooling during chemotherapy infusion has been reported to be quite effective to mitigate chemotherapy-induced alopecia. But data in Asian patients are quite limited.

Patients and methods

Japanese breast cancer female patients who planned to receive (neo)adjuvant chemotherapy were offered to participate in this prospective study of scalp cooling with Paxman Scalp Cooling System for alopecia prevention. The scalp cooling was done 30 minutes prior to and during and 90 minutes after each chemotherapy infusion. Photographs of the head of the participants were taken from 5 directions, namely front, back, both sides, and top, on the day of chemotherapy infusion and 1 month after the last infusion. Two investigators consisting of a physician and a nurse judged the grade of alopecia by looking at the photographs according to the WHO classification. The primary outcomes were the rates of patients with Grade 3 alopecia (defined as hair loss of > 50%) and the rates of patients who used a wig or hat to conceal the hair loss one month after the last infusion of chemotherapy. This paper reports on the former outcome mainly. They were asked to answer a brief questionnaire regarding headache, fatigue, chill etc. shortly after each cooling. They could use the cooling cap for free on the first cycle of chemotherapy. But they were required to purchase it (about 1,130 US$) for the scalp cooling of the following cycles.

Results

One hundred forty three patients participated in the study and actually used the cooling cap at least once. The mean and median age of them are 50.6 and 50, respectively (28 - 76). One hundred twenty nine patients completed the planned chemotherapy of 4 to 8 cycles (89 Pts 4 cycles, 1 Pt 6 cycles, 39 Pts 8 cycles). Among them (7 patients were not evaluable), 74 patients (60.7 %) had Grade 3 alopecia 1 month after chemotherapy. In 80 patients who used the scalp cooling system throughout the planned chemotherapy (1 patient was not evaluable), 36 patients (45.6 %) experienced Grade 3 alopecia. On the other hand, among 49 patients who discontinued the cooling mostly after the 1st cycle (6 were not evaluable), 38 (88.3 %) had Grade 3 alopecia. When we restrict them to 33 (5 were not evaluable) who decided to discontinue the cooling by day10 of the first cycle of chemotherapy to exclude the patients who discontinued it because of less effect on alopecia prevention than they expected, 25 (89.3 %) experienced Grade 3 alopecia. Comparing the results of those who completed the cooling and patients who decided to discontinue it by day10 of the first cycle, the rates of Grade 3 alopecia (45.6 % vs. 89.3 %) were statistically significantly different in favor of the former (P = 0.0001). Most patients complained of some headache, chill, and pain of the jaw.

Conclusion

Scalp cooling with Paxman Scalp Cooling System during chemotherapy infusion in Asian women seems as effective for hair loss mitigation as in Caucasian women.

Citation Format: Ohsumi S, Kiyoto S, Takahashi M, Hara F, Takashima S, Aogi K, Matsuda M, Yamamura N, Matsuda A, Yamauchi T, Doi M. Prospective study of scalp cooling for hair loss prevention in Japanese breast cancer women receiving (neo)adjuvant chemotherapy [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 P4-16-13.

Effects of assisted reproductive technologies in neonates with indications for surgery (2007-2016)

PURPOSE

Recently, the number of births using assisted reproductive technologies (ART) has increased. An associated increase in the incidence of congenital malformations in babies conceived using this technology has also been reported. Therefore, we aimed to investigate the rate of malformations in babies with neonatal surgical diseases, who were conceived using ART.

MATERIALS AND METHODS

Between January 2007 and December 2016, 1737 patients were admitted to our hospital. We analyzed the incidence of congenital cardiac diseases, genetic anomalies, and congenital anomalies of the kidney and urinary tract (CAKUT) in neonates conceived by ART. The χ2 test and logistic regression analysis were used to assess the odds ratios (ORs) for congenital malformations. A P-value < 0.05 indicated statistical significance.

RESULTS

The OR for CAKUT was 16.94 for the first-birth neonates conceived using ART, [P < 0.05, AUC (area under the curve) = 0.86]. However, for non-surgery neonates, the OR for CAKUT was 5.99 (P = 0.15, AUC = 0.87), compared to 32.27 (P < 0.05, AUC = 0.93) for parallel conditions in surgery-neonates.

CONCLUSION

Neonates conceived using ART are prone to develop CAKUT, which will need surgical treatment. Therefore, more management is necessary for associated malformations in these babies, particularly in cases with CAKUT.

Abstract P4-21-03: A randomized phase II study of Ki-67 response-guided preoperative chemotherapy for HER2-positive breast cancer

As for the HER2-positive breast cancer, there are many cases to be effective for neoadjuvant chemotherapy in comparison with other intrinsic subtypes. However, pCR is not provided by neoadjuvant chemotherapy in all cases. [Aim] This study evaluated the effectiveness of a therapeutic strategy that switches chemotherapy, based on Ki-67 tumor expression after initial therapy, relative to that of standard chemotherapy in patients with HER2-positive breast cancer. [patients and methods] Patients were randomly assigned to the control arm or the Ki-67 response-guided arm (Ki-67 arm). Primary tumor biopsies were obtained before treatment, and after three once-weekly doses of paclitaxel and trastuzumab to assess the interim Ki-67 index. In the control arm, paclitaxel and trastuzumab was continued for a total of 12 doses, regardless of the interim Ki-67 index. In the Ki-67 arm, subsequent treatment was based on the interim Ki-67 index. Early Ki-67 responders continued to received paclitaxel plus trastuzumab for a total of 12 doses, while early Ki-67 non-responders were switched to epirubicin plus cyclophosphamide every 3 weeks for three cycles with once-weekly trastuzumab for a total of 12 doses. The primary endpoint was the pathological complete response (pCR) rate. [Results] When 237 patients were enrolled, an interim analysis was conducted in 200 patients. There was almost linear correlation between the Ki-67 reduction rate at interim assessment and the pCR rate. The pCR rate in Ki-67 early non-responders in the Ki-67 arm (23.6%; 95% CI, 12.4 to 34.9) was inferior to that in the control arm (44.1%; 31.4 to 56.7; p=0.025). A strong correlation was not found between the Ki-67 reduction rate and the clinical response rate (Spearman's correlation coefficient 0.22).

pCR rate among Ki-67 early non-responders and responders TotalpCR nn%95%CIKi-67 early non responderControl arm59264431.4-56.7 Ki-67 response guided arm55132312.4-34.9Ki-67 early responderControl arm21104726.3-69.0 Ki-67 response guided arm2084018.5-61.5

Conclusions: The pCR rate in the Ki-67 arm was inferior to that in the control arm. A therapeutic strategy that switches chemotherapy, based on Ki-67 tumor expression after initial therapy, was not effective. The standard chemotherapy protocol remains as the recommended strategy for patients with HER2-positive breast cancer.

Citation Format: Takahashi M, Nishiyama Y, Hara F, Naito Y, Baba M, Sasaki M, Sato M, Watanabe K, Uemura Y, Yamaguchi T, Mukai H. A randomized phase II study of Ki-67 response-guided preoperative chemotherapy for HER2-positive breast cancer [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 P4-21-03.

Molecular Hydrogen Alleviates Cellular Senescence in Endothelial Cells

BACKGROUND

Substantial evidence indicates that molecular hydrogen (H2) has beneficial vascular effects because of its antioxidant and/or anti-inflammatory effects. Thus, hydrogen-rich water may prove to be an effective anti-aging drink. This study examined the effects of H2on endothelial senescence and clarified the mechanisms involved.

METHODS AND RESULTS

Hydrogen-rich medium was produced by a high-purity hydrogen gas generator. Human umbilical vein endothelial cells (HUVECs) were incubated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) for various time periods in normal or hydrogen-rich medium. The baseline H2concentration in hydrogen-rich medium was 0.55±0.07 mmol/L. This concentration gradually decreased, and H2was almost undetectable in medium after 12 h. At 24 h after TCDD exposure, HUVECs treated with TCDD exhibited increased 8OHdG and acetyl-p53 expression, decreased nicotinamide adenine dinucleotide (NAD(+))/NADH ratio, impaired Sirt1 activity, and enhanced senescence-associated β-galactosidase. However, HUVECs incubated in hydrogen-rich medium did not exhibit these TCDD-induced changes accompanying Nrf2 activation, which was observed even after H2was undetectable in the medium. Chrysin, an inhibitor of Nrf2, abolished the protective effects of H2on HUVECs.

CONCLUSIONS

H2has long-lasting antioxidant and anti-aging effects on vascular endothelial cells through the Nrf2 pathway, even after transient exposure to H2. Hydrogen-rich water may thus be a functional drink that increases longevity. (Circ J 2016; 80: 2037-2046).

[Fibrates]

Although fibrates was a medicine with a long history, at the clinical spot, the profitability had not permeated as compared with statin. However, many-sided effects, such as a fall of a cardiovascular event and control of arteriosclerosis prevention and a diabetic microangiopathy, were reported as a result of the large-scale clinical test in recent years. Accumulation of the further clinical evidence of a fibrates is expected.

Abstract P1-13-10: Efficacy, toxicity and quality of life in older patients with early-stage breast cancer treated with oral Tegafur-uracil or classical CMF (cyclophosphamide, methotrexate, and fluorouracil): an exploratory analysis of National Surgical Adjuvant Study for Breast Cancer (N-SAS BC) 01 Trial

Background: It is critically important to consider the issue of treatment for older breast cancer patients in developed countries where aging has been rapidly advanced such as in Japan. According to Oxford Overview analysis of 15-year results, benefit of adjuvant chemotherapy in older than 70 years remains uncertain. Recently CALGB 49907 trial clearly showed standard chemotherapy of either cyclophosphamide, methotrexate, and fluorouracil (CMF) or doxorubicin plus cyclophosphamide (AC) is superior to capecitabine in patients with early-stage breast cancer who are 65 years or older. In contrast, we demonstrated equivalent efficacy between six cycles of classical CMF and 2 years of oral Tegafur-uracil (UFT) in phaseIII randomized controlled trial: N-SAS BC01 (Watanabe T et al, JCO 2009). Of interest, UFT showed a trend toward better suppression of recurrence in patients over 50 years of age in this trial. In current exploratory analysis, we sought to examine whether UFT is not inferior to CMF in terms of efficacy, toxicity and quality of life (QOL) in older patients with early-stage breast cancer.

Patients and Methods: N-SAS BC 01 trial was a randomly assigned trial comparing adjuvant oral UFT with classical CMF in patients with node negative, high risk breast cancer. In this exploratory analysis, patients of 65 years or older enrolled in N-SAS BC 01 trial were analyzed in terms of efficacy, toxicity and quality of life.

Results: Of the 707 patients enrolled in N-SAS BC 01 trial, 97 patients (13.7%) were 65 years or older. Median age was 68 years (range, 65 to 75 years). The 5-year relapse-free survival (RFS) rate was 92.5% in the CMF arm and 93.0% in the UFT arm. Overall survival (OS) rate at 5 years were 98.1% and 97.7%, respectively. The hazard ratios of the UFT arm relative to the CMF arm were 1.07 for RFS (95% CI, 0.31 to 3.55) and for OS (95% CI, 0.15 to 10.25). However 95 % CIs were very wide due to the small sample size. Among patients who received CMF, frequency of grade 3/4 leukopenia (3.8%) and neutropenia (13.5%) were higher than 0% and 4.8% with UFT, respectively. Similarly, grade 3/4 increased liver enzyme and nausea/vomiting were more frequent with CMF than with UFT. In contrast, elevation of total bilirubin and diarrhea were more observed in UFT arm. Compared with patients received CMF, patients with UFT had better QOL scores assessed by EORTC QLQ-C30/BR23 and the FACT-B questionnaire. The rate of adherence was 79.2% (42/53) at 6 months in the CMF arm and 74.4% (32/43) at 2 years in the UFT arm.

Conclusion: The result of this study indicated that UFT might not be inferior to CMF in patient with early stage breast cancer who are 65 years of age or older in terms of efficacy, toxicity and QOL. UFT would be a promising option for adjuvant chemotherapy in older women with node-negative, high-risk breast cancer. Further larger randomized clinical trial in this patient population would be warranted to validate these results.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-13-10.

Abstract P3-02-06: Survival impact of early detection of recurrence after surgery in early breast cancer patients

Background and Object: Annual mammography and physical examination as the follow-up tests after surgery were recommended to early breast cancer patients based on the two randomized clinical trials (GIVIO and Rosselli Del Turco) which were reported in 1990s. Whereas, radiological imaging and blood test (serum tumor marker) for early detection of recurrence are not recommended due to the lack of evidence from clinical trial. However, the imaging techniques (helical CT, bone scan, PET/CT. MRI et al) to detect minute lesions and therapeutic options for metastatic breast cancer have been remarkably advanced since then. In fact, routine radiological examinations after surgery were performed in several Japanese hospitals for aiming early detection of recurrence as the clinical practice.

We here evaluate the possible benefit of early detection of recurrence by radiological and laboratory examinations during post-operative follow-up period.

Methods: Clinical information of breast cancer patients who were diagnosed as recurrence after surgery during 2005–2006 was collected from 30 hospitals in Japan. Clinical and pathological characteristics such as molecular subtype of breast cancer, survival time from initial therapy or 1st recurrence, detection methods and symptomatic information when they diagnosed as metastasis were analyzed retrospectively.

Results: As the routine examination of post-operative follow-up, serum tumor maker, chest x-ray/CT, abdominal US/CT and bone scan were done in 95%, 57%, 38%, 24% of 30 hospitals, respectively. Of the 698 patients individually evaluated in this analysis, 248 had loco-regional recurrences and 450 had distant metastases. The first distant metastatic site were 35% in bone, 30% in lung, 17% in liver and 11% in lymph node, respectively. All individual patients are divided into symptomatic (45.7%) or asymptomatic groups (54.3%) at the detection of metastases. Asymptomatic metastases were detected by serum tumor marker (26%), bone scan (18%), chest x-ray (17%), chest CT (17%), abdominal US (11%) and abdominal CT (5%), respectively. The median disease-free interval (DFI) was 3.0 years in both groups, but the median survival time after the diagnosis of recurrence to death were 3.7 years in asymptomatic patients and 3.0 years in symptomatic patients, respectively. In addition, asymptomatic group had significantly superior overall survival (from primary surgery to death) than symptomatic group with oligo-metastases such as limited organ disease (P &lt; 0.001).

Conclusions: Our data may support the hypothesis that early detection of breast cancer recurrences has beneficial impact on survival. Randomized clinical trial would be warranted to prove this hypothesis, and we are currently planning this.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-06.

Transcatheter atrial septal defect closure in a patient with paradoxical brain emboli: who should treat it and who should be treated?

This report presents the case of a 51-year-old female who was admitted to a local hospital because of a persistent headache. A diagnosis of multiple cerebral infarctions was thereafter made, but there was no evidence of either atherosclerosis or atrial fibrillation. The case was thought to be a cryptogenic stroke, however, Doppler ultrasonography of the lower extremities showed venous insufficiency. Transesophageal echocardiography revealed a secundum atrial septal defect (ASD) with a left to right shunt. Therefore, the final diagnosis was paradoxical brain emboli, and transcatheter ASD closure was successfully performed by cardiologists without any sequelae.

P3-07-14: Sensory Disturbance of the Ipsilateral Upper Arm after Breast Cancer Surgery with Sentinel Node Biopsy Alone Compared with Axillary Dissection – A Prospective Study

Background

Axillary surgery for breast cancer causes several postoperative complications including edema of the ipsilateral arm and sensory disturbance of the ipsilateral upper arm. Although sentinel node biopsy has been considered as a standard procedure for node-negative patients, some complications bother patients even after it. Although data regarding the quality of life of patients and/or subjective and objective assessment of arm morbidity after axillary surgery have been reported, to our knowledge, quite a few data have been reported on actual examination of sensory disturbance of the ipsilateral upper arm after sentinel node biopsy alone. We report comparative data regarding the objective and subjective degrees of postoperative sensory disturbance of the ipsilateral upper arm examined prospectively between sentinel node biopsy alone and axillary dissection.

Patients and Methods

A total of 118 patients, who received breast cancer surgery with sentinel node biopsy alone (51 patients)(SN group) or axillary dissection (67 patients)(AD group) at NHO Shikoku Cancer Center, were prospectively evaluated sensory disturbance regarding the following: (a) dysesthesia, (b) paresthesia, (c) degree of disturbed tactile sensation, (d) degree of disturbed pain sensation, (e) ratio of disturbed area of tactile sensation (defined as (A) length of disturbed area/(B) total length of upper arm), and (f) ratio of disturbed area of pain sensation (defined as A/B). Patients were either asked about the above or examined for them at one month, 6 months and 1 year, respectively, after surgery. At surgery it was recorded whether or not the intercostobrachial nerve(s) were totally preserved in patients who underwent axillary dissection. Unpaired t-test, Mann-Whitney U-test and Wilcoxon signed rank test were used to test statistical significance.

Results: The mean ages at surgery were 54.7 and 53.7 years in the SN and AD groups, respectively (P = 0.66). The mean number of biopsied lymph nodes in the SN group was 2.4 (range: 1–5). In 22 patients of the AD group the intercostobrachial nerves were totally preserved. There was no difference in dysesthesia, paresthesia, and the level of disturbed pain sensation between the two groups throughout one year after surgery. However, the patients in the SN group showed milder disturbed tactile sensation at one and 6 months than those in the AD group (P = 0.04 and 0.03, respectively). Both the ratios of disturbed area of tactile and pain sensation were statistically significantly lower in the SN group than in the AD group throughout one year (P = 0.03 ∼ &lt;0.0001). The mean ratios of disturbed area of those sensations were stable in the SN group over the year (0.03−0.05 for both tactile and pain sensations, P &gt; 0.12 for any comparison). On the other hand, the mean ratios in the AD group became lower from 0.23 to 0.17 for tactile sensation and from 0.20 to 0.13 in pain sensation (P = 0.02, and 0.05 for tactile and pain sensations, respectively).

Conclusion: Sensory disturbance of the ipsilateral upper arm after sentinel node biopsy alone was much milder than after axillary dissection throughout the study period.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-14.

P1-12-19: Phase I Study of Single Agent Trastuzumab Emtansine in Japanese Patients with Human Epidermal Growth Factor Receptor2 (HER2)-Positive Metastatic Breast Cancer (JO22591)

Background Trastuzumab emtansine (T-DM1), first-in-class anti-HER2 antibody-drug conjugate (ADC) is under development for the treatment of HER2−postive recurrent locally advanced or metastatic breast cancer (MBC). T-DM1 is composed of: trastuzumab; DM1, an inhibitor of tubulin polymerization derived from maytansine; and the stable MCC linker that conjugates DM1 and trastuzumab. T-DM1 has been evaluated at multiple dose levels in a phase I trial (TDM3569g): every 3 weeks (q3w) (0.3−1.8 mg/kg) and weekly (1.2−2.9 mg/kg), and in two subsequent phase II trials (TDM4258g and TDM4374g) for patients with heavily pretreated HER2−positive MBC. T-DM1 monotherapy (3.6 mg/kg q3w) has demonstrated robust clinical efficacy in these two phase II clinical studies. Dose escalation data from the TDM3569g provided the basis for this phase I study (JO22591) study, to investigate the maximal tolerated dose (MTD) in Japanese patients.

Methods This Japanese Phase I study was a single-arm, dose-escalation study in patients with HER2−positive MBC who had received prior therapies that included trastuzumab. The objective of the study was to determine the MTD of T-DM1 during Cycle 1, using the continual reassessment method, among three dose cohorts when administered as a single agent and to investigate safety, tolerability and pharmacokinetics of T-DM1 in patients with HER2−positive MBC. Eligibility criteria were standard for this type of study. T-DM1 was administered every 3 weeks at a dose level of 1.8 mg/kg, 2.4 mg/kg or 3.6 mg/kg. Outcomes were assessed by standard solid-tumor phase I methods. Adverse events were reported using CTCAE version 3.0, and tumor response was assessed according to RECIST version 1.0.

Results Ten patients were recruited: (1.8 mg/kg [n=1], 2.4 mg/kg [n=4], or 3.6 mg/kg [n=5]. One patient in the 2.4 mg/kg group experienced DLTs (Grade 3 AST increase and ALT increase). No other adverse events corresponding to a DLT were observed in any other patients during the DLT observation period. As a result, the MTD in Japanese MBC patients was determined to be 3.6 mg/kg q3w.

The most frequently reported adverse events, regardless of whether they were related to the study drug, were nausea, fatigue, arthralgia and pyrexia. The main changes in laboratory test values recorded were platelet count decrease, AST increase and ALT increase. Efficacy was preliminarily assessed with tumor responses, a partial response was observed in two patients. Most of the AEs were mild and manageable. There were no marked differences in any pharmacokinetic parameters for T-DM1, DM1 or total trastuzumab following administration of T-DM1 between the JO22591 study and the two Western studies (TDM3569g and TDM4258g), and no data obtained suggested any ethnic differences.

Conclusions T-DM1 monotherapy (3.6 mg/kg every 3 weeks) was well-tolerated in Japanese patients. PK and safety in Japanese patients were comparable to PK and safety in the Western population. These results support further clinical studies with T-DM1 in Japanese patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-19.

[Gastrointestinal hemorrhage associated with concurrent use of sorafenib and warfarin for hepatocellular carcinoma]

A 60-year-old man with liver cirrhosis caused by hepatitis C, who was receiving warfarin anticoagulation following acute myocardial infarction, was diagnosed with advanced hepatocellular carcinoma and multiple lung metastases, and began treatment with sorafenib 200 mg daily. From the treatment's start to 14 and 63 days later, sorafenib was increased to 400 mg and 600 mg, respectively. After increasing the quantity to 600 mg, he had an increase in PT-INR values and experienced a lower-extremity hemorrhage. For the patient with liver cirrhosis, who is receiving warfarin, PT-INR values might be elevated during the early period of sorafenib treatment dosage as for the increase in quantity. Therefore, when increasing dosage, a frequent measurement of PT-INR and a careful follow-up for PT-INR is necessary.

Detection of Isolated Regional Lymph Node Recurrences by PET-CT in Follow-Up of Postoperative Breast Cancer Patients

Background: It is not recommended to use imaging diagnostic methods in order to find small distant metastases in follow-up of postoperative breast cancer patients because of lack of improvement in survival with use of them in old randomized trials. However, use of new imaging modalities in follow-up of postoperative breast cancer patients may improve their survival due to detection of small regional lymph node recurrences without distant metastases which are potentially curable.Patients and methods: Between April 2006 and December 2008, we used PET-CT to find small recurrences in follow-up of 1908 postoperative breast cancer patients who received definitive surgery at the National Hospital Organization Shikoku Cancer Center. A total of 3283 times (1 to 4 times per a patient; median 1) of PET-CT imaging without contrast medium were performed during the period. A median age at the PET-CT imaging was 58 years (range, 22 to 91 years, mean 58.5 years). A median interval from the definitive surgery to the PET-CT imaging was 48 months (range, 3 to 385 months, mean 57.8 months). The results were analyzed retrospectively.Results: Seven patients were found to have isolated axillary node recurrence by PET-CT, and additional 3 patients were shown to have isolated subclavian node recurrence. Furthermore, only PET-CT showed that other 7 patients had isolated supraclavicular node recurrences and 6 patients had isolated parasternal node recurrences. All of those lymph node recurrences were missed by palpation or nonpalpable. A median interval from the definitive surgery to the diagnoses of the isolated regional node recurrences was 50 months (range, 19-167 months, mean 58.3 months). Those recurrences were found by the first examination with PET-CT in 14 patients and by the second examination in 9 patients. Fifteen asymptomatic other cancers including contralateral mammographically invisible breast cancers were found only by PET-CT (1 lung cancer, 2 gastric cancers, 1 colon cancer, 2 rectal cancers, 2 pancreatic cancers, 1 endometrial cancer, 4 thyroid cancers, and 2 contralateral breast cancers). The pathological lymph node status at the definitive surgery of 23 patients with the isolated regional lymph node recurrences was positive in 17 patients (number of positive nodes: 1 to 3 positive nodes in 7 patients, 4 to 9 in 8, 10 or more in 2), negative in 4, and unknown in 2. If the patients are limited to those who had the pathologically positive node(s) at the definitive surgery, the incidence of the patients with the isolated regional node recurrences found only by PET-CT will be 2.6% (17/663 patients).Conclusion: Early detection of isolated loco-regional recurrences of breast cancer is suggested to result in an improvement of survival. Therefore, the use of PET-CT in follow-up of postoperative node positive breast cancer patients may improve their survival because of early detection of isolated regional node recurrences which are still potentially curable and screening of other asymptomatic cancers.Reference: Lu WL et al. Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer. a meta-analysis. Breast Cancer Res Treat 114: 403-412, 2009

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4009.

Microtubule Associated Protein-Tau (MAPT) Is Influenced by ER: ICI182,780, a Selective ER Inhibitor, Down-Regulates MAPT Expression and Reverses Resistance to Taxanes in MAPT- and ER-Positive Breast Cancer Cells

Background: Taxanes are important drugs in treatment of breast cancer. These drugs bind to tubulin and suppress spindle microtubule dynamics, which leads to cell cycle arrest in the G2/M phase followed by apoptosis. However, resistance to taxane therapy prevents some patients from benefiting from these drugs. Several mechanisms of taxane resistance have been described, including the involvement of microtubule-associated protein-tau (MAPT). MAPT binds to the same pocket as taxanes in microtubules and obstructs the function of the drug. Estrogen receptors (ER) are transcriptional factors that play an important role in the development and progression of breast cancer. However, the relationship between ER and MAPT in breast cancer is not entirely clear. In this study we examined the correlation between MAPT expression and the sensitivity of human breast cancer cells to taxanes, and the relationship between ER and MAPT at the protein level in these cells. We also examined combination therapy with hormone drugs and taxanes.Methods: The correlation between MAPT expression and sensitivity to taxanes was examined in 12 human breast cancer cell lines using real time PCR, western blotting analysis and an MTS assay. Following small interfering RNA (siRNA) knockdown of MAPT expression, the alteration of cellular sensitivity to taxanes was examined by MTS assay, flow cytometry and immunofluorescence. To examine the relationship between ER and MAPT, ER expression was knocked down with siRNA or stimulated with 17-β-estradiol in MAPT- and ER-positive cell lines (MCF-7 and ZR75.1, respectively). The cells were also treated with hormone drugs (tamoxifen and ICI182,780) and changes in MAPT protein expression were examined.Results: Six cell lines showed high MAPT mRNA expression and four showed high MAPT protein expression; that is, expression at the mRNA level did not always correlate with that at the protein level. MAPT mRNA expression did not correlate with taxane resistance, but expression of MAPT protein isoforms under 70 kDa correlated with taxane resistance. Downregulation of MAPT increased sensitivity to taxanes. MAPT protein expression was decreased by ER knockdown and increased by 17-β-estradiol stimulation. The MAPT protein level was also increased by tamoxifen, but decreased by ICI182,780. Combination treatment of taxanes with ICI182,780 showed a strong synergistic effect, but similar treatment with tamoxifen had an antagonistic effect in both cell lines.Conclusions: Expression of MAPT protein isoforms under 70 kDa correlates with taxane resistance in breast cancer cells. MAPT expression is influenced by ER in breast cancer and ICI182,780, a selective ER inhibitor, can reverse the resistance to taxanes in both MAPT- and ER-positive breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2118.

Cyclic tensile stretch stimulates the release of reactive oxygen species from osteoblast-like cells

It is known that the excessive generation of reactive oxygen species (ROS) is a significant factor in tissue injury observed in many disease states. To determine whether extreme levels of mechanical stress applied to osteoblasts enhances ROS synthesis, we loaded cyclic tensile stretch on osteoblast-like HT-3 cells. Cyclic tensile stretch loaded on these cells clearly enhanced ROS synthesis in a time- and magnitude-dependent fashion. Cyclic tensile stretch also enhanced superoxide dismutase (SOD) activity. The disruption of microfilaments with cytochalasin D abolished the stress-induced ROS synthesis. Rotenone, an inhibitor of the mitochondrial electron transport chain, enhanced stress-induced ROS synthesis. These data suggest that actin filament and mitochondria are involved in this action.

Detection of tryptase-, chymase+ cells in human CD34+ bone marrow progenitors

BACKGROUND

Mast cells (MCs) arise from haematopoietic stem cells. We have recently reported that CD34(+) progenitors derived from human bone marrow (BM) develop into tryptase+, chymase+ MCs when cultured in the presence of recombinant human stem cell factor (rhSCF) and recombinant human IL-6 (rhIL-6). In an experiment for the expression of chymase during differentiation, chymase+ cells were detected in human BM, but tryptase+ cells were not found.

OBJECTIVE

The purpose of this study was to show the appearance of chymase+ cells in CD34(+) cells with an origin different from MC differentiation.

METHODS

CD34(+) cells from human BM were sorted with anti-CD117 monoclonal antibody (mAb), and cytospins of CD34(+), CD34(+)CD117(+), or CD34(+)CD117(-) were prepared. These cells were cultured with rhSCF+rhIL-6 for 12 weeks. Some of the cells were subjected to either histological stain with Wright-Giemsa or immunocytochemistry with anti-chymase mAb. Real-time RT-PCR was also performed to compare the transcriptional level of chymase from each cell preparation.

RESULTS

Chymase was expressed in CD34(+) cells as well as human MCs by immunocytochemistry. Substantial CD34(+)CD117(-) cells, but not CD34(+)CD117(+) cells, were stained immunocytochemically with anti-chymase mAb. For 1 week culture with rhSCF+rhIL-6, no cells expressed chymase in any preparation. Real-time RT-PCR revealed positivity for chymase mRNA in CD34(+) cells, but it reduced at 1 week of culture, and increased as cells developed into MCs. Chymase mRNA in CD34(+)CD117(+) cells was negligible compared with that in CD34(+)CD117(-). Tryptase mRNA was below the detectable level in CD34(+) cells, and increased along with MC differentiation. After 12 weeks of culture, CD34(+)CD117(+) developed predominantly into MCs, whereas CD34(+)CD117(-) developed into monocytes/macrophages.

CONCLUSION

Our findings suggested that chymase is present not only in MCs but also in CD34(+)CD117(-) BM progenitors, but that its origin is different from the MC lineage.

Functional expression of high-affinity receptor for immunoglobulin E on mast cells precedes that of tryptase during differentiation from human bone marrow-derived CD34 progenitors cultured in the presence of stem cell factor and interleukin-6

BACKGROUND

CD34(+) progenitor cells develop into tryptase(+), CD117(+) mast cells when cultured in the presence of recombinant human stem cell factor (rhSCF). However, spontaneous IgE receptor (FcepsilonRI) expression during human mast cell development is not well examined.

OBJECTIVE

Here, the expression and function of FcepsilonRI in and on human bone marrow-derived mast cells (HBMMCs) during development were investigated.

METHODS AND RESULTS

At 4 weeks of culture, predominant cells expressed high-affinity IgE receptor alpha chain (FcepsilonRIalpha) on the cell surface determined by flow cytometry, but CD117 was less expressed. Immunocytochemistry with antitryptase mAb and anti-FcepsilonRIalpha mAb revealed intracellular and surface expression of FcepsilonRIalpha at 2 weeks of culture, but tryptase was less expressed. FcepsilonRIalpha mRNA transcript preceded that of tryptase mRNA at 2 weeks of culture determined by real-time RT-PCR, and FcepsilonRIalpha, FcepsilonRIbeta, FcepsilonRIgamma, and tryptase mRNA increased along with differentiation. FcepsilonRIalpha cross-link on HBMMC and 4-week-old mast cells/mast cell precursors induced the release of IL-5 and granulocyte macrophage-colony stimulating factor, which was enhanced by rhSCF.

CONCLUSION

These data indicated that HBMMC constitutively and spontaneously expressed functional FcepsilonRI subunits at the early stage of differentiation, probably because of the differences in the ability and functional property of progenitors.

Cyclic tensile stretch loaded on bovine chondrocytes causes depolymerization of hyaluronan: involvement of reactive oxygen species

OBJECTIVE

We have previously demonstrated that reactive oxygen species (ROS) are involved in cartilage degradation. Decreased size of hyaluronan (HA), the major macromolecule in synovial fluid, to which it imparts viscosity, is reported in patients with arthritis. The purpose of this study was to determine the alteration in the molecular weight range of HA as a result of mechanical deformation loaded on the chondrocytes, as well as the involvement of ROS in this action.

METHODS

ROS were generated via the oxidation of hypoxanthine by xanthine oxidase. Cyclic tensile stretch was loaded using a vacuum-operated instrument. Levels of HA were measured using a sandwich enzyme-binding assay. Superoxide dismutase (SOD) activity and ROS were measured using water-soluble tetrazolium and a chemiluminescent probe, respectively.

RESULTS

ROS depolymerized HA molecules. Cyclic tensile stretch depolymerized HA and induced ROS. SOD inhibited not only ROS induction but also HA depolymerization caused by the mechanical stress.

CONCLUSION

ROS play an important role in mechanical stress-induced HA depolymerization.

Reactive oxygen species depolymerize hyaluronan: involvement of the hydroxyl radical

We have previously demonstrated that reactive oxygen species (ROS) are involved in cartilage degradation. A decrease in the size of hyaluronan (HA), which is the major macromolecule in synovial fluid and is responsible for imparting viscosity to it, is reported in arthritis patients. The purpose of this study is to determine the ROS that depolymerize HA. The luminol derivative, L-012, was used to determine the generation of ROS. To generate hydroxyl radicals, a mixture of hydrogen peroxide (H(2)O(2)) and ferrous ions (Fe(2+)) was added to HA. The antioxidants and the depolymerization of HA were studied in this system. The hydroxyl radical is one of the ROS, causing the depolymerization of HA, which reacts with L-01. These data suggest that hydroxyl radicals play an important role at the site of inflammation.

[Pulmonary adenocarcinoma of the fetal lung type; report of a case]

An asynptomatic 58-year-old male was admitted to the hospital because of an abnormal nodule in the left lung field on screening chest X-ray. Chest computed tomography (CT) showed a tumor shadow mass in the left lower lobe. Open biopsy was performed to diagnose the mass. The cytological diagnosis was low-grade malignant adenocarcinoma, underwent left lower lobectomy. The histological diagnosis was pulmonary adenocarcinoma of the fetal lung type which was one of pulmonary blastoma (PB). Recently, the concept of pulmonary blastoma has changed. It will be useful to investigate the old PB's case reports to classify new concept.

[A case of Coxiella burnetii pneumonia in an adult]

A 49-year-old man visited our hospital complaining of a continuous high-grade fever and cough which had appeared during his stay in Indonesia. He was admitted on the same day because his laboratory data showed marked inflammatory changes and his chest radiograph revealed an infiltrative shadow in the right upper lung field. Initial treatment with beta-lactams was not effective and both his symptoms and his chest radiograph worsened. However, treatment with erythromycin clearly had an effect. Then, we carried out several tests for detection of atypical pathogens including Mycoplasma and Chlamydia. Finally, the case was diagnosed as one of Coxiella burnetii pneumonia because the DNA of C. burnetii was detected from his sera and seroconversion of C. burnetii--specific antibody was observed among paired serum samples. C. burnetii is one of the most commonly recognized pathogens among community-acquired pneumonias in Western countries, but in Japan, reports of community-acquired C. burnetii pneumonia have been rare. This difference may be due to the features of Q fever, in which there are large differences in frequency and form from country to country and among areas of the same country. Surveillance of C. burnetii pneumonia in Japan and different area will be required.

A child with adrenocortical adenoma accompanied by congenital hemihypertrophy: report of a case

We report herein the findings of a 7-year-old male child with a ruptured adrenocortical adenoma and congenital hemihypertrophy which was incidentally detected after suffering a trauma. A review of 21 pediatric cases of adrenocortical neoplasms in the literature was made. The patient showed precocious puberty such as pubis and advanced bone age, but an endocrinological examination revealed no definite abnormalities. The right adrenal tumor with hematoma was resected after these evaluations. Adrenocortical adenoma is considered to occur more frequently in female children. However, the incidence of adrenocortical tumors accompanied by congenital hemihypertrophy does not differ between males and females. The outcomes were relatively good, although the observation periods were short in some patients. A large number of patients presented with a tumor and hemihypertrophy on the same side. This finding is of interest when considering the possible association between hemihypertrophy of the organs and tumor proliferation. However, their association in terms of development was unclear. It is necessary for patients with hemihypertrophy to have regular examinations for the possible development of malignant tumors, especially in the kidney, adrenal gland, and liver.

[A case of advanced hepatocellular carcinoma with portal invasion resected after treatment by continuous intra-arterial chemotherapy with cisplatin and 5-fluorouracil]

A 67-year-old male diagnosed as having inoperable advanced hepatocellular carcinoma with portal invasion was able to undergo resection after continuous intra-arterial chemotherapy with 5-fluorouracil (5-FU) and cisplatin (CDDP). These were continuously administered for 24 hours at doses of 5-FU of 250 mg and CDDP of 5 mg/day, from day 1 to day 5 in a week, repeated 6 times. In additions to the reductions of the levels of AFP and PIVKA-II from 212.6 ng/ml and 16,100 mAU/ml to 11.8 ng/ml and 12 mAU/ml, respectively, the volume of the tumor and the portal invasion were diminished remarkably. As a result, a left extended hepatectomy could be performed. No sign of recurrence was seen during 16 months of follow-up after the operation. Given the above results, continuous intra-arterial chemotherapy with 5-FU and CDDP therapy may be effective for patients with hepatocellular carcinoma.

Cyclic tensile stretch inhibition of nitric oxide release from osteoblast-like cells is both G protein and actin-dependent

Recent reports indicate the alteration of nitric oxide (NO) synthesis with mechanical stress loaded on the osteoblast and NO is considered to have a significant role in mechanotransduction. We found the involvement of guanine-nucleotide-binding regulatory proteins (G proteins), especially Gi, in stress-inhibited NO release of osteoblast-like cells (JOR:17;593-597, 1999). To determine further the mechanism involved in this process, we measured c-Jun N-terminal kinase/stress-activated protein kinase (JNK/SAPK) activity under cyclic tensile stretch loaded on osteoblast-like cells. Cyclic stretch significantly enhanced JNK/SAPK activity and pertussis toxin clearly reversed stress-enhanced JNK/SAPK activity. Cytochalasin D, actin microfilament disrupting reagent, also abolished the stress activation of JNK/SAPK. We propose a model for signaling events induced by cyclic tensile stretch, namely a transmembrane mechanosensor which couples Gi-protein, actin cytoskeleton and finally activates JNK/SAPK activity of osteoblasts.

[A case report of pneumococcal pneumonia diagnosed by urinary antigen]

Using a kit for the rapid detection of Streptococcus pneumoniae, we examined 3 clinical cases, clearly diagnosed as pneumococcal pneumonia. Case 1 was a 63-year-old man hospitalized for right middle lobular pneumonia. Streptococcus pneumoniae was detected by blood culture initiated on the day of admission. His urine sample was found to have Streptococcus pneumoniae antigen at hospital day 4, and positive test results were observed 3 times thereafter. The other 2 cases had negative sputum and blood cultures, but they were positive for urine antigen, with clinical courses consistent with those of pneumococcal pneumonia. The kit used was determined to provide a test result within 15 min for each urine sample, and it was easy to perform. Thus, this kit is expected to serve as a very useful clinical tool.

The cyclin-dependent kinase inhibitor p27 as a prognostic factor in advanced non-small cell lung cancer: its immunohistochemical evaluation using biopsy specimens

The expression of p27, which is known as a cyclin-dependent kinase inhibitor, on surgically resected specimens has considerable value for the prognosis of non-small cell lung cancer (NSCLC) patients. We immunohistochemically investigated the expression of the p27 protein in the biopsy specimens taken from 69 advanced NSCLC patients and assessed its clinical value. There was no significant correlation between p27 positivity and clinical parameters, including sex, age, histological type, clinical stage, smoking index and performance status. Furthermore, p27 positivity was not associated with response to chemotherapy. However, the Kaplan-Meier curve demonstrated that low p27 expression was significantly related to poor prognosis (P = 0.0019, by the log-rank test). Using multivariate analysis, p27, age and serum total protein level were found to be the independent prognostic parameters. The p27 positivity in the biopsy specimens of advanced NSCLC appears to be a useful prognostic marker.

Pertussis toxin-sensitive G proteins as mediators of stretch-induced decrease in nitric-oxide release of osteoblast-like cells

Mechanical loading plays an important role in regulating bone remodeling, and nitric oxide may be one regulator of this process. To determine how mechanical stress modulates osteoblast function, we loaded cyclic tensile stretch on osteoblast-like cells and measured levels of nitric oxide in the medium. High frequency of stretch at any magnitude inhibited release of nitric oxide; however, low frequency of stretch enhanced its release from the static control. To examine the involvement of G protein (guanine nucleotide-binding regulatory protein) in stress-inhibited release of nitric oxide, we added pertussis toxin, a specific inhibitor of the Gi class, and found that it completely reversed the stress-inhibited release. These data support the idea that pertussis toxin-sensitive G protein is activated in the presence of cyclic tensile stretch.

Effects of granisetron in children undergoing high-dose chemotherapy: a multi-institutional, cross-over study

The efficacy of granisetron hydrochloride 20 microg/kg and 40 microg/kg were compared using a cross-over method to determine the optimal dose in children with solid tumors receiving high-dose chemotherapy. Granisetron controlled the onset of vomiting in 17 of 23 patients (73.9%) who were given 40 microg/kg of granisetron, while 8 of 21 patients (38.1%) were free of vomiting in the 20 microg/kg group. The average frequency of vomiting was 7.22 times in the 20 microg/kg dose versus 4.44 times in the 40 microg/kg dose. No safety problems were associated with either dose. The 40 microg/kg dose of granisetron appears to be more optimal.

[Palliation for a recurrent lung cancer patient with superior vena cava syndrome by arterial infusion of CDDP through the implantable port system--a case report]

A case of lung cancer with superior vena cava syndrome treated with internal thoracic arterial infusion of anti-cancer drugs by the implantable port system was reported with our technique. In this case, blood supply was mainly from internal thoracic artery. A trans-catheterial contrast enhanced helical CT was very helpful to identify the routes of blood supply to the lung cancer.

Protein kinase C modulates the synthesis of nitric oxide by osteoblasts

To determine the involvement of protein kinase C (PKC) in nitric oxide (NO) synthesis of osteoblast, a combination of proinflammatory cytokines (tumor necrosis factor-alpha, interferon-gamma, bacterial lipopolysaccharide) were added on rat osteoblast-like cells. Results show that these cytokines clearly enhanced the synthesis of NO. The activation of PKC with phorbol ester also resulted in the stimulation of NO synthesis in these cells. These cytokines activated PKC and increased the levels of intracellular Ca2+. In addition, the cytokine-induced synthesis of NO was blocked by PKC inhibitors. Findings suggest the involvement of PKC in the synthesis of NO by rat osteoblasts.