Abstract P6-17-13: ZW49, a HER2 targeted biparatopic antibody drug conjugate for the treatment of HER2 expressing cancers

Background: HER2-targeted therapies have transformed the treatment of patients with HER2-expressing breast and gastric cancers. Despite this, there remains a need for new treatments that are well tolerated and effective not only for cancers with high HER2 expression levels but also those with lower levels of expression. ZW49 is an antibody drug conjugate (ADC) that combines a novel auristatin payload (potent anti-cancer agent) with the unique mechanisms of action of the anti-HER2 biparatopic antibody, ZW25, which binds to the same domains as trastuzumab and pertuzumab. In preclinical studies in cancer cell lines with low to high levels of HER2 expression, ZW25 is associated with increased binding and internalization compared to trastuzumab, while the novel N-acyl sulfonamide auristatin payload has demonstrated increased in vivo tolerability compared to other microtubule inhibitors. ZW49 therefore has the potential to address unmet medical need across a range of HER2-expressing cancers.

Methods: Multiple in vitro and in vivo experiments were performed to characterize ZW49 as a potential therapeutic candidate. Internalization and cell growth inhibition of ZW49 were evaluated in HER2-expressing cell lines. Anti-tumor activity was assessed in patient-derived xenograft (PDX) tumor models of HER2 low and high expressing breast cancers. Tolerability was assessed in a 6-week repeat-dose non-GLP toxicology study in non-human primates (NHP) with intravenous administration of ZW49 at either 9 mg/kg or 12 mg/kg once every two weeks.

Results: In vitro, ZW49 was more rapidly internalized into HER2-expressing cells compared to a monospecific trastuzumab-ADC. ZW49 also displayed potent in vitro cell growth inhibition in several breast cancer cell lines with a range of HER2 expression. This activity was confirmed in multiple in vivo PDX models, including a HER2 IHC 3+ HBCx-13b xenograft where two doses of ZW49 at 3 mg/kg or higher generated tumor regressions, and a HER2 IHC 1+ ST-910 xenograft where a single dose of ZW49 at 6 mg/kg or higher generated regressions. In both models, regressions occurred at exposures that were well tolerated in NHP. In a repeat dose pilot non-GLP study the highest dose tested (12 mg/kg) was considered to be the no observed adverse effect level (NOAEL) and a GLP repeat-dose toxicology study was ongoing at the time of abstract submission.

Conclusions: ZW49 is a novel biparatopic HER2-targeted ADC that demonstrated anti-tumor activity in low and high HER2-expressing breast cancer cell lines and PDX models. Notably, tumor regressions were observed at exposure levels that were well tolerated in NHP. These results support the potential of ZW49 as a novel therapeutic agent that may help address unmet medical need in patients with high and low HER2-expressing cancers.

Citation Format: Hamblett KJ, Barnscher SD, Davies RH, Hammond PW, Hernandez A, Wickman GR, Fung VK, Ding T, Garnett G, Galey AS, Zwierzchowski P, Clavette BC, Winters GC, Rich JR, Rowse GJ, Babcook JS, Hausman D. ZW49, a HER2 targeted biparatopic antibody drug conjugate for the treatment of HER2 expressing cancers [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 P6-17-13.

Molecular Evidence for Convergence and Parallelism in Evolution of Complex Brains of Cephalopod Molluscs: Insights from Visual Systems

Coleoid cephalopods show remarkable evolutionary convergence with vertebrates in their neural organization, including (1) eyes and visual system with optic lobes, (2) specialized parts of the brain controlling learning and memory, such as vertical lobes, and (3) unique vasculature supporting such complexity of the central nervous system. We performed deep sequencing of eye transcriptomes of pygmy squids (Idiosepius paradoxus) and chambered nautiluses (Nautilus pompilius) to decipher the molecular basis of convergent evolution in cephalopods. RNA-seq was complemented by in situ hybridization to localize the expression of selected genes. We found three types of genomic innovations in the evolution of complex brains: (1) recruitment of novel genes into morphogenetic pathways, (2) recombination of various coding and regulatory regions of different genes, often called "evolutionary tinkering" or "co-option", and (3) duplication and divergence of genes. Massive recruitment of novel genes occurred in the evolution of the "camera" eye from nautilus' "pinhole" eye. We also showed that the type-2 co-option of transcription factors played important roles in the evolution of the lens and visual neurons. In summary, the cephalopod convergent morphological evolution of the camera eyes was driven by a mosaic of all types of gene recruitments. In addition, our analysis revealed unexpected variations of squids' opsins, retinochromes, and arrestins, providing more detailed information, valuable for further research on intra-ocular and extra-ocular photoreception of the cephalopods.

The nurse lecturer's role in mentoring the mentors

AIM

This article reports on the results of a survey conducted early in 1999 investigating the effectiveness of current arrangements for mentor preparation and ongoing mentor support provided within adult placement areas within Greater Glasgow Health Board.

METHOD

A sample of 150 mentors was surveyed with a response rate of 47 per cent (n = 71).

RESULTS

Results indicate that although mentors are generally satisfied with the current approach to mentorship preparation, the issue of support from both managers and academic staff is problematic.

CONCLUSION

Respondents indicated that they wished to see lecturers visiting the practice placement areas and providing support, particularly in relation to assessment of students. Also highlighted in this study is the need for more effective communication between placement areas and academic staff.

Allograft vascular disease: comparison of heart and other grafted organs

A striking resemblance exists between the vasculopathy in several different allografts. The arteriopathy of epicardial coronary arteries is diffuse, involving proximal, distal, and small branch segments in a generally concentric pattern of intimal thickening. Smooth muscle cells in a lipid- and glycosaminoglycan-rich matrix are the predominant components of this expanded intima. Varying amounts of collagen are present, more being present late posttransplant. A superficial and, to a lesser degree, deep, bandlike infiltrate of T cells and macrophages is uniformly present, although it is somewhat more prominent in early lesions as compared to more severely narrowed arteries from longer-term, susceptible grafts. The media is likewise altered by areas of lipid and glycosaminoglycan deposition associated with smooth muscle cell loss and phenotypic modulation. The media is altered in an outside-to-inside direction, with percolation of adventitial leukocytes into the outer media. Virtually all of the coronary features are seen in the medium to large arteries of liver, pancreas, and kidney allografts. Chronic rejection in lung allografts is manifest by obliterative bronchiolitis; vascular changes, although architecturally similar, are somewhat less common and result in less-severe luminal narrowing. The role of allograft vasculopathy in chronic lung rejection is thus less certain. A finding perhaps unique to epicardial coronary arteries of heart allografts is the presence of eccentric lesions more typical of native atherosclerosis. Many of the latter grafts probably have preexistent, undetected donor disease. Sequential evaluation of vascular changes is limited in human biopsy material by their general absence in endomyocardial or core liver needle specimens. Fortunately, vascular changes can be detected in some renal and pancreas core needle biopsies, and these findings may provide an avenue for monitoring the effectiveness of immunosuppressive therapy, antiviral or lipid-altering therapies, or modifications of smooth muscle cell proliferation and glycosaminoglycan deposition yet to be developed.

Provisional practice: the nature of psychosocial bone marrow transplant nursing

PURPOSE/OBJECTIVE

To develop an empirically based description of the key concepts guiding psychosocial nursing practice for the patient undergoing bone marrow transplantation (BMT).

DESIGN

Retrospective, descriptive.

SETTING

National Cancer Institute-designated comprehensive cancer center.

SAMPLE

Medical records of 23 adults (11 males, 12 females; X age = 33 years) who have undergone BMT.

METHODS

All psychosocial-related charting was extracted manually from the subjects' medical records and nursing care plans. Text was analyzed for content, coded, and sorted into 42 categories. The investigators wrote category definitions.

MAIN RESEARCH VARIABLES

All present and past psychosocial problems that had been identified; psychosocial assessment; psychosocial-related admission and discharge teaching; and references to pain and sleep disturbances that included or implied psychosocial overlay.

FINDINGS

Thematic categories were present in each of five core concepts: discovering the lived reality, managing the flow, emerging awareness, keeping watch, and behind closed doors. Synthesis of these concepts led to one encompassing concept--the provisional nature of psychosocial BMT nursing practice.

CONCLUSIONS

The results provide empirical evidence that five key concepts exist within psychosocial BMT nursing and can be applied to a new paradigm of nursing care.

IMPLICATIONS FOR NURSING PRACTICE

Provisional practice, as a new paradigm, requires further development. The five concepts derived from this study provide a useful framework for delineating significant psychosocial needs of patients and families and for designing tailored nursing therapeutics. The study suggests that preparation for practicing BMT nursing should include education in specific psychosocial strategies, documentation, and coping with the personal implications of practice in this setting. The study raises important issues in psychosocial care requiring further clarification and elucidation. These center around the nature of uncertainty, caring, and social support in BMT.

Lipid overload and proteoglycan expression in chronic rejection of the human transplanted heart

The degree to which transplant arteriopathy in solid organ allografts is an atheromatous process remains somewhat controversial. If atheromata develop as common and integral components of the arteriopathic lesions, then the process may be approached therapeutically in a manner analogous to native atheromatous diseases. Approaches to understanding the arteriopathic process may include not only the modulation of alloimmunity, but also the interruption of "storage" phenomena. We have examined the epicardial coronary arteries of nearly 50 explanted human heart allografts using biochemical, morphological, morphometrical, immunohistochemical, and molecular techniques in an effort to establish the degree, nature, and distribution of lipid accumulation in the vessel walls. Concomitantly, we studied the ascertainment of proteoglycan gene expression, represented by biglycan and decorin messenger RNA, and the localization of proteoglycan proteins in the vessels. The degree of lipid and proteoglycan buildup in both the intima and media of transplanted vessels is striking, and correlated strongly with intimal thickening, cross-sectional area reduction of the lumen, cumulative cyclosporine dose, corticosteroid dose, and serum cholesterol levels. Notably, lipid accumulation is not related to implant duration, this being true in an unselected series of "failed" allografts ranging from 4 to 1610 days post-transplant. The profound lipid accumulation in coronary walls of many grafts begins very early post-transplant and appears to contribute substantially to intimal thickening. Whether dysregulation of proteoglycan production leads to entrapment of lipids and lipoproteins remains an important and testable hypothesis.

Measurement of right ventricular volume in human explanted hearts using ultrafast cine computed tomography

The quantitative measurement of right ventricular (RV) volume has been attempted by a number of methods, including nuclear magnetic resonance imaging, contrast angiography, echocardiography, and radionuclide angiography. All of these methods have limitations. Ultrafast cine computed tomographic (CT) scan is a new technology that may have an important role in on-line ventricular volume measurements. Twelve human explanted hearts, fixed in formalin, were subjected to ultrafast cine CT scans to estimate RV volume. The volumes derived from the CT scans were compared with actual fluid volumes needed to fill the RV volume measurements. All measurements were conducted independently by two observers. Actual RV volumes in the 12 hearts ranged from 29.8 ml to 174.6 ml. A strongly significant correlation between actual volume and CT volume was seen (r = 0.99). Agreement between observers was also seen to be highly significant (r = 0.992). Limitations to accurate in vivo assessment due to bolus injection of contrast medium might include alterations in ventricular pressure change. Similarly, differentiation of the endocardial border with contrast may not be as sharp as that with an air-tissue interface. This study demonstrates that RV volumes can be reliably determined by ultrafast cine CT scans in explanted hearts. On-line systolic and diastolic volumes and thus stroke volume, ejection fraction, etc, can be accurately defined independent of cardiac orientation. This technique offers opportunities to study ventricular function under various conditions.

Ethical issues in oncology nursing practice: an overview of topics and strategies

An understanding of common principles of biomedical ethics provide healthcare professions with a common language. Developing a standard approach to complex ethical cases in clinical situations allows professionals to involve significant individuals and to ensure that appropriate factors are considered. This article presents a case in oncology nursing practice, using a sample model for decision making. The case is developed to demonstrate a number of issues that arise with regard to symptom management, the nurse-patient relationship, informed consent, end-of-life decisions, and truth-telling. Ethical dilemmas arising from conflicts within principles and between individuals holding differing ethical perspectives are described. Because a true ethical dilemma goes beyond a simple "right" or "wrong" answer, arguments based on differing moral grounds are presented. Nursing responsibilities are delineated and directions are provided for furthering one's understanding of ethics.

Cardiac amyloidosis causing ventricular tachycardia. Diagnosis made by endomyocardial biopsy

In patients with malignant ventricular arrhythmias, endomyocardial biopsy may be helpful when all other findings from the workup are negative. A case of nonsustained polymorphic ventricular tachycardia is presented. The findings from an echocardiogram, coronary angiogram, and cardiac catheterization were negative. An electrophysiologic study showed inducible nonsustained ventricular tachycardia. A right ventricular endomyocardial biopsy was diagnostic of cardiac amyloid. The findings from a workup for systemic amyloidosis were negative. Primary cardiac amyloidosis should be considered in patients with malignant arrhythmias and no documented heart disease, and endomyocardial biopsy is helpful in making this diagnosis.

Ramoplanin (A-16686), a new glycolipodepsipeptide antibiotic. IV. Complete sequence determination by homonuclear 2D NMR spectroscopy

Homonuclear 2D NMR spectroscopy double quantum filter correlation spectroscopy (DQF-COSY), relayed-COSY, nuclear Overhauser enhancement spectroscopy (NOESY), and DQF-relayed-NOESY) allowed the complete determination of the core depsipeptide of antibiotic ramoplanin (A-16686). In particular, the DQF-relayed-NOESY experiments were essential in assigning the single signals close to the diagonal.

Ramoplanin (A-16686), a new glycolipodepsipeptide antibiotic. III. Structure elucidation

By combination of chemical, 1H and 13C NMR, and mass spectrometric studies, the structures of the three components of the antibiotic ramoplanin (A-16686), produced by Actinoplanes sp. ATCC 33076, have been elucidated. All the components have structures formed by a common depsipeptide skeleton carrying a dimannosyl group and are differentiated by the presence of various acylamide moieties, derived from C8, C9 and C10 fatty acids.

Diaphragmatic neurilemoma

The fourth case of diaphragmatic neurilemoma reported in the English literature is presented from our institution. Diaphragmatic tumors are usually benign and most are symptomatic. Utilizing CT scanning, these tumors can today be accurately localized. Excision via thoracotomy or celiotomy is easily accomplished and is the only reliable way to establish the identity of these lesions.

3-(1-Iminoethyl)-4,5-cycloalkylpyridine-2,6-diol derivatives. A novel class of benzodiazepine receptor antagonists and partial agonists

A series of 3-(1-iminoethyl)-4,5-cycloalkylpyridine-2,6-diol derivatives have been prepared from isoxazolo [5,4-b] pyridones. Some of these compounds had affinity for the benzodiazepine receptors in vitro and in vivo radioligand displacement assays. These compounds did not have any anticonvulsant properties and were not active in pharmacological tests predictive of antianxiety activity, but antagonised the anticonvulsant and muscle-relaxant effects of diazepam and had proconvulsant properties.

Posttraumatic intrauterine omental implantation mimicking lipomatous lesion 16 years later

A case of traumatic perforation of the uterus with subsequent omental implantation in the endometrial cavity clinically presenting 16 years later as an endometrial lipoma is discussed. This case should alert clinicians to the existence of such a complication to be included in their differential diagnosis of lipomatous lesions of the uterus.

Nocardia epididymo-orchitis in an immunosuppressed patient

The immunocompromised patient after organ transplantation is susceptible to unusual and life-threatening infections. We report a case of epididymitis that evolved into testicular nocardiosis after cardiac transplantation. An awareness of the potential for these infections and early diagnosis may prevent extensive morbidity in the post-transplantation patient.

Synthesis and analgesic activity of new tricyclic pyrazolo[3,4-b]pyridines

The title compounds have been obtained in a two-step synthesis from 5-amino-4-(1-cycloalkenyl)pyrazoles. Among the synthetized compounds, the 6,7,8,9-tetrahydro-1,3-dimethyl-3H-pyrazolo[3,4-c]isoquinoline, showed interesting antiinflammatory and analgesic activity.

Synthesis, in vitro [3H]prazosin displacement, and in vivo activity of 3-aryl-4,5,6,7-tetrahydropyrazolo[4,3-c]pyridines, a new class of antihypertensive agents

A series of new 3-aryl-4,5,6,7-tetrahydropyrazolo[4,3-c]pyridines was synthesized and screened for in vitro [3H]prazosin displacement activity. The results correlated well with their antihypertensive activity in spontaneous hypertensive rats. 1-Benzyl-3-(4-fluorophenyl)-4,5,6,7-tetrahydropyrazolo[4,3-c]pyrid ine (50, L 16052) was selected for further pharmacological evaluations of its potency when administered orally to conscious renal hypertensive dogs.

Bone regeneration in podiatric surgery

Many factors affect postoperative bone formation. Factors such as age, sex, and trauma cannot be controlled; however, proper technique, a controllable factor, is imperative in achieving good surgical results.

Cyclic hydrazides. V - synthesis and antiinflammatory activity of derivatives of the 2-amino-1,4-dihydroisoquinolin-3(2H)-one

The synthesis of the 2-amino-1,4-dihydroisoquinolin-3(2H)-one (II a) and of some of its derivatives starting from the o.methylphenylacetic acid, is described. Some of the described compounds possess a moderate antiinflammatory activity.

Synthesis and biological activities of some indolo[2,3-c]isoquinoline derivatives

Indolo[2,3-c]isoquinoline derivatives have been synthesized and tested for their antimicrobial activities. Some of them display good in vitro activity against fungi and gram-positive bacteria.

[Cyclic hydrazides. III. Synthesis and anti-inflammatory activity of 2-amino-3,4-dihydroisoquinolin-1(2H)-one]

The synthesis and the antiinflammatory activity of of 2-amino-3,4-dihydroisoquinolin-1(2H)-one and of a series of its derivatives on the amino function are described. Some of theses new componds show high activity in inhibiting the carrageenin oedema and granuloma formation in rats.

[Cyclic hydrazides. II. (1) Synthesis of 3-aminopyrazolo[1,2-b]hthalazine-1(1H),5(10 H)-diones]

The synthesis is described of a number of 3-aminopyrazolo[1,2-b]phthalazine-1(1H),5(10H)-diones (I) differently substituted on the amino group and in position 2, through condensation of alpha-chloro-beta-chlorocarbonylenamines (IV) with the 3,4-dihydrophthalazin-1(2H)-one (III). Alternatively cyanoacetylchlorides are condensed with (III) giving directly the 3-aminopyrazolo[1,2-b]phthalazine-1(1H),5(10H)-diones with the primary amino function (VII).