Joint Symposium of Korean Cancer Association & UICC-ARO-Cross-boundary cancer studies: cancer and Universal Health Coverage (UHC) in Asia

On 16 June 2016, the Korean Cancer Association (KCA) and Union for International Cancer Control-Asia Regional Office (UICC-ARO) organized a joint symposium as part of the official program of the 42nd Annual Meeting of the Korean Cancer Association to discuss the topic 'Cross-boundary Cancer Studies: Cancer and Universal Health Coverage (UHC) in Asia.' Universal Health Coverage is included in the Sustainable Development Goals adopted by the United Nations as part of the 2030 Agenda for Sustainable Development. The objectives of UHC are to ensure that all people can receive high-quality medical services, are protected from public health risks, and are prevented from falling into poverty due to medical costs or loss of income arising from illness. The participants discussed the growing cost of cancer in the Asian region and the challenges that this poses to the establishment and deployment of UHC in the countries of Asia, all of which face budgetary and other systemic constraints in controlling cancer in the region. Representatives from Korea, Japan and Indonesia reported on the status of UHC in their countries and the challenges that are being faced, many of which are common to other countries in Asia. In addition to country-specific presentations about the progress of and challenges facing UHC, there were also presentations from WHO Kobe Centre concerning advancing UHC in non-communicable diseases and prospects for further collaboration and research on UHC. A presentation from the University of Tokyo also highlighted the need to focus on multidisciplinary studies in an age of globalization and digitization.

Abstract 21: Regulation of proliferation and invasion through the inhibition of IGF signaling pathway on Epstein-Barr virus associated gastric cancer

Epstein-Barr virus associated gastric cancer (EBVaGC) is one subtype of four molecular classifications by TCGA group. Specifically, EBV related viral RNAs, microRNAs and proteins regulate cancer progression phenomena like aggressiveness, motility, invasion and metastasis. Nonetheless, understanding the mechanisms of viral growth dependency beyond malignant EBV transformation are still deficient. Finding the EBV dependent pathway with significant biological role and the clinically appropriated drug is needed for EBVaGC in this regard. We investigated new therapeutic target and its role of regulating in proliferation and invasion using EBVaGC cell line model. First, we determined proliferation both of AGS and EBV infected AGS (AGS-EBV) cell lines during 7 days by proliferation assay. For the test of BI836845 (IGF ligand neutralizing antibody, Boehringer Ingelheim, German) efficacy, CCK-8 assay was performed. mRNA expression levels of IGF-1R, IGF-1, IGFBP-3 and IGFBP-6 which is the key regulator of IGF-signaling were measured by RT-PCR. Also, protein expression levels of IGF associated and downstream factors were confirmed by Western blotting. Lastly, invasiveness of cells was detected by invasion assay. As a result, AGS-EBV showed the slower proliferation rate compared to AGS, but the sensitivity to BI836845 was significantly increased in a dose-dependent manner (p<0.001). Interestingly, baseline IGFBP-3 mRNA expression of was enhanced in AGS-EBV compared with AGS. In addition, BI836845 treated group showed up-regulated IGFBP-3 mRNA level in AGS and down-regulated IGFBP-3 mRNA level in AGS-EBV. When BI836845 treated to AGS-EBV, phospho-Akt level was highly inhibited. Moreover, invasiveness of AGS-EBV was elevated about 2 fold more than AGS. Treatment of BI836845 in AGS-EBV represented significant decrease the invasiveness (p=0.08). In conclusion, AGS-EBV seems to modulate their proliferation and invasion through the IGF signaling pathway. Inhibition of IGF signaling pathway would be the potential therapeutic strategy for EBV associated gastric cancer.

Citation Format: Inhye Jeong, Hoi Young Lee, Jae Kyung Roh, Tae Soo Kim, Suk Kyeong Lee, Woo-Ick Jang, Hyun Cheol Chung, Sun Young Rha. Regulation of proliferation and invasion through the inhibition of IGF signaling pathway on Epstein-Barr virus associated gastric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 21. doi:10.1158/1538-7445.AM2017-21

Changes in telomerase activity due to alternative splicing of human telomerase reverse transcriptase in colorectal cancer

Human telomerase reverse transcriptase (hTERT) expression level may not always correlate with telomerase activity. The present study analyzed hTERT splicing patterns with respect to hTERT and telomerase activity in colorectal cancer. Telomerase activity was determined by telomeric repeat amplification protocol assay, and spliced variants of hTERT were identified by reverse transcription-polymerase chain reaction in 40 colorectal cancer tissue samples. In the lower range of telomerase activity (0-100 units), the percentage of the β variant decreased with the increment in telomerase activity, whereas in the higher range of telomerase activity (>100 units), total hTERT expression level revealed a trend toward increment. There was a positive correlation between the full-length variant level and β variant level. Conversely, there was a negative correlation between the percentage of the full-length variant and β variant. Tumor-node-metastasis stage was the strongest prognostic factor in multivariate analysis and the percentage of the full-length variant was an independent prognostic factor for survival. Telomerase activity was primarily altered with changes in alternative splicing of the full-length and β variants of hTERT in colorectal cancer.

Symposium: "Oncology Leadership in Asia"

The symposium on “Oncology Leadership in Asia” was held as part of the official program of the 42nd Annual Meeting of the Korean Cancer Association with International Cancer Conference. Given the increasing incidence of cancer in all countries and regions of Asia, regardless of developmental stage, and also in light of the recognized need for Asian countries to enhance collaboration in cancer prevention, research, treatment and follow-up, the symposium was held with the aim of bringing together oncology specialists from eight countries and regions in Asia to present the status in their own national context and discuss the key challenges and requirements in order to establish a greater Asian presence in the area of cancer control and research. The task of bringing together diverse countries and regions is made all the more urgent in that while Asia now accounts for more than half of all new cancer cases globally, clinical guidelines are based predominantly on practices adopted in Western countries, which may not be optimized for unique ethnic, pharmacogenomic and cultural characteristics in Asia. Recognizing the need for Asia to better gather information and data for the compilation of Asia-specific clinical guidelines, the participants discussed the current status in Asia in the national and regional contexts and identified future steps towards integrated and collaborative initiatives in Asia. A key outcome of the symposium was a proposal to combine and integrate the activities of existing pan-Asian societies, including the Asian Pacific Federation of Organizations for Cancer Research and Control (APFOCC) and Asian Clinical Oncology Society (ACOS). Further proposals included the expansion of pan-Asian society membership to include individuals and the essential need to encourage the participation of young researchers in order to ensure self-sustainability of cancer control efforts in the future.

Abstract 430: Novel biomarkers for VEGFR inhibitors in metastatic renal cell carcinoma: BIM expression, and germline polymorphisms of BIM and PIK3R1

Molecular targeted therapy, especially VEGFR tyrosine-kinase inhibitors (TKIs) including sunitinib, pazopanib and sorafenib has been the most efficacious therapy for metastatic renal cell carcinoma (mRCC). However, approximately 35% of mRCC patients do not get the benefit from TKIs treatment, due to resistance and/or drug induced toxicities.

Pro-apoptotic Bcl-2 family member (BIM) is a particularly critical mediator of targeted therapy-induced apoptosis in solid tumors. In previous, it had known that TKIs induced to BIM upregulation and then accelerated to apoptosis of tumor. However, according to recent several studies, BIM germline deletion polymorphism was identified as one of the primary resistant mechanisms of various TKIs in EGFR mutated NSCLC or CML. In addition, the alteration of phosphoinositide 3 kinase(PIK3)/protein kinase B(AKT) pathway has also been found as important mechanism in various cancer cell growth, proliferation and survival. PI3KR1 encodes the p85α subunit, regulatory subunits of Class IA PIK3s. Germline PIK3R1 variant M326I(c.978G>A) might affect the sensitivity of receptor tyrosine kinase (RTK) inhibitors and its downstream pathway inhibitors.

We evaluated the possibility of BIM, PIK3R1 as a potential biomarker for VEGFR TKIs in mRCC. BIM deletion polymorphism status of gDNA from formalin fixed paraffin embedded (FFPE) tumor tissues and peripheral blood mononucleated cells (PBMC) of mRCC patients was determined by separated PCR. And we evaluated BIM protein expression by immunohistochemistry. We also evaluated PIK3R1 germline mutation by pyrosequencing in PBMC of mRCC patients.Germline BIM deletion accounted for 17.8% of total 124 mRCC patients. Unlike with previous other studies, our data suggested that BIM wild type showed tendency to poor prognosis with sunitinib or sorafenib treatments for clear cell type RCC (median OS of BIM wild and deleted type: 44.9 vs 67.3 months, p = 0.279), and high expression of BIM (median OS of BIM low(<10%), median(10-50%) and high(>50%) respectively: 76.5 vs 60.0 vs 21.3 months, p = 0.005). In addition, we found 26% (19/71) of the germline PIK3R1 variant in mRCC. Patients with PIK3R1 germline variant showed a tendency of poor prognosis to 1st line VEGFR TKI treatment than wild type (median PFS: 7.78 vs 15.87months, p = 0.342). Especially PFS of 1st line sunitinib treatment was significantly shorter in PIK3R1 variant compared to wild type (median PFS 7.78 vs 16.33 months, p = 0.004). But, there is no difference in mTOR inhibitor sensitivity both with PIK3R1 or BIM polymorphism.In conclusion, BIM expression and germline variants of BIM and PIK3R1 might be candidate biomarkers for VEGFR TKIs in mRCC.

Citation Format: Jee Hung Kim, Woo Sun Kwon, Won Suk Lee, Tae Soo Kim, Kyu Hyun Park, Jae Kyung Roh, Joong Bae Ahn, Hyun Cheol Chung, Sun Young Rha. Novel biomarkers for VEGFR inhibitors in metastatic renal cell carcinoma: BIM expression, and germline polymorphisms of BIM and PIK3R1. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 430.

Oxaliplatin and 5-FU/folinic acid (modified FOLFOX6) with or without aflibercept in first-line treatment of patients with metastatic colorectal cancer: the AFFIRM study

BACKGROUND

The combination of aflibercept with FOLFIRI has been shown to significantly prolong overall survival in patients with metastatic colorectal cancer (mCRC) after progression on oxaliplatin-based therapy. This trial evaluated the addition of aflibercept to oxaliplatin-based first-line treatment of patients with mCRC.

PATIENTS AND METHODS

Patients with mCRC were randomized to receive first-line therapy with mFOLFOX6 plus aflibercept (4 mg/kg) or mFOLFOX6 alone. The primary end point of this phase II study was the progression-free survival (PFS) rate at 12 months in each arm. The analysis of efficacy between the arms was a pre-planned secondary analysis.

RESULTS

Of 236 randomized patients, 227 and 235 patients were evaluable for the primary efficacy analysis and safety, respectively. The probabilities of being progression-free at 12 months were 25.8% [95% confidence interval (CI) 17.2-34.4] for the aflibercept/mFOLFOX6 arm and 21.2% (95% CI 12.2-30.3) for the mFOLFOX6 arm. The median PFS was 8.48 months (95% CI 7.89-9.92) for the aflibercept/mFOLFOX6 arm and 8.77 months (95% CI 7.62-9.27) for the mFOLFOX6 arm; the hazard ratio of aflibercept/mFOLFOX6 versus mFOLFOX6 was 1.00 (95% CI 0.74-1.36). The response rates were 49.1% (95% CI 39.7-58.6) and 45.9% (95% CI 36.4-55.7) for patients treated with and without aflibercept, respectively. The most frequent treatment-emergent grade 3/4 adverse events (AEs) excluding laboratory abnormalities reported for aflibercept/mFOLFOX6 versus mFOLFOX6 were neuropathy (16.8% versus 17.2%) and diarrhea (13.4% versus 5.2%). Neutropenia grade 3/4 occurred in 36.1% versus 29.3%. The most common vascular endothelial growth factor inhibition class-effect grade 3/4 AEs for aflibercept/mFOLFOX6 versus mFOLFOX6 were hypertension (35.3% versus 1.7%), proteinuria (9.2% versus 0%), deep vein thrombosis (5.9% versus 0.9%) and pulmonary embolism (5.9% versus 5.2%).

CONCLUSION

No difference in PFS rate was observed between treatment groups. Adding aflibercept to first-line mFOLFOX6 did not increase efficacy but was associated with higher toxicity.

CLINICAL TRIAL NUMBER

NCT00851084, www.clinicaltrials.gov, EudraCT 2008-004178-41.

UICC International Session: What are the implications of sharing the concept of Universal Health Coverage for cancer in Asia?

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC – Asia Regional Office organized an international session as part of the 74th Annual Meeting of the Japanese Cancer Association on the topic “What are the implications of sharing the concept of Universal Health Coverage for cancer in Asia?” Universal Health Coverage (UHC) is included in the United Nations’ Sustainable Development Goals and aims to ensure that all people can receive high‐quality medical services, are protected from public health risks, and are prevented from falling into poverty due to medical costs or loss of income arising from illness. The session discussed the growing cost of cancer and the challenges that this poses to the establishment and deployment of UHC in the Asian region, where countries face budgetary and other systemic constraints in tackling and controlling cancer. It was noted how sharing concepts on UHC will assist mutual learning among Asian countries and help in the formation of guidelines that can be adapted to national and regional realities. Presentations included a status report on UHC for cancer control in Thailand, and a report from the WHO Kobe Centre concerning prospects for collaborative research on UHC. Also discussed were the current status of cancer burden and control in China and Korea and Japan's progress in systemizing cost‐effectiveness evaluation. The final presentation highlighted the importance of gathering social and economic data across Asia in order to build a picture of commonalities and differences in the region.

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC‐Asia Regional Office (ARO) organized an international session as part of the official program of the 74th Annual Meeting of the Japanese Cancer Association to discuss the topic “What are the implications of sharing the concept of Universal Health Coverage for cancer in Asia?” The presenters and participants discussed the growing cost of cancer in the Asian region and the challenges that this poses to the establishment and deployment of UHC in the countries of Asia, all of which face budgetary and other systemic constraints in tackling and controlling cancer in the region.

Infusional 5-Fluorouracil, Leucovorin and Docetaxel in Advanced Gastric Cancer

PURPOSE

This study was performed to estimate the response rate and toxicity of a combination chemotherapy, which included infusional 5-Fluorouracil, Leucovorin and Docetaxel in the treatment of patients with an advanced gastric carcinoma.

MATERIALS AND METHODS

Twenty two advanced gastric cancer patients, with a bidimensionally measurable or an evaluable disease, were enrolled in this study. The patients received a 5-fluorouracil 1, 000 mg/m2 intravenous (IV) 24 hour infusion (Day 1~3), leucovorin 20 mg/m2 (Day 1~3) and docetaxel 75 mg/m2 intravenously (Day 2) every 3 weeks.

RESULTS

The overall response rate was 45.0%. The median duration of response was 10.0 weeks (range: 4~24), the median time to response was 8 weeks (range: 8~20) the median time to progression was 30.0 weeks (95% CI: 16.3~43.2) and the median overall survival duration was 36.0 weeks (95% CI: 1.7~70.2). The median cumulative dose of 5-fluorouracil were 316.2 mg/m2/week and docetaxel was 23.9 mg/m2/week. WHO grade III, IV neutropenia, thromocytopenia and anemia occurred in 50.0%, 4.5% and 4.5% of patients, respectively. There were no occurrence of WHO grade III and IV nausea, vomiting, mucositis, conspitation, diarrhea, or neurotoxicity.

CONCLUSION

This chemotherapy regimen, including infusional 5-fluorouracil, leucovorin and docetaxel was an active agent against advanced gastric cancer patients, especially for previous chemotherapy naive patients.

Paclitaxel and Cisplatin Combination Chemotherapy in Pretreated Breast Cancer

PURPOSE

A single institute trial of combination chemotherapy, with paclitaxel and cisplatin, in patients with metastatic breast cancer, having failed previous combination chemotherapy, was performed.

MATERIALS AND METHODS

Patients were only eligible for this study if there disease had progressed, following treatment with previous chemotherapy, in either an adjuvant or a metastatic setting. Paclitaxel 175 mg/m2 was administered as a 3-hour continuous infusion on day 1, and cisplatin 80 mg/m2 was administered for 2 hours on day 2, with adequate hydration. This was repeated every 3 weeks, and continued until one of the following events occurred: disease progression, unacceptable adverse effect or treatment refusal by the patient. Intercurrent palliative radiotherapy, or concurrent hormonal therapy, was permitted, depending on each patient's status. All the endpoints were evaluated under the principle of intention to treat analysis.

RESULTS

A total of 24 patients entered the study, and 18 had at least one measurable lesion, but 6 did not. The objective response rate of the 18 patients was 50%(9/18). Two were complete responses and seven showed partial responses. The median response duration, progression free and overall survival were 5.3 months (range, 4~18), 6 months (95% CI, 5~7) and 12 months (95% CI, 7~17), respectively. 67% of the planned dose was administered. Out of a total 135 cycles administered, about 20% of cycles showed grade 3 or 4 leukopenia and 7% showed grade 3 thrombocytopenia. Two patients suffered from pneumonia, and one experienced neutropenic fever. Mucositis, greater than grade 3, existed in three cases. No treatment related deaths were reported.

CONCLUSION

The combination chemotherapy, with paclitaxel and cisplatin, was active in the treatment of metastatic breast cancer patients having failed previous chemotherapy.

Efficacy of Pre- and Postoperative Chemotherapy in Patients with Osteosarcoma of the Extremities

PURPOSE

We evaluated the treatment efficacy including survival and recurrence, and factors associated with recurrence in osteosarcoma patients treated with preoperative chemotherapy, surgery, and adjuvant chemotherapy.

MATERIALS AND METHODS

Forty nine patients with osteosarcoma were treated with preoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion for 3 cycles, followed by surgery. According to the pathologic response, if tumor was necrotized more than 90%, the same adjuvant chemotherapy was reintroduced for 3 cycles, and if the response was not enough, then the salvage regimen was introduced. Plain chest film and chest CT scan were taken monthly and every 3 months, respectively. When tumor recurred, the metastasectomy was performed whenever possible.

RESULTS

Forty three patients were evaluable with amedian follow up of 53 months. Five-year disease-free and overallsurvival rate was 47.0% and 66.9%, respectively. The recurrence was observed in 22 patients (51.2%) with median time of 12.5 months. Baseline alkaline phosphatase (ALP) was the only significant factor for recurrence (p=0.03) and the patients with the possibility of metastasectomy recurrence showed higher post-relapse survival compared to other treatment modalities (26 momths vs 5~12 months).

CONCLUSION

These results indicates that pre- and postoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion showed comparable treatment efficacy and acceptable toxicities.

Roundtable discussion at the UICC World Cancer Congress: looking toward the realization of universal health coverage for cancer in Asia

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC-Asia Regional Office (ARO) organized a Roundtable Discussion as part of the official program of the UICC World Cancer Congress 2014 in Melbourne, Australia. The theme for the Roundtable Discussion was - Looking Toward the Realization of Universal Health Care (UHC) for Cancer in Asia - and it was held on December 5, 2014. The meeting was held based on the recognition that although each country may take a different path towards the realization of UHC, one point that is common to all is that cancer is projected to be the most difficult disease to address under the goals of UHC and that there is, therefore, an urgent and pressing need to come to a common understanding and awareness with regard to UHC concepts that are a priority component of a post-MDG development agenda. The presenters and participants addressed the issue of UHC for cancer in Asia from their various perspectives in academia and international organizations. Discussions covered the challenges to UHC in Asia, collaborative approaches by international organizations, the need for uniform and relevant data, ways to create an Asia Cancer Barometer that could be applied to all countries in Asia. The session concluded with the recognition that research on UHC in Asia should continue to be used as a tool for cancer cooperation in Asia and that the achievement of UHC would require research and input not only from the medical community, but from a broad sector of society in a multidisciplinary approach. Discussions on this issue will continue towards the Asia-Pacific Cancer Conference in Indonesia in August 2015.

A Randomized Phase 2 Study of Neoadjuvant Chemoradiaton Therapy With 5-Fluorouracil/Leucovorin or Irinotecan/S-1 in Patients With Locally Advanced Rectal Cancer

PURPOSE

The purpose of this study was to evaluate the rate of pathologic complete response (pCR) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation therapy (CRT) with leucovorin (FL) versus irinotecan/S-1 (IS).

METHODS AND MATERIALS

Patients with resectable LARC (clinical stage T3/4, lymph node positive, or both) were randomly assigned to receive preoperative radiation (45-50.4 Gy in 25 to 28 daily fractions) and concomitant chemotherapy either with a bolus injection of FL (400 mg/m(2)/day 5-fluorouracil and 20 mg/m(2)/day leucovorin) for 3 consecutive days every 4 weeks for 2 cycles (FL group) or with 40 mg/m(2) irinotecan on days 1, 8, 15, 22, and 29, and 35 mg/m(2) S-1 twice on the day of irradiation (IS group). Curative surgery was performed approximately 4 to 8 weeks after the completion of CRT. The postoperative chemotherapy regimen was FL with a primary endpoint of a pCR rate evaluation.

RESULTS

One hundred forty-two eligible patients were randomly assigned, and the median follow-up duration was 43.8 months (95% confidence interval, 40.8-46.8 months). One hundred thirty-three patients (93.7%) of 142 underwent total mesorectal excision; pCR was achieved in 11 (16.7%) of 66 patients in the FL group and 17 (25.8%) of 67 patients in the IS group (P=.246). When good responders were defined as patients with Mandard grades 1 and 2, the rate of good responders was significantly higher in the IS group than in the FL group (54.6% vs 36.4%, respectively, P=.036). The preoperative rates of grade 3 and 4 toxicities were higher in the IS group (7.0%) than in the FL group (1.4%, P=.095). The 3-year disease-free survival was not significantly different between the 2 groups (79.7% vs 76.6%, respectively, P=.896).

CONCLUSIONS

IS-based preoperative CRT did not increase pCR rate, but it did increase acute toxicities compared with standard 5-FU treatment. Therefore, further investigation is needed.

Abstract 1454: Patient-derived xenograft model using peritoneal fluid of gastric cancer patients

Peritoneal metastasis is the most frequent pattern of recurrence in patients with gastric cancer (GC). Patient derived xenograft (PDX) models using peritoneal fluid have been required to understand its biology and for the drug screening. So, we established the PDX model by peritoneal fluid in stage IV GC patients. First, we confirmed the preparation condition of peritoneal fluid cells for PDX model as approximately 1×107 cells in PBS. Then, we observed the engraftment rate of PDX which was 15.8% (3 of 19 patients, P2, P10 and P11). The time to 100 mm3 tumor size at F1 of 3 models was 47 ± 1, 26.7 ± 0.6 and 68 days respectively. Then, we checked the change of serial engraftment rate until F3. The more passage was progressed, the higher engraft rate was, 75% (3 of 4 mice) to 90% (9 of 10 mice) at P2, 60% (3 of 5 mice) to 85% (17 of 20 mice) at P10 and 33.3% (1 of 3 mice) to 86.7% (13 of 15 mice) at P11. In addition, time to 100mm3 tumor size of engrafted PDXs was faster at F3 than F1 in all 3 cases (41.1% in P2, 46.4% in P10 and 47.5% in P11). Also, tumor doubling time showed decreased in all engrafted PDXs according to passage (70.8% in P2, 11.5% in P10 and 71.5% in P12). Then, we checked the re-engraftment rate after thawing the frozen F3 tissue section of P2. F4 PDXs were re-engrafted 100% (3/ 3 mice) after thawing, and time to 100mm3 tumor size and tumor doubling times were not different between F3 and F4. It means that freezing and thawing of tumor fragment did not affect to engraft. After that, we compared the characterization of F0 peritoneal fluid of patient, F1∼F3 PDX tumor and the cell line established from F0. The morphologies of them were comparable by H&E staining. Also, molecule expressions ofF0 to F3 and cell lines were analogous. The genetic alterations according to passages in F0 to F3 are on-going. As a result, we observed PDX from peritoneal fluid of advanced gastric cancer is feasible but various according to each patient. The PDX model by peritoneal fluid of GC patients might be helpful the biological understanding and drug development for personalized therapies.

Citation Format: Jeong Min Kim, Won Suk Lee, Woo Sun Kwon, Han Na Park, Hye Rin Lee, Hyun Myong Kim, Tae Soo Kim, Hyunki Kim, Jae Kyung Roh, Hyun Cheol Chung, Sun Young Rha. Patient-derived xenograft model using peritoneal fluid of gastric cancer patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1454. doi:10.1158/1538-7445.AM2015-1454

Leiomyosarcoma: investigation of prognostic factors for risk-stratification model

BACKGROUND

We performed this study to define distinctive clinical features of leiomyosarcoma by assessing prognostic factors.

METHODS

Between 1988 and 2011, 129 leiomyosarcoma patients who underwent surgical resection with curative intent were retrospectively reviewed.

RESULTS

Of the 129 leiomyosarcoma patients, the distribution of anatomic locations was: extremity (n = 25), pelvis (n = 40), thoracic cavity (n = 11), intra-abdomen (n = 19), retroperitoneum (n = 23), and head/neck (n = 11). We classified the anatomic locations into two categories as abdominal (intra-abdomen and retroperitoneum, n = 42) and extra-abdominal (extremity, pelvis, thoracic cavity, and head/neck, n = 87). Prognosis was worse for the abdominal group than for the extra-abdominal group (median DFS 2.9 9.0 years, P = 0.04). Similarly, overall survival (OS) was also significantly worse for abdominal group (P = 0.027). Independent prognostic factors for survival were primary site (P = 0.041, hazard ratio (HR) 1.7; 95 % CI 1.2-2.8), tumor size (P = 0.038, HR 1.9; 95 % CI 1.13-3.38), margin status (P = 0.019, HR 2.1; 95 % CI 1.13-3.88), and histology grade (P = 0.01, HR 3.59; 95 % CI 1.64-7.87). We identified four different risk groups with different survival outcome: group 1 (n = 8), no adverse factors; groups 2 (n = 37) and 3 (n = 61) with one and two adverse factors, and group 4 (n = 23) with 3 or 4 adverse factors.

CONCLUSION

Primary site, tumor size, resection margin, and histology subtype were independently associated with survival outcome. A prognostic model for leiomyosarcoma patients revealed four distinct groups of patients with good prognostic discrimination.

p16 Hypermethylation and KRAS Mutation Are Independent Predictors of Cetuximab Plus FOLFIRI Chemotherapy in Patients with Metastatic Colorectal Cancer

Purpose

Hypermethylation of the CpG island of p16^INK4a occurs in a significant proportion of colorectal cancer (CRC). We aimed to investigate its predictive role in CRC patients treated with 5-fluorouracil, leucovorin, irinotecan (FOLFIRI), and cetuximab.

Materials and Methods

Pyrosequencing was used to identify KRAS mutation and hypermethylation of 6 CpG island loci (p16, p14, MINT1, MINT2, MINT31, and hMLH1) in DNA extracted from formalin-fixed paraffin-embedded specimens. Logistic regression and Cox regression were performed for analysis of the relation between methylation status of CpG island methylator phenotype (CIMP) markers including p16 and clinical outcome.

Results

Hypermethylation of the p16 gene was detected in 14 of 49 patients (28.6%) and showed significant association with KRAS mutation (Fisher exact, p=0.01) and CIMP positivity (Fisher exact, p=0.002). Patients with p16-unmethylated tumors had significantly longer time to progression (TTP; median, 9.0 months vs. 3.5 months; log-rank, p=0.001) and overall survival (median, 44.9 months vs. 16.4 months; log-rank, p=0.008) than those with p16-methylated tumors. Patients with both KRAS and p16 aberrancy (n=6) had markedly shortened TTP (median, 2.8 months) compared to those with either KRAS or p16 aberrancy (n=11; median, 8.6 months; p=0.021) or those with neither (n=32; median, 9.0 months; p < 0.0001). In multivariate analysis, KRAS mutation and p16 methylation showed independent association with shorter TTP (KRAS mutation: hazard ratio [HR], 3.21; p=0.017; p16 methylation: HR, 2.97; p=0.027).

Conclusion

Hypermethylation of p16 was predictive of clinical outcome in metastatic CRC patients treated with cetuximab and FOLFIRI, irrespective of KRAS mutation.

Novel methods for clinical risk stratification in patients with colorectal liver metastases

Purpose

Colorectal cancer patients with liver-confined metastases are classified as stage IV, but their prognoses can differ from metastases at other sites. In this study, we suggest a novel method for risk stratification using clinically effective factors.

Materials and Methods

Data on 566 consecutive patients with colorectal liver metastasis (CLM) between 1989 and 2010 were analyzed. This analysis was based on principal component analysis (PCA).

Results

The survival rate was affected by carcinoembryonic antigen (CEA) level (p < 0.001; risk ratio, 1.90), distribution of liver metastasis (p=0.014; risk ratio, 1.46), and disease-free interval (DFI; p < 0.001; risk ratio, 1.98). When patients were divided into three groups according to PCA score using significantly affected factors, they showed significantly different survival patterns (p < 0.001).

Conclusion

The PCA scoring system based on CEA level, distribution of liver metastasis, and DFI may be useful for preoperatively determining prognoses in order to assist in clinical decisionmaking and designing future clinical trials for CLM treatment.

Vascular soft-tissue sarcomas: a prognostic model from a retrospective single-center study

BACKGROUND

Vascular soft-tissue sarcomas are a rare form of sarcoma. Malignant subtypes exhibit a variety of biological behaviors. We describe the clinicopathological characteristics and patient survival outcomes of malignant vascular soft-tissue sarcomas.

METHODS

We conducted a retrospective study on a cohort of 84 patients diagnosed with vascular tumors by histological examination at the Yonsei University College of Medicine between April 1987 and August 2011. The primary end point was overall survival (OS).

RESULTS

The angiosarcoma patients had a significantly shorter OS than the patients with other subtypes of sarcomas (59.0 and 142.7 months, respectively; p < 0.001). Upon multivariate analysis of survival in patients who underwent surgical resection, the following independent prognostic factors were identified: primary site (trunk, p = 0.001), age (older than 65 years, p < 0.001), pathology (angiosarcoma, p = 0.006) and R2 resection (p = 0.002).

CONCLUSION

The independent prognostic factors for shorter survival are the trunk as the primary site, malignant angiosarcoma and age (>65 years). Complete excision should be attempted for providing a survival advantage in the patients with localized disease. In addition, bleeding episodes are much more frequent in patients with a poor survival outcome.

Prognostic value of mucinous histology depends on microsatellite instability status in patients with stage III colon cancer treated with adjuvant FOLFOX chemotherapy: a retrospective cohort study

BACKGROUND

The close association between mucinous histology and microsatellite instability (MSI) may have hindered the evaluation of prognostic significance of mucinous histology. The aim of this retrospective study was to investigate whether mucinous histology was associated with a worse prognosis, independent of MSI status, compared to nonmucinous histology in patients with stage III colon cancer.

METHODS

This study enrolled 394 consecutive patients with stage III colorectal cancer treated with adjuvant FOLFOX after curative resection (R0). Clinicopathological information was retrospectively reviewed. Tumors were analyzed for MSI by polymerase chain reaction to determine MSI status. Kaplan-Meier method, log-rank test, and Cox proportional hazard regression models were used.

RESULTS

The estimated rate of 3-year disease-free survival (DFS) in patients with nonmucinous adenocarcinoma (NMA 79.2 %) was significantly greater than that in patients with mucinous adenocarcinoma (MA) and adenocarcinoma with mucinous component (MC) (56.9 %; log-rank, P = 0.002). In univariate analysis, histology (NMA vs. MA/MC), American Joint Committee on Cancer stage (IIIA, IIIB, and IIIC), and lymphovascular invasion (present vs. absent) were significantly associated with DFS. In multivariate analysis, mucinous histology (MA/MC) was associated with decreased DFS in all patients (hazard ratio 1.82, 95 % confidence interval 1.03-3.23, P = 0.0403). In patients with MA/MC, no difference in DFS was observed between MSI and microsatellite stability (log-rank, P = 0.732).

CONCLUSIONS

Mucinous histology is an independent poor prognostic factor for DFS in patients with stage III colon cancer after adjuvant FOLFOX chemotherapy.

Prognostic implications of anaplastic lymphoma kinase gene aberrations in rhabdomyosarcoma; an immunohistochemical and fluorescence in situ hybridisation study

BACKGROUND

We investigated the diagnostic and prognostic usefulness of anaplastic lymphoma kinase (ALK) expression in Asian rhabdomyosarcoma (RMS) patients.

PATIENTS AND METHODS

A total of 38 RMS tissue samples were collected over a 14-year period (1998-2012). ALK protein expression and gene copy number were analysed by immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH).

RESULTS

Ten of the 38 RMS patients (26.3%) showed positive ALK protein expression. ALK protein expression was predominantly positive in alveolar RMS (ARMS) compared with embryonal RMS (ERMS) (80% vs 20%, p=0.03). ALK protein expression was statistically associated with ARMS histology, metastatic disease at diagnosis, and primary trunk site. In FISH analysis, no translocations were detected and ALK gene copy number gain was observed more frequently in ARMS than in ERMS (40% vs 17%). The ALK-positive group showed inferior overall survival (OS) compared with ALK-negative group (p=0.014) for both alveolar and embryonal RMS patients. In multivariate analysis, positive ALK expression was an independent prognostic factor for OS (p=0.02; HR, 3.1; 95% CI 1.2 to 8.3). There was a significant strong positive correlation between ALK gene copy number and protein expression (Spearman's r<0.001, r=0.77).

CONCLUSIONS

We demonstrated that ALK protein expression is statistically associated with ARMS histology, metastatic disease at diagnosis and primary trunk site. Additionally, ALK expression was an independent prognostic factor for worse survival. There was a strong correlation between IHC and FISH. Further studies are needed to evaluate the potential diagnostic and therapeutic role of ALK expression in RMS.

Union for International Cancer Control International Session: healthcare economics: the significance of the UN Summit non-communicable diseases political declaration in Asia

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC-Asia Regional Office (ARO) organized an international session as part of the official program of the 71st Annual Meeting of the Japanese Cancer Association to discuss the topic "Healthcare Economics: The Significance of the UN Summit non-communicable diseases (NCDs) Political Declaration in Asia." The presenters and participants discussed the growing cost of cancer in the Asian region and the challenges that are faced by the countries of Asia, all of which face budgetary and other systemic constraints in tackling and controlling cancer in the region. The session benefited from the participation of various stakeholders, including cancer researchers and representatives of the pharmaceutical industry. They discussed the significance of the UN Political Declaration on the prevention and control of NCDs (2011) as a means of boosting awareness of cancer in the Asian region and also addressed the ways in which stakeholders can cooperate to improve cancer control and treatment. Other issues that were covered included challenges relating to pharmaceutical trials in Asia and how to link knowledge and research outcomes. The session concluded with the recognition that with the onset of a super-aged society in most countries in Asia and an increasing focus on quality of life rather than quantity of life, it is more important than ever for all stakeholders to continue to share information and promote policy dialogue on cancer control and treatment.

Combination of CYP inhibitor with MEK/ERK inhibitor enhances the inhibitory effect on ERK in BRAF mutant colon cancer cells

BACKGROUND/AIM

To investigate mechanisms of discrepancy in response to a MEK/ERK inhibitor, U0126, in KRAS- and BRAF-mutant colorectal cancer cells.

MATERIALS AND METHODS

Multiparametric flow cytometry was performed on two colon cancer cell lines, HCT116 and HT29. Cells were treated with U0126, and phospho-specific antibodies were used to monitor ERK signaling.

RESULTS

HCT116 and HT29 cells were treated with increasing amounts of U0126. The western blot analysis revealed that by increasing the amount of U0126 resulted in inhibition of phospho-ERK, in HCT116 and to a lesser degree in HT29 cells. Microarray profiling identified CYP1A1 and 1A2 overexpression in HT29 cells and that inhibition of CYP1A1 with α-naphthoflavone and furanfylline restored sensitivity to U0126 in HT29 cells.

CONCLUSION

Combination of a CYP inhibitor with MEK/ERK inhibitor enhances the inhibitory effect on ERK in BRAF-mutant colon cancer cells.

Abstract 670: DNA methylation pattern predicts treatment response and survival in patients with metastatic or recurrent colorectal cancer

Background: The epigenetic changes such as DNA methylation affect various steps in tumorigenesis of colorectal carcinoma. The aim of this study was to investigate whether DNA methylation pattern was associated with chemotherapeutic response and survival in patients with metastatic or recurrent colorectal cancer.

Patients and method: We retrospectively collected tumor tissues of primary site from 236 patients with metastatic or recurrent colorectal cancer (mCRC). Pyrosequencing was used to examine the methylation of 7 CpG island loci (p16, p14, MINT1, MINT2, MINT31, hMLH1, DKK3) in DNA extracted from formalin-fixed paraffin-embedded specimens. To elucidate the predictive role of DNA methylation markers, Kaplan-Meier survival estimation and Cox regression were performed for time to progression (TTP) and overall survival (OS). KRAS and BRAF mutations were also analyzed.

Result: The methylation frequencies of the 7 genes analyzed were 45.8% for p16, 14.0% for p14, 22.0% for MINT1, 14.4% for MINT2, 19.9% for MINT31, 2.1% for MLH1, and 33.9% for DKK3. As for mutation status, 28.8% (68 of 229) tumors harbored KRAS mutation and 2.5% (6 of 125) tumors harbored BRAF mutation. Both mutations were mutually exclusive. We devided patients into three groups on the basis of the number of methylated genes (group 1, 0∼1 methylation n=117; group 2, 2∼4 methylation n=73; group 3, 5-7 methylation n=9). Median OS of group 3 was significantly shorter than other groups (median OS 38.1m in group1 vs 19.4m in group 3, log rank P=0.003; median OS 38.0m in group2 vs 19.4m in group3, log rank P=0.012). In 129 patients with measurable lesions, group 3 (n=6) showed a trend toward lower disease control rate (DCR=66.7%) and shortend TTP (median 3.5m) than group 1 (n=76, 86.8%, 7.6m) or group 2 (n=47, 80.9%, 6.6m). In multivariate analysis for OS, initial tumor stage (AJCC 1-3 vs 4: HR=2.67; 95%CI, 1.82-3.93, P &lt;0.0001), tumor differentiation (well/moderate vs poor/mucinous: HR=2.18; 95%CI, 1.41-3.37, P &lt;0.0001), resectability (resectable vs unresectable: HR=2.55; 95%CI, 1.54-4.22, P &lt;0.0001), and number of methylation (0-4 methylated vs 5-7 methylated: HR=2.26; 95%CI, 1.11-4.60, P=0.025) were independent prognostic factors.

Conclusion: This study suggests that DNA methylation status may predict treatment outcome and survival in patients with metastatic or recurrent colorectal carcinoma.

Citation Format: Se Hyun Kim, Kyu Hyun Park, Sang Joon Shin, Kang Young Lee, Tae Il Kim, Nam Kyu Kim, Sun Young Rha, Jae Kyung Roh, Joong Bae Ahn. DNA methylation pattern predicts treatment response and survival in patients with metastatic or recurrent colorectal cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 670. doi:10.1158/1538-7445.AM2013-670

Abstract 1359: Addressing diverse perceptions of cancer in Asia: Lifestyle and awareness study in China as preliminary step towards the creatin of an Asian cancer barometer

Although Asia is a region where incidence of cancer is rapidly increasing, it is a region with unique difficulties for providing uniform measures for cancer control and treatment, due to significant disparities in medical and healthcare standards and regional cultural diversity. Given the long-term nature of the disease and treatment regimens, cancer is affected not merely by medical factors, but also by a diversity of social factors, including politics, economics and culture. It is for this reason that actual perceptions of cancer as a threat and as a disease may be assumed to differ from region to region. Although a number of epidemiological studies have been implemented in Asia, there has not been any region-based comparative study implemented that takes into account varying lifestyle factors and seeks to obtain information about people's perceptions of cancer and its psychological impact. Facing changes in the global burden of disease and seeking to advance measures for cancer on the global health agenda, the Asia Cancer Forum has launched a university-based, multidisciplinary program referred to as “Cross-boundary Cancer Studies,” and preparations for an international collaborative projects between Japan, China and Korea are being made. From the platform of this program, by implementing a lifestyle and awareness survey on attitudes to cancer in Asia, the Asian Cancer Forum aims to: 1) identify differences and commonalities in the perception of cancer, 2) assess individual and shared needs, and 3) use the results as a barometer for cultural attitudes and social systems relating to cancer. The ultimate aim is to reflect regional lifestyles, customs and other environmental factors in cancer prevention and treatment as a means of contributing to cancer control in Asia. As a preliminary study for creating an Asian Cancer Barometer, a survey on attitudes to cancer was implemented in China in 2011. The correlation analysis of the results of the survey shows significant differences between men and women and different age groups concerning cancer prevention needs and trust in social systems. Applying the latest behavior science techniques to the results of the preliminary study, the Asia Cancer Forum will consider issues for further study and surveys, as well as methods of selecting study subjects, with a view to creating an Asian Cancer Barometer that can be comprehensively utilized in the diverse Asian region.

Citation Format: Norie Kawahara, Hideyuki Akaza, Zen-U Hotta, Shigeo Horie, Akira Nakagawara, Tohru Masui, Haruhiko Sugimura, Jae Kyung Roh. Addressing diverse perceptions of cancer in Asia: Lifestyle and awareness study in China as preliminary step towards the creatin of an Asian cancer barometer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1359. doi:10.1158/1538-7445.AM2013-1359

A randomized phase II study of neoadjuvant chemoradiotherapy with 5-FU/leucovorin or irinotecan/S1 in patients with locally advanced rectal cancer

511

Background: The purpose of this study was to evaluate rate of pathologic complete response (pCR) in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) with 5-FU/leucovorin (FL) versus Irinotecan/S-1 (IS) and surgery followed by fluoropyrimidine based adjuvant chemotherapy. Methods: Patients with resectable, locally advanced (cT3-4 and/or cN positive) adenocarcinoma of rectum were randomly assigned to receive preoperative radiation (45-50.4 Gy in 25-28 daily fractions) and concomitant chemotherapy with bolus injections of 5-FU 400 mg/m2/day and LV 20 mg/m2/day for 3 consecutive days every 4 weeks for 2 cycles (FL group), or with irinotecan 40 mg/m2 on days 1, 8, 15, 22, 29 and S-1 35mg/m2 twice on the day of irradiation (Monday-Friday) (IS group). Curative surgery was performed for about 4-8 weeks after the completion of chemoradiotherapy. Postoperative chemotherapy regimen is FL. The primary endpoint was pCR rate. Results: 142 eligible patients were randomly assigned. Of 142, 130 patients (91.5%) underwent total mesorectal excision. The pCR was achieved 11 (17.2 %) of 64 patients in the FL group and was 16 (24.2%) of 66 patients in the IS group (p=0.1). When pCR was combined with few residual cells, the rate was significantly higher in IS group compared to FL group (57.6 % vs. 39.1 %, p-value=0.035). Preoperative rate of grade 3-4 toxicity was 1.4% with FL and 7.0 % with IS group (p=0.095). Conclusions: The results have suggested that neoadjuvant CRT using IS is feasible and effective for patients with locally advanced rectal cancer. Longer follow-up is needed to assess survival. Clinical trial information: NCT01269216.

Randomized controlled trial of standardized education and telemonitoring for pain in outpatients with advanced solid tumors

Purpose

Previous studies have not defined the role of telemonitoring with educational tools in outpatients with advanced cancers. We tested the effectiveness of standardized education and telemonitoring for improving pain, distress, anxiety, depression, quality of life (QoL), and performance in outpatients with advanced cancers.

Methods

A total of 108 patients were randomly assigned to receive pain education alone (control arm) or pain education plus telemonitoring (experimental arm). Nursing specialists provided video-assisted educational material in both arms and daily telemonitoring for the first week in the experimental arm. Assessment was performed at baseline and 1 week and included evaluations of pain (Brief Pain Inventory, BPI), distress (Distress Thermometer, DT), anxiety, and depression (Hospital Anxiety and Depression Scale, HADS), QoL (QLQ-C30), and a Karnofsky score.

Results

Overall (n = 108), pain intensity was significantly improved at 1 week, including worst pain (7.3 to 5.7, P < 0.01) and average pain (4.6 to 3.8, P < 0.01). Additionally, anxiety (HADS score ≥ 11, 75 % to 56 %, P < 0.01), depression (HADS score ≥ 11, 73 % to 51 %, P < 0.01), QoL (fatigue and insomnia), and the Karnofsky score (32 to 66, P < 0.01) were also significantly improved at 1 week. However, the level of distress did not improve. The telemonitoring plus standardized education group showed more significant improvement in portion of pain >4 on VAS scale (35 % vs. 19 %, P = 0.02).

Conclusions

Standardized pain education using nursing specialists is an efficient way to improve not only pain itself but also anxiety, depression, performance, and QoL. The addition of telemonitoring helps to improve pain management in the outpatient setting.

Changing treatment patterns in elderly patients with resectable colon cancer

AIM

To evaluate changing treatment patterns and survival outcomes of elderly patients (age 70 years or older) with resectable colon cancer over the past 15 years.

METHODS

A total of 857 patients aged over 70 years who were managed for a resectable colon cancer between 1994 and 2010 were identified and their clinical variables were analyzed retrospectively.

RESULTS

The patients' median age was 74 years (range: 70-94 years). In all, 171 patients (20%) were stage I, 375 (43.8%) were stage II and 311 (36.3%) were stage III. Over 95% of all patients underwent surgery regardless of age or diagnosis year. In stage III colon cancer the proportion of patients who received adjuvant treatment increased the more recent the year of diagnosis (1994-2000, 47%; 2001-2005, 66%; 2006-2010, 70%; P = 0.017). According to analysis by age group, older patients were less likely to receive adjuvant chemotherapy in both stage II (more than 75 years, 47.3%; 70-74 years, 59.4%; P < 0.001) and stage III (more than 75 years, 51.1%; 70-74 years, 76.7%; P < 0.001). Age-adjusted Charlson comorbidity index (CCI) is an independent prognostic factor for overall survival in stage II colon cancer patients.

CONCLUSION

Elderly patients with resectable colon cancer received surgical treatment in more than 95% of cases without reference to age or diagnosis year. The proportion of patients who received adjuvant treatment increased according to the recency of diagnosis, but decreased abruptly according to increase in age.

Quantitative analysis of ERK signaling inhibition in colon cancer cell lines using phospho-specific flow cytometry

OBJECTIVE

To evaluate the activity of U0126, a MEK1/2 inhibitor, in downregulating the phosphorylation of ERK in colon cancer cell lines and to explore the correlation of phospho-flow cytometry with standardized methods to validate its use in clinical settings. Phospho-specific flow cytometry provides an optimal platform for the analysis of signaling abnormalities in cancer. In this study, we used phospho-specific flow cytometry to monitor intracellular signaling in cells stimulated with phorbol 12-myristate 13-acetate (PMA).

STUDY DESIGN

Multiparametric flow cytometry was performed on two colon cancer cell lines, HCT116 and HT29. PMA-stimulated cells were treated with U0126, and phospho-specific antibodies were used to monitor ERK signaling. The resulting data were compared to western blotting and immunofluorescence staining.

RESULTS

HCT116 and HT29 cells were treated with increasing amounts of U0126 after PMA stimulation. The western blot analysis revealed that increasing the amount of U0126 resulted in inhibition of phospho-ERK (p-ERK). Fluorescence-activated cell sorting plots of phosphorylation of ERK demonstrated that the levels of p-ERK decreased with increasing concentrations of U0126. Results of immunofluorescence staining indicated that the staining density of the immunofluorescent dye decreased as the concentration of U0126 increased from 0.1 microM to 100 microM.

CONCLUSION

Quantitative and correlated expression profiles for ERK signaling suggest that phospho-specific flow cytometry will provide new insights into mechanisms underlying defective signaling in cancer and enable us to predict drug responses in cancer cell lines.

Estimating the adjuvant chemotherapy effect in elderly stage II and III colon cancer patients in an observational study

PURPOSE

Adjuvant chemotherapy has been known as a standard treatment for patients with resected colon cancer. However, in elderly colon cancer patients, the characteristics of patients are heterogeneous with regard to life expectancy and comorbidities. Thus, with regard to the effectiveness of adjuvant chemotherapy for colon cancer, it is difficult to extrapolate data of clinical trials from the younger into the older general population.

METHODS

Data for 382 elderly colon cancer patients were analyzed: 217 in Stage II and 165 in Stage III. The efficacy of adjuvant chemotherapy was evaluated in elderly colon cancer patients after a match by the propensity score method.

RESULTS

For matched patients with Stage II colon cancer, there was no significant efficacy of adjuvant chemotherapy in the risk of death during all follow-up periods (P-value, 0.06-0.37). Though there was a tendency that the adjuvant chemotherapy reduces the death rate during the follow-up periods, it was not statistically significant. In the case of Stage III, the adjuvant chemotherapy was significantly effective in matched patients for 5-year (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.30-0.90) and overall survival (HR, 0.56; 95% CI, 0.34-0.94).

CONCLUSIONS

Adjuvant chemotherapy for elderly patients with Stage II colon cancer is not effective, whereas elderly patients with Stage III with adjuvant chemotherapy appear to have a better survival rate in the general population.

The eighth Asia cancer forum: seeking to advance the outcomes of the UN summit: 'global health as the key to a new paradigm in cancer research'

To date, the Asia Cancer Forum has focused its efforts on creating a common concept for collaborative efforts in international cancer research with a focus on Asia, where cancer incidence is rising dramatically, and also sharing information and knowledge among cancer specialists about the importance of cancer as a global health agenda issue. The Eighth Asia Cancer Forum was held following the historic outcome of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases held in New York in September 2011, at which cancer was duly recognized as a global health agenda issue. Despite this significant development, however, the issue of cancer, one of the most intractable of all non-communicable diseases, still faces a variety of challenges if it is to be addressed on the global level. The Eighth Asia Cancer Forum sought to address these various issues, seeking ways to capitalize on the outcomes of the UN Meeting and take global collaborative studies and alliances in the field of cancer further. It was recognized that one of the main challenges for the Asia Cancer Forum is to formulate a proposal that demonstrates how middle-income countries can provide a good level of care using only their own limited medical resources. Given that the Asia Cancer Forum is one of the organizations that can provide assistance in working to further boost awareness about cancer research and the situation relating to cancer in Asian countries, discussion also focused on how to concretize activities in the future.

Application of the Western-based adjuvant online model to Korean colon cancer patients; a single institution experience

Background

Adjuvant Online (AOL) is web-accessible risk-assessment model that predicts the mortality and the benefits of adjuvant therapy (http://www.newadjuvantonline.com). AOL has never been validated for Asian colon cancer patients.

Methods

Using the Yonsei Tumor Registry database, patients who were treated within the Yonsei University Health System between 1990 and 2005 for T1-4, N0-2, and M0 colon cancer were included in the calculations for survival. Observed and predicted 5-year overall survival was compared for each patient.

Results

The median age of the study population of 1431 patients was 60 years (range, 15–87 years), and the median follow-up duration was 7.9 years (range, 0.06–19.8 years). The predicted 5-year overall survival rate (77.7%) and observed survival (79.5%) was not statistically different (95% Confidential interval, 76.3–81.5) in all patients. Predicted outcomes were within 95% confidential interval of observed survival in both stage II and III disease, including most demographic and pathologic subgroups. Moreover, AOL more accurately predicted OS for patients with stage II than stage III.

Conclusions

AOL tended to offer reliable prediction for 5-year overall survival and could be used as a decision making tool for adjuvant treatment in Korean colon cancer patients whose prognosis is similar to other Asian patients.

Methylation status of lamin A/C in gastric cancer cell lines

BACKGROUND/AIMS

Epigenetic regulations play a role in the development and progression of cancer. Therefore, discovering novel epigenetically regulated genes could provide useful information in understanding cancer. Lamin A/C is an intermediate filament protein whose expression is reported to be suppressed in tissues of gastro-intestinal malignancies. We examined expression of lamin A/C in gastric and colorectal cancer cell lines and its association with DNA methylation.

METHODOLOGY

The methylation status of CpG island in 19 gastric, 5 colorectal cancer cells and 1 normal colon cell line were examined with methylation-specific PCR using paired methylated and unmethylated primers. The level of mRNA expression of lamin A/C was detected using RT-PCR.

RESULTS

Eighteen gastric cancer cell lines showed 95% unmethylation of lamin A/C and 1 cell line showed partial methylation. In colorectal cancer, only 1 out of 5 cancer cell lines (20%) was partially methylated and the remaining cell lines, including 1 normal colon cell line was unmethylated. With RT-PCR, all cell lines demonstrated mRNA expression of lamin A/C regardless of methylation status.

CONCLUSIONS

We observed that the expression of lamin A/C was not suppressed in gastrointestinal cancer cell lines different from hematologic malignant cells and it is not regulated through DNA methylation.

Mucinous histology to predict disease-free survival in microsatellite stable stage III colon cancer patients treated with adjuvant FOLFOX chemotherapy

e14084

Background: The prognostic role of mucinous histology of the colon cancer has been studied for decades and remained controversial. The aim of this retrospective study was to investigate whether mucinous adenocarcinoma (MA) is associated with a worse prognosis than that of non-mucinous adenocarcinoma (NMA) in patients with stage III colon cancer. Methods: This study enrolled unselected 402 patients with stage III colorectal cancer treated with adjuvant FOLFOX after curative resection (R0). Clinicopathological information was retrospectively reviewed. Tumors were analyzed for microsatellite instability (MSI) by polymerase chain reaction (PCR) to determine MSI-high (MSI-H) or microsatellite stable (MSS). Kaplan-Meier method, log-rank test, and Cox proportional hazards regression models were used. Results: Among 402 patients, 42 patients (10.4%) were MA and 26 patients (6.5%) were MSI-H. Compared with MSS tumors, MSI-H tumors was associated with a higher rate of MA (26.9% vs 9.3%, P=0.005). In MSS tumors (n=376), 3-year disease-free survival (DFS) rate was 79% and 55% in NMA and MA, respectively (log rank, P=0.014). In MSI-H tumors (n=26), no statistically significant difference of DFS between MA and NMA was found. In multivariate analysis, MA remained an independent significant poor prognostic factor for DFS (HR=1.9; 95% CI, 1.003-3.717; P=0.049) in MSS patients. Conclusions: Mucinous histology is an independent poor prognostic factor for DFS in patients with microsatellite stable stage III colon cancer after adjuvant FOLFOX chemotherapy. [Table: see text]

Molecular analysis of the randomized phase II/III study of the anti-IGF-1R antibody dalotuzumab (MK-0646) in combination with cetuximab (Cx) and irinotecan (Ir) in the treatment of chemorefractory KRAS wild-type metastatic colorectal cancer (mCRC)

3531

Background: Previously reported results of this randomized study demonstrated that the addition of dalotuzumab (Dz) worsened the PFS and OS of chemofractory mCRC patients receiving Cx and Ir (Watkins et al; ASCO 2011). Comprehensive molecular analysis has been undertaken retrospectively to identify possible predictors of Cx resistance and Dz response. Methods: Quantitative RT-PCR for IGF-1, IGF-2, immunohistochemistry for IGF-1R and microarray expression profiling was conducted on archival tumor tissue. All patients had received Cx and Ir with either placebo (n=107), weekly Dz (n=112), or 2 weekly Dz (n=110). Results: Data from 292 and 206 patients was successfully obtained by RT-PCR or microarray respectively. Within the placebo arm, high IGF-1 expression was found to be associated with resistance to Cx (IGF-1-/IGF-1+; PFS 6.7/3.7 months, OS 15.5/9.6 months). High IGF-1 expression was associated with benefit from the addition of weekly Dz (placebo/weekly Dz; PFS 3.7/5.7 months, OS 9.6/18.2 months). By contrast the addition of Dz was not effective in tumors with high IGF-2 expression (placebo/weekly Dz; PFS 8.4/2.7 months). Microarray analysis revealed distinct populations that differentially correlated with Cx and Dz response. An epithelial phenotype appeared more associated with Cx response, whereas a mesenchymal phenotype more associated with Dz response. Rectal cancers showed greater association with increased IGF-1 expression, EMT gene signature and Dz response. Conclusions: These data support IGF-1 and IGF-2 as potential biomarkers for response to Dz therapy and high IGF-1 as a marker of resistance to Cx therapy. Based on these data Dz is being further evaluated in a molecularly selected population of mCRC. [Table: see text]

Implications of clinical risk score to predict outcomes of liver-confined metastasis of colorectal cancer

OBJECTIVE/BACKGROUND

We investigated the usefulness of a clinical risk scoring system (CRS) for guiding management and defining prognosis for patients with colorectal liver met"astases (CLM).

METHOD

We retrospectively analyzed data about the correlation between outcomes and Fong's CRS from 1989 to 2010 for patients treated for CLM at the Severance Hospital.

RESULTS

Of 566 patients, 232 received adjuvant treatment after liver resection. Of these patients, 185 (81%) had a low CRS (0-2) and 47 (19%) had a high CRS (3-5). Stratification into high and low CRS allowed significant distinction between Kaplan-Meier curves for outcome. The 5-year survival rate was 88.5% and 11.5% among patients with a low and high CRS, respectively (P < 0.001). Seventy patients with initially unresectable CLM underwent liver resection after tumor downsizing by induction chemotherapy. Shifting of the CRS from high to low (8 patients; 11.4%) improved disease-free survival and overall survival.

CONCLUSION

High CRS is associated with worse survival after resection in resectable and unresectable disease. The CRS may be used for risk assessment when recommending oncological surgical timing in initially unresectable disease and treatment options for perioperative or adjuvant treatment in resectable disease.

Abstract 2236: Perifosine induces in vitro and in vivo antitumor activity in gastric cancer cells

Perifosine, a novel phosphatidylinositol-3-kinase (PI3K)/Akt signaling inhibitor is currently being tested in several phase II/III trials for treatment of major human cancers. However, the efficacy of perifosine in human gastric cancer has not been established. As Akt is known to be highly activated in gastric cancer, we investigated the antitumor effect and gene expression patterns of perifosine on gastric cancer cells. The antitumor efficacy was examined in 25 gastric cancer cell lines (4 from ATCC, 4 from JCRB, 8 from KCBL, and 9 cell lines established from Korean gastric cancer patients at the Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea). Several in vitro assays {MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphnyltetrazolium bromide] assay, western blotting for Akt pathway, apoptosis, cell cycle and microarray analysis} were used to assess the cytotoxic effect of 5-fluorouracil (5-FU) and perifosine. In vivo response study of human gastric cancer cell line was measured after perifosine treatment. Perifosine inhibited gastric cancer cell growth as a dose and time-dependent manner with the median 1.09 μmol/L of IC50 (range 0.2-5.8 μmol/L). 5-FU alone inhibited cell growth with the median 11.1 μmol/L of IC50 (range 2.6 to 380 μmol/L). For the combination effect, perifosine and 5-FU were synergistic in 14 (56%) cell lines and antagonistic in 8 (32%) cell lines. To clarify the different mechanism of synergistic and antagonistic effect, we selected one synergistic (YCC2, 5-FU IC 50= 11.1) and antagonistic cell lines (SNU 628, 5-FU IC 50=57.2) among those relatively 5-FU insensitive cell lines. In terms of signal pathway, perifosine inhibited pAkt and pERK1/2 expression and it activated pJNK expression. However, this change was not seen in the antagonistic cell line (SNU 638). In addition, for the perifosine and 5-FU combination, these patterns were also similarly demonstrated. Apoptotic molecule, cleaved PARP was also increased as a dose and time dependent manner. Then, we compared gene expression patterns between 6 perifosine-sensitive and 3 perifosine-resistant cell lines and identified 122 genes related to perifosine sensitivity (by 4-folds, P&lt;0.05) including 49 up-regulated and 48 down-regulated known genes in the resistant cells. Antitumor efficacy of perifosine monotherapy and combination with 5-FU derivative (capecitabine) were treated for YCC2 tumor bearing xenograft mice. Perifosine monotherapy demonstrated moderate antitumor activity. The combination of both agents produced a more prominent antitumor response as compared to monotherapy. Taken together, in gastric cancer cells, perifosine demonstrated antitumor activity and enhances the efficacy of 5-FU even in taxane-resistant cancer cell lines. Current data provide strong support for further development of this combination in clinical trials.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2236. doi:1538-7445.AM2012-2236

Abstract 4454: Global health as the key to a new paradigm in cancer research

Promoting perceptions of cancer as an integral part of the global health agenda will help to focus attention on the ever-present and growing threat of cancer, particularly in emerging economies, many of which are in Asia. It is imperative that a blueprint for the future direction for cancer research is founded in the global health context and aimed squarely at overcoming health disparities. As part of its ongoing initiatives the Asia Cancer Forum (ACF) implemented a questionnaire survey targeting cancer specialists, entitled “Survey on Inclusion of Cancer in the Global Health Agenda.” Following up on the survey results gathered at the AACR, the Asia Cancer Forum is committed to creating a common awareness among cancer researchers about the imperative of tackling cancer in the global health context. The outcomes of the UN Meeting on the Prevention and Control of Non-communicable Diseases in September 2011 should be harnessed to give further impetus to a future direction for cancer research. It is therefore essential for an academic basis to be laid out for global health that provides definitions and common language for stakeholders. The ACF is seeking to support the creation of an academic platform, or Global Collaborative Cancer Studies, as a means of further promoting the concept of global health in the cancer research community. Global health is founded on concepts of equality and human rights and universities are therefore ideally positioned to promote multi-disciplinary collaborations between science and the humanities. The knowledge created through collaborative studies could also be utilized to inform policymaking and identify new ways to tackle the existing challenges presented by increasing costs and aging populations in developed societies. Given cultural and historical differences the situation surrounding cancer varies significantly from country to country, with health disparities being particularly apparent in the Asian region. By linking universities in global collaborative efforts we can ensure a bottom-up approach to global health that brings together diverse communities. Given the downturn in the global economy we cannot expect that funding for programs to tackle NCDs will be forthcoming. It is therefore imperative to establish a network for assistance to developing countries that is based on our own experiences of overcoming challenges to create successful outcomes. A major challenge is to implement clinical trials in emerging economies, which will require the provision of technical assistance and stronger links between pharmaceutical companies and cancer researchers in emerging economies. The ACF is continuing its research activities on perceptions of cancer among the research community, seeking to build a global network that will overcome health disparities.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4454. doi:1538-7445.AM2012-4454

Weekly gemcitabine and docetaxel in refractory soft tissue sarcoma: a retrospective analysis

PURPOSE

The combination of gemcitabine and docetaxel (GD) is used to effectively treat patients with soft tissue sarcoma (STS). It is widely considered that the conventional doses used are too high for long term use and many patients must discontinue GD treatment due to its toxicity. Therefore, to determine the appropriate dose meeting acceptable efficacy results, while minimizing toxic side effects, we treated patients with a weekly infusion of GD (weekly GD).

MATERIALS AND METHODS

A total of 22 patients presenting a variety of STSs were treated at Yonsei Cancer Center. All patients had metastatic or recurrent cancer and had previously received doxorubicin and ifosfamide combination chemotherapy. In all cases, gemcitabine (1,000 mg/m(2)) and docetaxel (35 mg/m(2)) were administered intravenously on days 1 and 8 of a 21-day cycle. We retrospectively reviewed the medical records of these patients.

RESULTS

The response rate was 4.5%, with one patient diagnosed with leiomyosarcoma having a partial response, and the disease control rate was 40.9%. The median progression-free survival (PFS) duration was 2.7 months and the PFS was correlated with the treatment response to a weekly GD. The median overall survival (OS) duration was 7.8 months and the OS was correlated with histology. There was no significant difference in OS between patients who received weekly GD as a 2nd line chemotherapy and those who received 3rd line or more. Treatment was generally well tolerated.

CONCLUSION

Weekly GD was well tolerated and showed moderate efficacy, indicating that this could be a reasonable option as a salvage treatment for metastatic STS.

Advanced detection of recent changing trends in gastric cancer survival: up-to-date comparison by period analysis

OBJECTIVE

To establish a comprehensive cancer treatment and prevention policy, data collection should be performed in a timely manner, and survival analysis needs to reflect changes in treatment strategy. Therefore, we introduced the concept of period analysis for gastric cancer, the most prevalent cancer in Korea. We estimated 5- and 10-year survival trend of gastric cancer, based on data from the Yonsei Cancer Center Tumor Registry between 1990 and 2004.

METHODS

We compared the differences in survival between cohort, complete and period analyses for two different periods, 1995-99 and 2000-04.

RESULTS

A total of 11 724 cases were included. The median age of cancer diagnosis gradually increased over time, and more patients were diagnosed with Stage I disease in recent years. In the basic comparison of three estimated analytic methods (cohort, complete and period), period analysis (45.8%) was most similar to the actual 5-year observed survival rate (48.5%), when compared with cohort (43.6%) and complete (44.8%) analyses. When we compared survival between different 10-year periods (1990-99 and 1995-2004), period analysis demonstrated a greater difference than complete analysis (9.0 versus 3.9%). Subgroup analysis indicated that the survival improvement was determined by period analysis, and it was more pronounced for the age group <74 years and in Stages III-IV patients.

CONCLUSIONS

We observed that period analysis demonstrates the most similar results to the actual observed survival and is, therefore, a useful method to derive precise cancer survival in gastric cancer. This information is useful to understand survival differences that are influenced by changing treatment strategy.

Abstract C43: The impact of ADAM-9 protease activity on invasiveness of gastric cancer

ADAM (A Disintegrin and Metalloproteinase)-9 is a cell-surface membrane glycoprotein, which enables diverse roles in a wide range of cellular process. Over-expression of ADAM-9 has been reported in several cancers but its biological role remained to be clarified in gastric cancer. Herein, we investigated the possible involvement of ADAM-9 related to invasion and metastasis in gastric cancer. We also evaluated its possibility as a therapeutic target for anti-metastasis treatment.

We examined transcription and expression pattern of ADAM-9 in 24 gastric cancer cell lines. ADAM-9 protease activity was measured using fluoregenic ADAM-9 substrate (R&D systems). We conducted trans-well assay coated with matrigel to associate ADAM-9 expression with invasion activity. A specific anti-ADAM-9 monoclonal antibody (RAV-18, Macrogenics, Inc.) was used to evaluate its anti-invasion property. And then, to evaluate the ADAM-9 protease activity in vivo, MKN-28, one of high ADAM-9 cell lines, was subcutaneously inoculated in flank of mice. The IP of mice were injected with or without RAV-18.

The protein expression and protease activity of ADAM-9 was various by each cell line. The protease activities were moderately correlated with the protein expressions (mature form) (R2 = 0.49). ADAM-9 protease activity was decreased dose-dependently on RAV-18 treatment, being remarkable in the cells of high ADAM-9 expression (SNU-638, YCC-1, MKN-74 and MKN-28) compared with low expressing cells (YCC-6, YCC-7 and HS-746T). Baseline level of invasiveness was poorly correlated with ADAM-9 expression, but in high ADAM-9 cells, the administration of RAV-18 significantly suppressed invasiveness, while not in low ADAM-9 cells. Exposure to hypoxia (1% O2, 5% CO2, 37°C) up-regulated protease activity and invasiveness in low ADAM-9 cells, and these were suppressed dose-dependently by the treatment of RAV-18. RAV-18 inhibited ERK phosphorylation in high ADAM-9 cells, which suggests that that ADAM-9-related invasiveness depends on its protease activity and it is, at least partially, via MAPK pathway. In vivo, the tumor volume of mice of RAV-18 treated group (n=7) was smaller than control group (n=7). As in vitro results, EGFR and Erk phosphorylation were reduced in RAV-18 treated group than control group.

This study shows that ADAM-9 is upregulated in gastric cancer, and that ADAM-9 might be a plausible target for therapeutic inhibition of invasion/metastatic process.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr C43.

Abstract B26: Expression of the KLF4 and SOX10 predicting for survival in colorectal cancer

The zinc finger transcription factor Krüppel-like factor 4 (KLF4) is involved in many important cellular processes such as growth, development, differentiation, proliferation, and apoptosis. A loss of KLF4 expression has been observed in human tumors, particularly in the gastrointestinal tract. Sry box 10 (SOX10) is a transcription factor expressed in nerve cell and melanocytes. SOX10 is believed to be essential for neural crest fate determination and to maintain the multipotency of neural crest cells. Here, to investigate the roles of KLF4 and SOX10 in colorectal cancers (CRC), we examined the expression of KLF4 and SOX10 in tumor tissues and paired normal tissues in 125 CRC patients by real-time reverse transcription-polymerase chain (real-time RT-PCR). CRC had significantly lower KLF4 and SOX10 levels compared with matched normal tissues (KLF4: 2007±1531 Copies/ul in CRC, 6585±2833 Copies/ul in normal tissues, SOX10: 60±100 Copies/ul in CRC, 399±215 Copies/ul in normal tissues) (P&lt;0.0001). Statistically, KLF4 and SOX10 expression was not associated with age, sex, stage, lymph node metastasis, differentiation, tumor location. However, in univariate analyses, KLF4 and SOX10 were significant predictors of survival (P=0.002, P=0.039) and in multivariate analyses, KLF4 was significantly predictor of survival (P=0.045). Therefore, these findings suggest that KLF4 and SOX10 might have a potent oncogenic role in CRC tumorigenesis and prognostic value in predicting survival of CRC patients.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr B26.

Salvage chemotherapy of biweekly irinotecan plus S-1 (biweekly IRIS) in previously treated patients with advanced gastric cancer

PURPOSE

This phase II trial first describes the combination chemotherapy of biweekly irinotecan plus S-1 (biweekly IRIS) for pretreated advanced gastric cancer (AGC) patients.

METHODS

Patients who had previously been treated with greater than or equal to one regimen were enrolled. They received S-1 35 mg/m(2) twice daily on days 1-14 and irinotecan 150 mg/m(2) on days 1 and 15, every 4 weeks. The primary endpoint was overall survival (OS).

RESULTS

Among the 38 patients enrolled, 18 patients were treated as second line, and the remaining 20 patients were enrolled as third- or fourth line. A total of 208 cycles were administered with the median being four cycles (range 1-16). The median OS was 8.7 months [95% confidence interval (CI) 7.5-10.3], and the median progression-free survival was 6.3 months (95% CI 5.3-7.3). Low serum albumin (<3.5 mg/dL) was an independent adverse prognosticator for survival. Overall response rate was 17% (95% CI 4-30%). The major grade 3/4 toxicities were neutropenia (26%) and diarrhea (18%).

CONCLUSIONS

Biweekly IRIS showed the moderate activity as salvage treatment in AGC. Considering high neutropenia and gastrointestinal toxicity, patient selection should be warranted; serum albumin may be a predictive factor for treatment decision.

Abstract 92: Effects of p16 methylation on the efficacy of cetuximab in metastatic colorectal cancer

Background: Promoter DNA methylation is an important epigenetic factor of gene inactivation in human carcinogenesis and gene silencing of tumor suppressor genes in colorectal cancer. Global DNA methylation, reflected by the status of LINE-1 methylation, plays an important role in genomic instability and carcinogenesis. We examined the role of p16 methylation and LINE-1 methylation in metastatic colorectal cancer patients treated with cetuximab chemotherapy.

Methods: The study was performed using fresh frozen specimens from 42 metastatic colorectal cancer patients treated with cetuximab. Samples were analyzed by bisulfied-based approaches to study the methylation status of p16 and LINE-1 by pyrosequecing. KRAS mutation was determined by pyrosequencing.

Results: Methylation of p16 was associated with decreased progression-free survival in all patients (n=42, 4.9 months in p16 methylated patients vs 15.7 months in p16 unmethylated patients, p=0.01). When proximal location tumors were analyzed separately, methylation of p16 was associated with decreased progression-free survival (n=11, 4 months vs 15.7 months, p&lt;0.01), and decreased overall survival (14.5 months vs 35 months, p&lt;0.01). Among KRAS wild type tumors (n=35), methylation of p16 demonstrated a tendency toward decreased progression-free survival (6.3 months in methylated patients vs 15.7 months in unmethylated patients, p=0.07). In 3rd line erbitux treatment patients (n=13), the median PFS was 4.0 months for p16 methylated patients and 9.6 months for unmethylated patients (p=0.25). In the response rate analysis, compared with KRAS wild type tumors, KRAS mutant tumors had a significantly lower response rate (0 % vs 45.7%, p=0.033). Compared with P16-methylated tumors, p16 unmethylated tumors demonstrated a tendency toward better response rate (10% vs 46.9%, p=0.061). LINE-1 methylation was not associated with either progression-free survival (p=0.53) or response rate (p = 0.53).

Conclusions: 16 methylation may be a factor other than KRAS mutation associated with resistance to anti-EGFR monoclonal antibodies. Because we analyzed heterogeneous population and our sample size was too small, we suggest that further studies are necessary to determine the predictive role of DNA methylation markers.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 92. doi:10.1158/1538-7445.AM2011-92

Abstract 3907: Gene expression profile of aging-related genes in human gastric cancer development

Background: Aging process modifies gene expression pattern and might be related to certain disease like cancer. As clinical outcome worsens with age, different molecular behavior of cancer between aging should be elucidated to accomplish future personalized medicine, especially in geriatric cancer patients.

Methods: Primary gastric cancer tissues and corresponding normal mucosa were obtained from 81 patients. cDNA microarray analysis was performed using 14,125 probes. To select differentially expressed genes between aging, multiple regression model considering age, sex, stage, and pathology was applied. Functional study and pathway analysis was performed through database for annotation, visualization and integrated discovery (DAVID) and Ingenuity pathway analysis.

Results: In normal tissues, two hundred and ninety-six genes were determined as aging-related genes that were involved in aging-process relation with mitochondria and ubiquitination. In tumor tissues, sixty-two genes were identified that showed significantly different expression according to age. Twenty genes were up-regulated and forty-two genes were down-regulated. Apoptosis (6 genes), carbohydrate metabolism (4 genes), cell cycle (8 genes), cellular proliferation (7 genes), DNA repair (3 genes), and inflammation (5 genes) were related. In pathway analysis with tumor tissues, gene expression was down-regulated with age in proliferation pathways including growth hormone, PI3K/Akt, TGF-β, and TNFR signaling. Furthermore, genes involved in tumor suppressor pathways involving apoptosis and PTEN were down-regulated in older tumors.

Conclusions: As gastric cancer develops later, carcinogenesis is less dependent from proliferation, but also tumor suppressor pathways. Our results could be one explanation of less chemotherapy response and enhancing defense mechanism is needed in old-age gastric cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3907. doi:10.1158/1538-7445.AM2011-3907

Abstract 1840: What are the implications for cancer research of placing cancer on the global health agenda

Unlike infectious diseases, including HIV/AIDS and malaria, which are recognized as issues on the global health agenda, cancer has yet to be given its rightful position as a global health issue of pressing importance. This is due to perceptions of cancer as being a disease of the industrialized world, and one that affects individuals as a result of lifestyle choices. The Asia Cancer Forum is engaged in efforts to raise awareness among specialists of the importance of placing cancer on the global health agenda. Recently the global health implications of cancer have been gaining international attention and momentum is growing toward concerted global action against cancer.

As part of its ongoing initiatives the Asia Cancer Forum implemented a questionnaire survey targeting cancer specialists, entitled “Survey on Inclusion of Cancer in the Global Health Agenda.” The survey was implemented at the 101st Annual Meeting of the AACR and at the World Cancer Congress UICC 2010. The responses received from these surveys showed a number of divergent views, which underline the need to establish shared recognition among cancer specialists. Asked why cancer is not yet included in the global health agenda, respondents mentioned the following: (1) there are too many targets; (2) cancer is a disease that affects individuals; (3) Cancer is an issue for individual countries to address; (4) cancer requires enormous budgetary provision; and (5) there is insufficient global data. These responses encapsulate the challenges for cancer research. In contrast to measures implemented to date for tackling infectious diseases, which have been discussed in linear terms, the global challenge of cancer requires a multi-layered response. Cancer prevention, diagnosis, treatment and palliative care vary from country to country, and strategies for combating cancer therefore exist on multiple levels. To truly combat cancer in the global sense it is therefore essential to gain broad participation of cancer researchers. Given the limitations for medical treatment in the context of international aid, it is important to create a framework whereby the benefit of solutions to common challenges can be enjoyed by both the developing and industrialized world. Research is now tending to concentrate on increasingly specialized areas, making it all too easy to lose sight of the bigger picture. Placing cancer on the global health agenda will help to demonstrate how cancer research can contribute to the wellbeing of humanity as a whole. Following up on the valuable survey results gathered at the AACR in 2010, the Asia Cancer Forum is committed to creating a common awareness among cancer researchers about the tremendous value for society of placing their work and achievements in a global health context.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1840. doi:10.1158/1538-7445.AM2011-1840

Abstract 1965: Antitumor activity of novel Akt inhibitor, perifosine in gastric cancer cell lines

Perifosine, a novel phosphatidylinositol-3-kinase (PI3K)/Akt signaling inhibitor is currently being tested in several phase II/III trials for treatment of major human cancers. However, the efficacy of perifosine in human gastric cancer has not been established. As Akt is known to be highly activated in gastric cancer, we investigated the antitumor effect and gene expression patterns of perifosine on gastric cancer cells.

The antitumor efficacy of perifosine and taxane (docetaxel/paclitaxel) were examined in 25 gastric cancer cell lines (4 from ATCC, 4 from JCRB, 8 from KCBL, and 9 cell lines established from Korean gastric cancer patients at the Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea) using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphnyltetrazolium bromide) assay. Preliminary studies to investigate mechanism of action include western blot for pAkt/Akt, pErk/Erk and pJNK/JNK. We also performed 22K oligonucleotide microarray analysis to elucidate pharmacogenomic profiles evaluating potential predictive biomarkers for perifosine.

After 72 hours after perifosine exposure, it showed the modest chemosensitivity in 25 gastric cancer cell lines with IC50 of median 1.09 uM (range 0.18-9.34) as a dose-dependent manner. The median IC 50 of paclitaxel and docetaxel monotherapy were 0.6 (range &lt;0.001-15.28) and 3.08 (range &lt;0.001-15.06) and they were strongly correlated each other (Spearman correlation, P&lt;0.001). When the expression of pAkt by immunoblotting was categorized based on the expression of KATO cell, 72 % of the cells demonstrated higher pAkt expression, whereas most of the cell lines demonstrated pErk expression. Based on the pAkt expression level, cell lines with higher Akt expression demonstrated more sensitive to perifosine (P=0.003. median 0.6 vs 1.35). When we evaluated the antitumor activity of perifosine in combination with taxane, 10 (40%) and 11 cell lines (44%) showed synergistic effect with paclitaxel/perifosine and docetaxel/perifosine combinations, retrospectively. In addition, 6 out of 10 taxol resistant and 5 out of 10 docetaxel resistant gastric cancer cell lines demonstrated synergistic antitumor effect. Then, we compared gene expression patterns between 6 perifosine-sensitive and 3 perifosine-resistant cell lines and identified 122 genes related to perifosine sensitivity (by 4-folds, P&lt;0.05) including 49 up-regulated and 48 down-regulated known genes in the resistant cells.

Taken together, in gastric cancer cell lines, perifosine demonstrated antitumor activity and enhances the antitumor activity of taxane even in taxane-resistant cancer cell lines. Further evaluation of in vivo efficacy and downstream signaling pathway is ongoing. Current data may be useful to establish response predictive profiles and figure out the underlying action mechanisms of perifosine.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1965. doi:10.1158/1538-7445.AM2011-1965