Trichohepatoenteric syndrome: founder mutation in asian indians

Trichohepatoenteric syndrome (THES) is characterized by chronic diarrhea, dysmorphic facies and hair abnormalities. Hepatic involvement varies from no abnormality to cirrhosis and hemochromatosis. Recently, mutations in the tetratricopeptide repeat domain 37 (TTC37) gene were identified to cause THES. The c.2808G>A variation was suggested as a possible founder mutation among the South Asians. We further report 2 unrelated cases of Asian-Indian ethnicity (Gujrati) with THES, wherein targeted mutation analysis revealed the same mutation in homozygous form in both cases. These findings, as well as haplotype analysis, corroborate the founder mutation hypothesis amongst Asian Indo-Pakistani ethnic groups. A restriction enzyme-based method is also described to identify this founder mutation. One of our probands had multiple hepatic hemangiomas, a feature not previously observed in this syndrome.

Phase IB study of the combination of docetaxel, gemcitabine, and bevacizumab in patients with advanced or recurrent soft tissue sarcoma: the Axtell regimen

BACKGROUND

To assess the response of patients with soft tissue sarcoma (STS) to the combination of docetaxel, bevacizumab, and gemcitabine. Vascular endothelial growth factor (VEGF)-A levels and expression of VEGF-A and VEGF receptors 1 and 2 were evaluated.

PATIENTS AND METHODS

Thirty-eight chemotherapy-naive patients with STS were enrolled. A dose-finding study for gemcitabine from 1000, 1250, then 1500 mg/m(2) was done in nine patients (three cohorts), followed by an expansion cohort of 27 patients. Dose of docetaxel was 50 mg/m(2), bevacizumab was 5 mg/kg, and gemcitabine was 1500 mg/m(2), every 2 weeks. Serum VEGF-A was measured by enzyme-linked immunosorbent assay and tissue VEGF-A and its receptors by immunohistochemistry.

RESULTS

The median follow-up was 36 months. The overall response rate observed was 31.4%, with 5 complete and 6 partial responses, and 18 stable diseases lasting for a median of 6 months. There was no significant hematologic toxicity. The adverse events with the highest grade were attributed to bevacizumab. There was no correlation of VEGF pathway biomarkers with outcome.

CONCLUSIONS

The combination of gemcitabine, docetaxel, and bevacizumab is safe and effective in patients with STS. The most concerning adverse events were consequences of bevacizumab administration. The benefit of bevacizumab in this patient population remains unclear.

Breast Cancer in Young Women: The University of New Mexico Cancer Center (UNMCC) Experience

Background: While only a small proportion of breast cancer is attributable to hereditary susceptibility, identifying high-risk individuals is essential for appropriate medical management. Furthermore, identifying individuals with inherited breast cancers have significant impact on both patient and their family. Beyond early age of onset, family history of multiple cancers may warrant a referral to cancer genetics professional. However, in a busy oncology practice, documentation of a full family history can be time consuming and referral opportunities for genetic counseling may be missed. In this study, we evaluated the strength of family history documentation in breast cancer patients' charts, and whether or not appropriate referrals to the Hereditary Cancer Assessment Program (HCAP) were made. Racial differences in these referral patterns were also assessed.Materials and Methods: All charts of patients last known to be living as of 03/29/06 per the UNMCC Tumor Registry with an invasive breast cancer who were 40 years old or younger at the time of diagnosis were reviewed. Baseline data included patient age at diagnosis, self-reported ethnicity, histology, bilaterality and cancer status. The presence or absence of family history of breast and other cancers, and referral to the HCAP was documented. Descriptive statistics were performed on baseline data. Correlative analyses were conducted to note any racial differences in referral to HCAP.Results: A total of 211 women met inclusion criteria. Patients in the Tumor Registry were seen at diagnosis at UNMCC from 01/01/67 through 12/31/04. Mean age was 35. Racial distribution was similar to that of the New Mexican population: 44% Caucasian, 41% Hispanic, 10% Native American (NA) and 3% African American. Predominant histology was infiltrating ductal carcinoma (79%); 10% of women had a second breast primary. 63% of women had a positive family history of cancer; however, family history was not recorded in 17%. After HCAP was established, 109 women were eligible for referral, yet 68 (62%) of women had not been referred for genetic counseling. Only 39% of Caucasian, 40% of Hispanic and 34% of NA eligible women were referred.Discussion: Women under the age of 40 at time of breast cancer diagnosis are more likely to have a hereditary cancer syndrome. In our population, 17% of women had no documentation of family history, and almost 70% were never referred for hereditary counseling. There was no difference in referral patterns among different racial/ethnic backgrounds. On the basis of this review, quality improvement initiatives were undertaken to improve referral patters of young women with breast cancer for genetic counseling and potential genetic testing.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4079.

Expression of the epidermal growth factor receptor (EGFR) pathway in cervical cancer (CC) patients (pts)

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Background: EGFR, a membrane tyrosine kinase receptor that regulates multiple functions such as cell growth, differentiation, gene expression and development through at least 3 pathways, is overexpressed in a wide variety of solid tumors, including CC. The downstream activation of the EGFR pathways has not been studied extensively. The aim of this study is to assess the correlation between EGFR-HER-2-HER-3-HER-4 status, downstream pathways (STAT 3, survivin, RAS) with pt characteristics, overall survival and recurrence free survival in pts diagnosed with invasive CC. Methods: Receptor expressions were assessed by immunohistochemistry on 80 pts from our clinic. Tumors were scored by percentage of cells stained multiplied by intensity for a score range of 0–300 by two pathologists. Median EGFR score was 140. Pts were categorized as low expressor (EGFR score lower than 140) or as high expressor (EGFR score greater than 140). Differences in receptor expression were compared using the Log-rank test for overall (OS) and recurrence-free survivals (RFS) and by Chi-square analyses for the clinical parameters (age, stage, histology, and grade). Results: A total of 80 pts data was analyzed. Mean age of the sample was 48 years. 23% of pts had well differentiated tumors. 80% had squamous histology. 39% had stage IIB or higher. 25% died of cancer. By Log-rank test, standard prognostic factors (age, stage, grade, and histology) showed the expected differences in survival, confirming the validity of the sample. However there were no correlations between the clinical parameters, OS, or RFS with EGFR expression. Data on HER-2–3-4, STAT3, survivin and RAS will be presented at the meeting. Conclusions: Although no correlation has been found between clinical outcome and EGFR expression, EGFR inhibitors of the extracellular domain are expected to be useful for the treatment of CC that overexpress this receptor. These results will serve as baseline data needed to test cetuximab and other EGFR inhibitors in pts with CC.

No significant financial relationships to disclose.

Vitamins B6 and B12 supplementation to prevent chemotherapy-induced neuropathy (CiN): Interim analysis of the taxane cohort

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Background: Chemotherapy-induced neuropathy (CiN) is common with heavy metals, taxanes, and vinca alcaloids. Pyridoxine (Vit B6) is used for diabetic neuropathy and cyanocobalamine (Vit B12) is required for synthesis of myelin and maintenance of the integrity of neuronal tissue. We hypothesized that supplementing patients (pts) with these 2 vitamins will prevent CiN. There were 3 pt cohorts depending on the chemotherapy regimen. Pts receiving any taxane enrolled in the taxane cohort (N=46), pts receiving vincristine or vinblastine enrolled in the vinca cohort (N=7), and all other pts receiving a platinum enrolled in the heavy metal cohort (N=25). The taxane cohort is reported here. Methods: Pts starting treatment with a taxane were randomized to a 1/6 of 100% of the daily recommended dose of a multivitamin/day (placebo) versus the same plus Vit B6, 50 mg tid, and Vit B12, 1 mg q 3–4 weeks (MV+Vit), during 4 cycles of chemotherapy. No other supplements were allowed. Taxane Fact G and a formal neurologic examination were performed prior to, and after 2 & 4 cycles of chemotherapy. Statistical methods were based on least squared means with ANCOVA and t-test (Cella, JCO, 2008). Results: To date, 46 pts treated with taxanes were randomized; 22 to placebo and 24 to MV+Vit. 13 and 16 pts completed 2 cycles and 8 and 6 pts completed 4 cycles, respectively. On the neuro examination, the only significant difference between placebo and MV+Vit was in the cold sensation (p=0.0097). The physical well being and the neuro modules of the Taxane Fact G significantly worsened after 4 cycles of chemotherapy in the placebo group (p=0.0289 and 0.0173, respectively), but this significant trend was not observed in the MV+Vit group (p=0.8318 and p=0.0866). The study will accrue 76 pts per cohort. Conclusions: The preliminary trends in this study suggest that vitamin supplementation with Vit B6 and B12 may reduce CiN during taxane-based chemotherapy.

No significant financial relationships to disclose.

Role of shigella infection in endometriosis: A novel hypothesis

Endometriosis is the presence of endometrial cells and stroma at ectopic sites outside the uterine cavity. The natural history of endometriosis is uncertain, its etiology unknown, the clinical presentation inconsistent, diagnosis difficult and the treatment poorly standardized. It causes significant morbidity due to pelvic pain and infertility among 15-25% of women during their reproductive age. The benign disease causes peritoneal inflammation, fibrosis, adhesions and ovarian cysts but displays features of malignancy, like neo-vascularization, local invasion and distant metastasis. Mechanical, hormonal, immunological, environmental and genetic factors have been implicated in its etiology but provide inconclusive explanations. Present study was carried out on ectopic and eutopic endometriotic tissue specimens collected during laproscopy/laprotomy from cases of endometriosis. mRNA was isolated from the tissues and converted to cDNA by RT and subsequently subjected to differential display Polymerase Chain Reaction using seven sets of arbitrary primers. A unique band was identified only in the ectopic endometriotic tissue, which was sequenced. BLAST search results revealed sequence homology to shigella bacterial DNA leading us to hypothesize that infection may be playing a role in the etiology of endometriosis. This is the first report implicating the role of bacterial infection in the etiology of endometriosis. Shigella is known to invade the mucosa of the colon through the feco-oral route causing Shigellosis. The pathogenesis of shigellosis involves inflammation, ulceration, haemorrhage, tissue destruction and fibrosis of the colonic mucosa resulting in abdominal pain and diarrhoea/dysentery, this is similar to the pathogenesis of endometriosis which also involves inflammation, haemorrhage, tissue destruction and fibrotic adhesions of the pelvic peritoneum resulting in abdominal pain and infertility. The non-motile shigella bacteria invade the deeper mucosal layers by travelling from cell to cell of colonic epithelium, reaching the lamina propria of the colonic mucosa. We propose that, by the same mechanism, the bacteria travel across the colon wall to reach the outer peritoneal surface of the colon, which is in close proximity to the posterior uterine surface in the Pouch of Douglas, the site which incidentally happens to be the commonest site of early endometriosis. Our hypothesis therefore proposes that shigella or shigella-like organisms may be the trigger for the initiation of immunological changes in the pelvic peritoneum causing endometriosis. Once the endometrial cells are implanted at ectopic sites they are sustained by hormones and angiogenic factors. Hence "Infection hypothesis" provides a novel explanation for the etiopathogenesis of endometriosis.

Utility of PET imaging in predicting the aggressiveness and histopathology of lymphoma

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Background: F (18)-fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in the staging and restaging of non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). Few studies have investigated whether the intensity of tumor FDG uptake, measured by standard uptake value (SUV), a semiquantitative measure, could differentiate between indolent and aggressive disease. The clinical utility of SUV in determining the aggressiveness of NHL and HD and in differentiating histopathological subtypes was investigated in the present study. Methods: FDG-PET studies and histopathology of patients with NHL and HD were evaluated retrospectively. Inclusion criteria include PET before any therapy or on relapse of the disease, no diagnosis of diabetes mellitus or other types of cancer and time interval of < 90 days between PET and biopsy. After reviewing the PET scans, the SUV of biopsy site were measured by drawing regions of interest. Mean ± SD of SUV was calculated for HD and various histopathological subgroups of NHL. Results: Fifty-five patients (mean age 58.1 ± 17.2 years, 30 males, 25 females, 13 patients with HD, 42 with NHL, among which 24 with aggressive and 18 with indolent NHL) were included. The mean SUV was 9.9 ± 7.8 for aggressive NHL, 4.1 ± 2.6 for indolent NHL and 11.5 ± 7.3 for HD. Mean SUV was statistically different between aggressive and indolent NHL (p < 0.001) and HD and indolent NHL (p < 0.001), but not between aggressive NHL and HD (p = 0.4). The SUV for the aggressive NHL can be subdivided further as follows: anaplastic (n =3, 15.1 ± 1.7), diffuse large cell (n=19, 9.6 ± 5.3) and follicular grade III (n=2, 8.1 ± 2.2). Indolent NHL included: mantle cell (n=1, 4.3), marginal zone (n=1, 6.3), small cleaved (n=12, 4.2 ± 3.5), low grade follicular (n=4, 3.2 ± 1.4) and small lymphocytic NHL (n=1, 2.3). Conclusions: Our study suggests that FDG- PET can distinguish aggressive from indolent lymphomas. There was a considerable overlap between HD and aggressive NHL.A SUV of seven or less indicates indolent lymphoma. PET could potentially differentiate between different histopathological subgroups of lymphomas. Future studies with greater sample size are warranted.

No significant financial relationships to disclose.