Pilot study of the ability to probabilistically link clinical trial patients to administrative data and determine long-term outcomes.

BACKGROUND: Clinical trials are important but extremely costly. Utilization of routinely collected administrative data may simplify and enhance clinical trial data collection. PURPOSE: The aim of this study was to test the feasibility of use of administrative databases in Ontario, Canada, for long-term clinical trial follow-up, specifically (a) to determine whether limited patient identifiers held by the Canadian Cancer Trials Group can be used to probabilistically link with individuals in the Institute for Clinical Evaluative Sciences databases and if so, (b) the level of concordance between the two data sets. METHODS: This retrospective study was conducted through collaboration of established health service (Institute for Clinical Evaluative Sciences) and clinical trial (Canadian Cancer Trials Group) research groups in the province of Ontario, Canada, where healthcare is predominantly funded by the government. Adults with pre-treated metastatic colorectal cancer previously enrolled in the Canadian Cancer Trials Group CO.17 and CO.20 randomized phase III trials were included, limited to those in Ontario. The main outcomes were rate of successful probabilistic linkage and concordance of survival data, stated a priori. RESULTS: Probabilistic linkage was successful in 266/293 (90.8%) participants. In those patients for whom linkage was successful, the Canadian Cancer Trials Group (trial) and the Institute for Clinical Evaluative Sciences (administrative) data sets were concordant with regard to the occurrence of death during the period of clinical trial follow-up in 206/209 (98.6%). Death was recorded in the Institute for Clinical Evaluative Sciences, but not the Canadian Cancer Trials Group, for 57 cases, where the event occurred after the clinical trial cut-off dates. The recorded date of death matched closely between both databases. During the period of clinical trial conduct, administrative databases contained details of hospitalizations and emergency room visits not captured in the clinical trial electronic database. CONCLUSION: Prospective use of administrative data could enhance clinical trial data collection, both for long-term follow-up and resource utilization for economic analyses and do so less expensively than current primary data collection. Recording a unique identifier (e.g. health insurance number) in trial databases would allow deterministic linkage for all participants.

Potential therapeutic applications of phosphodiesterase inhibition in prostate cancer.

OBJECTIVE: Phosphodiesterases (PDEs) play a role in controlling cyclic nucleotide action, including cyclic guanosine monophosphate (cGMP). Previous studies have ascribed a protective role of cGMP signaling on hypoxia-mediated cancer progression. Herein, we determine their potential role in hypoxia-mediated chemoresistance and immune escape. MATERIALS AND METHODS: Phosphodiesterase assays were used to measure PDE activity in prostate cancer cell lines (DU145, PC3). Immunoblots were performed to determine the presence of PDEs in human prostate tissue samples. The effect of PDE inhibition on hypoxia-induced chemoresistance (compared to normoxic controls, 20% O2) was determined using clonogenic assays. Flow cytometry was used to determine the effects of PDE inhibition on surface MHC class I-related chain A (MICA), a natural killer (NK) cell-activating ligand. A mouse model was used to evaluate the in vivo effects of PDE inhibition on the growth of human prostate cancer cells. RESULTS: PDE5 and PDE11 were the most prominent PDEs in the cell lines, representing between 86 and 95% of the total cGMP-specific PDE activity. Treatment of DU-145 cells with a PDE inhibitor significantly reduced the hypoxia-associated acquisition of resistance to doxorubicin, with a mean 51% reduction in surviving fraction compared to controls (p < 0.001, ANOVA). As well, PDE inhibition completely reversed (p = 0.02, ANOVA) hypoxia-induced shedding of the immune stimulatory molecule, MICA, and attenuated the growth of human prostate tumor xenografts in an NK cell-competent murine model (p = 0.03, Wilcoxon, Mann-Whitney). CONCLUSIONS: These results suggest a rationale for future studies on the potential therapeutic applications of PDE inhibitors in men with prostate cancer.

Atrial natriuretic peptide attenuates hypoxia induced chemoresistance in prostate cancer cells.

PURPOSE: Low tumor oxygenation (hypoxia) correlates with resistance to chemotherapeutic agents. We recently reported that in vitro hypoxia induced resistance to various anti-cancer drugs can be attenuated by nitric oxide mimetic agents. Natriuretic peptides are molecules that mediate their cellular effects by activating a signaling pathway similar to that activated by nitric oxide. In the current study we determined whether atrial natriuretic peptide is able to inhibit hypoxia induced chemoresistance in prostate carcinoma cells. MATERIALS AND METHODS: Reverse transcriptase-polymerase chain reaction and atrial natriuretic peptide binding studies were used to determine the presence and function of natriuretic peptide receptors on a panel of human cell lines as well as in tissue samples. Drug sensitivity assays of cell lines exposed to hypoxic or standard conditions were performed in the presence of various concentrations of atrial natriuretic peptide. RESULTS: These studies revealed the presence of the 3 known natriuretic peptide receptors A, B and C in PC-3 and DU-145 human prostate carcinoma cells (American Type Culture Collection, Manassas, Virginia) as well as in tissue samples of human prostate cancer. Atrial natriuretic peptide binding to these cells was unaffected by culture in 0.5% vs 20% O(2). Clonogenic assays revealed that incubation of these cells in 0.5% O(2) for 24 hours resulted in a subsequent 4 to 10-fold increase in their survival following 1-hour exposure to doxorubicin (Sigma) (12.5 microM) (p <0.001). While small concentrations of atrial natriuretic peptide (10(-7) to 10(-13) M) did not affect sensitivity to doxorubicin in cells incubated in 20% O(2), similar concentrations of atrial natriuretic peptide inhibited the survival of these cells incubated in 0.5% O(2) by up to 50% (p <0.006). Using the cyclic guanosine monophosphate dependent protein kinase G inhibitor KT5823 (15 microM) the chemosensitizing effect of atrial natriuretic peptide was abrogated. CONCLUSIONS: These results indicate the potential use of natriuretic peptides as adjuvants to chemotherapy for prostate cancer.