A phase III trial of exemestane plus bevacizumab maintenance therapy in patients with metastatic breast cancer after first-line taxane and bevacizumab: a GINECO group study.

BACKGROUND: Maintenance strategies beyond response or tumor stabilization with first-line chemotherapy in metastatic breast cancer (MBC) have not been extensively studied. Endocrine therapy combined with continued bevacizumab may be a helpful option for estrogen receptor (ER)-positive MBC. PATIENTS AND METHODS: In this prospective, open-label, phase III study, patients with histologically confirmed ER-positive, HER2-negative MBC and non-progressive disease after 16-24 weeks of taxane plus bevacizumab (T + BEV) were randomized to continuation of T + BEV or maintenance bevacizumab plus exemestane (E + BEV). The primary end point was progression-free survival (PFS) from randomization. To have 80% power to detect an improvement in the 6-month PFS rate (PFS6m) from 50% to 65%, 186 assessable patients were needed for a total of 141 PFS events. An interim analysis was planned after 40% of the required events. RESULTS: The interim analysis with 98 patients showed that the probability of reaching a statistically significant improvement in PFS by the end of the study was only 7%. This led the Independent Data and Monitoring Committee to recommend termination of patient enrollment. After a median of 21-month follow-up of all randomized patients (117 in total), PFS6m from randomization was 67.2% [95% confidence interval (CI) 53.6-77.7] with T + BEV and 55.2% (95% CI 41.5-66.9) with E + BEV [hazard ratio (HR): 1.0, 95% CI 0.7-1.5, P = 0.998]. Median PFS from BEV initiation was 12.5 and 12.3 months in the T + BEV and E + BEV arms, respectively. In the T + BEV arm, taxane was prematurely stopped for the majority of patients (94.9%), mainly due to toxicity (49.2%). Updated data after 35 months' median follow-up showed death rates of 44% and 55% in T + BEV and E + BEV arms, respectively. CONCLUSION: In this trial, maintenance therapy with E + BEV in ER-positive, HER2-negative MBC patients with no evidence of progression after first-line T + BEV did not achieve longer PFS compared with continuation of T + BEV. CLINICALTRIALSGOV: NCT01303679.

Randomized comparison of prophylactic antidiarrheal treatment versus no prophylactic antidiarrheal treatment in patients receiving CPT-11 (irinotecan) for advanced 5-FU-resistant colorectal cancer: an open-label multicenter phase II study.

Delayed diarrhea is the main toxicity of irinotecan at the currently recommended dose of 350 mg/m2 30-minute intravenous infusion, once every 3 weeks. This phase II, multicenter, open-label, randomized study was primarily designed to evaluate the effect of a 15-day Tiorfan (racecadotril) treatment on the incidence and severity of irinotecan-induced delayed diarrhea. One hundred thirty-six patients with metastatic colorectal cancer who failed to respond to a 5-fluorouracil-based treatment received 714 cycles of irinotecan. The patients were randomly allocated either to group A (68 patients) and received Tiorfan (300 mg/day) from D0 to D15 or to group B (68 patients) with no prophylactic treatment. Delayed diarrhea occurred in 197 of 355 cycles (55%) in Group A and 203 of 344 cycles (59%) in Group B. grade III-IV diarrhea was reported in 17 of 40 compliant patients (42%) in group A and 31 of 68 evaluable patients (45%) in group B. No difference was observed between the two groups for delayed diarrhea characteristics, incidence, or severity. The response rate in 99 evaluable patients was 12.1% (6.4%-20.2%). This study has shown that Tiorfan given prophylactically at 300 mg/day has no effect on delayed diarrhea.

Long-term prognostic and predictive factors in 107 stage II/III breast cancer patients treated with anthracycline-based neoadjuvant chemotherapy.

The heterogeneity of therapeutic modalities and eligibility criteria and the lack of long-term follow-up in most reports of neoadjuvant chemotherapy for breast cancer preclude us from drawing conclusions about its value in clinically relevant patient subgroups. The present study aims to identify predictive and prognostic factors in 107 non-inflammatory stage II/III breast cancer patients treated between November 1980 and October 1991 with an anthracycline-based induction regimen before locoregional surgery. Preoperative chemotherapy comprised 3-6 cycles of doxorubicin (pirarubicin after 1986), vindesine, cyclophosphamide and 5-fluorouracil. Type of subsequent surgery and adjuvant treatment were decided individually. In analysis of outcome, univariate comparisons of end points were made using the log-rank test, and significant (P < or = 0.05) pre- and post-therapeutic factors were incorporated in a Cox multivariate analysis. With a median follow-up of 81 months (range 32-164+ months), the median disease-free survival (DFS) is 90.5 months while median overall survival has not yet been reached. Cytoprognostic grade and histopathological response in both the primary and lymph nodes were independent covariates associated with locoregional relapse with or without DFS and overall survival. Eleven patients with pathological complete response remain free of disease with a 68-month median follow-up, while the 18 with residual microscopic disease on the specimen showed a 60% cumulative incidence of locoregional recurrence. Despite encouraging response rates based on clinical or radiological evaluation (87% or 70%), neither method showed any significant correlation with pathological response and failed to contribute prognostic information on patients' outcome. Pathological evaluation of antitumoral activity of primary chemotherapy remains a major source of prognostic information and might be used to select patients in need of additional adjuvant treatment.

Phase II study of irinotecan in the treatment of advanced colorectal cancer in chemotherapy-naive patients and patients pretreated with fluorouracil-based chemotherapy.

PURPOSE: To assess the efficacy of irinotecan (CPT-11) in the treatment of advanced colorectal cancer in both chemotherapy-naive and pretreated patients. PATIENTS AND METHODS: Two hundred thirteen patients (aged 18 to 75 years) with metastatic colorectal cancer, World Health Organization (WHO) performance status < or = 2, and life expectancy > or = 3 months were treated with CPT-11 350 mg/m2 every 3 weeks. All 178 patients eligible for efficacy analysis had not received more than one prior fluorouracil (5-FU)-based chemotherapy regimen (adjuvant or palliative) and had adequate hematologic, renal, and hepatic function. RESULTS: Primary tumor sites were the colon (71%) and rectum (28%). Sixty-six percent of the patients had > or = two metastatic sites. Ninety-eight percent of the patients had undergone previous surgery, and 77.5% had received prior chemotherapy. Thirty-two of 178 eligible patients achieved on objective response (four complete responses [CRs] and 28 partial responses [PRs]; response rate, 18%; 95% confidence interval, 12.6% to 24.4%), 65 were stable, and 59 progressed. The response rate was 17.7% in the pretreated group and 18.8% in the chemotherapy-naive group. Within the former subgroup, response rates of 16.1% were reported in patients who were progressive on prior 5-FU chemotherapy and 19.1% in patients who were progressive off such treatment. The median duration of objective response (9.1 months) and median time to achievement of a response (9.3 weeks) did not differ between chemotherapy-naive and pretreated patients. The most frequent adverse events were neutropenia, which developed in 80% of the patients, delayed diarrhea (87%), alopecia (88%), fatigue (81%), and nausea/vomiting (77%). All these adverse events were manageable. Severe (WHO grade 3 or 4) neutropenia was only observed in 18% of the cycles, leukopenia in 11%, delayed diarrhea in 11%, and nausea and vomiting in 3%. Development of simultaneous grade 3 or 4 neutropenia and delayed diarrhea during 4% of the cycles was the safety issue of greatest concern. CONCLUSION: CPT-11 has definite activity in the treatment of advanced metastatic colorectal cancer both in chemotherapy-naive and in pretreated patients who experienced disease progression on 5-FU, which suggests a lack of cross-resistance between CPT-11 and 5-FU. Diarrhea and neutropenia, the major toxicities of CPT-11, contribute to the risk to develop febrile neutropenic sepsis.

Equine lentivirus, comparative studies on four serological tests for the diagnosis of equine infectious anaemia.

Serological diagnosis of equine infectious anemia is of necessity group-reactive, i.e. based on viral core protein p26, because viral envelope components as well as the host's immune response to them undergo rapid antigenic change. Since 1970 the agar gel-immunodiffusion test ("Coggins-test") has been the diagnostic method of choice. Recently, ELISA tests have been introduced for faster and theoretically more sensitive serodiagnosis, while Western blots have been used to clarify doubtful results obtained in Coggins-tests. A commercial competitive ELISA was found to give practically equivalent results to the Coggins-test. The sensitivity of this market product is intentionally kept marginal in order to avoid false-positive "reactor horses". Another commercial ELISA, non-competitive, gave inconsistent results, creating great turmoil among horse owners when falsely positive. Caution is also indicated when interpreting Western blots. Sera of strongly positive horses gave as many as eleven bands, of medium positives fewer bands, and of the weakest reactors solely the p26 band. Single p26 banding was, however, also encountered in 5% healthy horses, in two of them consistently over time, which are accordingly considered non-specific. In order to be interpreted as positive, a Western blot for this equine lentivirus must band with its core protein plus at least one glycoprotein, similar to the recommended criterion for a positive reading of serum samples from AIDS patients.

[Three cases of virus isolation from horse fetuses diagnosed with equine arteritis virus (EAV) abortion from stud farms with different breeds]. / Drei durch Virusisolierung aus Pferdefeten abgesicherte Equine Arteritis Virus-(EAV-)Aborte aus Gestüten mit unterschiedlichen Zuchtrassen.

Three cases of abortions were diagnosed as caused by Equine Arteritis Virus (EAV) by isolation and typing of this virus from the respective fetuses. All 3 abortions were single cases, one occurring on a stud with Iceland Ponies, one with Warmbloods, one with Lipizzaner horses. On each stud horses of the respective breed were kept exclusively, therefore there existed no epidemiologic link. By means of seroneutralization tests performed on in contact horses it could be shown, that EAV had only been introduced recently into the stud with the Iceland Ponies. An extraneous mare stabled temporarily for covering by the stud's stallion could be incriminated for introducing EAV. By means of post-abortion serology it could be demonstrated that the Warmblood stud had been harbouring EAV for a longer period of time. Likewise, the Lipizzaner stud could be shown to have been persistently infected, this time on pre-abortion serums stored frozen at our Institute. On both these studs preexisting neutralizing antibodies accounted for the single case of abortion and prevented serial abortions. By investigating frozen serums taken in earlier years we could show that the Lipizzaner stallions had reacted positively to EAV for several years already. However, the gestation period of the aborting mare allowed to exclude EAV-positive semen transmitted on copulation as cause of its abortion. Both the Iceland Pony stallion as well as the Warmblood stallion could be excluded as sources of infection for the respective aborting mares as both repeatedly were seronegative.(ABSTRACT TRUNCATED AT 250 WORDS)

Attempts to immunoprotect adult horses, specifically pregnant mares, with commercial vaccines against clinical disease induced by equine herpesvirus-1.

In a project lasting 4 years more than 300 Lipizzans, around 180 of them adults, were vaccinated systematically against Equine Herpesvirus-1 (EHV-1) and representative groups thereof were serologically controlled for their antibody responses. In part, vaccination intervals recommended on packing slips were followed, in part other intervals, implicated by intermediary results, were used. A live virus vaccine proved ineffective if humoral antibodies were present. An oil-adjuvanted vaccine proved of highest antiviral immunogenicity, but after repeated revaccinations caused severe local reactions so frequently that we had to discontinue its use in adults. Fetal calf serum originating from the cell cultures used for viral propagation and not eliminated from the marketed product, was accused of being responsible for the incompatibilities. An inactivated mixed virus vaccine was of weak antigenicity regarding its EHV-1 component (whereas good regarding the influenza viruses) so that it proved unsatisfactory for primary immunization. It was, however, potent enough, and clinically well tolerated, to maintain suitable antibody levels in horses which had been initially primed by the oil-adjuvanted vaccine. Consequently, optimal humoral immunity as well as clinical acceptability resulted when two different vaccines were used, one for induction, the other for maintenance of protection. Vaccination intervals different from those on the packing slips are recommended for the mixed vaccine.

[Year-round antibody profile of groups of horses of a herd kept in isolation after differently terminating use of an experimental viral combination vaccine]. / Jahres-Antikörperprofile von Pferdegruppen eines isoliert gehaltenen Bestandes nach unterschiedlich terminisierter Anwendung eines viralen Kombinations-Versuchsimpfstoffs.

The commercial vaccine "Resequin F Konz." devised against viral respiratory infections of horses contains the abortigenic Equine Herpesvirus-1 (EHV-1). Therefore we had used it in our protection project of the Austrian Lipizzaners+ primarily to prevent abortions. Taking into account the recent perception that for young horses the respiratory-pathogenic EHV-4 type is essential Behringwerke Marburg added this particular virus to their market product to produce a multicomponent experimental vaccine. We examined this vaccine for its antibody induction as well as their persistence against each of its viral components. On groups of foals we did this regarding its prophylactic effect against respiratory infections. Furthermore, we investigated its immunogenicity in adult horses, hoping for a potentiating effect of EHV-4 against EHV-1, mediating enhanced protection against abortion caused by the latter virus. This experimental vaccine proved excellently tolerable, its immunogenicity against either equine herpesvirus type was considerable, was very good against both equine influenza subtypes, was low, however, against retroviruses types 1 and 3. Recommendations are made for seasonal optimal spacing of vaccinations, taking into account the prevalent dissemination phases of the viruses involved, the different age groups of horses and their respective use.

Comparative evaluation of the agar gel immunodiffusion test and two commercial ELISA kits for the serodiagnosis of equine infectious anemia.

Selected sets of serum samples of horses were tested blindly in a comparative investigation for antibodies against Equine Infectious Anemia (EIA) virus. Three commercial kits were used, a well-established agar-gel immuno-diffusion kit which our laboratory has been using routinely for 14 years on one hand, a competitive ELISA kit (CELISA) and a non-competitive ELISA kit on the other hand. The American EIA Reference Laboratory in Ames cotested 56 serum samples with the same 3 products, with highest-level correlation, thereby ascertaining full dependability of our own results. Five EIA experts supplied us critically weak or doubtfully reacting serum samples of experimentally infected horses together with their own test results, by necessity limited to the then available AGID in most instances. A high degree of correlation was found between our and their AGID results. In our own laboratory good correlation was found between the AGID test and one lot of the CELISA product. Time of seroconversion was coincident in some experimentally infected horses, partly AGID, partly CELISA proved more sensitive. Another lot of the CELISA product deteriorated completely long before the warranted validity, an unpleasant finding experienced by many other laboratories alike. The non-competitive ELISA product showed unacceptable inter-lot differences, oscillation between positive and negative results on consecutive samples of one and the same horse, never reacted with the weak positive International Reference Serum, and one lot deteriorated well beyond its expiration date. We discuss our results with the background: high sensitivity versus false-positive horses and advocate to maintain at their present sensitivity levels the AGID and the CELISA tests and not to push them further, as would be technically possible.

Viraemia and abortions are not prevented by two commercial equine herpesvirus-1 vaccines after experimental challenge of horses.

Eighteen horses, vaccinated on a number of occasions over a period of 12 to 20 months with either a live equine herpesvirus-1 (EHV-1) or an inactivated EHV-1 vaccine, were challenged by the intranasal instillation of the subtype 1 virus isolated from the 1983 outbreak of abortion and paralytic disease at the Lipizzan Stud, Piber, Austria. The prechallenge serum titres of all vaccinated horses were remarkably low, although most horses had received their last vaccine dose only 3 weeks before test-infection. Higher titres were obtained with the inactivated product than with the live virus vaccine. However, no obvious differences were found between the two vaccines in their ability to prevent disease, in that all vaccinated and two 'sentinel' horses became infected and developed viraemia and some degree of clinical disease after challenge; five of the 10 in-foal mares aborted.

[Training of the immune system of foals against ERP virus infections by frequent vaccination with presently available commercial vaccines]. / Schulung des Immunsystems von Fohlen gegen ERP-Virusinfekte durch frequente Impfungen mit derzeit verfügbaren Marktimpfstoffen.

During 3 foaling seasons around 150 Lipizzaner foals were vaccinated against ERP with commercial vaccines and groups thereof were serotested in CF and SN for their humoral immune response. In addition, 6 horses of cheaper common breeds were vaccinated on the University premises, were continuously serologically screened and subjected to virulent nasal test infection. The live-virus vaccine Prevaccinol interfered so profoundly and up to the 20th week of life with maternal antibodies that its further use was discontinued. The inactivated vaccine Pneumabort-K proved to be of impressive immunogenicity, but without any doubt must be used 4 times instead of 3 times only during the first year of life as recommended by its manufacturer. Proofs that the vaccination intervals as recommended on the packing slips are too far-spaced and that 3 basic doses of vaccine induce unsatisfactory protection became apparent under two aspects. Firstly, yearling mares experienced an enzootic field infection by subtype 1 of EHV 1 while on summer pasture. Secondly, experimental nasal infection of horses of the University herd gave takes certified clinically, virologically, and serologically. Data as well as arguments are brought forward which shed doubt on the merits of CF-titers as indicators of immunity as recommended by other authors; SN-titers were shown to be more dependable parameters. With regard to the frequently needed revaccinations there is an absolute "must" for the producer of Pneumabort-K to purify this product before marketing it.

A heteroploid permanent cell line originating from embryonic calf thyroid supporting the replication of all known bovine adenovirus serotypes.

An embryonic calf thyroid cell culture was established as a permanent heteroploid cell line, which is now in its 150th subculture. It allowed replication of all nine bovine adenovirus serotypes at its 15th as well as its 60-150th passages. All viruses induced typical cytopathic effects. Yields obtained on the permanent calf thyroid line were, on average, 0.8 log10 lower than those obtained on primary calf testicle cells.