Phase III study on efficacy of taxanes plus bevacizumab with or without capecitabine as first-line chemotherapy in metastatic breast cancer.

Taxanes (T) plus bevacizumab (B) and taxanes plus capecitabine (X) showed better progression-free survival (PFS) compared to taxanes alone. Since life-threatening or highly symptomatic situations require polychemotherapy in metastatic breast cancer (MBC), combination of taxanes, capecitabine plus bevacizumab appears reasonable. TABEA (NCT01200212), a prospectively randomized, open-label, phase III trial compares taxanes (paclitaxel 80 mg/m(2) i.v. d1,8,15 q22 or docetaxel 75 mg/m(2) i.v. d1 q22) plus bevacizumab (15 mg/kg i.v. d1 q22) with (TBX) or without capecitabine (TB, 1800 mg/m(2) daily d1-14 q22) as first-line therapy in MBC. Histologically confirmed HER2-negative, locally advanced or MBC patients with a chemotherapy indication and measurable or non-measurable target lesions (RECIST criteria) were included. Primary objective was PFS. Secondary objectives were response rate and duration, clinical benefit rate (complete response, partial response, stable disease ≥24 weeks), 3-year overall survival, PFS in patients ≥65 years, toxicity, and compliance. We assumed 10 and 13.3 months PFS for TB and TBX, respectively (HR = 0.75), requiring 432 patients and 386 events. Preplanned interim futility and safety analyses after 100 events in 202 patients showed no efficacy benefit and higher toxicity for TBX. Recruitment and therapy were stopped following advice from the IDMC. Final analysis revealed a HR 1.13 [95 %CI 0.806-1.59], P = 0.474, for PFS. Overall grade 3-4 adverse event (77.3 vs. 62.1 %, P = 0.014) and serious adverse event (40.0 vs. 30.2 %, P = 0.127) rates were higher for TBX after 26.1 months median follow-up, with six deaths for TBX versus 1 for TB. Adding capecitabine to TB cannot be recommended as first-line therapy in MBC.

σ-Bond electron delocalization of branched oligogermanes and germanium containing oligosilanes.

In order to evaluate the influence of germanium atoms in oligo- and polysilanes, a number of oligosilane compounds were prepared where two or more silicon atoms were replaced by germanium. While it can be expected that the structural features of thus altered molecules do not change much, the more interesting question is, whether this modification would have a profound influence on the electronic structure, in particular on the property of σ-bond electron delocalization. The UV-spectroscopic comparison of the oligosilanes with germanium enriched oligosilanes and also with oligogermanes showed a remarkable uniform picture. The expected bathochromic shift for oligogermanes and Ge-enriched oligosilanes was observed but its extent was very small. For the low energy absorption band the bathochromic shift from a hexasilane chain (256 nm) to a hexagermane chain with identical substituent patterns (259 nm) amounts to a mere 3 nm.

The Randomized AMBORA Trial: Impact of Pharmacological/Pharmaceutical Care on Medication Safety and Patient-Reported Outcomes During Treatment With New Oral Anticancer Agents.

PURPOSE: Oral anticancer drugs (eg, kinase inhibitors) play an important role in cancer therapy. However, considerable challenges regarding medication safety of oral anticancer drugs have been reported. Randomized, controlled, multicenter studies on the impact of intensified clinical pharmacological/pharmaceutical care on patient safety and patient treatment perception are lacking. METHODS: Patients were eligible for the randomized, multicenter AMBORA study, if they were newly started on any of the oral anticancer drugs approved in 2001 or later without restriction to certain tumor entities. Patients were randomly assigned to receive either standard of care (control group) or an additional, intensified clinical pharmacological/pharmaceutical care, which included medication management and structured patient counseling, over a period of 12 weeks (intervention group). Primary end points were the number of antitumor drug-related problems (ie, side effects and unresolved medication errors) and patient treatment satisfaction with the oral anticancer therapy after 12 weeks measured with the Treatment Satisfaction Questionnaire for Medication, category convenience. RESULTS: Two hundred two patients were included. Antitumor drug-related problems were significantly lower in the intervention compared with the control group (3.85 v 5.81 [mean], P < .001). Patient treatment satisfaction was higher in the intervention group (Treatment Satisfaction Questionnaire for Medication, convenience; 91.6 v 74.4 [mean], P < .001). The hazard ratio for the combined end point of severe side effects (Common Terminology Criteria for Adverse Events ≥ 3), treatment discontinuation, unscheduled hospital admission, and death was 0.48 (95% CI, 0.32 to 0.71, P < .001) in favor of the intervention group. CONCLUSION: Treatment with oral anticancer drugs is associated with a broad range of medication errors and side effects. An intensified clinical pharmacological/pharmaceutical care has considerable, positive effects on the number of medication errors, patient treatment perception, and severe side effects.

Shuttling germanium atoms into branched polysilanes.

Lewis acid-catalyzed rearrangement reactions of trimethylgermylated small permethylated oligosilanes were found to show a strong tendency of the germanium atoms to move to the more highly silylated positions of the molecule. This makes possible the construction of molecules with high germanium content in the core parts of the molecules by the following repeated sequence: introduction of trimethylgermyl group followed by rearrangement. Quantum-mechanical computations at the B3LYP/6-311+G(d,p) level suggest that the exergonic rearrangement proceeds in a reaction cascade via germylium and silylium ions, which transform by 1,2-silyl and -methyl shifts.

Rearrangement/Fragmentation Reactions of Oligosilanes with Aluminum Chloride.

Reinvestigation of the Lewis acid catalyzed rearrangement of some open-chain permethyloligosilanes with the Al(Fe)Cl(3) catalyst system exhibited several cases of additional reactivity: namely, a fragmentation/cyclization reaction. Introduction of (trimethylsilyl)methyl substituents into the oligosilane substrates strongly facilitated this reaction, yielding cyclic or bicyclic carbacyclosilanes. Investigations concerning the composition of the catalyst system indicated that the incorporation of about 0.1% FeCl(3) into the AlCl(3) lattice provided an effective catalyst.

Conformational Control of Polysilanes: Use of CH(2) Spacers in the Silicon Backbone.

By the reaction of a number of oligosilyl potassium compounds with (trimethylsilyl)chloromethane, derivatives containing the (trimethylsilyl)methyl substituent were prepared. Using X-ray single-crystal structure analysis and UV spectroscopy the conformational properties of some of the compounds were studied. It was found that the (trimethylsilyl)methylated examples exhibit UV absorption properties which correspond to lower energy transitions in comparison to those of analogous trimethylsilylated molecules. The influence of this effect decreases, however, with increasing chain lengths.

Synthesis and structural diversity of oligosilanylzinc compounds.

Reactions of potassium oligosilanyls with ZnCl(2) lead to the formation of oligosilanylzinc compounds with zinc's coordination sphere expanded by ligation of TMEDA, an additional oligosilanyl group, or a chloride ion.

Open, cyclic, and bicyclic compounds of double silylated phosphorus and boron.

Salt elimination reactions of tris(trimethylsilyl)silyl potassium (1), and two 1,4-dipotassiooligosilanes (3, 5) with 2,2,6,6-tetramethylpiperidinodichloroborane and diethylaminodichlorophosphane have generated open (2), cyclic (4) and bicyclic (6) bora- and phosphaoligosilanes. A monosilylated phosphane and the two five-membered cyclosilanes have been subjected to single crystal X-ray diffraction analysis.

Genomic organization of the human gene HEP27: alternative promoter usage in HepG2 cells and monocyte-derived dendritic cells.

We used representational difference analysis to discover new genes with specific expression in dendritic cells. Among other genes, we identified HEP27, encoding a member of the short chain alcohol dehydrogenase/reductase family to be upregulated during monocyte to dendritic cell differentiation. Originally cloned from hepatocellular carcinoma cells (HepG2), HEP27 was exclusively expressed in monocyte-derived dendritic cells within the hematopoietic system. The presence of different transcripts in monocyte-derived dendritic cells, HepG2 cells, and various tissues could be traced back to alternative splicing and alternative promoter usage. We describe here the complete genomic organization of HEP27, including two alternative promoter regions: a hepatocyte-specific promoter which was induced by the histone deacetylase inhibitor sodium butyrate in several other cell types, and a second upstream promoter which was specifically active in monocyte-derived dendritic cells. Its exclusive usage in monocyte-derived dendritic cells makes the alternative HEP27 promoter an interesting target to study dendritic-cell-specific gene regulation.