Safety assessment of sorafenib in Chinese patients with unresectable hepatocellular carcinoma: subgroup analysis of the GIDEON study.

BACKGROUND: This study aimed to investigate the safety of sorafenib for the treatment of unresectable hepatocellular carcinoma in Chinese patients. METHODS: A subgroup of 345 Chinese patients from the international database of the Global Investigation of therapeutic DEcisions in hepatocellular carcinoma and Of its treatment with sorafeNib (GIDEON) study was included in this analysis. Safety assessment measures were adverse events (AEs) and serious adverse events (SAEs) graded using the National Cancer Institute Common Terminology Criteria version 3.0. RESULTS: Of 331 evaluable patients, 98% started sorafenib at 800 mg/day. The median treatment duration was 22 weeks (range, 0.1-116 weeks), and median overall survival (OS) was 322 days (10.7 months). Approximately 50% of patients had at least one adverse event, and 6% had grade 3-4 adverse events. Drug-related adverse events were experienced by 29% of patients, and 3.6% had grade 3-4 drug-related adverse events. Overall, 23% of patients (n = 77) experienced serious adverse events, among which only 1 event was drug-related (0.3%). No differences in overall adverse events, serious adverse events, and deaths were observed between Child-Pugh A and Child-Pugh B patients. The most frequent drug-related adverse events were dermatological/skin (24%), hand-foot skin reaction (20%), gastrointestinal (11%), and diarrhea (11%). The majority of adverse events occurred within 30 days of beginning sorafenib. CONCLUSION: Sorafenib has satisfactory efficacy and safety in Chinese Child-Pugh A and B patients with unresectable HCC using the recommended dosage of 800 mg/day, and the safety of sorafenib is not affected by liver function. Prophylaxis for gastrointestinal adverse events may help to decrease dose interruptions or discontinuation. TRIAL REGISTRATION: ClinicalTrials.gov ; Identifier: NCT00812175. Date of registration: December 19, 2008.

The beneficial effect of Rheum tanguticum polysaccharide on protecting against diarrhea, colonic inflammation and ulceration in rats with TNBS-induced colitis: the role of macrophage mannose receptor in inflammation and immune response.

Rhubarb has been used as a folk remedy for gastrointestinal disease in China for over two thousand years. In the present study, we evaluated the effect of Rheum tanguticum polysaccharide (RTP), a water soluble fraction extracted from rhubarb, on protection from inflammation and colonic damage in 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats. RTP protected against diarrhea, colon weight increase, and ulceration induced by TNBS. It was at least as effective as dexamethasone (DEX). RTP significantly decreased myeloperoxidase (MPO) activity in the colonic mucosa. Oral administration of RTP was as effective as intraperitoneal (i.p.) injection on toxicity protection and MPO activity. To further investigate the possible underlying mechanism, we studied the role of mannose receptor (MR) in cytokine secretion, ligand binding and endocytosis of macrophages. The secretion of IFN-gamma was dramatically increased while IL-4 decreased in colitis compared to the control (normal rats), and RTP restored the condition similar to the control in vivo. The secretion of IFN-gamma by macrophages was induced by RTP and lipoarabinomannan (LAM) but not mannose in vitro. Mannose completely inhibited the effect of RTP, while RTP and LAM affected each other on IFN-gamma secretion. The MR-mediated ligand binding and endocytosis of macrophages were markedly decreased in colitis and RTP restored their function to near normal condition. The results indicated that RTP targeted MR and down-regulation of Th1-polarized immune response may be the possible mechanism for its attenuation of intestinal inflammation and damage. RTP may be useful for treatment of patients with inflammatory bowel disease.

Structural analysis of water-soluble glucans from the root of Angelica sinensis (Oliv.) Diels.

Two water-soluble glucans (designated APS-1cI and APS-1cII) were extracted from the roots of Angelica sinensis (Oliv.) Diels and further purified by anion-exchange and gel-filtration chromatography. Their molecular weights were determined to be 1.7 x 10(5) and 3.9 x 10(4)Da, respectively. The structures of the purified glucans were investigated by a combination of chemical and instrumental analysis, such as methylation analysis, periodate oxidation, GC-MS, as well as FTIR and NMR spectroscopy ((1)H, (13)C, H-H COSY, HSQC, HMBC, TOCSY and NOESY). The data obtained indicated that APS-1cI was a linear alpha-glucan composed of only (1-->6)-alpha-D-Glcp, and APS-1cII had a repeating unit consisting of (1-->4)-alpha-D-Glcp and (1-->6)-alpha-D-Glcp in a molar ratio of 4:1. Such glucans isolated from A. sinensis (Oliv.) Diels have not been previously reported.