Adcitmer® , a new CD56-targeting monomethyl auristatin E-conjugated antibody, is a potential therapeutic approach in Merkel cell carcinoma.

BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive skin cancer, whose tumour cells often express CD56. While immune checkpoint inhibitors constitute a major advance for treating patients with MCC with advanced disease, new therapeutic options are still urgently required. OBJECTIVES: To produce and evaluate the therapeutic performance of a new antibody-drug conjugate (Adcitmer® ) targeting CD56 in preclinical models of MCC. METHODS: CD56 expression was evaluated in a MCC cohort (immunohistochemistry on a tissue microarray of 90 tumour samples) and MCC cell lines. Interaction of an unconjugated CD56-targeting antibody with CD56+ MCC cell lines was investigated by immunohistochemistry and imaging flow cytometry. Adcitmer® product was generated by the bioconjugation of CD56-targeting antibody to a cytotoxic drug (monomethyl auristatin E) using the McSAF Inside® bioconjugation process. The chemical properties and homogeneity of Adcitmer® were characterized by hydrophobic interaction chromatography. Adcitmer® cytotoxicity was evaluated in vitro and in an MCC xenograft mice model. RESULTS: Similar to previous reports, CD56 was expressed by 66% of MCC tumours in our cohort, confirming its relevance as a therapeutic target. Specific binding and internalization of the unconjugated CD56-targeting antibody was validated in MCC cell lines. The high homogeneity of the newly generated Adcitmer® was confirmed by hydrophobic interaction chromatography. The CD56-mediated cytotoxicity of Adcitmer® was demonstrated in vitro in MCC cell lines. Moreover, Adcitmer® significantly reduced tumour growth in a MCC mouse model. CONCLUSIONS: Our study suggests that Adcitmer® should be further assessed as a therapeutic option in patients with MCC, as an alternative therapy or combined with immune checkpoint inhibitors.

Feasibility and outcomes of a goal-directed physical therapy program for patients with metastatic breast cancer.

PURPOSE: To evaluate the feasibility and outcomes of a tailored, goal-directed, and exercise-based physical therapy program for patients with metastatic breast cancer (MBC). METHODS: This was an observational, uncontrolled feasibility study. The physical therapy intervention was highly tailored to the individual patient's goals, abilities, and preferences and could include functional, strength, aerobic, and relaxation exercises. Feasibility outcomes were participation rate (expected: 25%), safety, and adherence (percentage of attended sessions relative to scheduled sessions). Additional outcomes were goal attainment, self-reported physical functioning, fatigue, health-related quality of life, and patient and physical therapist satisfaction with the program. RESULTS: Fifty-five patients (estimated participation rate: 34%) were enrolled. Three patients did not start the intervention due to early disease progression. An additional 22 patients discontinued the program prematurely, mainly due to disease progression. Median intervention adherence was 90% and no major intervention-related adverse events occurred. A goal attainment score was available for 42 patients (of whom 29 had completed the program and 13 had prematurely dropped out). Twenty-two (52%) of these patients achieved their main goal fully or largely and an additional 15 patients (36%) partially. Eighty-five percent would "definitely recommend" the program to other patients with MBC. We observed a modest improvement in patient satisfaction with physical activities (Cohen's dz 0.33). CONCLUSION: The tailored intervention program was feasible in terms of uptake, safety, and outcomes and was highly valued by patients and physical therapists. However, disease progression interfered with the program, leading to substantial dropout. TRIAL REGISTRATION: NTR register: NTR6475.

Operating room ventilation and the risk of revision due to infection after total hip arthroplasty: assessment of validated data in the Norwegian Arthroplasty Register.

BACKGROUND: The air in the operating room is considered a risk factor for surgical site infection (SSI) due to airborne bacteria shed from the surgical staff or from patients themselves. AIM: To assess the influence of validated operating room (OR) ventilation data on the risk of revision surgery due to deep infection after primary total hip arthroplasty (THA) reported to the Norwegian Arthroplasty Register (NAR). METHODS: Forty orthopaedic units reporting THAs to the NAR during the period 2005-2015 were included. The true type of OR ventilation in all hospitals at the time of primary THA was confirmed in a previous study. Unidirectional airflow (UDF) systems were subdivided into: small, low-volume, unidirectional vertical flow (lvUDVF) systems; large, high-volume, unidirectional vertical flow (hvUDVF) systems; and unidirectional horizontal flow (UDHF) systems. These three ventilation groups were compared with conventional, turbulent, mixing ventilation (CV). The association between the end-point, time to revision due to infection, and OR ventilation was estimated by calculating relative risks (RRs) in a multivariate Cox regression model, with adjustments for several patient- and surgery-related covariates. FINDINGS: A total of 51,292 primary THAs were eligible for assessment. Of these, 575 had been revised due to infection. A similar risk of revision due to infection after THA performed was found in ORs with lvUDVF and UDHF compared to CV. THAs performed in ORs with hvUDVF had lower risk of revision due to infection compared to CV (RR = 0.8; 95% CI: 0.6-0.9; P = 0.01). CONCLUSION: THAs performed in ORs with hvUDVF systems had lower risk of revision due to infection compared to THAs performed in ORs with CV systems. The perception that all UDF systems are similar and possibly harmful seems erroneous.

Granulomatous enteritis in rainbow trout (Oncorhynchus mykiss) associated with soya bean meal regardless of water dissolved oxygen level.

This study investigated morphological changes associated with soya bean meal-induced enteritis (SBMIE) in distal intestine (DI) of rainbow trout (Oncorhynchus mykiss) fed a soya bean meal (SBM)-based diet and exposed to normoxia or hypoxia created by optimal and low water flow rates, respectively. A 28-day adaption period was followed by a 42-day challenge period where 600 fish were subjected to dietary challenge and/or hypoxia. Twelve tanks each containing 50 juvenile trout were assigned randomly in triplicate to each treatment. Histopathological and immunohistochemical evaluation revealed pathological features that have not previously been described in association with SBMIE. Vacuolar degeneration of epithelial cells mainly at the base of mucosal folds, epithelial cysts, epithelial dysplasia, necrosis, shedding of necrotic cells, and granulomatous inflammation including infiltration of enlarged, sometimes finely vacuolated or "foamy" macrophages, multinucleated giant cells and increased proliferation of fibroblasts were observed. Acid-fast bacteria were not detected in enlarged macrophages; however, these cells contained AB-PAS- and sometimes cytokeratin-positive material, which was interpreted to be of epithelial/goblet cell origin. Hypoxia did not affect the morphological changes in DI. These results suggest that SBM was associated with a granulomatous form of enteritis in DI of rainbow trout regardless of water oxygen level.

Baseline comprehensive geriatric assessment is associated with toxicity and survival in elderly metastatic breast cancer patients receiving single-agent chemotherapy: results from the OMEGA study of the Dutch breast cancer trialists' group.

AIM: To evaluate the association between baseline comprehensive geriatric assessment (CGA) or the Groningen Frailty Indicator (GFI) and toxicity in elderly metastatic breast cancer (MBC) patients treated with first-line palliative chemotherapy. PATIENTS AND METHODS: MBC patients (≥65 years) were randomized between pegylated liposomal doxorubicine or capecitabine. CGA included instrumental activities of daily living (IADL), cognition using the mini-mental state examination (MMSE), mood using the geriatric depression scale (GDS), comorbidity using the Charlson index, polypharmacy and nutritional status using the body mass index. Frailty on CGA was defined as one or more of the following: IADL ≤ 13, MMSE ≤ 23, GDS ≥ 5, BMI ≤ 20, ≥5 medications or Charlson ≥2. The cut-off for frailty on the GFI was ≥4. RESULTS: Of the randomized 78 patients (median age 75.5 years, range 65.8-86.8 years), 73 were evaluable for CGA; 52 (71%) had one or more geriatric conditions. Grade 3-4 chemotherapy-related toxicity was experienced by 19% of patients without geriatric conditions compared to 56% of patients with two geriatric conditions and 80% of those with three or more (p = 0.002). Polypharmacy was the only individual factor significantly associated with toxicity (p = 0.001). GFI had a sensitivity of 69% and a specificity of 76% for frailty on CGA, and was not significantly associated with survival or toxicity. CONCLUSION: In this study of elderly patients with MBC, the number of geriatric conditions correlated with grade 3-4 chemotherapy-related toxicity. Therefore, in elderly patients for whom chemotherapy is being considered, a CGA could be a useful addition to the decision-making process.

An aCGH classifier derived from BRCA1-mutated breast cancer and benefit of high-dose platinum-based chemotherapy in HER2-negative breast cancer patients.

BACKGROUND: Breast cancer cells deficient for BRCA1 are hypersensitive to agents inducing DNA double-strand breaks (DSB), such as bifunctional alkylators and platinum agents. Earlier, we had developed a comparative genomic hybridisation (CGH) classifier based on BRCA1-mutated breast cancers. We hypothesised that this BRCA1-like(CGH) classifier could also detect loss of function of BRCA1 due to other causes besides mutations and, consequently, might predict sensitivity to DSB-inducing agents. PATIENTS AND METHODS: We evaluated this classifier in stage III breast cancer patients, who had been randomly assigned between adjuvant high-dose platinum-based (HD-PB) chemotherapy, a DSB-inducing regimen, and conventional anthracycline-based chemotherapy. Additionally, we assessed BRCA1 loss through mutation or promoter methylation and immunohistochemical basal-like status in the triple-negative subgroup (TN subgroup). RESULTS: We observed greater benefit from HD-PB chemotherapy versus conventional chemotherapy among patients with BRCA1-like(CGH) tumours [41/230 = 18%, multivariate hazard ratio (HR) = 0.12, 95% confidence interval (CI) 0.04-0.43] compared with patients with non-BRCA1-like(CGH) tumours (189/230 = 82%, HR = 0.78, 95% CI 0.50-1.20), with a significant difference (test for interaction P = 0.006). Similar results were obtained for overall survival (P interaction = 0.04) and when analyses were restricted to the TN subgroup. Sixty-three percent (20/32) of assessable BRCA1-like(CGH) tumours harboured either a BRCA1 mutation (n = 8) or BRCA1 methylation (n = 12). CONCLUSION: BRCA1 loss as assessed by CGH analysis can identify patients with substantially improved outcome after adjuvant DSB-inducing chemotherapy when compared with standard anthracycline-based chemotherapy in our series.

Soybean meal induces intestinal inflammation in common carp (Cyprinus carpio L.).

The development of soybean meal (SBM) induced enteritis in the hindgut of the omnivorous common carp (Cyprinus carpio L.). The developed condition was assessed when carp, continuously fed on animal protein, were transferred to a diet in which 20% of the protein was replaced by SBM. After week 1, most of the inflammation parameters were already present, but at week 3, a strong aggravation of the condition was observed which included a shortening of the mucosal folds, the disappearance of the supranuclear vacuoles, an increased number of goblet cells, a thickened lamina propria and sub-epithelial mucosa with increased numbers of basophilic granulocytes as well as a decreased uptake capacity of enterocytes (impaired endocytosis and microvilli). Contrary to previous observations made with respect to Atlantic salmon, common carp start to recover from the fourth to the fifth week after switching to SBM feeding. At this stage, the supranuclear vacuoles refill and most of the parameters revert to basal levels. During the enteritis process, a real-time quantitative PCR analysis was conducted to measure the expression of inflammatory and anti-inflammatory cytokine genes in the isolated intraepithelial lymphocytes (IEL). The pro-inflammatory interleukin 1 beta (IL-1 beta) and tumour necrosis factor alpha1 (TNF-alpha1) genes were up-regulated during the inflammation process while the anti-inflammatory interleukin 10 (IL-10) was down-regulated after an initial up-regulation at week 1. Transforming growth factor beta (TGF-beta) expression showed an up-regulation from week 3 onwards despite the high Ct value and the low primer efficiency shown. This study confirms the contribution of IEL (mainly T-like cells) and basophils in the enteritis process. In addition, the results show a clear involvement of up- and down-regulated cytokine genes in both the onset and recovery of the SBM-induced enteritis in the hindgut of carp.

A randomised phase III study on capecitabine, oxaliplatin and bevacizumab with or without cetuximab in first-line advanced colorectal cancer, the CAIRO2 study of the Dutch Colorectal Cancer Group (DCCG). An interim analysis of toxicity.

BACKGROUND: Targeting the vascular endothelial growth factor or the epidermal growth factor receptor (EGFR) has shown efficacy in advanced colorectal cancer (ACC), but no data are available on the combination of these strategies with chemotherapy in the first-line treatment. The CAIRO2 study evaluates the effect of adding cetuximab, a chimeric mAb against EGFR, to capecitabine, oxaliplatin and bevacizumab in the first-line treatment of ACC. PATIENTS AND METHODS: In all, 755 patients were randomly assigned between treatment with capecitabine, oxaliplatin and bevacizumab with or without cetuximab. The primary end point is progression-free survival. We here present the toxicity results in the first 400 patients that entered the study. RESULTS: The incidence of overall grade 3-4 toxicity was significantly higher in arm B compared with arm A (81% versus 72%, P = 0.03). This difference is fully attributed to cetuximab-related skin toxicity. The addition of cetuximab did not result in an increase of gastrointestinal toxicity or treatment-related mortality. CONCLUSIONS: The addition of cetuximab to capecitabine, oxaliplatin and bevacizumab in the first-line treatment of ACC appears to be safe and feasible. No excessive or unexpected toxicity in the cetuximab-containing treatment arm was observed.

Palliative chemotherapy after failure of high-dose chemotherapy in breast cancer--toxicity and efficacy.

We evaluated the toxicity and efficacy of the first palliative chemotherapy regimen after failure of high-dose chemotherapy in 148 patients with primary or metastatic breast cancer treated with high-dose chemotherapy (one full dose CTC, (cyclophosphamide 6000 mg/m2, thiotepa 480 mg/m2, carboplatin 1600 mg/m2) or multiple courses CTC or 'tiny' CTC (tCTC) (two-thirds of the agents of the full-dose regimen), all divided over 4 days). After a median follow-up time of 46.8 (range 1-120) months, 79 patients had a relapse or progressive disease and 41 patients were treated with palliative chemotherapy. The most commonly used regimens were classical CMF (n = 13), docetaxel (n = 16) and less frequently anthracycline (n = 4), paclitaxel (n = 5), capecitabine (n = 2) and vinorelbine (n = 2). In both the CMF and docetaxel group, 3 patients required a dose reduction because of hematological toxicity. Objective responses were seen with CMF (23%) and docetaxel (69%) with a median duration of 161 (range 28-481) and 196 (range 62-437) days, respectively. We found no relationship of toxicity and response with treatment-free interval after high-dose chemotherapy. This report shows that conventional-dose palliative chemotherapy regimens may be safe and effective after failure of high-dose chemotherapy.

Toxicity of the high-dose chemotherapy CTC regimen (cyclophosphamide, thiotepa, carboplatin): the Netherlands Cancer Institute experience.

High-dose chemotherapy (HD-CT) has a role in the potentially curative treatment of several tumours. The relative efficacies of the different regimens have not been studied in comparative trials, but it is clear that toxicities differ significantly between them. We analysed the immediate and long-term toxicity in the first 100 consecutive patients treated with the CTC regimen (cyclophosphamide 6000 mg m(-2), carboplatin 1600 mg m(-2) (or 20 mg ml(-1) min under the curve (AUC)) both as daily 1 h infusion, thiotepa 480 mg m(-2) as twice daily 30 min infusion, all divided over 4 consecutive days) followed by peripheral blood progenitor cell reinfusion (PBPC-Tx). Most patients had high-risk (n=86) or metastatic (n=4) breast cancer, or a germ cell tumour (n=8). Two patients (with a medulloblastoma and an aesthesioneuroblastoma, respectively) received CTC as off-protocol salvage regimen. The main toxicity was bone marrow suppression. Most patients had PBPC-Tx with granulocyte colony-stimulating factor (G-CSF), and the median time to neutrophil count 500 x 10(6) l(-1) and platelet count >20 x 10(9) l(-1) without transfusion independence was 10 (range 8-25) and 13 (8-60) days, respectively. The toxic death rate was 1%. Other frequent toxicities were neutropenic fever requiring antibiotics (n=65), central catheter-related infection (n=12) or a bleeding episode (n=48), mostly epistaxis (n=26). Reversible cardiac toxicity was seen in six patients and pulmonary events occurred in seven patients (infection (n=6), embolism (n=1)). Grade 3-4 gastrointestinal toxicity was frequent: nausea and vomiting 55%, diarrhoea 28% and mild liver toxicity (transaminase elevations) 9%. One patient pretreated with cisplatin had a kidney transplantation 8 years after HD-CT. Late complications included reversible radiation pneumonitis (n=12) and chronic heart failure (n=2). We found five second solid malignancies and two myelodysplasias. In conclusion, the CTC regimen is associated with a moderate, mainly reversible, toxicity. Future studies need to compare the efficacy and toxicity of the different HD-CT regimens.

Dietary betaine supplementation affects energy metabolism of pigs.

The effect of dietary betaine supplementation on energy partitioning in growing pigs under energy-restricted dietary conditions was assessed. The effect of betaine on the adaptation in energy metabolism of pigs over time after a change in diet and housing also was studied. Six groups of 14 group-housed barrows were assigned to one of two experimental diets: control or betaine-supplemented (0 or 1.29 g/kg of feed). Diets were corn- and soybean meal-based and were formulated to be limiting in energy content but sufficient in amino acids. The experiment comprised a 3-wk adaptation and a 3-wk experimental period. At the start of the experimental period, initial BW was 46 kg, each group of pigs was housed in a climate-controlled respiration chamber, and all pigs were subjected to a change in diet. During the experimental period, diets were diluted with 10% oat hulls. Pigs were fed at 2.5 times the energy requirements for maintenance, and during the experimental period, heat production, energy, and nitrogen balances were measured weekly. Metabolizibility of energy did not differ (P > 0.10) between diets. Averaged over the experimental period, betaine reduced heat production (P < 0.05) and energy requirements for maintenance (P < 0.10) and consequently increased energy retention (P < 0.10). Moreover, the difference in heat production between diets increased with time (P < 0.05). Similarly, the effect of betaine on the energy requirements for maintenance changed with time (P < 0.05). Maintenance requirements were similar in wk 1 and were decreased by betaine supplementation by 5.5% during wk 3 (477 vs. 452 kJ/[kg(0.75) x d]). Results of this study show that dietary betaine supplementation affects energy partitioning by growing pigs. However, based on the observed time-related changes in energy partitioning, it was concluded that dietary betaine supplementation did not influence adaptation by pigs to a change in housing and diet.

Effects of two different dietary fermentable carbohydrates on activity and heat production in group-housed growing pigs.

The effects of two sources of dietary fiber (DF) on behavior and heat production (HP) in group-housed growing pigs were studied. Twenty clusters of 14 barrows (50 kg) were fed one of 10 diets. Diets differed mainly in type and content of fermentable DF (fDF) and in content of digestible starch. Five diets contained solvent-extracted coconut meal (SECM) and five diets contained soybean hulls (SBH) as the main fDF source. On an as-fed basis, pigs received 3.5, 13.2, 23.0, 32.7, or 42.4 g x kg(-0.75) x d(-1) of SECM or SBH. A total of 280 crossbred growing pigs were used, divided into clusters of 14 pigs each. Pigs were group-housed and fed at 2.5 times the assumed maintenance energy requirements. All clusters were fed similar amounts of NE, ileal-digestible protein and amino acids, vitamins, and minerals. Consequently, DMI differed among diets because NE content decreased with increasing DF content. After a 32-d preliminary period, HP was measured per cluster during a 7-d experimental period in environmentally controlled respiration chambers. Behavior of the pigs was recorded using time-lapse video recordings during two different days within the experimental period. Intake of digestible starch and fDF was different (P < 0.001) among diets, whereas intake of digestible CP was similar among diets. On average, pigs spent 153 min standing, 42 min sitting, 202 min lying on their chest, and 1,043 min lying on their flanks each day. Pigs fed SECM diets spent, on average, less time (P < 0.05) lying on their chest than pigs fed SBH diets. Total time spent on physical activity (i.e., standing plus sitting, 195 min/d) was not affected by diet. Total HP and resting HP were affected by diet and were on average lower (P < 0.01) for pigs fed SECM diets than for pigs fed SBH diets. Activity-related heat production (AHP) averaged 65 kJ x kg(-0.75) x d(-1) and was not affected by diet. There was a linear relationship (P < 0.001) between fDF intake and HP, but there was no relationship between fDF intake and AHP. During different parts of the day, fDF intake also affected HP. The saving effect of physical activity on the NE values of fDF from SECM and SBH were 0.56 and 0.84 kJ/g of fDF intake, respectively. Neither of these saving effects was significantly different from zero. We conclude that fDF from SECM and SBH did not affect energy expended on physical activity by growing pigs, and that the NE value of fDF from SECM and SBH was not affected by changes in physical activity.

Effects of dietary fermentable carbohydrates on behavior and heat production in group-housed sows.

The effects of dietary nonstarch polysaccharides (NSP) on behavior and heat production in group-housed sows were studied. Twelve groups of six nonpregnant sows were fed one of four experimental diets that were similar in composition except for starch and NSP contents. Exchanging sugar beet pulp silage (SBPS) for tapioca created the difference in dietary starch and NSP ratio. On a dry matter (DM) basis, diets contained 0, 10, 20, or 30% SBPS. Sows were group-housed. Intake of fermentable NSP (fNSP) for diets containing 0, 10, 20, or 30% SBPS averaged 7.06, 9.18, 11.61, and 13.73 g x kg(-0.75) d(-1), respectively. Sows were fed, once a day at 0800. Dry matter intake for diets containing 0, 10, 20, or 30% SBPS, averaged 38.05, 38.38, 38.53, and 38.35 g x kg(-075) x d(-1), respectively, and ME intake averaged 523, 518, 514, and 493 kJ x kg(-0.75) x d(-1), respectively. On average, sows spent 177 min/d on physical activity, of which 8.8% was spent on eating. Time spent in physical activity was affected by diet (P = 0.005). Sows fed 0 or 10% SBPS spent more time on physical activity than sows fed 20 or 30% SBPS (P = 0.002). Energy cost of physical activity averaged 464 kJ x kg(-0.75) x d(-1) (standard estimated mean of 31) and was similar for diets (P = 0.679). Total heat production (HP) and activity-related heat production (AHP) were affected by diet (P < 0.05). Sows tended to be quieter when fNSP intake increased (P = 0.063). The effect of fNSP intake on HP and AHP was not constant during the day. During the night period, fNSP intake did not affect HP and AHP (P > 0.10). During the day period, increased fNSP intake decreased HP (P = 0.006) and tended to decrease AHP (P = 0.062). During eating, increased fNSP intake increased HP (P = 0.012) and tended to increase AHP (P = 0.074). Despite similar DMI, sows fed 0 or 10% SBPS spent less time eating than sows fed 20 or 30% SBPS (P = 0.009). Feed consumption rate was higher (P = 0.003) in groups fed 0 or 10% SBPS than in groups fed 20 or 30% SBPS. Feed consumption rate decreased by 0.19 g DM x kg(-0.75). min(-1) (P = 0.003) for each gram of fNSP intake. The energy saving effect of physical activity on the NE value of fNSP from SBPS ranged between 2.3 and 3.7 kJ/g of fNSP intake. In conclusion, intake of fNSP from SBPS affected energy expenditure for physical activity (P = 0.063); however, this effect was not constant during the day.

Breast cancer response to neoadjuvant chemotherapy: predictive markers and relation with outcome.

The aim of this study was to provide a better insight into breast cancer response to chemotherapy. Chemotherapy improves outcome in breast cancer patients. The effect of cytotoxic treatment cannot be predicted for individual patients. Therefore, the identification of tumour characteristics associated with tumour response and outcome is of great clinical interest. We studied 97 patients, who received anthracycline-based neoadjuvant chemotherapy. Tumour samples were taken prior to and after chemotherapy. We quantified the response to chemotherapy clinically and pathologically and determined histological and molecular tumour characteristics. We assessed changes in the expression of Bcl-2, ER, P53 HER2 and Ki-67. Association with response and outcome was tested for all parameters. The experimental results showed 15 clinical (17%) and three (3%) pathological complete remissions. There were 18 (20%) clinical vs 29 (33%) pathological nonresponders. The expression of most markers was similar before and after chemotherapy. Only Ki-67 was significantly decreased after chemotherapy. Factors correlated with response were: large tumour size, ER negativity, high Ki-67 count and positive P53 status. Tumour response and marker expression did not predict disease-free or overall survival. In conclusion, clinical and pathological response assessments are poorly associated. Proliferation decreases significantly after chemotherapy. ER negativity and a high proliferation index are associated with better response. HER2 status does not predict response, and outcome is not related to tumour response.

Randomized trial of high-dose chemotherapy and hematopoietic progenitor-cell support in operable breast cancer with extensive lymph node involvement: final analysis with 7 years of follow-up.

BACKGROUND: The aim of this study was to present an update of overall (OS) and disease-free survival (DFS) and to evaluate the correlation between outcome and pathological findings at surgery in a randomized trial of high-dose chemotherapy following neoadjuvant chemotherapy and surgery in high-risk breast cancer patients. PATIENTS AND METHODS: Ninety-seven women <60 years of age with breast cancer and extensive axillary lymph node involvement received three courses of FE120C (5-fluorouracil 500 mg/m2, epirubicin 120 mg/m2, cyclophosphamide 500 mg/m2) followed by surgery. Eighty-one patients were randomized to receive either a fourth FE120C course alone or a fourth FE120C course followed by high-dose chemotherapy (cyclophosphamide 6 g/m2, thiotepa 480 mg/m2, carboplatin 1600 mg/m2). We performed a univariate analysis on possible prognostic factors and analyzed the sites of relapse. RESULTS: After a median follow-up of 6.9 years, 47 (48%) patients were alive, of whom 36 (38%) were without disease. Sixty patients relapsed after treatment. One patient died of myelodysplastic syndrome, without a relapse. In intention-to-treat analysis, the 5-year DFS rates were 47.5% in the conventional treatment arm and 49% in the high-dose arm, and the 5-year OS rates were 62.5% and 61%, respectively. In the univariate analysis, the clinical T-stage before chemotherapy and the number of tumor-positive axillary lymph nodes after induction chemotherapy (P = 0.027) were significant prognostic factors for OS. The same factors (both P = 0.06) plus the estrogen receptor (P = 0.08) were borderline significant factors for DFS. CONCLUSIONS: After a median follow-up of 6.9 years there was no difference in OS or DFS rates between the two treatment groups. The number of tumor-positive axillary lymph nodes after induction chemotherapy and the clinical T-stage before chemotherapy were significant factors for OS.

Phase II study of a multi-course high-dose chemotherapy regimen incorporating cyclophosphamide, thiotepa, and carboplatin in stage IV breast cancer.

The purpose of this study was to determine the feasibility and efficacy of multiple courses of high-dose cyclophosphamide, carboplatin and thiotepa with peripheral blood progenitor cell (PBPC) transplantation in women with advanced breast cancer. Forty-one patients with advanced hormone-refractory breast cancer were enrolled in the study. The treatment started with two courses of 5-fluorouracil 500 mg/m(2), epirubicin 120 mg/m(2) and cyclophosphamide 500 mg/m(2) (FE(120)C) followed by PBPC harvesting. The high-dose regimen consisted of three subsequent courses of 'tiny' CTC, cyclophosphamide 4000 mg/m(2), thiotepa 320 mg/m(2) and carboplatin 1060 mg/m(2) (target AUC 13.3 mg/ml/min) (tCTC) divided over 4 consecutive days. The second and third courses were scheduled to begin on day 28 after the previous transplantation. A total of 86 tCTC courses was given to 33 of the 41 enrolled patients. Major toxicities consisted of hemorrhagic cystitis (six patients), prolonged gastro-intestinal toxicity (three patients) and veno-occlusive disease (two patients). There was one therapy-related death (unknown cause). Twenty patients (49%) achieved a complete response, nine (22%) a partial response and three patients stable disease after treatment. The median follow-up of the surviving patients was 43 months (range 25-61). Six patients remain in complete remission beyond 3 years. At 4 years, the progression-free survival (PFS) and overall survival (OS) for the whole patient group were 23 and 30% with a median duration of 12 and 27 months, respectively and for FE(120)C-responsive patients 32 and 36%, respectively with a median duration of 15 and 33 months. In the patient group with a PFS > or = 18 months all patients had limited disease (metastatic disease in only one or two sites) and fewer patients had bone or liver metastases compared to the overall patient group (33% vs 51%). This report shows that three closely spaced courses of tCTC are feasible, with acceptable toxicity. Triple tCTC can achieve complete or partial remission in most patients and long-term PFS in a selected subgroup of patients who have limited metastatic disease and are responsive to conventional-dose chemotherapy.

Dose-intensive chemotherapy for locally advanced breast cancer.

The availability of hematopoietic growth factors has allowed a range of feasibility and uncontrolled studies with high-dose chemotherapy (with or without stem-cell support) to take place. Preliminary data from some randomized studies are now available as well. Dose-intensive chemotherapy appears to be effective in downstaging the tumor. Only a minority of patients achieve a pathologic complete remission and additional therapeutic options to control minimal residual disease are urgently needed. There are few indications that high-dose chemotherapy is superior to conventional dose therapy in terms of relapse-free or overall survival. Although the results of most randomized studies are premature or unknown at this time, a modest but clinically significant survival advantage may still emerge.

Changes in energy metabolism in relation to physical activity due to fermentable carbohydrates in group-housed growing pigs.

Fermentable nonstarch polysaccharides (dietary fiber) affect energy retention in group-housed growing pigs by reducing physical activity. This study assessed the effects of fermentation and bulkiness of dietary carbohydrates on physical activity in relation to energy metabolism. Eight clusters of 14 pigs were fed one of four diets in a 2x2 factorial arrangement. Factors included 1) gastrointestinal fermentation and 2) dietary bulkiness. Contrasts in fermentation were created by exchanging gelatinized maize starch with raw potato starch on a volume basis. Bulkiness was altered by adding 15% milled wheat straw to the diets. Apart from these differences, amounts of other dietary ingredients fed to the pigs were similar. Pigs were housed in groups. Nitrogen and energy balances were measured per cluster during a 14-d period. Dietary bulkiness did not affect ME intake, heat production, or energy retention. Metabolizability decreased when maize starch was replaced with raw potato starch (P< .01), resulting in a lower energy retention on the potato starch diets (P<.01). However, the lower ME intake on the potato diets was partially compensated by a reduced energy expenditure on physical activity (P< .01), which was 17.6% lower than that of pigs fed the maize starch diets. Dietary bulkiness did not affect physical activity. The effect of fiber-rich diets (nonstarch polysaccharides) on activity in growing group-housed pigs seems to be related to fermentation in the gastrointestinal tract, and not to bulkiness (volume).

[Penis fracture]. / Penisfraktur.

Fracture of the penis is a rare condition caused by blunt trauma to the erect penis resulting in tearing of the tunica albuginea. The injury occurs mainly during sexual intercourse or as a result of forceful manipulation. Two cases are described. Diagnosis is based on the patient's narrative and the clinical findings. One patient was treated by immediate surgery, while the other was treated by corrective surgery for his disabling posttraumatic penile deformity. Based on available literature and our own observations we recommend immediate surgical repair in order to avoid serious complications.