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1.
Clin Cancer Res ; 17(22): 7183-93, 2011 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-21976532

RESUMEN

PURPOSE: To investigate the associations between baseline and posttreatment circulating tumor cell (CTC) gene expression and outcome of patients enrolled in four North Central Cancer Treatment Group metastatic breast cancer (MBC) trials in which specimens were shipped (at 4°C) from community-based sites to a reference laboratory (Mayo Clinic, Rochester, MN). EXPERIMENTAL DESIGN: Blood was collected at treating sites from MBC patients before (baseline), during, and at the end of treatment with erlotinib + gemcitabine (N0234), sorafenib (N0336), irinotecan + cetuximab (N0436), or paclitaxel-poliglumex + capecitabine (N0437). CTCs from 10 mL of EDTA blood were enriched with CD45 depletion, 24 to 30 hours postblood collection. Reverse transcription/quantitative PCR was used to determine cytokeratin-19 (CK19) and mammaglobin (MGB1) mRNA levels in CTCs from up to 13 (N0234), 16 (N0336), 18 (N0436), and 39 (N0437) patients. The gene expressions were normalized to ß(2)-microglobulin and calibrated to healthy blood using the 2(-ΔΔCq) algorithm; positivity was defined as 2 or more. RESULTS: CK19+mRNA cells were detected in 56% to 75% and MGB1+mRNA cells in 23% to 38% of 86 patients at baseline. CK19+mRNA cells were detected in 30% to 67% and MGB1+mRNA cells in 14% to 64% of 110 postbaseline serial samples. The presence of baseline CK19+mRNA cells (P = 0.01) but not MGB1+mRNA cells (P = 0.14) was significantly associated with shorter overall survival. A decrease in MGB1+mRNA levels (baseline-week 8) seemed to be associated with clinical response (P = 0.05). CONCLUSIONS: CTC gene expression analysis conducted by a reference laboratory is feasible when blood is collected from treating sites and processed 24 to 30 hours postcollection. The presence of baseline CK19+mRNA CTCs was associated with poor prognosis; a decrease in MGB1+mRNA CTCs may help predict response to therapy of MBC patients.


Asunto(s)
Neoplasias de la Mama/genética , Queratina-19/genética , Mamoglobina A/genética , Células Neoplásicas Circulantes/metabolismo , Adulto , Anciano , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Femenino , Expresión Génica , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Pronóstico , ARN Mensajero/análisis , Resultado del Tratamiento
2.
Am J Hematol ; 84(12): 795-8, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19894247

RESUMEN

No published survey has specifically addressed the beliefs, knowledge, and usage of complementary and alternative medicine (CAM) in long-term (5-20 years) lymphoma survivors alone. In this pilot project, 95 subjects were randomly selected from a population of 2,475 long-term lymphoma survivors and mailed a questionnaire. The median time from lymphoma diagnosis to completion of the questionnaire was 11 years (range 6-20). Overall, 68% (95% CI: 54-80%) of the long-term lymphoma survivors reported that they have used CAM, a rate higher than the estimated usage rate reported for the general population The most commonly used modalities were chiropractic (39%, 95% CI: 27-53%) and massage therapy (21%, 95% CI: 12-34%). Less than 10% used meditation (5%, 95% CI: 1-15%) and relaxation (7%, 95% CI: 2-17%). In terms of common herbal usage, 5% (95% CI: 1-15%) had used St. John's Wort and 7% (95% CI: 2-17%) had used shark cartilage. Although none of the patients reported that CAM usage was directed specifically towards treating their lymphoma, 4% (95% CI: 0-12%) of patients reported that CAM could cure cancer, and 14% (95% CI: 6-26%) reported that CAM could increase their feeling of control over their health. This pilot study suggests that long-term lymphoma survivors appear to use CAM at a rate higher than the general population. The use of potential agents of risk by the survivors and the lack of access to potentially beneficial modalities highlights the need for further study of CAM in this population.


Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Linfoma , Sobrevivientes/estadística & datos numéricos , Adolescente , Adulto , Anciano , Terapias Complementarias/psicología , Recolección de Datos , Utilización de Medicamentos , Femenino , Humanos , Linfoma/psicología , Linfoma/terapia , Masculino , Persona de Mediana Edad , Terapias Mente-Cuerpo/psicología , Terapias Mente-Cuerpo/estadística & datos numéricos , Manipulaciones Musculoesqueléticas/psicología , Manipulaciones Musculoesqueléticas/estadística & datos numéricos , Panácea/uso terapéutico , Fitoterapia/psicología , Fitoterapia/estadística & datos numéricos , Proyectos Piloto , Preparaciones de Plantas/uso terapéutico , Calidad de Vida , Terapias Espirituales/psicología , Terapias Espirituales/estadística & datos numéricos , Encuestas y Cuestionarios , Sobrevivientes/psicología , Terapéutica/efectos adversos , Adulto Joven
3.
J Clin Oncol ; 27(23): 3808-14, 2009 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-19470922

RESUMEN

PURPOSE: To define the optimal dose of Polyphenon E for chronic daily administration and tolerability in patients with chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS: Previously untreated patients with asymptomatic Rai stage 0 to II CLL were eligible for participation. Polyphenon E with a standardized dose of epigallocatechin-3-gallate (EGCG) was administered using the standard phase I design with three to six patients per dose level (range, 400 to 2,000 mg by mouth twice a day). Trough plasma EGCG levels were measured 1 month after initiation of therapy. Response was classified using the National Cancer Institute (NCI) Working Group (WG) Criteria. RESULTS: Thirty-three eligible patients were accrued to dose levels 1 to 8. The maximum-tolerated dose was not reached. The most common adverse effects included transaminitis (33%, all grade 1), abdominal pain (30% grade 1, 0% grade 2, and 3% grade 3), and nausea (39% grade 1 and 9% grade 2). One patient experienced an NCI WG partial remission. Other signs of clinical activity were also observed, with 11 patients (33%) having a sustained > or = 20% reduction in absolute lymphocyte count (ALC) and 11 (92%) of 12 patients with palpable adenopathy experiencing at least a 50% reduction in the sum of the products of all nodal areas during treatment. Trough plasma EGCG levels after 1 month of treatment ranged from 2.9 to 3,974 ng/mL (median, 40.4 ng/mL). CONCLUSION: Daily oral EGCG in the Polyphenon E preparation was well tolerated by CLL patients in this phase I trial. Declines in ALC and/or lymphadenopathy were observed in the majority of patients. A phase II trial to evaluate efficacy using 2,000 mg twice a day began in November 2007.


Asunto(s)
Anticarcinógenos/uso terapéutico , Catequina/análogos & derivados , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Leucemia Linfocítica Crónica de Células B/patología , Administración Oral , Adulto , Anciano , Anticarcinógenos/administración & dosificación , Anticarcinógenos/efectos adversos , Anticarcinógenos/sangre , Catequina/administración & dosificación , Catequina/efectos adversos , Catequina/sangre , Catequina/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Selección de Paciente , , Resultado del Tratamiento
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