Prognostic factors associated with response in platinum retreatment of platinum-resistant ovarian cancer.

The goal of this study was to determine the factors associated with response to platinum retreatment in patients with platinum-resistant ovarian cancer. A review of patients with epithelial ovarian cancer retreated with cisplatin or carboplatin between 2002 and 2004 was performed. The platinum-free interval (PFI) and treatment-free interval (TFI) were determined for each patient. Response was based on serial CA125 levels using a modification of the Rustin criteria. Patients with clinical benefit ([CB] those who attained at least stable disease) were compared to patients with disease progression (PD). An analysis was performed to determine factors associated with CB in platinum-resistant patients retreated with platinum. Of 48 patients identified, 37 were evaluable included in this analysis. CB was observed in 27 (73%) while disease progression was noted in 10 (27%) women. The PFI was longer in those women who achieved CB (12.3 vs 6.9 months; P = 0.02). The TFI was 7.1 months for patients benefited from platinum retreatment vs 3.5 months for those with disease progression (P = 0.06). There was no statistically significant difference in the number of cytotoxic agents between the time of platinum retreatment and the prior platinum regimen (2 vs 1.5 months; P = 0.61). A prolonged PFI was associated with an improved chance of achieving CB with platinum retreatment. There was no association between the response to platinum retreatment and the number of intervening cytotoxic agents utilized. Further prospective study is warranted to define the optimal timing of platinum retreatment.

A multi-institutional evaluation of factors predictive of toxicity and efficacy of bevacizumab for recurrent ovarian cancer.

While bevacizumab has shown activity in recurrent ovarian cancer, a higher than expected incidence of bowel perforations has been reported in recent trials. We sought to determine factors associated with toxicity and tumor response in patients with relapsed ovarian cancer treated with bevacizumab. A retrospective review of patients with recurrent ovarian cancer treated with bevacizumab was undertaken. Response was determined radiographically and through CA125 measurements. Statistical analysis to determine factors associated with toxicity and response was performed. Sixty-two eligible patients were identified. The cohort had received a median of 5 prior chemotherapy regimens. Single-agent bevacizumab was administered to 12 (19%), while 50 (81%) received the drug in combination with a cytotoxic agent. Grade 3-5 toxicities occurred in 15 (24%) patients, including grade 3-4 hypertension in 4 (7%), gastrointestinal perforations in 7%, and chylous ascites in 5%. Development of chylous ascites and gastrointestinal perforations appeared to correlate with tumor response. The overall response rate was 36% (4 complete response, 17 partial response), with stable disease in 40%. A higher objective response rate was seen in the bevacizumab combination group compared to single-agent treatment (43% vs 10%) (P = 0.07). However, 29 grade 3-5 toxic episodes were seen in the combination group vs only 1 in the single-agent bevacizumab cohort (P = 0.071). We conclude that bevacizumab demonstrates promising activity in recurrent ovarian cancer. The addition of a cytotoxic agent to bevacizumab improved response rates at the cost of increased toxicity. Gastrointestinal perforations occurred in 7%. The perforations occurred in heavily pretreated patients who were responding to therapy.

Increased risk for abnormalities on perioperative colon screening in patients with microsatellite instability-positive endometrial carcinoma.

Microsatellite instability (MSI) is a feature of certain hereditary and sporadic endometrial and colon cancers. We set out to determine whether molecular stratification of endometrial cancers based on tumor MSI status could help identify patients at increased risk for abnormalities found on perioperative colon screening. From a prospectively accrued series of 413 patients, medical records were reviewed from 94 patients with MSI positive (MSI+) and 94 patients with MSI negative (MSI-) endometrial cancers, matched by year of diagnosis. We reviewed clinicopathologic data and results of perioperative colon screening. Differences were analyzed using Fisher exact test and logistic regression analysis. There were no significant clinicopathologic differences between the two cohorts. Sixty-five percent of patients in each group underwent perioperative colon screening. However, patients with MSI+ cancers had a twofold increase in the frequency of colonic abnormalities (30% versus 14.8%, P = 0.044) over those with MSI- cancers. Furthermore, the only primary colon cancers (N = 2) were found in women with MSI+ endometrial cancers that were unmethylated at the MLH1 promoter. Our data suggest that patients with MSI+ endometrial cancers are at increased risk for abnormalities on perioperative colon screening. Those with MSI+MLH1 unmethylated cancers appear to be at highest risk.

Use of diphenylamine in the detection of apoptosis.

The diphenylamine assay is a very useful tool in measuring apoptosis by determining the percentage of fragmentation of known amounts of DNA into oligosomal-sized fragments. Another advantage of the diphenylamine assay is that apoptotic DNA fragmentation can be analyzed in both adherent and shed cells following treatment or experimentation. Data obtained from the experiment are expressed as a percentage relative to uninduced or untreated controls. This assay was first described by Dische (1,2) in the 1930s and later modified by Burton (3) in the mid-1950s. These modifications have resulted in an enhanced sensitivity of up to five times by adding sulfuric acid and acetaldehyde, and by allowing the colorimetric reaction to develop overnight at room temperature. These changes have also resulted in a reduction of the interference from other substances that were an initial drawback with the originally described method, further enhancing the sensitivity of the assay. The diphenylamine reaction takes advantage of the bonds between purines and deoxyribose, which are very labile. Once these bonds are broken, inorganic phosphates are liberated from the DNA and provide the substrate, which is measured by the reaction. The overall preparation time is approximately 3 h for 30 samples with incubation occurring overnight for 12 to 16 h. Reading of the results takes approximately 1 min per sample. This assay has been used to detect apoptotic fragmentation by others, and more recently by our group to evaluate cisplatin and Taxol induced fragmentation in ovarian carcinoma cell lines (4).

Taxol-induced bcl-2 phosphorylation in ovarian cancer cell monolayer and spheroids.

Expression of Bcl-2, Bax, p53 and induction of apoptosis were studied in cisplatin or Taxol treated monolayer and spheroid cultures of ovarian cancer cell lines (SKOV-3, UL-1, UL-3C). While cisplatin (15-75 microg/ml) induced apoptosis in monolayer and spheroid cultures, Taxol (100-800 nM) induced fragmentation in monolayers only. Cisplatin induced up to 5-fold DNA fragmentation in monolayers, while 3-fold (UL-3C, SKOV-3), and 1.5-fold (UL-1) in spheroids. Taxol treatment of monolayers resulted in the characteristic phosphorylation of Bcl-2, which was not demonstrated in spheroid cultures. Bax expression was reduced in spheroids following cisplatin or Taxol treatment, while p53 levels remained unchanged.

Endometrial stromal sarcoma involving the placenta.

This report presents two cases of endometrial sarcoma tumor detected in decidua submitted with placentas for pathologic evaluation. The first patient had low-grade endometrial stromal sarcoma discovered in the omentum and decidua at the time of a cesarean section for placenta previa. The second patient underwent a cesarean section for breech presentation and was noted to have a mass beneath the placenta that was histologically compatible with low-grade endometrial stromal sarcoma. We believe these to be the first reported cases of endometrial stromal sarcoma involving the decidua. These findings should elevate awareness that endometrial stromal tumors may be detected during placental examination.

Inhibition of endometrial cancer cell lines by mifepristone (RU 486).

OBJECTIVE: To determine the role of mifepristone (RU 486) in the growth of endometrial cancer cell lines, and the mechanism associated with this regulation. METHODS: Three endometrial cancer cell lines (Hec-1A, KLE, and RL95-2) were used in this study. Growth inhibition was demonstrated by sulforhodamine B cytotoxicity assay. Mode of inhibition by RU 486 was studied by induction of DNA fragmentation. The effect of RU 486 on steady-state accumulation of the progesterone and glucocorticoid receptors (PRs and GRs, respectively) and apoptosis-associated gene products was studied by Western blotting. RESULTS: We demonstrated a dose-dependent inhibition of growth in all of the three endometrial cancer cell lines. Following treatment with 5.0 micrograms/mL of RU 486, there was 39.3%, 66.3%, and 75.5% inhibition of KLE, Hec-1A, and RL95-2 cells, respectively. Decreased expression of GR in RL95-2 (0.1-10 micrograms/mL) and in KLE cells (10 micrograms/mL) was observed. A marked decrease of PR was seen with RL95-2 cells at 10 micrograms/mL, there was no change in the KLE cells, and a dose-dependent decrease was seen with Hec-1A cells. Various levels of apoptosis were demonstrated by DNA fragmentation in all three cell lines. Of the genes associated with apoptosis, dose-dependent reduction of bax expression was demonstrated in KLE cells, while induction of WAF-1 was seen in Hec-1A and RL95-2 cells, and reduction of bcl-2 was demonstrated in RL95-2 cells. CONCLUSION: Clinically achievable doses of RU 486 inhibit endometrial cancer cell lines. The mechanism of inhibition involves apoptosis, and regulation of bax, bcl-2, and WAF-1 is demonstrated. Therapeutic application of these findings remains to be determined.

Identification of a unique form of p53 in human cord blood associated with the development of maternal autoantibodies.

PROBLEM: The possible link between p53-reactive antibodies in multiparous women and exposure to a unique p53 protein during pregnancy was examined. METHOD OF STUDY: p53-reactive antibodies were evaluated in sera from nulligravid and multiparous women and patients with ovarian cancer by Western immunoblot. Furthermore, the presence of p53 protein was assayed in cord blood by enzyme-linked immunosorbent assay. Cord blood-derived p53 was compared structurally by protein fingerprinting and functionally by gel mobility shift assay to other isolates of p53. RESULTS: Antibodies reactive with wild-type p53 were observed in 92% of multiparous women and 42% were reactive with one tumor-derived p53 protein. p53 protein was detected in 27 of 154 samples of cord blood. Structural analysis indicated that the fetal p53 resembled the UL-1 p53. Functionally, the fetal and UL-1 protein failed to bind DNA. CONCLUSIONS: Fetal p53 protein seems to be distinct from wild-type p53, characterized by enhanced stability, structural differences and inability to bind DNA, analogous to alternatively spliced variants. Exposure to fetal p53 protein may form the basis for immunologic protection against cancer induced by multiparity.

Lymphokine-activated killer (LAK)-mediated lysis of sequentially isolated ovarian cancer cell lines.

PROBLEM: Understanding immunologic eradication of cancer is hampered by failure to explore tumor evolution. Cell surface molecules may alter with therapy and disease progression. These alterations can translate into variable susceptibility to immune-mediated cell lysis. METHOD OF STUDY: Cell lines from a patient with ovarian carcinoma isolated at surgical debulking (UL-3A), during chemotherapy (UL-3B), and after progression (UL-3C) were used to study changes in cell lysis by natural killer (NK) and lymphokine-activated killer (LAK) cells. The role of adhesion molecules ICAM-1, LFA-3, and glycoproteins in the demonstrated differential killing was also examined. RESULTS: An inverse relationship between attachment and lysis was demonstrated. UL-3C, the most sensitive to lysis (50%), attached the least lymphocytes (40%), whereas UL-3A, the least sensitive (33%), attached the most lymphocytes (71%). A correlation with ICAM-1 and LFA-3 expression was not demonstrated. CONCLUSION: Ovarian cancer cells evolve throughout the disease course, and this may manifest as differential sensitivity to immune-mediated cell lysis.

Apoptosis as a measure of chemosensitivity to cisplatin and taxol therapy in ovarian cancer cell lines.

OBJECTIVE: Cisplatin- and Taxol-induced apoptosis was studied in four human ovarian cancer cell lines to evaluate apoptosis as a measure of chemosensitivity. METHODS: In vitro sensitivities of OVCAR-3, SKOV-3, UL-1, and UL-2 cells to cisplatin or Taxol were determined by the sulforhodamine B assay. Induction of apoptosis was studied by DNA fragmentation following treatment with cisplatin and/or Taxol after 24- and 48-hr exposure. DNA fragmentation was further quantitated by the diphenylamine assay and the proportion of cells in the G1, G2/M, and S phase of the cell cycle was determined by flow cytometry. Presence of the p53 gene product was examined by Western blotting. RESULTS: The four cell lines represent various sensitivities to cisplatin and Taxol (LD50 range for cisplatin, 5-30 microg/ml; Taxol, 30-1000 nM). UL-2 represents a resistant cell line which was 10-30 times resistant to Taxol and 6 times resistant to cisplatin when compared to the others. Demonstration of apoptosis correlated with the sensitivity of the cell lines to both cisplatin and Taxol for OVCAR-3 and UL-2. DNA fragmentation of OVCAR-3 was uniformly present when treated with cisplatin or Taxol, at 24 or 48 hr. UL-2 demonstrated no apoptosis after 24 or 48 hr of treatment with either cisplatin or Taxol. When sequencing experiments were performed with cisplatin and Taxol, DNA fragmentation correlated with the cytotoxicity assays, except in UL-1 cells where no significant difference was observed in different interactions of cisplatin and Taxol. Pretreatment with Taxol generally resulted in enhanced cytotoxicity in a schedule-dependent manner, and increased fragmentation was demonstrated; cisplatin pretreatment consistently resulted in decreased fragmentation. Quantitation of the fragmented DNA correlated with that seen on gel electrophoresis. OVCAR-3 and UL-1 demonstrated the greatest change from baseline at 24 hr (3.8 and 3.7 times baseline, respectively), whereas UL-2 had little change from the baseline following treatment. G1 arrest occurred more readily in OVCAR-3 and SKOV-3 cells. UL-2 cells had very little change in the proportion of cells entering G1 arrest, but had a significant increase in the G2/M proportion. In OVCAR-3, UL-1, and UL-2 cells, we demonstrated the presence of an aberrantly expressed p53 gene product, while no p53 was detected in the SKOV-3 cells. CONCLUSIONS: Our findings indicate that the ability to achieve significant cytotoxicity by cisplatin and Taxol may be directly related to the induction of apoptosis; however, cellular and genetic characteristics determine the eventual outcome of these treatments.