Phase IB study of sorafenib in combination with gemcitabine and cisplatin in patients with refractory solid tumors.

PURPOSE: Sorafenib (BAY 43-9006), a multikinase inhibitor, has been shown to inhibit tumor growth and tumor angiogenesis by targeting Raf kinase, vascular endothelial growth factor receptor, and platelet-derived growth factor receptor. This study investigated the safety, pharmacokinetics, and preliminary efficacy of sorafenib in combination with gemcitabine and cisplatin. METHODS: Patients with advanced solid tumors were treated with 75 mg/m(2) cisplatin on day 1 and 1,250 mg/m(2) gemcitabine on days 1 and 8 of each 21-day cycle. On day 5 of cycle 1, sorafenib 400 mg twice daily was started and continued throughout the complete treatment cycles without interruption. RESULTS: Nineteen patients were valid for safety analysis. The most frequent toxicities related to the cytotoxic agents were hematological disorders. Sorafenib-related toxicities were skin-related, gastrointestinal, and constitutional symptoms. No clinically relevant pharmacokinetic drug-drug interaction between sorafenib, cisplatin, and gemcitabine was detected. AUC(0-72) and C (max) of total and unbound platinum were only marginally changed by concomitant sorafenib. Concomitant sorafenib increased mean AUC and C (max) of gemcitabine by 12 and 21%. CONCLUSIONS: Sorafenib as continuous oral treatment in combination with gemcitabine and cisplatin demonstrated an acceptable safety profile. No clinically relevant pharmacokinetic interaction was detected. Preliminary antitumor activity, pharmacokinetic, and safety data support the recommendation of 400 mg sorafenib twice daily in combination with cisplatin and gemcitabine to be further evaluated in clinical studies.

Allogeneic CD34-enriched peripheral blood stem cell transplantation in a patient with paroxysmal nocturnal haemoglobinuria.

Paroxysmal nocturnal haemoglobinuria (PNH) is an acquired clonal disorder of haematopoietic stem cells associated with a somatic mutation in the phosphatidylinositol glycan complementation class A (PIG-A) gene. The only curative option is an allogeneic stem cell transplant (SCT), although treatment is hazardous. A 46-year-old male patient with PNH and obvious signs of severe, progressive haemolysis was transplanted in July 2002 with highly purified CD34 T-cell depleted peripheral blood stem cells from his HLA-identical brother. Prior to transplantation, the PNH was resistant to immunosuppressive therapy. The patient received 6.1 x 10(6)/kg bodyweight CD34-positive cells with a proportion of CD3-positive cells of 0.81 x 10(4)/kg bodyweight. After engraftment, 12 days post transplant (neutrophils>1.0/nl) the patient's physical condition steadily improved and parameters of haemolysis decreased. No glycophosphatidylinositol-deficient cells in peripheral blood could be detected by flow cytometry 40 and 100 days after transplant. We conclude that PNH may be cured by allogeneic CD34-enriched SCT from a sibling donor attempting to avoid acute GVHD and to reduce cumulative organ toxicity by using this transplantation modality.

Transplantation of highly purified HLA-identical sibling donor peripheral blood CD34+ cells without prophylactic post-transplant immunosuppression in adult patients with first chronic phase chronic myeloid leukemia: results of a phase II study.

The feasibility of transplantation using highly purified G-CSF-mobilized peripheral blood CD34+ cells from HLA-identical sibling donors without prophylactic post-transplant immunosuppression was prospectively studied in 10 adult first chronic phase chronic myeloid leukemia (CML) patients with special reference to graft engineering performance and follow-up studies of minimal residual disease and immune reconstitution. CD34+ cells were enriched by clinical-scale magnetic-activated cell separation (MACS) using iron-dextran beads bound to monoclonal anti-CD34 antibody. Grafts contained a median of 9.7 (range 1.7-16.6) x 10(6) CD34+ cells per kilogram of recipient body weight with a purity between 94.5% and 98.3% (median 97.2%). The median number of transfused CD3+ T lymphocytes was 1.0 (range 0.5-8.5) x 10(4)/kg, corresponding to a log10 T lymphocyte depletion between 3.8 and 5.0 (median 4.6). All patients engrafted rapidly with a median duration to neutrophil counts >500/microl of 8 (range 8-19) days and to self-sustaining platelet counts >20,000/microl of 12 (range 9-25) days. Isolated skin acute graft-versus-host disease (GVHD) of stages I to II occurred in three patients. One patient developed secondary graft failure and was successfully salvaged by an unmanipulated blood stem cell graft from the same donor. All 10 patients are surviving in complete hematologic, cytogenetic and molecular remission (four patients after donor lymphocyte infusions) between 12 and 22 (median 16) months post transplant. In conclusion, transplantation of MACS-purified blood CD34+ cells from HLA-identical sibling donors in adult CML patients appears safe, effectively prevents acute GVHD without prophylactic post-transplant immunosuppression, and is capable of inducing complete cytogenetic and molecular remissions.

Unique alterations of thyroid function parameters after i.v. administration of alkylating drugs (cyclophosphamide and ifosfamide).

Alkylating drugs (cyclophosphamide and ifosfamide) have been in clinical use for the treatment of malignant diseases in the past. They are most useful anticancer agents and cyclophosphamide is also widely used for its immunosuppressive properties. However the effect of alkylating drugs on thyroid hormone parameters have not been evaluated so far. Three groups of patients were prospectively evaluated: Group I: 15 patients with Wegener's granulomatosis and 4 patients with severe scleritis received a single dose cyclophosphamide (15 mg/kg bw/day) and 250 mg prednisone i.v. Group II: 9 patients with malignant lymphomas were treated according to the IMVP 16-protocol. Patients received daily ifosfamide 1000 mg/m2 from day 0 to 4 and vepesid from day 0 to 2. Patients did not receive corticosteroids additionally. Group III: 6 patients with a relapse of malignant lymphomas received ifosfamide 1.500 mg/m2/day from day 0 to 4 i.v. and dexamethasone 40 mg/m2 as well as ara-c and etoposid. All patients received mesna to prevent hemorrhagic cystitis and odansetran or metoclopramide as antiemetic drugs. Alkylating drugs were given as a one hour infusion. Thyroid hormone parameters were determined before and on day 1, 2, 3, 4 after drug administration. We observed a significant increase in T4 and fT4 concentrations and a concomitant fall in TSH in either group one day after the administration of alkylating drugs. The effect was most pronounced in group III: T4 increased from 113 +/- 8 nmol/L to 175 +/- 8 (normal: 58-154) and fT4 from 14.0 +/- 0.8 to 24.8 +/- 2.5 pmol/L (normal 10-25). TSH dropped from 1.27 +/- 0.16 to 0.33 +/- 0.07 mU/L (normal 0.3-4). All changes were significant: p < 0.001. Two of the six patients displayed biochemical hyperthyroidism. Also reverse T3 increased significantly. Two days after drug administration a gradual normalization occurred. However, T3, Tg, TBG, Transthyretin and albumin levels did not change throughout the study period. One patient with coexisting hypothyroidism, who received his last thyroxine substitution therapy one day before the administration of cyclophosphamide (as in group I), also demonstrated an increase in T4, fT4 and rT3 and a fall in TSH concentrations. I.v. administrations of cyclophosphamide and ifosfamide induce a transient increase in T4 and fT4 concentrations and a concomitant fall of TSH in the presence of normal Tg, T3 and thyroid binding protein concentrations. These data suggest, that the changes are not due to a release of thyroid hormones from the thyroid itself, but is likewise related to a release of thyroxine from cellular pools such as the liver.

Significant changes in thyroid hormone parameters after a four week recreation period at the North Sea without alterations of iodine intake.

UNLABELLED: Many studies have been carried out evaluating thyroid hormone parameters in patients suffering from various illnessess. However data on thyroid function after a recreation period are missing. Therefore we evaluated thyroid hormone parameters in 178 patients (mostly suffering from chronic obstructive lung disease) undergoing a four week recreation period in a health spa on the island Borkum at the North Sea. We observed a subtle, but significant increase in basal TSH concentrations from 1.20 mU/l (median) to 1.50 mU/l; (p<0. 001) and a fall in T4 values from 97.5 +/- 17.7 nmol/l (mean +/- SD) to 90.3 +/- 17.0 (p<0.001) and T3 from 2.21 +/- 0.33 nmol/l to 2.09 +/- 0.33 (p<0.001). However no increase in iodine intake occurred during the four weeks: median iodine excretion 61 microg iodine/g creatinine at the beginning vs 65 microg iodine/g creatinine at the end. IN CONCLUSION: a recreation period at the North Sea is associated with subtle but significant changes in thyroid hormone parameters. However no increase in iodine intake occurs during the four week observation period.

Rapamycin antagonizes interleukin-6 mediated growth arrest and differentiation of myeloblastic M1 cells.

The immunosuppressant rapamycin is known to be a potent inhibitor of cytokine driven proliferation of T-lymphocytes and other cell types. Here we have examined the effect of rapamycin on the myeloblastic cell line M1 which responds to interleukin-6 (IL-6) with growth arrest and monocytoid differentiation. Single-agent rapamycin led to a retardation of M cell growth. In spite of this intrinsic antiproliferative effect, rapamycin was found to abrogate IL-6 induced growth arrest. Concomitant exposure to rapamycin and IL-6 also reduced the extent of monocytoid differentiation as compared to treatment with IL-6 alone. Excess levels of the FK-506 analogue ascomycin reversed the antagonistic effect of rapamycin on IL-6 mediated growth suppression, suggesting that this biological action of rapamycin is mediated by a rapamycin/immunophilin complex. The findings demonstrate that rapamycin can also act as an antagonist of cytokine induced growth arrest and differentiation.

High-affinity binding of crustacean hyperglycemic hormone (CHH) to hepatopancreatic plasma membranes of the crab Carcinus maenas and the crayfish Orconectes limosus.

The binding properties of the crustacean hyperglycemic hormone (CHH) of two species, the shore crab, Carcinus maenas (Brachyura) and the crayfish, Orconectes limosus (Astacura), were investigated using purified plasma membranes of one of the main target organs, the hepatopancreas. Assays were performed under equilibrium binding conditions with 125I-CHH as labeled ligand and unlabeled CHH in increasing concentrations as displacing ligand. In both cases, comparable binding characteristics were observed for the homologous CHH to the respective hepatopancreatic membrane source, indicating saturable and displaceable binding with nonlinear dependence on monovalent cations and a dissociation constant (Kd) of 4 to 6 x 10(-10) M. Binding capacity was in the range of 200-400 fmol/mg membrane protein. In heterologous displacement studies a certain degree of species specificity was found, particularly with regard to selective binding by the Orconectes receptor, suggesting that the group specificity of biological activity of CHH reflects coevolution of both hormone and receptor.

Opposite sensitivity to the antiproliferative action of interferon-alpha and granulocyte-macrophage colony-stimulating factor in monoblastic U937 cells.

Three variants of the human monoblastic cell line U937 with different degrees of sensitivity to the antiproliferative action of interferon-alpha (IFN-alpha were examined for phenotypic differences. The highly IFN-sensitive variant U937-V expressed twice as many IFN-alpha binding sites as both its IFN-alpha-resistant derivative U937-VR and the cell line U937 exhibiting a 20-fold reduction in IFN-alpha sensitivity as compared to U937-V cells. All three variants were IFN-reactive with regard to induction of 2',5'-oligoadenylate (2-5A) synthetase activity and were similarly sensitive to the growth-inhibiting action of IFN-gamma and tumor necrosis factor. Responsiveness to the antiproliferative effect of granulocyte-macrophage colony-stimulating factor (GM-CSF), however, was confined to cell lines U937 and U937-VR. Although expressing a comparable number of GM-CSF receptors, the highly IFN-sensitive variant U937-V was refractory to GM-CSF. Flow cytometry revealed a marked difference in the expression of the antigen CD11b which was detectable on 85% of cells of the U937-V line but only on approximately 25% of cells derived from the U937 and U937-VR lines. Results thus demonstrate opposite sensitivity of U937 cells to the growth-inhibiting action of IFN-alpha and GM-CSF, apparently dependent on the state of U937 differentiation as determined by expression of the CD11b antigen.

Relation between leukocyte counts and cortisol secretion in CML patients undergoing combined TNF alpha/IFN alpha therapy.

During long-term interferon alpha-2b (IFN) therapy of Philadelphia chromosome-positive chronic myelogenous leukemia (CML) patients, short-term effects of tumor necrosis factor alpha (TNF) on peripheral leukocyte counts, as well as cortisol and corticotropin (ACTH) release were studied. TNF (40-160 micrograms/m2) was given as a 2-h infusion on 5 consecutive days every 3 weeks, in addition to s.c. daily IFN injections (4 mio U/m2), to four (two male/two female) patients, who had been treated for more than 8 months with IFN and additionally for 0-7 months with TNF. Leukocyte counts, cortisol, and ACTH were determined at 30-min intervals between 4 p.m. and midnight. Profiles were determined the day before and on day 1 of TNF therapy. Leukocyte numbers decreased 30 min after start of TNF administration and increased 30-60 min later with a rebound until the next TNF application. The increase of leukocyte counts was due mostly to neutrophil granulocytes. ACTH levels increased 30 min, cortisol 60 min, and leukocyte counts 90 min after start of TNF infusion. Metopirone, an inhibitor of cortisol synthesis given to one patient, suppressed the TNF-induced stimulation of cortisol secretion and subsequent increase of leukocyte counts, while ACTH blood levels were enhanced. It was concluded that leukocyte count increases after TNF/IFN administration might be related to TNF-evoked cortisol secretion.

Induction of 2'-5' oligoadenylate synthetase during interferon treatment of chronic myelogenous leukemia.

Activity of the interferon-induced enzyme 2'-5' oligoadenylate synthetase (2-5 OAS) was measured in peripheral blood mononuclear cells (PBMCs) and serum of patients with chronic phase Ph'-positive chronic myelogenous leukemia (CML) treated with interferon-alpha (IFN-alpha) (4 x 10(6) IU/m2) alone or in combination with 50 micrograms IFN-gamma. At the beginning of IFN therapy, marked elevation of 2-5 OAS titers was detected in PBMCs (pretreatment 0.03-1.62, median 0.2; during treatment 0.8-13.14, median 4.31; 22 patients studied) and in serum (pretreatment 21-156 pmol/dl, median 62; during treatment 532-1740 pmol/dl, median 800; eight patients studied). However, 2-5 OAS titers were not related to clinical outcome or IFN therapy and also during IFN resistance elevated 2-5 OAS activity in PBMCs (median 3.45; range 1.05-13.14; 11 patients studied) were detected. These data argue against direct involvement of the 2-5 OAS system in the therapeutic effect of IFN in CML. However, 2-5 OAS titers in PBMCs or serum appear to be a reliable control of biologically active IFN therapy.

Tumor necrosis factor alpha modifies resistance to interferon alpha in vivo: first clinical data.

Patients with Philadelphia-positive chronic-phase chronic myelogenous leukemia (CML) resistant to interferon (IFN) alpha were treated in a phase I/II study with recombinant human tumor necrosis factor alpha to overcome IFN alpha resistance. Doses of 40, 80, 120 or 160 micrograms/m2 TNF alpha were given as 2-h infusions on 5 consecutive days every 3 weeks. IFN alpha (4 x 10(6) IU/m2 s.c., daily) treatment was continued. Six patients were treated, completing 1-24 (median, 12) treatment cycles. Five of the six patients achieved partial hematological remission, while the remaining patient had to stop treatment because of WHO grade 4 thrombocytopenia following the first TNF alpha cycle. No complete hematologic remission or cytogenetic improvement was seen. Side-effects were similar to those described for both substances alone. Maximum tolerable TNF doses usually varied between 80 micrograms/m2 and 160 micrograms/m2. To examine possible pathways of TNF activity in these patients, interferon receptor status and (2'-5')-oligoadenylate synthetase levels were examined in peripheral blood mononuclear cells. Both parameters remained unchanged during TNF alpha treatment. These preliminary data point to significant clinical efficacy of additionally applied TNF alpha in IFN alpha-resistant CML patients.

[Assessment of diagnostic lung function and diagnostic laboratory parameters in workers exposed to diesel exhaust below ground in comparison with non-exposed workers]. / Untersuchungen zur Beurteilung lungenfunktionsdiagnostischer und labordiagnostischer Parameter bei Dieselabgasexponierten unter Tage im Vergleich zu Nichtexponierten.

Toxic gases caused by the use of large Diesel-driven devices in underground mines may lead to impairment of health, especially in the respiratory system. By means of occupational hygiene supervision it may be checked if the effectiveness of accomplished occupational hygiene measures are sufficient. By an enlarged examination programme of the respiratory function and laboratory diagnostic investigation miners exposed to Diesel-exhaust-gas were compared within the above mentioned supervision with a non-exposed population. In this study was not found any difference between the respiratory results attributed to influence of Diesel-exhaust-gas. Among the laboratory parameters the exposition to Diesel-exhaust-gas will only affect the mercapturic acid, however, which also may be influenced by other factors. Under the conditions of the measured low degree of exposition was not found any correlation between the level of mercapturic acids and the duration of exposure as well as to the actual degree of exhaust-gas exposition.

[Assessment of diagnostic lung function parameters in underground workers exposed to diesel gas]. / Untersuchungen zur Beurteilung lungenfunktionsdiagnostischer Parameter bei Dieselabgasexponierten unter Tage.

Evaluations of lung function parameters were carried out in underground miners with outstanding exposition to diesel exhaust by diesel-driven machines. Data obtained over a three year period were compared with the results of a non-exposed population. There were no differences between both groups following to the influence of diesel exhaust.

[Effect of physical stress on airway resistance determined by oscillometry]. / Der Einfluss physischer Belastung auf die oszillatorisch gemessene Resistance.

For evaluation of reference values of airway resistance measured by forced oscillation technique (Ros) in connection with physical exercise, 193 healthy persons were examined. In this study could be shown that reference values measured at rest are also valid under exercise conditions to find out functional disorders.

[Results of an epidemiologic analysis on the pathogenesis of chronic obstructive bronchitis in miners]. / Ergebnisse einer epidemiologischen Analyse zur Pathogenese der chronisch obstruktiven Bronchitis des Bergmannes.

An epidemiological evaluation of chronic obstructive bronchitis in miners showed that smoking ranges in first place in the aetiopathogenesis. In addition, after prolonged underground exposure, the irritating nuisance of the respiratory tract must be considered as causal cofactor.

[Correlation between average pulmonary artery pressure under rest and stress conditions in relation to the stage of silicosis]. / Zusammenhang zwischen den Pulmonalarterienmitteldrucken unter Ruhe- und Belastungsbedingungen in Abhängigkeit vom Silikosestadium.

The value of measuring the median pressure of the pulmonary artery for the prognosis of silicosis remains undebatable since the development of pulmonary heart disease has multifactorial causes and extreme interindividual variations. On the other side, during the course of silicosis disease, the increase of pressure is relatively small or even absent during years. Thus, measuring of mean pulmonary artery pressure is only required at larger intervals.

[Possibility for using microcomputers for the storage and evaluation of spirographic data]. / Eine Möglichkeit der Nutzung von Mikrorechnern zur Speicherung und Auswertung von spirographischen Daten.

The recent advent of microcomputers offers a possibility and challenge to use them for data acquisition, storage and analysis. The paper describes a simple program which allows to analyze and storage the spirometric data. The program was written in BASIC-80 so that it could be easily modified and extended. A microcomputer MC 80 was used.

[An electronic data processing program for respiratory function diagnosis with the KRS 4201 computer]. / Ein EDV-Programm für die Atemfunktionsdiagnostik mit dem Rechner KRS 4201.

The computer program LSD 1 published in 1973 which was used for daily processing of lung function data in a number of hospitals is at present realized on the computer KRS 4 201. In the last years new reference values and new valuations of parameters lead to changed and more complete programs. The here presented new program is based consequently in magnetic files from data input with DEG 1 370 to output of the computed parameters. It concludes new reference values and SI-units also. With the computer KRS 4 201 parameters were corrected and computed, respectively, derivated diagnostic valuations were printed out and all data stored by magnetic files.