Second-line chemotherapy for non-small-cell lung cancer with monthly docetaxel and weekly gemcitabine: A phase II trial

Background:Docetaxel and gemcitabine are active againstchemotherapy-pretreated non-small-cell lung cancer (NSCLC). The purpose ofthis phase II study was to evaluate the efficacy and safety of monthlydocetaxel combined with weekly gemcitabine in NSCLC patients failing one priorregimen. Patients and methods:Forty patients were enrolled. Priorchemotherapy was a platinum-based combination in 36 patients, usingvinorelbine in 26 patients and etoposide in 10 patients. The other fourpatients had prior single agents. Tumors were refractory or resistant tofront-line therapy in 80% of patients. Treatment was gemcitabine 800mg/m² days 1, 8, 15 and docetaxel 100 mg/m² day 1, withcycles repeated every four weeks. Results:Thirteen patients responded (32.5%; 95%confidence interval (CI): 19%–49%), including one completeand 12 partial responses. Responses were observed at all metastatic sites,with similar response frequencies in platinum-sensitive andplatinum-resistant/refractory tumors. The median time to progression forresponders was nine months, with two responses lasting longer than a year.Median survival was 8.1 months. Hematologic toxicities included grade 4neutropenia in 23 patients, with 4 episodes of febrile neutropenia, grade3–4 thrombocytopenia in 9 patients, and anemia requiring red celltransfusions in 9 patients. With the exception of asthenia, severenon-hematologic toxicities were infrequent. Conclusions:Monthly docetaxel, combined with weekly gemcitabine,is an active and safe second-line therapy for NSCLC patients.     

Spectrum and origin of phenylketonuria mutations in Spain

In order to characterize the molecular heterogeneity of phenylalanine hydroxylase deficiencies in the Spanish population, 37 PKU patients were initially screened for 16 known European mutations. For the remaining unidentified alleles, we used a combined strategy based on single strand conformation polymorphism analysis and DNA sequencing. Overall, a total of 15 different mutations were found in our sample, which account for 62% of the total mutant alleles. We also investigated the association between the mutations, haplotypes and variable number of tandem repeats described on the phenylalanine hydroxylase gene. In addition, we analyzed the geographical distribution in Spain of the two most prevalent mutations in our population: IVS10 and I65T.     

Phase I study of Doxil and vinorelbine in patients with advanced malignancies

Introduction. This study was designed to define the maximum tolerated dose of pegylated liposomal doxorubicin (Doxil®) and multiday vinorelbine (VNB), without and with prophylactic filgrastim, and to identify antineoplastic effect. Patients and Methods: Patients with resistant cancers were treated with Doxil 50 mg/m² every four weeks, and with VNB 15 mg/m² on the same day. The VNB dose escalations were accomplished in subsequent patient cohorts by adding VNB doses on consecutive days. When the maximum tolerated dose (MTD) of VNB with Doxil was defined, prophylactic filgrastim was added to define a second MTD. Results. Of 29 patients entered, two had early adverse events, and 27 received at least one full cycle with at least one month follow-up. The MTD of VNB, combined with Doxil 50 mg/m², was 15 mg/m² on day 1, with neutropenia as the dose-limiting toxicity. With prophylactic filgrastim, the MTD was15 mg/m² daily for two days, with neutropenia and stomatitis as dose-limiting toxicities. Palmar plantar erythrodysesthesia occurred frequently, usually after the third cycle. Objective responses were documented in six patients, all of whom received multiday VNB. Conclusion. Doxil 50 mg/m² on day 1 of a 28-day cycle can be safely combined with VNB 15 mg/m2 day 1, or with VNB 15 mg/m² days 1 and 2 with filgrastim prophylaxis. Antineoplastic activity was observed in this heavily pretreated population. Future studies of Doxil 35-40 mg/m² with multiday VNB may be worthwhile, especially in metastatic breast cancer.     

Daily times four vinorelbine plus cisplatin in advanced non-small-cell lung cancer: A phase II trial of a novel schedule

Purpose: To evaluate the efficacy of a novel multiday schedule of vinorelbine and cisplatin in patients with advanced NSCLC.Patients and methods: Thirty patients were enrolled, including 27 patients with stage IV disease, and 11 patients with performance status of 2. They received a maximum of four chemotherapy cycles with cisplatin 20 mg/m²/day and vinorelbine 15 mg/m²/day intravenously (i.v.) for four consecutive days, every three weeks, with prophylactic filgrastim.Results: Sixteen patients responded (53%, 95% confidence interval (95% CI): 34%–72%), including two complete and fourteen partial confirmed responses. Median survival for all patients was 8.1 months, with actuarial one-year and two-year survival rates of 40% and 15%. Despite prophylactic filgrastim, the delivered vinorelbine dose intensity of 16.8 mg/m²/week caused febrile neutropenia in 48% of patients (16% of cycles), resulting in one treatment-related death. Common nonhematologic toxicities included delayed emesis, asthenia, and constipation.Conclusions: This multiday vinorelbine–cisplatin schedule is highly active against advanced NSCLC but results in frequent neutropenic complications. The myelotoxicity and antitumor efficacy of vinorelbine in NSCLC patients may be schedule-dependent.     

Concurrent Cisplatin, Prolonged Oral Etoposide, and Vincristine plus Chest and Brain Irradiation for Limited Small Cell Lung Cancer: A Phase II Study of the Southwest Oncology Group (SWOG-9229)

Purpose: The primary objectives of the study were to evaluate the efficacy and safety of prolonged oral (PO) etoposide as part of cisplatin-based chemotherapy plus concurrent chest/brain irradiation induction, followed by CAV consolidation, in the treatment of patients with limited-stage small cell lung cancer (SCLC-LD) within a cooperative group setting.

Methods and Materials: Fifty-six eligible patients with SCLC-LD received three 28-day cycles of cisplatin 50 mg/m² i.v. (days 1, 8; 29, 36; and 57, 64), PO etoposide 50 mg/m² (days 1–14, 29–42, and 57–70), and vincristine 2 mg i.v. (days 1, 29, and 57). Thoracic irradiation (TRT) was administered at 1.8 Gy in 25 daily fractions to a total dose of 45 Gy via an AP:PA arrangement, to begin concomitantly with induction chemotherapy. Prophylactic cranial irradiation (PCI) was started on day 15 of induction therapy. Fifteen daily fractions of 2.0 Gy were administered to the entire brain to a total dose of 30 Gy to finish at approximately the same time as TRT. Two 21-day cycles of consolidation cyclophosphamide 750 mg/m² i.v., doxorubicin 50 mg/m² i.v., and vincristine 2 mg i.v. (all on days 1 and 22), were given beginning on day 106 or week 16, from the start of induction therapy.

Results: Among 56 eligible patients, 93% had SWOG performance status 0–1. All had adequate organ function and had not received prior therapy. The overall confirmed response rate was 46%, including 16% complete responders and 30% partial responders. After a minimun follow-up duration of 17 months, the Kaplan-Meier median progression-free (PFS) and overall survival (OS) were 10 and 15 months, respectively. Two-year survival is 28%. Only 28 of 56 patients (50%) completed chemotherapy per protocol, while 52 of 56 patients (93%) completed radiation per protocol. Eleven patients (20%) discontinued secondary to toxicity and two patients died from treatment. The major toxicity was hematologic. The two deaths were secondary to infection. Of the nonhematologic toxicities, there were 10 cases of pulmonary fibrosis (including one Grade 3) and six cases of pneumonitis (including one Grade 3).

Conclusion: Concomitant chemoradiation with oral etoposide as part of a platinum-based chemotherapy and TRT induction regimen is toxic. The CR rate is not better than our prior best group-wide experience. The progression-free and overall survival are similar to published trials utilizing short-course i.v. etoposide. As in chemotherapy for extensive-stage SCLC, there is no apparent advantage to prolonged exposure to etoposide, and toxicity resulted in an inferior therapeutic index compared to programs with shortened exposure.     

Evidence for B cell participation in the in vitro and in vivo maintenance of in vivo staphylococcal enterotoxin B-induced T cell anergy

The mechanisms involved in the maintenance of staphylococcal enterotoxin B (SEB)-induced T cell anergy are poorly understood. Here, we demonstrate that CD4+ T cell anergy induced by SEB treatment is under partial B cell control. This effect is not mediated by anti-SEB antibodies or any in vitro B cell-produced suppresser factor. At day 13 after SEB immunization, T cells from B cell-deficient mice proliferate upon in vitro stimulation with SEB. These results suggest that SEB- induced T cell anergy is reversible and that B cells have an important function in anergy maintenance in CD4+ T cells, both in vivo and in vitro.      

A new spontaneous mouse mutation of Hoxd13 with a polyalanine expansion and phenotype similar to human synpolydactyly

Human synpolydactyly (SPD) is an inherited congenital limb malformation caused by mutations in the HOXD13 gene. Heterozygotes are typically characterized by 3/4 finger and 4/5 toe syndactyly with associated duplicated digits; hands and feet of homozygotes are very small because of a shortening of the phalanges, metacarpal and metatarsal bones. Here we describe the phenotype and molecular basis of a spontaneous mutation of Hoxd13 in mice that provides a phenotypically and molecularly accurate model for human SPD. The new mutation, named synpolydactyly homolog (spdh), is a 21 bp in-frame duplication within a polyalanine- encoding region at the 5'-end of the Hoxd13 coding sequence. The duplication expands the stretch of alanines from 15 to 22; the same type of expansion occurs in human SPD mutations. spdh/spdh homozygotes exhibit severe malformations of all four feet, including polydactyly, syndactyly and brachydactylia. The phenotype of spdh is much more severe than that exhibited by mice with a genetically engineered, presumably null, disruption of Hoxd13. Thus spdh probably acts in a dominant-negative manner and will be valuable for examining interactions with other Hox genes and their protein products during limb development. Homozygous mice of both sexes also lack preputial glands and males do not breed; therefore, spdh/spdh mice may also be valuable in studies of reproductive physiology and behavior.      

维生素C及E联合作用对体外大鼠胚胎中脑神经细胞分化和增殖的影响

目的:观察维生素C,维生素E和维生素C 维生素E联合后对胚胎中脑神经细胞生长发育的影响。方法:实验于2006-03/04在江苏大学医学院研究中心细胞培养室完成。采用16d大鼠胚胎中脑神经细胞体外培养方法,观察不同剂量的维生素C(5,10,25,50μmol/L),维生素E(10,25,50,100μmol/L)和维生素C、维生素E联合作用(维生素C25μmol/L 维生素E50μmol/L,维生素C50μmol/L 维生素E100μmol/L),培养10d后收集细胞,并利用图像分析细胞形态的变化、蛋白质、丙二醛含量及超氧化物歧化酶活性指标。结果:①维生素C、维生素E和维生素C 维生素E联合能促进体外培养中脑神经细胞突起生长,集落数增多。②与正常对照组比较,维生素C10,25μmol/L组、维生素E10,25,50μmol/L组、维生素C25μmol/L 维生素E50μmol/L组神经细胞总蛋白相对含量明显增加。③与正常对照组比较,维生素C10,25μmol/L组、维生素E25,50μmol/L组、维生素C25μmol/L 维生素E50μmol/L组神经细胞超氧化物酶活性增加,丙二醛含量降低。④维生素C50μmol/L组、维生素E100μmol/L组和维生素C50μmol/L 维生素E100μmol/L组超氧化物酶活性低于正常对照组,丙二醛含量高于正常对照组。结论:维生素C、维生素E和维生素C 维生素E联合剂量在一定范围内能够明显提高中脑神经细胞的抗氧化能力,同时能促进胚胎中脑神经细胞分化和增殖作用。