Protroca: A Noninterventional Study on Prophylactic Lipegfilgrastim against Chemotherapy-Induced Neutropenia in Nonselected Breast Cancer Patients

BackgroundProtroca evaluated the efficacy and safety of primary and secondary prophylaxis of neutropenia with lipegfilgrastim (Lonquex®) in breast cancer patients receiving neoadjuvant or adjuvant chemotherapy (CT).Patients and MethodsOf the 255 patients enrolled, 248 patients were evaluable for the intent-to-treat (ITT) and 194 patients for the per-protocol set. Primary and secondary end points after lipegfilgrastim treatment were assessed.ResultsNine patients of the ITT set receiving lipegfilgrastim as primary prophylaxis (n = 222) had febrile neutropenia of grade 3–4 (5 patients) or infection of grade 3–4 (4 patients); 1/26 of those receiving secondary prophylaxis had an event. Dose reductions were performed in 9.5% of the patients. Postponement of cancer CT cycles for >3 days occurred in <15% of patients; 10.8% (92/851 AEs) and 8% (2/25 SAEs) of documented adverse events and serious adverse events, respectively, were related to lipegfilgrastim.ConclusionsApplication of lipegfilgrastim was effective as primary and secondary prophylaxis in the prevention of CT-induced neutropenia in breast cancer.     

Effects of cholic acid, 7 beta-hydroxy- and 12 beta-hydroxy-isocholic acid on bile flow, lipid secretion and bile acid synthesis in the rat

The effects of three epimeric trihydroxy-cholanoic acids, cholic acid (C), 7 beta-hydroxy-(7 beta) and 12 beta-hydroxy-(12 beta) isocholic acids on bile flow, lipid secretion, bile synthesis and bile micellar properties were studied in the rat with a bile fistula. The bile salts were infused intraduodenally starting 72 hours after cannulation when endogeneous bile salt synthesis had plateaued after the bile salt pool was drained. The bile salts were infused at two levels approximately 2 and 4 mumol min-1 kg-1. All three bile salts were absorbed and secreted almost quantitatively into the bile. Cholic acid was secreted in the conjugated form, 7 beta conjugated to approximately 60% and 12 beta completely in the unconjugated form. The bile salts did not undergo any significant biotransformations during the one passage from the intestine through the liver. Bile flow increased from the preinfusion level for all three bile salts infused in the order 7 beta greater than 12 beta greater than C. The bile flow increased linearly with bile salt secretion more for 7 beta than for C and 12 beta. Infusion of C increased the secretion into bile of phospholipid (PL) and cholesterol (CH) over the preinfusion values. Infusion of 7 beta as well as 12 beta resulted in a parallel decrease in the secretion of PL as well as CH compared to the preinfusion values. The infusion of C and 7 beta at the two levels used decreased the secretion of newly synthesized bile salt below the control level.(ABSTRACT TRUNCATED AT 250 WORDS)     

Neoadjuvant chemotherapy with paclitaxel and everolimus in breast cancer patients with non-responsive tumours to epirubicin/cyclophosphamide (EC) ± bevacizumab – Results of the randomised GeparQuinto study (GBG 44)

BackgroundWe tested the oral mammalian target of rapamycin (mTOR) inhibitor everolimus in addition to paclitaxel in patients with HER2-negative tumours not responding to initial neoadjuvant cytotoxic and anti-angiogenic treatment.MethodsPatients with primary HER2-negative tumours received four neoadjuvant cycles of epirubicin/cyclophosphamide (EC) with or without bevacizumab. Patients without clinical response were randomised to receive weekly paclitaxel (80 mg/m²) with or without everolimus (5 mg p.o. daily, after a step-wise dose–escalation starting from 2.5 mg bid) for 12 weeks before surgery. To detect an increase in pathological complete response (pCR; ypT0 ypN0) from 5% to 12.1% (odds ratio 2.62) 566 patients had to be recruited. The trial was stopped prematurely due to completion of accrual in the main study.FindingsOf 1948 patients initially starting neoadjuvant treatment 403 were randomised. A total of 18 (4.6%) patients, 7 (3.6%) treated with paclitaxel and everolimus and 11 (5.6%) treated with paclitaxel alone had a pCR (odds ratio 0.36 (OR) (95% confidence interval (CI), 0.24–1.6) p = 0.34). Overall response rate in breast and lymph nodes at surgery was 52.2% after paclitaxel plus everolimus and 61.7% after paclitaxel alone (p = 0.063). Breast conserving treatment was performed in 54.4% of patients with the combination treatment and 61.9% with paclitaxel alone (p = 0.20). Mucosal inflammation, thrombocytopenia, neutropenia, infection, and skin rash were more frequent when everolimus was added to paclitaxel.InterpretationNeoadjuvant therapy with everolimus and paclitaxel for patients with HER2-negative disease unresponsive to EC with or without bevacizumab did not improve the pCR rate. Long-term outcome is awaited.FundingNovartis, Roche, and Sanofi-Aventis.     

Deconjugation of bile salts: does it occur outside the contents of the intestinal tract in the rat?

Several different methods have been applied to measure the extent of bile salt deconjugation (deamidation), if any, outside the gastro-intestinal tract of the rat. A breath test has been applied to the rat using peroral or intravenous administration of cholyl-glycine-1-14C. Results for normal rats have been compared with rats with a continuous recirculation of bile to a tail vein. Bile salts labelled with 2,4-3H in the sterol moiety and conjugated with glycine-1-14C have been infused in rats and recirculated via a bile duct tail-vein shunt. The 3H:14C ratio in the bile has been used as an indication of deconjugation. In these experiments the radioactivity pattern of the bile salts has been determined after thin-layer chromatography. Different labelled bile salts have also been infused intraperitoneally and the composition of bile secreted through bile fistulae studied. In none of these experiments, in which the gastro-intestinal content was bypassed and a return of bile salts to the liver in the physiological range ensured, was any deconjugation of glycine-conjugated bile salts observed. When the liver, however, was stressed by anaesthesia and the intraportal infusion of deoxycholyl-2,4-3H-glycine in unphysiological levels, deconjugation occurred as indicated by the appearance in bile of labelled taurine conjugates. In these rats the dose of deoxycholylglycine was clearly toxic as evidenced by partial or complete cholestasis and eventually death of the animal.     

Effects of feeding ursocholic acid to germfree rats

Germfree rats were fed 24-14C-ursocholic acid (UC) mixed into the diets for 10 days. The bile was then drained by cannulation for 6 hours to collect the bile salt pool. No biotransformation of the labelled UC occurred and it constituted approximately equal to 75% of an enlarged bile salt pool. Less phospholipid and cholesterol were secreted into the bile per mumol bile salt compared to normal rats. The critical micellar concentration (CMC) of the bile was determined by equilibrium dialysis and found to be increased. Faecal excretion of labelled triolein added to the diet was unaffected by feeding ursocholic acid. Excretion of 14C-octadecane and 14C-cholesterol increased significantly under the same conditions. Ursocholic acid feeding thus resulted in a selective malabsorption of octadecane and cholesterol.     

Reducing chemotherapy use in clinically high-risk,genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective,randomised phase 3 West German Study Group (WSG) PlanB trial

Purpose

To determine whether BPE in preoperative breast MRI influences patients’ recurrence-free survival (RFS).

Methods

Between February 2010 and December 2011, 804 consecutive women with invasive breast cancer who had undergone preoperative breast MRI and curative cancer surgery were identified. BPE was visually graded by two reviewers. We determined the correlation between BPE grade and other clinicopathological variables, including age, adjuvant therapy, menopausal status, histologic grade, T stage, N stage, lymphovascular invasion, molecular subtype, surgical margin status, and mammographic density. A Cox proportional hazards model was used to analyze the effects of clinicopathological variables and radiological findings (BPE grade, mammographic density) on RFS.

Results

High BPE was associated with premenopausal status (Ps < 0.0001), higher mammographic density (Ps < 0.0001), progesterone receptor positivity (Ps = 0.039, 0.007, respectively), presence of lymphovascular invasion (Ps = 0.008, 0.001, respectively), and close surgical margin (Ps < 0.0001). Recurrences were observed in 75 patients after a mean follow-up period of 61.8 months (range 4–81 months). Non-minimal BPE grade (RFS hazard ratio = 3.086, P = 0.003 for reader 1; RFS hazard ratio = 2.221, P = 0.075 for reader 2) and T3 stage were associated with worse outcomes in postmenopausal women. In premenopausal women, non-minimal BPE grade by readers 1 and 2 did not affect the patients’ outcomes.

Conclusions

Increased BPE on preoperative breast MRI in postmenopausal women has potential as a predictor of poor RFS.

     

Appetite suppression through delayed fat digestion

High-fat diets are often associated with greater caloric intake and weight gain. Since satiety during fat intake is induced by fat in the intestine we investigated the efficiency of a lipid compound that retards fat digestion to regulate fat intake. We found this compound to reduce high-fat food intake, body weight and blood lipids in Sprague-Dawley rats, without causing steatorrhea. The absence of steatorrhea is explained by an increased pancreatic lipase/colipase secretion, compensating the impaired lipolysis by the added compound. The animals also had an elevated CCK secretion. The satiety for fat may be the consequence of elevated CCK and procolipase/enterostatin levels. We conclude that compounds can be found that delay intestinal fat digestion and control high-fat food intake through the release of satiety signals, without causing steatorrhea. The absence of steatorrhea makes such compounds advantageous over lipase inhibitors in the treatment of obesity.     

Correction to: Reducing chemotherapy use in clinically high-risk,genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective,randomised phase 3 West German Study Group (WSG) PlanB trial

Breast Cancer Research and Treatment - The article Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the...