Eizo Kimura

Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial

BACKGROUNDnPaclitaxel and carboplatin given every 3 weeks is standard treatment for advanced ovarian carcinoma. Attempts to improve patient survival by including other drugs have yielded disappointing results. We compared a conventional regimen of paclitaxel and carboplatin with a dose-dense weekly regimen in women with advanced ovarian cancer.nnnMETHODSnPatients with stage II to IV epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer were eligible for enrolment in this phase 3, open-label, randomised controlled trial at 85 centres in Japan. Patients were randomly assigned by computer-generated randomisation sequence to receive six cycles of either paclitaxel (180 mg/m(2); 3-h intravenous infusion) plus carboplatin (area under the curve [AUC] 6 mg/mL per min), given on day 1 of a 21-day cycle (conventional regimen; n=320), or dose-dense paclitaxel (80 mg/m(2); 1-h intravenous infusion) given on days 1, 8, and 15 plus carboplatin given on day 1 of a 21-day cycle (dose-dense regimen; n=317). The primary endpoint was progression-free survival. Analysis was by intention to treat (ITT). This trial is registered with ClinicalTrials.gov, number NCT00226915.nnnFINDINGSn631 of the 637 enrolled patients were eligible for treatment and were included in the ITT population (dose-dense regimen, n=312; conventional regimen, n=319). Median progression-free survival was longer in the dose-dense treatment group (28.0 months, 95% CI 22.3-35.4) than in the conventional treatment group (17.2 months, 15.7-21.1; hazard ratio [HR] 0.71; 95% CI 0.58-0.88; p=0.0015). Overall survival at 3 years was higher in the dose-dense regimen group (72.1%) than in the conventional treatment group (65.1%; HR 0.75, 0.57-0.98; p=0.03). 165 patients assigned to the dose-dense regimen and 117 assigned to the conventional regimen discontinued treatment early. Reasons for participant dropout were balanced between the groups, apart from withdrawal because of toxicity, which was higher in the dose-dense regimen group than in the conventional regimen group (n=113 vs n=69). The most common adverse event was neutropenia (dose-dense regimen, 286 [92%] of 312; conventional regimen, 276 [88%] of 314). The frequency of grade 3 and 4 anaemia was higher in the dose-dense treatment group (214 [69%]) than in the conventional treatment group (137 [44%]; p<0.0001). The frequencies of other toxic effects were similar between groups.nnnINTERPRETATIONnDose-dense weekly paclitaxel plus carboplatin improved survival compared with the conventional regimen and represents a new treatment option in women with advanced epithelial ovarian cancer.nnnFUNDINGnBristol-Myers Squibb.

Long-term results of dose-dense paclitaxel and carboplatin versus conventional paclitaxel and carboplatin for treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (JGOG 3016): a randomised, controlled, open-label trial

BACKGROUNDnThe primary analysis of the JGOG 3016 trial showed that a dose-dense paclitaxel and carboplatin regimen significantly improves progression-free and overall survival compared with the conventional regimen as first-line chemotherapy for patients with epithelial ovarian, fallopian tube, or primary peritoneal cancer. We report the long-term follow-up results for survival.nnnMETHODSnThis randomised controlled trial was done at 85 centres in Japan. Patients with stage II-IV ovarian cancer were randomly assigned to receive conventional treatment (carboplatin area under the curve [AUC] 6 mg/mL per min and paclitaxel 180 mg/m(2) on day 1) or dose-dense treatment (carboplatin AUC 6 mg/mL per min on day 1 and paclitaxel 80 mg/m(2) on days 1, 8, and 15). The treatments were repeated every 3 weeks for six cycles; responding patients had three additional cycles. The randomisation was done centrally by telephone or fax, stratified by residual disease, stage, and histological type. The primary endpoint was progression-free survival; overall survival was a secondary endpoint. Long-term information on adverse events was not collected. Efficacy analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00226915.nnnFINDINGSn637 patients were enrolled, of whom 631 were analysed (312 assigned to the dose-dense regimen, 319 to the conventional regimen). Median follow-up was 76·8 months (IQR 68·9-85·6). Median progression-free survival was significantly longer in the dose-dense treatment group than in the conventional treatment group (28·2 months [95% CI 22·3-33·8] vs 17·5 months [15·7-21·7]; hazard ratio [HR] 0·76, 95% CI 0·62-0·91; p=0·0037). Median overall survival was 100·5 months (95% CI 65·2-∞) in the dose-dense treatment group and 62·2 months (52·1-82·6) in the conventional treatment group (HR 0·79, 95% CI 0·63-0·99; p=0·039).nnnINTERPRETATIONnDose-dense treatment offers better survival than conventional treatment and is a potential new standard of care for first-line chemotherapy for patients with advanced epithelial ovarian cancer.

Evaluation of human epididymis protein 4 (HE4) and Risk of Ovarian Malignancy Algorithm (ROMA) as diagnostic tools of type I and type II epithelial ovarian cancer in Japanese women

Human epididymis protein 4 (HE4) levels and the Risk of Ovarian Malignancy Algorithm (ROMA) have recently been shown to improve the sensitivity and specificity of epithelial ovarian cancer (EOC) diagnosis. We evaluated HE4 levels and ROMA as diagnostic tools of type I and type II EOC in Japanese women. Women who had a pelvic mass on imaging and were scheduled to undergo surgery were enrolled as ovarian mass patients. Serum levels of carbohydrate antigen 125 (CA125) and HE4 were tested in 319 women (131 benign, 19 borderline, 75 malignant, and 94 healthy controls). CA125, HE4, and ROMA were evaluated for sensitivity and by receiver operating characteristics (ROC) in type I and type II EOC. The results showed that, at 75xa0% specificity, the sensitivity of CA125 and HE4 for type II was 92.1xa0% for both markers and for type I was 51.5xa0% and 78.8xa0%, respectively. The sensitivities of ROMA (type I, 84.8xa0% and type II, 97.4xa0%) were better than those of CA125 and HE4. CA125, HE4, and ROMA were all highly accurate markers for type II. For type I, HE4 and ROMA showed better sensitivity than CA125. ROMA displayed the best diagnostic power for type I and type II including for the early stage of type I. In conclusion, HE4, CA125, and ROMA are valuable markers for type II EOC diagnosis. HE4 and ROMA analyses may improve differentiation between type I EOC and a benign mass. Measurement of combined HE4 and CA125 levels provides a more accurate method for EOC diagnosis.

Analysis of the cytotoxic interaction between cisplatin and hyperthermia in a human ovarian carcinoma cell line.

Expression of the heat-shock protein HSP-60 is associated with poor survival in patients with ovarian carcinoma. We examined both the nature of the interaction between hyperthermia and cisplatin (DDP) using the human ovarian carcinoma cell line 2008 and the effect on this interaction of the induction of the heat-shock response. The nature of the interaction was assessed using medianeffect analysis. Despite the observation that 45°C hyperthermia increased the intracellular uptake of the DDP analog [3H]-cis-dichloro(ethylenediamine)platinum(II)(DEP) during a 1-h exposure by 155%±5% (P=0.02), median-effect analysis indicated only cytotoxic additivity (combination index at the level of 50% cell kill, 0.96±0.25). When cells were first exposed to hyperthermia for various periods and then allowed to incubate at 37° C for 4 h to allow induction of the heat-shock genes before being treated with DDP for 1 h, there was a very small degree of antagonism between hyperthermia and DDP (combination index at 50% cell kill, 1.11±0.04). Our results indicate that DDP and hyperthermia interact only in an additive manner against this human ovarian carcinoma cell line and that the induction of heat-shock proteins by hyperthermia does not significantly antagonize the activity of DDP.

Serum placental alkaline phosphatase (PLAP) in gynecologic malignancies — with special reference to the combination of PLAP and CA54/61 assay

Serum placental alkaline phosphatase (PLAP) levels in patients with gynecological tumors were measured by two kinds of enzyme-antigen immunoassay kits provided by Innogenetics (PLAP-I) and Sangtec Medical (PLAP-S), and the combination assays for PLAP with other tumor markers were studied. None of the healthy women studied were PLAP positive, and the positive rate in patients with benign ovarian tumors was less than 6%. The positive rate in patients with ovarian cancers was about 35%, which was higher than the rates for other cancers. It was significantly higher in patients with ovarian serous cystadenocarcinoma (60%). Remarkably high PLAP-I values were observed in patients with dysgerminoma. By the combination assay for PLAP with CA54/61 antigen in ovarian cancers, the diagnostic efficiency increased compared with that for PLAP and CA125. We conclude that PLAP is useful in the diagnosis of ovarian serous cystadenocarcinoma and dysgerminoma and that CA54/61 is the better partner for the combination assay.

A prospective observational study on chemotherapy-induced nausea and vomiting (CINV) in patients with gynecologic cancer by the CINV Study Group of Japan

OBJECTIVEnThis study was performed to investigate the occurrence of and risk factors for chemotherapy-induced nausea and vomiting (CINV) in patients with gynecologic cancer.nnnMETHODSnIn total, 214 patients with gynecologic cancer who underwent highly emetogenic (HEC) or moderately emetogenic chemotherapy (MEC) were evaluated. We investigated the relationship between CINV and clinical factors and the accuracy of estimation of CINV by medical staff in the acute and late phases. Vomiting was evaluated in terms of frequency, and nausea was evaluated with a 100-mm visual analog scale on days 1 to 7. We also analyzed the risk factors and changes in CINV over time using a generalized linear mixed (GLM) model.nnnRESULTSnThe multivariate analysis revealed no significant risk factors for acute CINV. The independent risk factors for delayed nausea were a morning sickness history (odds ratio [OR], 2.687; 95% confidence interval [95% CI], 1.450-4.976; p=0.0017), age (each 1-year increment) (OR, 0.97; 95% CI, 0.944-0.996; p=0.0235), and HEC (OR, 2.134; 95% CI, 1.039-4.383; p=0.0391). The GLM model demonstrated that the independent factors affecting nausea were significant morning sickness (p=0.0101) and HEC (p=0.0136). These data also showed more severe nausea from days 3 to 5, but the negative predictive value for estimation of delayed nausea by medical staff was 57.8%.nnnCONCLUSIONnOur data suggest that improvement of preventive antiemetic administration is needed for patients with risk factors to manage delayed CINV caused by HEC and by MEC.

Establishment and characterization of JHUCS-1 cell line derived from carcinosarcoma of the human uterus

The cell line designed JHUCS-1 was established from a carcinosarcoma (malignant mixed mesodermal tumor) of the uterus that was surgically removed from a 57-year-old Japanese woman. We carefully examined the histopathology of the original tumor after the cell line was established and noted differentiation into a neuroendocrine carcinoma within the tumor’s epithelial components. Immunohistochemical staining of the tumorous tissue that had been heterotransplanted was positive for Leu7. Additionally, secretary granules were observed in the grafted cells as determined by electron microscopy. These results support the existence of neuroendocrine cells within the JHUCS-1 cell line.

Establishment and characterization of a cell line designated Nur-1 derived from human endometrioid adenocarcinoma of uterine corps

A new cell line designated Nur-1 has been established from human endometrioid adenocarcinoma, Grade 1, pT1a, PN1 (3/24), Stage IIIc (International Federation of Gynecology and Obstetrics/Union for International Cancer Control (FIGO/UICC TNMClassification of Malignant Tumours, 7th ed.). Cytological findings of Nur-1 cells reveal anaplastic and pleomorphic features such as anisonucleosis, nucleolar pleomorphism, and piling-up tendency in cellular arrangement. Distribution of the chromosome number is found at the hyperploid range, and the apparent marker chromosome has not been identified. The original tumor and graft of the Nur-1 cell line had a large amount of estrogen receptors and progesterone receptors, as revealed by immunohistochemistry. The cytokeratin pattern of the tumor was positive for cytokeratin-7 and negative for cytokeratin-20. However, a few cells were positive for cytokeratin-20 in the original tumor. Nur-1 cells express mRNA of estrogen receptors and progesterone receptors, cytokeratin-7, and cytokeratin-20 at 105 passages. These findings are consistent with the cytokeratin pattern of endometrial glandular cells. The cells make contact with each other via interdigitation and desmosomes. They possess bundles of microtubules and tonofilaments and many free ribosomes. Some cells have various sizes of phagosomes. The Nur-1 cell line exceeded 102 passages in 5xa0years, and multiplication of the cells is stable. The modal number of the Nur-1 cell line is 91–92 (56xa0%). The Nur-1 cells develop well-differentiated adenocarcinoma in tumors sustained in nude mice that resemble the original tumors.

Clinical experience of J‐VAC drain for skin closure in the laparotomy of obstetrics and gynecology

The frequency of wound dehiscence after abdominal surgery has been reported to be approximately 4–29%, and that of surgical site infections is said to be of about 20%. We examined the effectiveness of the subcutaneous J‐VAC drain (JVD) in the drainage of bleeding and exudates from surgical wounds.