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Para conocer los resultados de la radioembolización (transarterial radioembolization o TARE), en el tratamiento de tumores hepáticos, se realizó una valoración retrospectiva tras 112 TARE con 90Y-microesferas administradas en 82 pacientes en un único hospital, analizando la eficacia y la seguridad, tras un seguimiento mayor o igual a 1 año post-TARE en todos los pacientes, y evaluando la posible relación entre la respuesta al tratamiento y la supervivencia de los pacientes. Se administraron 57 TARE únicas y 55 TARE múltiples en pacientes con hepatocarcinoma (53), metástasis hepáticas (25) y colangiocarcinoma (4), con evaluación previa multidisciplinar clínica, angiográfica y gammagráfica (planar/SPECT/SPECT-TC con 99mTc-MAA), modelo multicompartimental (ecuaciones MIRD), valoración gammagráfica post-TARE (planar/SPECT/SPECT-TC), seguimiento clínico-radiológico, evaluación de respuesta tumoral (criterios mRECIST) y análisis (Kaplan Meier) de supervivencia libre de progresión (SLP) y supervivencia global (SG). La intención terapéutica fue paliativa (82%) y como puente a trasplante hepático/resección quirúrgica (17%). Se obtuvo respuesta (R), completa o parcial, en el 65,9% de los casos. Al año post-TARE estaban libres de progresión el 34,7% de los pacientes con R y 19,2% de los no R (p:0,003), con SG del 80% para los R y 37,5% para los no R (p:0,001). Las curvas de supervivencia mostraron mediana de SG de 18 meses (95% IC 15,7-20,3) para los R y 9 meses (95% IC 6,1-11,8) para los no R (p:0,03). Efectos secundarios leves (27,6%) y severos (5,3%) resueltos, sin mayor incidencia tras TARE múltiple. La TARE con 90Y-microesferas en pacientes adecuadamente seleccionados con tumores hepáticos, aporta eficacia terapéutica y bajo índice de toxicidad, con SLP y SG superiores en los pacientes con respuesta a la TARE respecto a los que no respondieron. To determine the results of radioembolization transarterial (TARE), in the treatment of liver tumors, a retrospective evaluation was performed after 112 TARE with 90Y-microspheres administered in 82 patients in a single hospital, analyzing efficacy and safety, after a follow-up greater than or equal to 1 year post-TARE in all patients, and evaluating the possible relationship between treatment response and patient survival. We have administered 57 single TARE and 55 multiple TARE in patients with hepatocellular carcinoma (53), liver metastases (25) and cholangiocarcinoma (4), with prior multidisciplinary evaluation, clinical, angiographic and gammagraphic (planar/SPECT/SPECT-CT with 99mTc-MAA), multicompartment model (MIRD equations), post-TARE screening (planar/SPECT/SPECT-CT), clinical and radiological follow-up, tumor response evaluation (mRECIST criteria) and Kaplan–Meier analysis to determine progression-free survival (PFS) and overall survival (OS). Therapeutic intention was palliative (82%) and as bridge to liver transplantation/surgical resection (17%). We obtained response (R), complete or partial, in 65.9% of cases. One year after TARE 34.7% of patients with R and 19.2% of non-R were progression-free (p : 0.003), with OS of 80% for R and 37.5% for non-R (p : 0.001). Survival analysis showed median OS of 18 months (95% CI 15.7–20.3) for R and 9 months (95% CI 6.1–11.8) for non-R (p : 0.03). We found mild (27.6%) and severe (5.3%) side effects, all of them resolved, without higher incidence after multiple TARE. TARE with 90Y-microspheres, in appropriately selected patients with liver tumors, provides therapeutic efficacy and low rate of toxicity, with higher PFS and OS in patients with TARE response compared to those who did not respond. [ABSTRACT FROM AUTHOR]

The coffee leaf rust, Hemileia vastatrix, is the most destructive coffee-growing disease and the most important economically. More aggressive outbreaks of the disease were recently reported worldwide, including in Mexico, where coffee production showed a 40% decrease. This work aimed to determine the environmental conditions that favor release and air transport of the H. vastatrix urediniospores in coffee crops in Veracruz. The monitoring of airborne coffee leaf rust urediniospores was performed using three types of aerobiological traps at different heights: Hirst Spore Trap (HST, 1.5 m), Passive Spore Trap (PST 1.5, 3, 6, and 9 m), and Sedimentation Spore Sampler (SSS 1 m) from January 2014 to October 2015, in two plots in Veracruz, Mexico. The airborne urediniospores counts exhibited a bimodal distribution. Low concentrations that increase over time are evident from January to April, decreasing abruptly in May and June, only to rise again in August, reaching the highest record for airborne urediniospores during the mid-summer drought phenomenon. Dispersal of coffee rust urediniospores is mainly influenced by temperature, rain, wind, and humidity in leaves. They can reach heights in the air up to 9 m (above the canopy) in shade coffee crops. The dispersal of pathogens in the atmosphere comprises complex processes interconnected; their knowledge allows better comprehensive management of them. [ABSTRACT FROM AUTHOR]

The loggerhead (Caretta caretta) is the most common sea turtle in the Azores. Since they do not nest in the area, a tagging program was started in the 1980's to try to discover their origin. The result based on size distribution, suggested that they mainly are coming from beaches in SE United States. A collaboration between University of Florida and the University of the Azores began in 1984 in order to proceed with further research. [ABSTRACT FROM AUTHOR]

Abstract: In situ effects of ocean acidification on carbonate dissolution by microboring flora, also called biogenic dissolution, have only been studied once in tropical environments. Naturally acidified seawaters due to CO2 vents offer a perfect setting to study these effects in temperate systems. Three sites were selected at Ischia (Italy, Mediterranean Sea) with one experiencing ambient pH and the two others a mean pHT of 7.2 and 7.5. At Faial (Azores, NE Atlantic), one site with ambient pH and one acidified site with a mean pHT of 7.4 were selected. Experiments were carried out during 1.5 months and 6 months in Azores and Ischia, respectively, to determine the effects of OA on microboring communities in various carbonate substrates. Low pH influenced negatively boring microflora development by limiting their depth of penetration and abundance in substrates. Biogenic dissolution was thus reduced by a factor 3 to 7 depending on sites and substrate types. At sites with ambient pH in Faial, biogenic dissolution contributed up to 23% to the total weight loss, while it contributed less than 1% to the total weight loss of substrates at the acidified sites. Most of the dissolution at these sites was due to chemical dissolution (often Ω ≤ 1). Such conditions maintained microboring communities at a pioneer stage with a limited depth of penetration in substrates. Our results, together with previous findings that showed an increase of biogenic dissolution at pH > 7.7, suggest that there is a pH tipping point below which microborer development and thus carbonate biogenic dissolution is strongly limited. [ABSTRACT FROM AUTHOR]

Background: Platinum-based systemic chemotherapy is considered the backbone for management of advanced urothelial carcinomas. However there is a lack of real world data on the use of such chemotherapy regimens, on patient profiles and on management after treatment failure. Methods: Fifty-one randomly selected physicians from 4 European countries registered 218 consecutive patients in progression or relapse following a first platinum-based chemotherapy. Patient characteristics, tumor history and treatment regimens, as well as the considerations of physicians on the management of urothelial carcinoma were recorded. Results: A systemic platinum-based regimen had been administered as the initial chemotherapy in 216 patients: 15 in the neoadjuvant setting, 61 in adjuvant therapy conditions, 137 in first-line advanced setting and 3 in other conditions. Of these patients, 76 (35 %) were initially considered as cisplatin-unfit, mainly because of renal impairment (52 patients). After platinum failure, renal impairment was observed in 44 % of patients, ECOG Performance Status ≥ 2 in 17 %, hemoglobinemia < 10 g/dL in 16 %, hepatic metastases in 13 %. 80 % of these patients received further anticancer therapy. Immediately after failure of adjuvant/neoadjuvant chemotherapy, most subsequent anticancer treatments were chemotherapy doublets (35/58), whereas after therapy failure in the advanced setting most patients receiving further anticancer drugs were treated with a single agent (80/114). After first progression to chemotherapy, treatment decisions were mainly driven by Performance Status and prior response to chemotherapy (>30 % patients). The most frequent all-settings second anticancer therapy regimen was vinflunine (70 % of single-agent and 42 % of all subsequent treatments), the main reasons evoked by physicians (>1 out of 4) being survival benefit, safety and phase III evidence. Conclusion: In this daily practice experience, a majority of patients with urothelial carcinoma previously treated with a platinum-based therapy received a second chemotherapy regimen, most often a single agent after an initial chemotherapy in the advanced setting and preferably a cytotoxic combination after a neoadjuvant or adjuvant chemotherapy. Performance Status and prior response to chemotherapy were the main drivers of further treatment decisions. [ABSTRACT FROM AUTHOR]

A seismic hazard assessment study of continental Ecuador is presented in this paper. The study begins with a revision of the available information on seismic events and the elaboration of a seismic catalog homogenized to magnitude Mw. Different seismic source definitions are revised and a new area-source model, based on geological and seismic data, is proposed. The available ground motion prediction equations for crustal and subduction sources are analyzed and selected for the tectonic environments observed in Ecuador. A probabilistic seismic hazard assessment approach is carried out to evaluate the exceedance probability of several levels of peak ground acceleration PGA and spectral accelerations SA (T) for periods (T) of 0.1, 0.2, 0.5, 1 and 2s. The resulting hazard maps for continental Ecuador are presented, together with the uniform hazard spectra of four province capital cities. Hazard disaggregation is carried out for target motions defined by the PGA values and SA (1s) expected for return periods of 475 and 2475 years, providing estimates for short-period and long-period controlling earthquakes. [ABSTRACT FROM AUTHOR]

Substance P (SP) is implicated in stress regulation and affective and anxiety-related behavior. Particularly high expression has been found in the main output region of the amygdala complex, the central amygdala (CE). Here we investigated the cellular mechanisms of SP in CE in vitro, taking advantage of glutamic acid decarboxylase-green fluorescent protein (GAD67-GFP) knockin mice that yield a reliable labeling of GABAergic neurons, which comprise 95% of the neuronal population in the lateral section of CE (CEl). In GFP-positive neurons within CEl, SP caused a membrane depolarization and increase in input resistance, associated with an increase in action potential firing frequency. Under voltage-clamp conditions, the SP-specific membrane current reversed at -101.5 ± 2.8 mV and displayed inwardly rectifying properties indicative of a membrane K+ conductance. Moreover, SP responses were blocked by the neurokinin type 1 receptor (NK1R) antagonist L-822429 and mimicked by the NK1R agonist [Sar9,Met(O2)11]-SP. Immunofluorescence staining confirmed localization of NK1R in GFP-positive neurons in CEl, predominantly in PKCδ-negative neurons (80%) and in few PKCδ-positive neurons (17%). Differences in SP responses were not observed between the major types of CEl neurons (late firing, regular spiking, low-threshold bursting). In addition, SP increased the frequency and amplitude of GABAergic synaptic events in CEl neurons depending on upstream spike activity. These data indicate a NK1R-mediated increase in excitability and GABAergic activity in CEl neurons, which seems to mostly involve the PKCδ-negative subpopulation. This influence can be assumed to increase reciprocal interactions between CElon and CEloff pathways, thereby boosting the medial CE (CEm) output pathway and contributing to the anxiogenic-like action of SP in the amygdala. [ABSTRACT FROM AUTHOR]

Neurosteroids are formed de novo in the brain and can modulate both inhibitory and excitatory neurotransmission. Recent evidence suggests that the anxiolytic effects of neurosteroids are mediated by the amygdala, a key structure for emotional and cognitive behaviors. Tonic inhibitory signaling via extrasynaptic type A γ-aminobutyric acid receptors (GABAARs) is known to be crucially involved in regulating network activity in various brain regions including subdivisions of the amygdala. Here we provide evidence for the existence of tonic GABAergic inhibition generated by the activation of δ-subunit-containing GABAARs in neurons of the lateral section of the mouse central amygdala (CeAl). Furthermore, we show that neurosteroids play an important role in the modulation of tonic GABAergic inhibition in the CeAl. Taken together, these findings provide new mechanistic insights into the effects of pharmacologically relevant neurosteroids in the amygdala and might be extrapolated to the regulation of anxiety. [ABSTRACT FROM AUTHOR]

This paper presents the results of controlled blasting experiments and blast modelling carried out to understand and quantify the effect of blasting on the creation of fractures inside fragments referred to as conditioning. Fragment conditioning is studied through the use of indirect and direct measurement techniques on samples collected from different zones around an explosive charge. Modelling is used to map different levels of conditioning throughout the blasted samples and explore the impact of boundary conditions on the spatial distribution of conditioning levels. Combined statistical analysis of repeatable tests showed that the measured impact breakage ranking parameter (A*b) increased by 20 and 33% within the low and intermediate conditioning zones respectively. This translates into a statistically significant strength reduction of the material. These results in conjunction with other documented experience suggest that blast-induced conditioning can have a positive impact on comminution performance and thus energy consumption. Results from this work provide the basis for a methodology to better define postblast breakage strength inputs into comminution performance models; as well as a preliminary approach to scale up the extent and degree of conditioning by blasting. Further work is required to evaluate the ability to control the degree of conditioning through the application of improvements in designs and novel blasting technology [ABSTRACT FROM AUTHOR]

Background:The aim of this open label phase II study (NCT00407459) was to assess the activity of the vascular endothelial growth factor (VEGF) inhibitor bevacizumab combined with pemetrexed and carboplatin in patients with previously untreated, unresectable malignant pleural mesothelioma (MPM).Methods:Eligible patients received pemetrexed 500 mg m−2, carboplatin area under the plasma concentration-time curve (AUC) 5 mg ml−1 per minute and bevacizumab 15 mg kg−1, administered intravenously every 21 days for six cycles, followed by maintenance bevacizumab. The primary end point of the study was progression-free survival (PFS). A 50% improvement in median PFS in comparison with standard pemetrexed/platinum combinations (from 6 to 9 months) was postulated.Results:Seventy-six patients were evaluable for analysis. A partial response was achieved in 26 cases (34.2%, 95% CI 23.7-46.0%). Forty-four (57.9%, 95% CI 46.0-69.1%) had stable disease. Median PFS and overall survival were 6.9 and 15.3 months, respectively. Haematological and non-haematological toxicities were generally mild; however, some severe adverse events were reported, including grade 3-4 fatigue in 8% and bowel perforation in 4% of patients. Three toxic deaths occurred.Conclusion:The primary end point of the trial was not reached. However, due to the limitation of a non-randomised phase II design, further data are needed before drawing any definite conclusion on the role of bevacizumab in MPM. [ABSTRACT FROM AUTHOR]

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Gefitinib ('Iressa', ZD1839) is an orally active epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor that has demonstrated antitumour activity and favourable tolerability in Phase II studies. We investigated whether EGFR expression levels could predict for response to gefitinib in patients with advanced non-small-cell lung cancer (NSCLC), who received gefitinib (250 mg day(-1)) as part of a worldwide compassionate-use programme. Tissue samples were analysed by immunohistochemistry to assess membrane EGFR immunoreactivity. Of 147 patients enrolled in our institution, 50 patients were evaluable for assessment of both clinical response and EGFR expression. The objective tumour response rate was 10% and disease control was achieved in 50% of patients. Although high EGFR expression was more common in squamous-cell carcinomas than adenocarcinomas, all objective responses were observed in patients with adenocarcinoma. Response and disease control with gefitinib were not associated with high EGFR expression. Overall, median survival was 4 months, and the 1-year survival rate was 18%. Strong EGFR staining correlated with shorter survival time for all patients. Gefitinib demonstrated promising clinical activity in this group of patients with NSCLC. These results have also shown that EGFR expression is not a significant predictive factor for response to gefitinib. [ABSTRACT FROM AUTHOR]

We analyzed 57 HIV-1 isolates from Cameroon and the Republic of Congo, with respect to the env C2V3 and/or the pol integrase regions. The results indicated that the topology of the pol tree correlated well with that of the env tree for four clusters of subtype D, F G and H, suggesting that these trees reflect the true evolution of the overall genome structures of these subtypes. However, of 22 Cameroonian isolates that were classified as subtype A based on env, 20 of them diverged in their pol sequence into two lineages that were completely different from the prototypical subtype A, tentatively designated as subtypes A1 and A2. The subtype A1 isolates (6 out of 22) were related in their env C2V3 regions with prototypical subtype A strain, but in their pol regions, they formed an independent cluster that diverged from known HIV-1 subtypes so far reported (except for subtypes I and J). The subtype A2 isolates (14 out of 22), which represent the major epidemic type of HIV-1 in Cameroon, clustered distinctly in both the env and pol trees with the recently described A/G mosaic strains from Nigeria and Djibouti. These two lineages were not spreading in the neighboring Republic of Congo. [ABSTRACT FROM AUTHOR]

Background To examine the possible alteration in Lp(a) composition, protein and lipid contents of Lp(a) were determined in 10 haemodialysis patients (HD) matched with 10 controls (C) fox apo(a) phenotypes. Methods All subjects (HD and C) had Lp(a) concentrations greater than 30 mg/dl (mean±SD : 82.3±41.4 vs 49.3±22.5 mg/dl), a concentration which has been determined to be associated with an elevated cardiovascular risk. Apo(a)-containing particles were isolated by immunoaffinity chromatography using a monoclonal anti-apo(a) antibody. Results The molar concentrations of lipid and protein constituents of immunoaffinity isolated Lp(a) were expressed as number of moles per mole of apo(a). Lp(a) from HD patients were significantly richer in apo Clll (P<0.05) and triglycerides (TG) (P<0.05), compared to those of controls. Molar ratios of apo B, apo E, cholesterol and phospholipids per apo(a)-containing particles were in the same range in both groups. Conclusions Lp(a) from HD patients is characterized by an elevated content in TG and apo Clll in comparison with those of controls. Further studies are needed to evaluate in HD patients the contribution of changes in Lp(a) composition towards the metabolism of these particles. [ABSTRACT FROM PUBLISHER]

Measurement of lipids, apolipoproteins A-I, A-II, B, C-III, Lp(a) and cholesterol, phospholipids, apo C-III in lipoprotein with and without apolipoprotein B was made in 49 patients (18 women and 31 men; mean age 50±15 years) undergoing maintenance haemodialysis for chronic renal failure. A group of 49 healthy people, matched for sex and age, acted as controls. In the haemodialysis group, special attention was placed upon the comparison of patients who had evident cardiovascular alterations (=17) with the residual group (=32). The concentration of apo C-III in apolipoprotein B containing lipoproteins was statistically higher in the patients with arterial disease than in the remaining sub jects, whereas the ratio apo C-III from Lp no B/apo C-III from Lp B was decreased. Compared to controls, haemodialysis patients had significantly higher values of triglycerides, apolipoproteins C-III, Lp(a), and apolipoprotein C-III from apolipoprotein B-containing lipoproteins (LpB); in contrast, concentrations of phospholipids and cholesterol from lipoproteins without apolipoprotein B (Lp no B) and apolipoprotein A-II were significantly reduced in patients. Discriminant analysis indicated that the levels of apolipoprotein C-III and apolipoprotein C-III from LpB were the best indicators of deranged lipid transport in patients with chronic renal failure. Our data suggest that chronic haemodialysis patients tend to exhibit qualitative abnormalities of serum apolipoprotein-B triglyceride rich particles containing apolipoprotein C-III or (a). [ABSTRACT FROM PUBLISHER]

We report the allele frequencies of the apolipoprotein B (Apo B) signal peptide polymorphism in patients with myocardial infarction and compare them with controls. The first sample consists of 197 myocardial infarction patients and 168 controls from Belfast (UK). The second sample consists of 167 myocardial infarction patients and 205 controls from Strasbourg (France), and the third consists of 71 patients and 146 controls from Haute-Garonne (Toulouse, France). No significant differences were observed in the frequency distribution of genotypes among cases and controls or between populations. However, there were more rare homozygotes in the Belfast cases. Significant associations were observed between the Apo B signal peptide polymorphism and mean levels of total cholesterol, low density lipoprotein cholesterol, Apo B and lipoprotein particles containing Apo (a) [Lp(a)] in the Strasbourg control population. Individuals homozygous for the rare allele had higher levels of these lipid parameters. In Belfast, although not statistically significant, the Apo B signal peptide polymorphism had a similar effect on Apo-B-related parameters as seen in Strasbourg. No significant associations were observed in the Haute-Garonne population where the risk of myocardial infarction is three times lower than in Belfast. In all three populations, the average Lp(a) levels were consistently different among Apo B signal peptide genotypes. These data implicate the Apo B signal peptide in determining some of the risks of myocardial infarction in these populations. Regardless of the exact mechanism, the Apo B signal peptide is an important candidate locus for the study of potentially atherogenic lipid variants. [ABSTRACT FROM AUTHOR]

The polymorphism affecting codon 4311 of the apolipoprotein B gene (ApoB/4311) was investigated in a large case-control study in two French and one Northern Irish geographically defined populations. Cases were recruited 3 to 9 months after a myocardial infarction (MI) and controls were randomly selected from the population. The polymorphism was assessed using allele-specific oligonucleotides (ASO). The genotype frequencies of the ApoB/4311 polymorphism did not differ in Northern Ireland and France and were in Hardy-Weinberg equilibrium in all groups; strong associations with three other polymorphisms of the ApoB gene ( XbaI, EcoRI, VNTR(34 repeats)) were observed and it was possible to identify highly sensitive and specific markers of the ApoB/4311 rare variant. Homozygotes for the ApoB 4311 rare variant were slightly less frequent in cases than in controls: 22 (4.4%) and 35 (6.7%) respectively (population adjusted χ=3.3 P<0.07), especially in Belfast: 6 (3.1%) and 12 (7.6%), respectively ( P<0.06). Several lipid and lipoprotein parameters were measured. Consistently among control groups, rare homozygotes had lower mean levels of ApoB ( P<0.02), triglycerides ( P<0.02), and lipoprotein particles containing ApoE and ApoB (LpE:B; P<0.001) and a higher mean level of lipoprotein particles containing ApoAI and not ApoAII (LpAI; P<0.02) than heterozygotes and frequent homozygotes combined. The strong association between the ApoB/4311 polymorphism and LpE:B was also observed in patients with MI. When present in the homozygous form, the ApoB/ 4311 Asn→Ser variant is associated with a lipoprotein profile that is apparently favourable. [ABSTRACT FROM AUTHOR]

A total of 10 desmoplastic small round-cell tumour patients were treated by high-dose chemotherapy with stem cell support. After high-dose chemotherapy, no complete response conversion was obtained and EWS-WT1 fusion transcript detection was positive in the peripheral blood during follow-up in all patients. High-dose chemotherapy did not seem to change the results in desmoplastic small round-cell tumour.British Journal of Cancer (2003) 89, 1159-1161. doi:10.1038/sj.bjc.6601304 www.bjcancer.com [ABSTRACT FROM AUTHOR]

Background: Platinum-based systemic chemotherapy is considered the backbone for management of advanced urothelial carcinomas. However there is a lack of real world data on the use of such chemotherapy regimens, on patient profiles and on management after treatment failure.Methods: Fifty-one randomly selected physicians from 4 European countries registered 218 consecutive patients in progression or relapse following a first platinum-based chemotherapy. Patient characteristics, tumor history and treatment regimens, as well as the considerations of physicians on the management of urothelial carcinoma were recorded.Results: A systemic platinum-based regimen had been administered as the initial chemotherapy in 216 patients: 15 in the neoadjuvant setting, 61 in adjuvant therapy conditions, 137 in first-line advanced setting and 3 in other conditions. Of these patients, 76 (35 %) were initially considered as cisplatin-unfit, mainly because of renal impairment (52 patients). After platinum failure, renal impairment was observed in 44 % of patients, ECOG Performance Status ≥ 2 in 17 %, hemoglobinemia < 10 g/dL in 16 %, hepatic metastases in 13 %. 80 % of these patients received further anticancer therapy. Immediately after failure of adjuvant/neoadjuvant chemotherapy, most subsequent anticancer treatments were chemotherapy doublets (35/58), whereas after therapy failure in the advanced setting most patients receiving further anticancer drugs were treated with a single agent (80/114). After first progression to chemotherapy, treatment decisions were mainly driven by Performance Status and prior response to chemotherapy (>30 % patients). The most frequent all-settings second anticancer therapy regimen was vinflunine (70 % of single-agent and 42 % of all subsequent treatments), the main reasons evoked by physicians (>1 out of 4) being survival benefit, safety and phase III evidence.Conclusion: In this daily practice experience, a majority of patients with urothelial carcinoma previously treated with a platinum-based therapy received a second chemotherapy regimen, most often a single agent after an initial chemotherapy in the advanced setting and preferably a cytotoxic combination after a neoadjuvant or adjuvant chemotherapy. Performance Status and prior response to chemotherapy were the main drivers of further treatment decisions. [ABSTRACT FROM AUTHOR]

Traditionally, the efficacy of an anticancer agent has been measured by response rate. With the development of biological molecular-targeted agents, which have a different mechanism of action from conventional agents, it may be appropriate to consider alternative criteria that reflect the positive effect of these biological agents on disease control, palliation, symptom improvement and quality of life. One such targeted agent is the orally active epidermal growth factor receptor tyrosine kinase inhibitor gefitinib (‘Iressa’, ZD1839). This article reviews the clinical experience of patients with advanced/metastatic non-small-cell lung cancer, who have received gefitinib as part of a clinical trial or through the ‘Iressa’ Expanded Access Programme. Disease-control rates of ~50% were observed in some Expanded Access Programme series, comparable with results obtained from Phase II trials. Symptom improvement was also reported. Information that will help identify those patients most likely to respond to treatment will become increasingly important. Therefore, the possible role of prognostic markers and the relationship between epidermal growth factor receptor status and response to gefitinib has been investigated. No clear association between epidermal growth factor receptor expression and response was observed. Future studies of other biomarkers in the epidermal growth factor receptor pathway should help to identify which patients are likely to benefit most from gefitinib.British Journal of Cancer (2003) 89 (Suppl 2), S3-S8. doi:10.1038/sj.bjc.6601476 www.bjcancer.com [ABSTRACT FROM AUTHOR]

Some subgroups of patients with advanced/metastatic non-small-cell lung cancer (NSCLC) are frequently considered ineligible for the aggressive, platinum-based combination chemotherapy that is the recommended treatment. Elderly patients may have a poorer tolerance of chemotherapy due to impaired organ function and frequent comorbidities; patients with poor performance status (PS; ?2 due to NSCLC and/or coexisting illnesses) are often considered unfit for chemotherapy; other patients may be unable or unwilling to endure the toxicity or inconvenience of chemotherapy. These patient groups may benefit from novel, relatively nontoxic treatment modalities. Gefitinib (‘Iressa’, ZD1839) 250?mg?day-1 is well tolerated and has proven antitumour and symptom improvement activity in patients with previously treated NSCLC. Phase II trials (IDEAL 1 and 2) of gefitinib in advanced/metastatic NSCLC included 70 out of 425 (16.5%) patients with PS ?2, and their response rate, clinical benefit rate and rates of adverse events were similar to those of the overall trial population. In addition, many patients with advanced/metastatic NSCLC with poor PS or advanced age have received gefitinib 250?mg?day-1 in an Expanded Access Programme (EAP). Observations from the EAP support those of IDEAL 1 and 2, and indicate that gefitinib 250?mg?day-1 warrants further investigation in these patient groups.British Journal of Cancer (2003) 89 (Suppl 2), S19-S23. doi:10.1038/sj.bjc.6601479 www.bjcancer.com [ABSTRACT FROM AUTHOR]