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Background: Gemcitabine is used to treat a wide range of tumours, but its efficacy is limited by cancer cell resistance mechanisms. NUC-1031, a phosphoramidate modification of gemcitabine, is the first anti-cancer ProTide to enter the clinic and is designed to overcome these key resistance mechanisms.Methods: Sixty-eight patients with advanced solid tumours who had relapsed after treatment with standard therapy were recruited to a dose escalation study to determine the recommended Phase II dose (RP2D) and assess the safety of NUC-1031. Pharmacokinetics and anti-tumour activity was also assessed.Results: Sixty-eight patients received treatment, 50% of whom had prior exposure to gemcitabine. NUC-1031 was well tolerated with the most common Grade 3/4 adverse events of neutropaenia, lymphopaenia and fatigue occurring in 13 patients each (19%). In 49 response-evaluable patients, 5 (10%) achieved a partial response and 33 (67%) had stable disease, resulting in a 78% disease control rate. Cmax levels of the active intracellular metabolite, dFdCTP, were 217-times greater than those reported for equimolar doses of gemcitabine, with minimal toxic metabolite accumulation. The RP2D was determined as 825 mg/m2 on days 1, 8 and 15 of a 28-day cycle.Conclusions: NUC-1031 was well tolerated and demonstrated clinically significant anti-tumour activity, even in patients with prior gemcitabine exposure and in cancers not traditionally perceived as gemcitabine-responsive. [ABSTRACT FROM AUTHOR]

Object: The anterior commissure is a critical interhemispheric pathway in animals, yet its connections in humans are not clearly understood. Its distribution has shown to vary greatly between species, and it is thought that in humans it may convey axons from a larger territory than previously thought. The aim was to use an anatomical mapping tool to look at the anterior commissure fibres and to compare the distribution findings with published anatomical understanding. Materials and methods: Two different diffusion-weighted imaging data sets were acquired from eight healthy subjects using a 3 Tesla MR scanner with 32 gradient directions. Diffusion tensor imaging tractography was performed, and the anterior commissure fibres were selected using three-dimensional regions of interest. Distribution of the fibres was observed by means of registration with T2-weighted images. The fibre field similarity maps were produced for five of the eight subjects by comparing each subject's fibres to the combined map of the five data sets. Results: Fibres were shown to lead into the temporal lobe and towards the orbitofrontal cortex in the majority of subjects. Fibres were also distributed to the parietal or occipital lobes in all five subjects in whom the anterior commissure was large enough for interhemispheric fibres to be tracked through. The fibre field similarity maps highlighted areas where the local distances of fibre tracts were displayed for each subject compared to the combined bundle map. Conclusion: The anterior commissure may play a more important role in interhemispheric communication than currently presumed by conveying axons from a wider territory, and the fibre field similarity maps give a novel approach to quantifying and visualising characteristics of fibre tracts. [ABSTRACT FROM AUTHOR]

MRI has a vital role in the assessment of intracranial lesions. Conventional MRI has limited specificity and multiparametric MRI using diffusion-weighted imaging, perfusion-weighted imaging and magnetic resonance spectroscopy allows more accurate assessment of the tissue microenvironment. The purpose of this educational pictorial review is to demonstrate the role of multiparametric MRI for diagnosis, treatment planning and for assessing treatment response, as well as providing a practical approach for performing and interpreting multiparametric MRI in the clinical setting. A variety of cases are presented to demonstrate how multiparametric MRI can help differentiate neoplastic from non-neoplastic lesions compared to conventional MRI alone. [ABSTRACT FROM AUTHOR]