4635 Background: In the U.S. there are about 70,000 annual prostate cancer recurrences. The purpose of this study is to evaluate a product to decrease incidence of recurrence. This study is based on objective clinical responses in Phase I studies with AdV-tk (ProstAtak™, Advantagene, Inc) as monotherapy in recurrent disease and preclinical data demonstrating synergy between AdV-tk and radiation. AdV-tk is an adenoviral vector expressing the herpes thymidine kinase gene delivered to the prostate via TRUS-guided injection followed by 14 days of oral prodrug. The mechanisms of function involve direct tumor cytotoxicity, local elicitation of danger signals, recruitment and activation of antigen presenting cells and stimulation of systemic anti-tumor T-cell immunity. Method: AdV-tk was evaluated in combination with radiation in 66 newly diagnosed patients: 33 low risk (Arm A, PSA <10, Gleason <7, and T1c-T2a) and 33 intermediate-high risk (Arm B, PSA ≥10, Gleason ≥7, or T2b-T3). Arm A received two treatments with AdV-tk, immediately before and 14 days into radiation. Arm B received an additional treatment at initiation of androgen deprivation therapy. Results: Two surrogate and one definitive end-point were evaluated. Frequency of patients in Arm A with PSA nadir ≤0.2 ng/ml was 71% vs 56% in a control group of concurrent patients without AdV-tk. The two-year pathologic complete response (pCR) rate by sextant biopsy was 90% in Arm A and 94% in Arm B, compared to an expected range of 70–73%. Freedom from failure (FFF) after 60 month median follow up is 100% for Arm A and 90% for Arm B (95% for intermediate, 75% for high risk) vs best reported results of 79–90% for low risk and 48–79% for intermediate-high risk patients. The three failures in Arm B occurred within months after treatment leading to a Kaplan-Meier curve that plateaus at 90% beyond year 3. This is notably different than previous reports in which the curves continue to drop beyond year 5. Conclusion: These results suggest that AdV-tk combined with radiation therapy may significantly reduce the recurrence rate in patients with prostate cancer, particularly in patients with intermediate-high risk disease. A randomized controlled trial is warranted. [Table: see text]
Almost half of penile squamous cell carcinomas (SCCs) are of the usual type but there is a variegated spectrum of morphologically distinctive subtypes. In a pathologic review of 375 uniformly diagnosed and treated patients with penile SCC, we found 7 tumors with predominant pseudoglandular or adenoid features. The aim of the study was to delineate clinicopathologic features and outcome of an unusual variant of penile SCC. Clinical charts and pathologic materials were reviewed. The following informations were obtained: patient's age, tumor site, size, histologic grade (1, 2, and 3), thickness in millimeters, anatomic level of invasion [corpus spongiosum, corpus cavernosum (CC)], vascular and perineural invasion, groin nodal status, and follow-up in months. These features were compared with those of 224 cases of usual SCCs. Median age of the patients was 54 years. Tumors were large (average 4.6 cm) and involved multiple sites in 4 cases; exclusively the glans in 2 and site was unknown in 1. Microscopically, tumors were SCC with acantholytic areas ranging from solid nests with early necrosis or empty pseudoluminal spaces lined by 1 layer of squamous cells or cylindrical cells strikingly simulating glands. Tumors were deeply infiltrating (4 invaded CC, 2 corpus spongiosum, and 1 invaded preputial dermis) and were of high histologic grade (6 cases). Vascular invasion was present in 4 cases and perineural invasion in 2. The differential diagnosis was with gland forming penile tumors (surface adenosquamous, mucoepidermoid, and urethral adenocarcinomas) and the angiosarcomatoid variant of sarcomatoid carcinomas. There was regional nodal metastasis in 3 patients, 2 of which died from disease. The other 5 were either alive with no evidence of disease (12 and 21 y after diagnosis) or died from causes other than penile cancer (3, 4, and 7 y after diagnosis). Comparing with usual SCCs, pseudoglandular SCCs were of higher grade (88% vs. 44%), invaded deeper into CC (71% vs. 52%), and showed a higher incidence of regional metastasis (42% vs. 25%) and higher mortality (29% vs. 19%).
<div>Abstract<p>GGAP2/PIKE-A is a GTP-binding protein that can enhance Akt activity. Increased activation of the AKT and nuclear factor-κB (NF-κB) pathways have been identified as critical steps in cancer initiation and progression in a variety of human cancers. We have found significantly increased expression GGAP2 in the majority of human prostate cancers and GGAP2 expression increases Akt activation in prostate cancer cells. Thus, increased GGAP2 expression is a common mechanism for enhancing the activity of the Akt pathway in prostate cancers. In addition, we have found that activated Akt can bind and phosphorylate GGAP2 at serine 629, which enhances GTP binding by GGAP2. Phosphorylated GGAP2 can bind the p50 subunit of NF-κB and enhances NF-κB transcriptional activity. When expressed in prostate cancer cells, GGAP2 enhances proliferation, foci formation, and tumor progression <i>in vivo</i>. Thus, increased GGAP2 expression, which is present in three quarters of human prostate cancers, can activate two critical pathways that have been linked to prostate cancer initiation and progression. [Cancer Res 2009;69(3):819–27]</p></div>
Summary This paper presents and evaluates a simplified method for the determination of the seismic performance of structures, suitable for application to plane and three-dimensional asymmetric frames in which the contribution of higher modes of vibration to the response is important. The steps required in the application of the method and in the evaluation of its results are established. To illustrate its application, two reinforced concrete plane frames 8 and 17 storey high, two reinforced concrete asymmetric three-dimensional frames 4 and 8 storey high and the super-structure of a bridge are studied. The obtained results are compared with those corresponding to true non-linear step by step dynamic analyses. A procedure for the performance based design of structures founded in the same simplified method is proposed.