Sinnvoller Einsatz von Tumormarkern

Tumor markers refer to all detectable and measurable analytes which are able to indicate a solid tumor or contribute to its characterization or judgment concerning tumor spread and therapy efficacy. Among the markers, humoral circulating tumor substances, such as precursors of normal antigens, ectopically produced hormones or enzymes, ontogenetic old reactivated antigens, hybridoma-defined mucins and cytokeratins are of special interest. Up to now, no tumor specific biomarker has been detected, all markers known so far are physiological components of blood; thus, their diagnostic capacity is more related to quantity than to quality. The tumor marker concentration depends on the tumor blood supply and reflects tumor mass and tumor spread as a sum of marker expression, synthesis, release, the catabolism of the organism, as well as the marker excretion. Changes in biomarker levels without correlation to tumor load can be due to impairment of the liver and kidney function or due to invasive diagnostic methods (endoscopy, biopsy, ureteral catheter) or due to acute reactions on treatment (surgery, radio-chemotherapy). Due to problems with standardization between assays from different producers measuring the same antigen, interpretation of biomarkers of single measurements, such as PSA (prostate specific antigen), must be performed using assay specific reference ranges and interpretation of serial measurements must be performed using the identical assay. The test result has to be indicated together with the assay used (kit and producer). Among the potential indications for tumor marker determinations, the early detection or screening of a tumor is unrealistic - except PSA in prostate cancer detection. In rare cases, biomarkers can be helpful in tumor localization (HTG (human thyreoglobuline), PSA) and support of primary diagnosis, the knowledge about their prognostic relevance is increasing, the most widely used indication is therapy control and follow-up care in context with medical imaging. Provided that markers are critically selected following the localization of the tumor, that serial determinations are performed using the identical assay and that the clinical question is relevant, tumor markers contribute to a significant degree to diagnosis, prognosis, therapy control and early detection of metastatic or recurrent disease. Especially in the field of diagnostic oncology, the quality of the investigator is significantly linked to the quality of the test result

Outcome of ATP-based tumor chemosensitivity assay directed chemotherapy in heavily pre-treated recurrent ovarian carcinoma

BACKGROUND: We wished to evaluate the clinical response following ATP-Tumor Chemosensitivity Assay (ATP-TCA) directed salvage chemotherapy in a series of UK patients with advanced ovarian cancer. The results are compared with that of a similar assay used in a different country in terms of evaluability and clinical endpoints. METHODS: From November 1998 to November 2001, 46 patients with pre-treated, advanced ovarian cancer were given a total of 56 courses of chemotherapy based on in-vitro ATP-TCA responses obtained from fresh tumor samples or ascites. Forty-four patients were evaluable for results. Of these, 18 patients had clinically platinum resistant disease (relapse < 6 months after first course of chemotherapy). There was evidence of cisplatin resistance in 31 patients from their first ATP-TCA. Response to treatment was assessed by radiology, clinical assessment and tumor marker level (CA 125). RESULTS: The overall response rate was 59% (33/56) per course of chemotherapy, including 12 complete responses, 21 partial responses, 6 with stable disease, and 15 with progressive disease. Two patients were not evaluable for response having received just one cycle of chemotherapy: if these were excluded the response rate is 61%. Fifteen patients are still alive. Median progression free survival (PFS) was 6.6 months per course of chemotherapy; median overall survival (OAS) for each patient following the start of TCA-directed therapy was 10.4 months (95% confidence interval 7.9-12.8 months). CONCLUSION: The results show similar response rates to previous studies using ATP-TCA directed therapy in recurrent ovarian cancer. The assay shows high evaluability and this study adds weight to the reproducibility of results from different centre

Molecular testing for the clinical diagnosis of fibrolamellar carcinoma.

Fibrolamellar carcinoma has a distinctive morphology and immunophenotype, including cytokeratin 7 and CD68 co-expression. Despite the distinct findings, accurate diagnosis of fibrolamellar carcinoma continues to be a challenge. Recently, fibrolamellar carcinomas were found to harbor a characteristic somatic gene fusion, DNAJB1-PRKACA. A break-apart fluorescence in situ hybridization (FISH) assay was designed to detect this fusion event and to examine its diagnostic performance in a large, multicenter, multinational study. Cases initially classified as fibrolamellar carcinoma based on histological features were reviewed from 124 patients. Upon central review, 104 of the 124 cases were classified histologically as typical of fibrolamellar carcinoma, 12 cases as 'possible fibrolamellar carcinoma' and 8 cases as 'unlikely to be fibrolamellar carcinoma'. PRKACA FISH was positive for rearrangement in 102 of 103 (99%) typical fibrolamellar carcinomas, 9 of 12 'possible fibrolamellar carcinomas' and 0 of 8 cases 'unlikely to be fibrolamellar carcinomas'. Within the morphologically typical group of fibrolamellar carcinomas, two tumors with unusual FISH patterns were also identified. Both cases had the fusion gene DNAJB1-PRKACA, but one also had amplification of the fusion gene and one had heterozygous deletion of the normal PRKACA locus. In addition, 88 conventional hepatocellular carcinomas were evaluated with PRKACA FISH and all were negative. These findings demonstrate that FISH for the PRKACA rearrangement is a clinically useful tool to confirm the diagnosis of fibrolamellar carcinoma, with high sensitivity and specificity. A diagnosis of fibrolamellar carcinoma is more accurate when based on morphology plus confirmatory testing than when based on morphology alone

Institutional creativity and pathologies of potential space: The modern university

This paper proposes the applicability of object relations psychoanalytic conceptions of dialogue (Ogden, 1986, 1993) to thinking about relationships and relational structures and their governance in universities. It proposes that: the qualities of dialogic relations in creative institutions are the proper index of creative productivity; that is of, as examples, ’thinking’ (Evans, 2004), ’emotional learning’ (Salzberger-Wittenburg et al., 1983) or ’criticality’ (Barnett, 1997); contemporary institutions’ explicit preoccupation in assuring, monitoring and managing creative ’dialogue’ can, in practice, pervert creative processes and thoughtful symbolic productivity, thus inhibiting students’ development and the quality of ’thinking space’ for teaching and research. In this context the paper examines uncanny and perverse connections between Paulo Freire’s (1972) account of educational empowerment and dialogics (from his Pedagogy of the oppressed) to the consumerist (see, for example, Clarke & Vidler, 2005) rhetoric of student empowerment, as mediated by some strands of managerialism in contemporary higher education. The paper grounds its critique of current models of dialogue, feedback loops, audit and other mechanisms of accountability (Power, 1997; Strathern, 2000), in a close analysis of how creative thinking emerges. The paper discusses the failure to maintain a dialogic space in humanities and social science areas in particular, exploring psychoanalytic conceptions from Donald Winnicott (1971), Milner (1979), Thomas Ogden (1986) and Csikszentmihalyi (1997). Coleridge’s ideas about imagination as the movement of thought between subjective and objective modes are discussed in terms of both intra- and inter-subjective relational modes of ’dialogue’, which are seen as subject to pathology in the pathologically structured psychosocial environment. Current patterns of institutional governance, by micromanaging dialogic spaces, curtail the ’natural’ rhythms and temporalities of imagination by giving an over-emphasis to the moment of outcome, at the expense of holding the necessary vagaries of process in the institutional ’mind’. On the contrary, as this paper argues, creative thinking lies in sporadic emergences at the conjunction of object/(ive) outcome and through (thought) processes

Comfort radicalism and NEETs: a conservative praxis

Young people who are not in education, employment or training (NEET) are construed by policy makers as a pressing problem about which something should be done. Such young people's lack of employment is thought to pose difficulties for wider society in relation to social cohesion and inclusion and it is feared that they will become a 'lost generation'. This paper(1) draws upon English research, seeking to historicise the debate whilst acknowledging that these issues have a much wider purchase. The notion of NEETs rests alongside longstanding concerns of the English state and middle classes, addressing unruly male working class youth as well as the moral turpitude of working class girls. Waged labour and domesticity are seen as a means to integrate such groups into society thereby generating social cohesion. The paper places the debate within it socio-economic context and draws on theorisations of cognitive capitalism, Italian workerism, as well as emerging theories of antiwork to analyse these. It concludes by arguing that ‘radical’ approaches to NEETs that point towards inequities embedded in the social structure and call for social democratic solutions veer towards a form of comfort radicalism. Such approaches leave in place the dominance of capitalist relations as well as productivist orientations that celebrate waged labour

Toward a geography of black internationalism: Bayard Rustin, nonviolence and the promise of Africa

This article charts the trip made by civil rights leader Bayard Rustin to West Africa in 1952, and examines the unpublished ‘Africa Program’ which he subsequently presented to leading American pacifists. I situate Rustin’s writings within the burgeoning literature on black internationalism which, despite its clear geographical registers, geographers themselves have as yet made only a modest contribution towards. The article argues that within this literature there remains a tendency to romanticize cross-cultural connections in lieu of critically interrogating their basic, and often competing, claims. I argue that closer attention to the geographies of black internationalism, however, allows us to shape a more diverse and practiced sense of internationalist encounter and exchange. The article reconstructs the multiplicity of Rustin’s black internationalist geographies which drew eclectically from a range of Pan-African, American and pacifist traditions. Though each of these was profoundly racialized, they conceptualized race in distinctive ways and thereby had differing understandings of what constituted the international as a geographical arena. By blending these forms of internationalism Rustin was able to promote a particular model of civil rights which was characteristically internationalist in outlook, nonviolent in principle and institutional in composition; a model which in selective and uneven ways continues to shape our understanding of the period

ENGOT-ov-6/TRINOVA-2: Randomised, double-blind, phase 3 study of pegylated liposomal doxorubicin plus trebananib or placebo in women with recurrent partially platinum-sensitive or resistant ovarian cancer

Aims: Trebananib, a peptide-Fc fusion protein, inhibits angiogenesis by inhibiting binding of angiopoietin-1/2 to the receptor tyrosine kinase Tie2. This randomised, double-blind, placebo-controlled phase 3 study evaluated whether trebananib plus pegylated liposomal doxorubicin (PLD) improved progression-free survival (PFS) in patients with recurrent epithelial ovarian cancer. / Methods: Women with recurrent ovarian cancer (platinum-free interval ≤12 months) were randomised to intravenous PLD 50 mg/m2 once every 4 weeks plus weekly intravenous trebananib 15 mg/kg or placebo. PFS was the primary end-point; key secondary end-points were objective response rate (ORR) and duration of response (DOR). Owing to PLD shortages, enrolment was paused for 13 months; the study was subsequently truncated. / Results: Two hundred twenty-three patients were enrolled. Median PFS was 7.6 months (95% CI, 7.2–9.0) in the trebananib arm and 7.2 months (95% CI, 4.8–8.2) in the placebo arm, with a hazard ratio of 0.92 (95% CI, 0.68–1.24). However, because the proportional hazards assumption was not fulfilled, the standard Cox model did not provide a reliable estimate of the hazard ratio. ORR in the trebananib arm was 46% versus 21% in the placebo arm (odds ratio, 3.43; 95% CI, 1.78–6.64). Median DOR was improved (trebananib, 7.4 months [95% CI, 5.7–7.6]; placebo, 3.9 months [95% CI, 2.3–6.5]). Adverse events with a greater incidence in the trebananib arm included localised oedema (61% versus 32%), ascites (29% versus 9%) and vomiting (45% versus 33%). / Conclusions: Trebananib demonstrated anticancer activity in this phase 3 study, indicated by improved ORR and DOR. Median PFS was not improved. No new safety signals were identified. / Trial registration: ClinicalTrials.gov, NCT0128125

GENDER DIFFERENCES IN THE RELATIONSHIP BETWEEN QUADRICEPS MVIC AND HAMSTRING TO QUADRICEPS RATIO

No previous research has evaluated the relationship between degree of Q activation and its’ effect on H:Q ratio, despite the fact that Q dominance and low H:Q ratios are thought to increase the risk of H and ACL injury (Baratta et al., 1988; Hewitt et al., 2001). Compared to males, females may be at greater risk, due to higher Q co-activation (Colliander and Tesch, 1989; White et al., 2003). The purpose of this study was to evaluate gender differences in the relationship between Q activation and it’s effect on H:Q ratios

Systematic Analysis of Circulating Soluble Angiogenesis-Associated Proteins in ICON7 Identifies Tie2 as a Biomarker of Vascular Progression on Bevacizumab

background: There is a critical need for predictive/resistance biomarkers for VEGF inhibitors to optimise their use. methods: Blood samples were collected during and following treatment and, where appropriate, upon progression from ovarian cancer patients in ICON7, a randomised phase III trial of carboplatin and paclitaxel with or without bevacizumab. Plasma concentrations of 15 circulating angio-biomarkers were measured using a validated multiplex ELISA, analysed through a novel network analysis and their relevance to the PFS then determined. results: Samples (n=650) were analysed from 92 patients. Bevacizumab induced correlative relationships between Ang1 and Tie2 plasma concentrations, which reduced after initiation of treatment and remained decreased until progressive disease occurred. A 50% increase from the nadir in the concentration of circulating Tie2 (or the product of circulating Ang1 and Tie2) predicted tumour progression. Combining Tie2 with GCIG-defined Ca125 data yielded a significant improvement in the prediction of progressive disease in patients receiving bevacizumab in comparison with Ca125 alone (74.1% vs 47.3%, P<1 × 10−9). conclusions: Tie2 is a vascular progression marker for bevacizumab-treated ovarian cancer patients. Tie2 in combination with Ca125 provides superior information to clinicians on progressive disease in patients with VEGFi-treated ovarian cancers

Fourth worlds and neo-Fordism: American Apparel and the cultural economy of consumer anxiety

This article examines the strategies of the ‘sweatshop-free’ clothing company American Apparel in the context of ongoing debates over the cultural turn and cultural economy. American Apparel’s key selling point is that it does not outsource: it manufactures in Los Angeles, pays ‘good’ wages and provides healthcare, yet the workers are not unionised and the migrant labour it depends upon is often temporary. These same employees are used in promotional material to create its brand identity of an irreverent, hip and quasi-sexualised ‘community’ of consumers and workers. A design- and brand-led company that nonetheless doesn’t see itself as a brand in any conventional sense, and markets itself as ‘transparent’, the company’s ethos turns on consumer anxiety towards the socio-economic injustices of post-Fordism. Indeed, it marks a partial return to Fordist modes of production by aiming to manufacture everything under one roof, whilst deploying modes of informality (and technology) stereotypically associated with the post-Fordist creative industries. This paper considers the complex dynamics of American Apparel’s emergence in a reflexive marketplace (in relation to what Callon has termed an ‘economy of qualities’) and discusses its problematic negotiations with ‘fourth worlds’, or the zones of exclusion Castells terms ‘the black holes of informational capitalism’