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Purpose To compare the overall survival rates of good-prognosis carcinomas of an unknown primary site (CUPS) patients treated with cisplatin alone (C) or in combination with gemcitabine (CG). Patients and methods Good prognosis was defined according to the GEFCAPI (Groupe d’Etude Francais des Carcinomes de site Primitif Inconnu) classification by PS (Performance Status) ⩽1 and LDH (Lactate Deshydrogenase) within the normal range. Patients were randomly assigned to receive C or CG. Patients in the C arm received cisplatin 100 mg/m2 repeated every 3 weeks. In the CG arm, chemotherapy consisted of gemcitabine 1250 mg/m2 on days 1 and 8 and cisplatin 100 mg/m2 IV on day 1, repeated every 3 weeks. The original plan was to accrue 192 patients in order to detect a 20% difference in overall survival. Results Fifty-two patients were enrolled (arm A: 25; arm B: 27). The trial was stopped early due to insufficient accrual. The median overall survival (OS) rate was 11 months [95% confidence interval: 9–20] and 8 months [95% CI: 6–12], in the CG arm and in the C arm, respectively. The 1-year survival rate was 46% [95% CI: 28–64] in the combination arm and 35% [95% CI: 19–56] in the C arm (log rank test: p = 0.73). The median progression-free survival (PFS) rate was 5 [95% CI: 3–11] and 3 [95% CI: 1–8] months in the CG and in the C arm, respectively. The 1-year PFS rate was 29% [95% CI: 15–48] in the combination arm and 15% [95% CI: 5–35] in the C arm (log rank test: p = 0.27). No toxic deaths occurred. Grade 3–4 neutropenia (63% versus 12%) and grade 3–4 thrombocytopenia (37% versus 4%) were more frequent in the CG arm than in the C arm. Conclusion A non-significantly better outcome was observed with CG as compared to C in patients with CUP and a non-unfavourable prognosis. The toxicity profile of the combined arm was represented by haematologic toxicity with thrombocytopenia and leuconeutropenia. International collaboration is required to conduct phase III trials in patients with CUP.

Treating patients with anthracycline- and taxane-pretreated metastatic breast cancer (MBC) represents a significant challenge to oncologists. The tumour-activated oral fluoropyrimidine, capecitabine, is the only treatment approved for these patients. Our study evaluated the efficacy, safety and impact on quality of life (QOL) of capecitabine in this setting. Patients (n=126) with anthracycline- and taxane-pretreated metastatic breast cancer received capecitabine 1250 mg/m 2 twice daily, days 1–14, followed by a 7-day rest period. Median time to progression was 4.9 months (95% Confidence Interval (CI): 4.0–6.4). Thirty-five patients (28%) achieved an objective response (95% CI: 20–36%), including five (4%) complete responses. Median overall survival was 15.2 months (95% CI: 13.5–19.6 months). Capecitabine demonstrated a favourable safety profile, with a low incidence of treatmentrelated grade 3/4 adverse events. The most common adverse events were hand–foot syndrome and gastrointestinal effects. QOL assessment showed that capecitabine treatment was associated with an increase in mean Global Health Score. Capecitabine is active, well tolerated and improves the QOL of patients with anthracycline- and taxane-pretreated metastatic breast cancer. Based on the consistently high activity demonstrated in clinical trials, capecitabine has become the reference treatment in this setting. # 2003 Elsevier Ltd. All rights reserved.

The objective of this study was to examine and compare two core measures of Quality Of Life (QOL) used in cancer clinical trials: the European Organisation for Research and Treatment of Cancer QOL Core Questionnaire 30 (EORTC QLQ-30) and the Functional Assessment of Chronic Illness Therapy (FACIT), in order to identify which one patients have the strongest preference for using. 68 patients suffering from Carcinomas of an Unknown Primary site (CUP) were recruited in a multicentric study; all of them completed both questionnaires, administered in a randomised manner. The criteria were the percentage of preferences, and four indicators of acceptability. The results indicated that an equal proportion of patients preferred the QLQ-C30 (19%) and FACIT (19%). 54% of patients felt both questionnaires were acceptable. All the indicators of acceptability favoured the QLQ-C30. Analysis of open-ended questions shed light on the difficulties encountered by the patients. As no significant preference was observed for one of the questionnaires, the QLQ-C30 was chosen on the basis of its significantly better acceptability criteria.

thought to play an important role in carcinogenesis by protecting cells from apoptosis. Recent publications disclosing FASN inhibitors suggest a pharmacophore common to many chemical series, wherein an aromatic group and an acylated cyclic amine are attached to a central scaffold. We postulated that imidazolinone would be an acceptable and drug-like scaffold, inspired by the precedent of irbesartan, an approved antihypertensive drug with a spirocyclopentyl-imidazolinone core. This hypothesis led to the discovery of a new series of imidazolinone-based FASN inhibitors. Extensive structure–activity relationship work in our laboratories resulted in numerous molecules with potent enzyme and cell activity, selectivity, and oral bioavailability. One such compound is a potent inhibitor of human FASN enzymatic activity (IC50 = 28 nM) and also potently inhibits proliferation of A2780 ovarian cells in lipid-reduced medium (IC50 = 13 nM). Addition of palmitate to the medium rescues the cells from FASN inhibition, demonstrating on-target effects. Potent activity is also seen in other cancer cells such as PC3M (IC50 = 25 nM) and LnCaP-Vancouver prostate cells (IC50 = 66 nM). This lead compound is highly bioavailable (F 61%) in mice and shows good plasma and tumor exposures after oral dosing. In a pharmacodynamics (PD) model in H460 lung xenograft-bearing mice, oral treatment resulted in elevated tumor levels of malonyl-CoA and decreased tumor levels of palmitate. This compound and other members of the imidazolinone series potently inhibit the FASN KR domain (IC50 = 54 nM); specific binding to KR was confirmed by co-crystal structures of several examples. In summary, we discovered a new series of FASN inhibitors built upon an imidazolinone scaffold that are potent in enzyme and in cell proliferation assays, are highly bioavailable, and bind to KR domain. Moreover, rescue of lipid-reduced cellular activity upon addition of palmitate suggests selectivity, and PD studies in tumor-bearing mice confirm target engagement.

J.P. Delord, N. Houede, A. Awada, C. Lebbe, T. Lesimple, J.H.M. Schellens, S. Rottey, R. Kefford, N. Rejeb, E. Raymond. Centre Claudius Regaud, Clinical Research Unit, Toulouse, France; Institut Bergonie, Bordeaux, France; Jules Bordet Institute, Brussels, Belgium; APHP Hopital Saint-Louis, Paris, France; Centre Eugene Marquis, Rennes, France; The Netherlands Cancer Institute, Amsterdam, The Netherlands; Heymans Institute of Pharmacology Ghent University Hospital, Ghent, Belgium; Westmead Hospital and Melanoma Institute, University of Sydney, Sydney NSW, Australia; Merck Serono S.A. − Geneva, Geneva, Switzerland; Beaujon University Hospital, Clichy, France

Material From 1960 to 1990, 581 cases of male breast cancer (MBC) were reviewed in 19 Cancer Institutes in France. 23 (4%) were pure DCIS. The median age was 56.5 years (ext. 26–77). Five patients had less than 40 years (22%). Gynecomastia was found in 10 out of 23 patients (43%). Three had family history of B. C. According to TNM classification, we found 6 impalpable lesions (T0) discovered by serosanguineous nipple discharge, 7 T1, 6 T2, and 4 Tx. Treatment The surgery consisted of 3 lumpectomies, 16 modified, 2 subcutaneous and 2 radical mastectomies. 16 patients had axillary dissections and 6 irradiation on the chest wall. Histology All cases were pure DCIS: in 14 the subtype was clearly identified: papillary (4), papillary intracystic (3), mixed papillary and cribriform (3), comedocarcinoma (2), cribriform (1), apocrine (1). Three patients had local recurrences: two occurred in the patients initially treated by lumpectomy alone: the first was again a DCIS, but the second was an infiltrating carcinoma; this patient died by metastases. The last relapse occurred on the chest wall in a patient treated by mastectomy. One patient developed a contralateral DCIS. Two patients developed a lung and kidney cancer respectively. In the literature the rate of DCIS in man varies from 0 to 16%. The serosanguineous nipple discharge seems a frequent symptom, especially in young men. The main histologic subtype is papillary (pure or intracystic). Mastectomy is the treatment of choice.