Search

Purpose: Racial disparity in breast cancer outcomes exists between African American and white women in the United States. We have evaluated the impact of genetically determined ancestry on disparity in efficacy and therapy-induced toxicity for patients with breast cancer in the context of a randomized, phase III adjuvant trial. Methods: This study compared outcomes between 386 patients of African ancestry (AA) and 2,473 patients of European ancestry (EA) in a randomized, phase III breast cancer trial, ECOG-ACRIN-5103. The primary efficacy end point, invasive disease–free survival (DFS), and clinically significant toxicities were compared, including anthracycline-induced congestive heart failure, taxane-induced peripheral neuropathy (TIPN), and bevacizumab-induced hypertension. Results: Overall, AAs had significantly inferior DFS (P =.002; hazard ratio, 1.5) compared with EAs. This was significant in the estrogen receptor–positive subgroup (P =.03), with a similar, nonsignificant trend for those who had triple-negative breast cancer (P =.12). AAs also had significantly more grades 3 to 4 TIPN (odds ratio [OR], 2.9; P = 2.4 × 10−11) and grades 3 to 4 bevacizumab-induced hypertension (OR, 1.6; P =.02), with a trend for more congestive heart failure (OR, 1.8; P =.08). AAs had significantly more dose reductions in paclitaxel (P = 6.6 × 10−6). In AAs, dose reductions in paclitaxel had a significant negative impact on DFS (P =.03), whereas in EAs, dose reductions did not have an impact on outcome (P =.35). Conclusion: AAs had inferior DFS, with more clinically important toxicities, in ECOG-ACRIN-5103. The altered risk-to-benefit ratio for adjuvant breast cancer chemotherapy should lead to additional research with the focus on the impact of genetic ancestry on both efficacy and toxicity. Strategies to minimize dose reductions in paclitaxel, especially as the result of TIPN, are warranted for this population. [ABSTRACT FROM AUTHOR]

Abstract: Methamphetamine (MP) is a widely abused psychostimulant. There are currently no FDA approved pharmacotherapies for the MP addict. The antidepressant, mirtazapine (Mirt) is a high affinity antagonist at several monoaminergic receptors that are affected by MP. This study evaluated the potential of Mirt as a therapeutic agent for MP addiction and described associated changes in neuronal signaling. A single pairing conditioned place preference (CPP) paradigm was utilized as a behavioral measure of MP -induced effects. Rats learned to associate unique environmental cues with the effects of 1.0mg/kg (i.p.) MP (day 1) or saline (day 2). Mirt (5.0mg/kg i.p.) was given in the home cage on day 3 and CPP was assessed on day 4. To evaluate signaling events that correlate with this behavior, brain tissue of these rats were dissected for immunoblot assays of extracellular signal-regulated kinase (ERK) and a transcriptional regulator, cAMP response element-binding protein (CREB) after the CPP test. During the CPP test, rats conditioned with MP spent more time in the environment associated with MP. Importantly, rats given Mirt did not express CPP. MP-induced CPP was associated with a decrease in phosphorylated CREB (pCREB) in the ventral tegmental area, and decreased phosphorylated ERK and pCREB in the nucleus accumbens and treatment with Mirt did not reverse these changes. No changes in signaling proteins were obtained from rats similarly treated with MP and Mirt, without exposure to cues of the conditioning paradigm. Overall, a post-conditioning treatment with Mirt can nullify MP-induced associative learning. However, additional studies are needed to ascertain the molecular events underlying this effect of Mirt. [Copyright &y& Elsevier]