BACKGROUND An improvement in overall survival among patients with metastatic melanoma has been an elusive goal. In this phase 3 study, ipilimumab — which blocks cytotoxic T-lymphocyte–associated antigen 4 to potentiate an antitumor T-cell response — administered with or without a glycoprotein 100 (gp100) peptide vaccine was compared with gp100 alone in patients with previously treated metastatic melanoma. METHODS A total of 676 HLA-A⋆0201–positive patients with unresectable stage III or IV melanoma, whose disease had progressed while they were receiving therapy for metastatic disease, were randomly assigned, in a 3:1:1 ratio, to receive ipilimumab plus gp100 (403 patients), ipilimumab alone (137), or gp100 alone (136). Ipilimumab, at a dose of 3 mg per kilogram of body weight, was administered with or without gp100 every 3 weeks for up to four treatments (induction). Eligible patients could receive reinduction therapy. The primary end point was overall survival. RESULTS The median overall survival was 10.0 months among patients receiving ipilimumab plus gp100, as compared with 6.4 months among patients receiving gp100 alone (hazard ratio for death, 0.68; P<0.001). The median overall survival with ipilimumab alone was 10.1 months (hazard ratio for death in the comparison with gp100 alone, 0.66; P = 0.003). No difference in overall survival was detected between the ipilimumab groups (hazard ratio with ipilimumab plus gp100, 1.04; P = 0.76). Grade 3 or 4 immune-related adverse events occurred in 10 to 15% of patients treated with ipilimumab and in 3% treated with gp100 alone. There were 14 deaths related to the study drugs (2.1%), and 7 were associated with immune-related adverse events. CONCLUSIONS Ipilimumab, with or without a gp100 peptide vaccine, as compared with gp100 alone, improved overall survival in patients with previously treated metastatic melanoma. Adverse events can be severe, long-lasting, or both, but most are reversible with appropriate treatment. (Funded by Medarex and Bristol-Myers Squibb; ClinicalTrials.gov number, NCT00094653.)

BACKGROUND:The alpha v beta 3 (a v b 3 ) integrin is involved in intracellular signaling regulating cell proliferation, migration, and differentiation and is important for tumor-induced angiogenesis. METHODS: This phase 2, randomized, open-label, 2-arm study was designed to capture safety data and evaluate the antitumor efficacy of etaracizumab (Abegrin), an IgG1 humanized monoclonal antibody against the a v b 3 integrin, in patients with previously untreated metastatic melanoma. The objective was to evaluate whether etaracizumab AE dacarbazine had sufficient clinical activity to warrant further study in a phase 3 clinical trial. RESULTS: One hundred twelve patients were randomized to receive etaracizumab alone (N ¼ 57) or etaracizumab þ dacarbazine (N ¼ 55). Safety of etaracizumab AE dacarbazine was acceptable with infusion-related, gastrointestinal, and metabolic reactions being the most common adverse events (AEs). The majority of AEs were grade 1 or 2 in severity in both study arms; most events were not considered serious, except for cardiovascular (myocardial infarction, atrial fibrillation) and thromboembolic events, which occurred in 3 and 5 patients, respectively. None of the patients in the etaracizumab-alone study arm and 12.7% of patients in the etaracizumab þ dacarbazine study arm achieved an objective response. The median duration of objective response in the etaracizumab þ dacarbazine study arm was 4.2 months. Stable disease rate, time to progression (TTP), and progression-free survival (PFS) appeared to be similar between the 2 treatment arms. Stable disease occurred in 45.6% of patients in the etaracizumab-alone study arm and 40.0% of patients in the etaracizumab þ dacarbazine study arm. Median TTP and median PFS were both 1.8 months in the etaracizumab-alone study arm and 2.5 and 2.6 months in the etaracizumab þ dacarbazine study arm, respectively. Median overall survival was 12.6 months in the etaracizumab-alone study arm and 9.4 months in the etaracizumab þ dacarbazine study arm. CON-CLUSIONS: The survival results in both treatment arms of this study were considered unlikely to result in clinically meaningful improvement over dacarbazine alone. Cancer 2010;116:1526-34.

A general approach (oxyanion-Cope strategy) for the synthesis of sarpagine/ajmaline indole alkaloids has been developed. (+)-Ajmaline 1 and alkaloid G 2 as well as norsuaveoline 3 have been synthesized from d-(+)-tryptophan in enantiospecific fashion via the asymmetric Pictet−Spengler reaction and a stereocontrolled oxyanion-Cope rearrangement as key steps. The synthesis of these indole alkaloids employed a stereospecific Pictet−Spengler/Dieckmann protocol to prepare the key intermediate, (−)-N b-benzyl tetracyclic ketone (7a or 7b). This ketone was converted into α,β-unsaturated aldehyde (8a or 8b) and further transformed into (+)-ajmaline 1 and alkaloid G 2 as well as norsuaveoline 3. It was also found that reduction of 29 can be done stereospecifically to form the 2-epidiacetylajmaline derivative 30 which has the same configuration at C(2) as that of quebrachidine and of the bisindole alstonisidine. The ring closure reaction (from 27 to 28) to form the sarpagine skeleton was completed in 91% yield. It should now be possible to prepare the antipode of (+)-ajmaline via this approach for biological screening.

E + P resulted in a statistically significant doubling of median PFS, with an acceptable toxicity profile and encouraging OS. A multinational, phase III trial (SYMMETRY) of E + P compared with paclitaxel alone in metastatic melanoma has closed.

We have prepared a series of tetrahydro-beta-carbolines (TH beta C), beta-carbolines (beta-C), and other nitrogen heterocycles and evaluated them in vitro with respect to their ability to bind to benzodiazepine receptors. The fully aromatic beta-C's were more potent than their corresponding TH beta C derivatives. When substituents possessing a carbonyl (CO2Me, COCH3, CHO) were introduced at the beta-C 3-position the in vitro potency was augmented. Alcohol substituents (CH2OH, CHOHCH3) demonstrated decreased in vitro potency. The importance of the carbonyl moiety was further demonstrated when beta-carboline-3-carboxylic acid was shown to bind tighter to benzodiazepine receptors at lower pH. A lower pH increases the concentration of the acid and decreases the concentration of the anion. 3-(Hydroxymethyl)-beta-carboline (24), 3-formyl-beta-carboline (25) and 3-acetyl-beta-carboline (27) were benzodiazepine antagonists in vivo. Methyl isoquinoline-3-carboxylate (31a) also had in vitro activity. The same structure-activity relationships seen in beta-C's were also observed for isoquinolines.

Starch-based loose-fi ll packaging foams were made in a single-screw laboratoryscale extruder. Corn starch was blended with polystyrene in the ratio of 70 : 30 and extruded into foams using talc and polycarbonate as additives. Extrusions were carried out at moisture contents of 16, 18 and 20% (dry basis), and at barrel temperatures of 140 and 160ºC. The infl uences of extrusion temperature, moisture content of starch, talc and polycarbonate on the radial expansion and other selected physical properties of starch foams were investigated. The effects of moisture and talc contents on the radial expansion of foams were found to be critical, while the role of temperature was close to signifi cant. The expansion ratio increased when the moisture content was increased from 16 to 18%, and then decreased when moisture content was increased to 20%. In general, the expansion ratios of foams were higher at 160ºC as compared to 140ºC. Although polycarbonate mixed well with the starchpolystyrene melt, it was not effective as a structural and anti-shrinking agent, and it did not contribute to the radial expansion. In general, the bulk densities and unit densities of the starch foams decreased as the moisture content and extrusion temperature increased. Scanning electron microscope images showed that the addition of talc yielded foams with smaller-sized cells, with less expansion of the foam melt, and thus a higher density. X-ray diffractograms revealed that the crystallinity of starch foams increased post-extrusion, and there was adequate dispersion of the starch and polystyrene polymers to make the foam water-resistant.

Bifunctional chelators for labeling antibodies with 99mTc based on the N3S core of (mercaptoacetyl)-triglycine having ester or amide linking moieties were synthesized and site-specifically attached to the sulfhydryl groups of the Fab' fragment of antimyosin. Protein labeling was quantitative after 15 min; postlabeling purification was not necessary. The radiolabeled conjugates exhibited no loss of immunoreactivity. Under basic conditions, the ester-linked conjugate lost 95% of the radiolabel in the form of the 99mTc complex of (mercaptoacetyl)triglycine as determined by RP-HPLC, while the radioactivity in the amide-linked conjugate remained completely bound to the protein. In a mouse biodistribution study, the ester-linked conjugate showed a 2-fold enhancement in clearance from the kidney when compared to the amide-linked product.

A hypothesis generating study was conducted to evaluate the safety and efficacy of prolonged (3 y) administration of granulocyte-macrophage colony-stimulating factor (GM-CSF, sargramostim) as surgical adjuvant therapy in patients with melanoma at high risk of recurrence. Ninety-eight evaluable patients with stages II(T4), III, or IV melanoma were given prolonged treatment with GM-CSF after surgical resection of disease. The GM-CSF was administered subcutaneously in 28-day cycles, such that a dose of 125 microg/m2 was delivered daily for 14 days followed by 14 days rest. Treatment cycles continued for 3 years or until disease recurrence, which could not be surgically excised. Patients were evaluated for toxicity, disease-free survival, and melanoma-specific survival. Prolonged administration of GM-CSF was well tolerated; grade 1 or 2 side effects occurred in 82% of the patients. There were no grade 3 or 4 treatment-related side effects. Two patients developed acute myelogenous leukemia after completion of 3 years of GM-CSF administration. With a median follow-up of 5.3 years, the median melanoma-specific survival has not yet been reached. The 5-year melanoma-specific survival rate was 60%. The current study has expanded the preliminary evidence on GM-CSF as adjuvant therapy of patients with melanoma who are at high risk for recurrence.