Purpose: Malignant ascites in ovarian carcinoma patients is associated with poor prognosis and reduced quality of life. The trifunctional antibody catumaxomab (anti-EpCAM × anti-CD3) enhances the antitumor activity by redirecting T cells and Fcγ receptor I/III–positive accessory cells to the tumor. This multicenter phase I/II dose-escalating study investigated tolerability and efficacy of i.p. catumaxomab application in ovarian cancer patients with malignant ascites containing epithelial cell adhesion molecule (EpCAM)–positive tumor cells.
Experimental Design: Twenty-three women with recurrent ascites due to pretreated refractory ovarian cancer were treated with four to five i.p. infusions of catumaxomab in doses of 5 to 200 μg within 9 to 13 days.
Results: The maximum tolerated dose was defined at 10, 20, 50, 200, and 200 μg for the first through fifth doses. Side effects included transient fever (83%), nausea (61%), and vomiting (57%), mostly CTCAE (Common Terminology Criteria for Adverse Events) grade 1 or 2. A total of 39 grade 3 and 2 grade 4 treatment-related adverse events (AE), 9 of them after the highest dose level (200 μg), were observed in 16 patients. Most AEs were reversible without sequelae. Treatment with catumaxomab resulted in significant and sustained reduction of ascites flow rate. A total of 22/23 patients did not require paracentesis between the last infusion and the end of study at day 37. Tumor cell monitoring revealed a reduction of EpCAM-positive malignant cells in ascites by up to 5 log.
Conclusion: I.p. immunotherapy with catumaxomab prevented the accumulation of ascites and efficiently eliminated tumor cells with an acceptable safety profile. This suggests that catumaxomab is a promising treatment option in ovarian cancer patients with malignant ascites.
In recent years, powerful new methods for the generation of alkoxyl radicals under mild and neutral conditions have been developed. This progress has led to a thorough investigation of most O-radical elementary reactions. Today, sufficiently reliable thermodynamic and kinetic data are available either from experimental or from theoretical studies in order to predict alkoxyl radical reactivities and selectivities in synthesis. For instance, alkoxyl radicals readily add to carbon-carbon and carbon-nitrogen double bonds. Due to generally low activation barriers and strongly negative reaction enthalpies, inter-and intramolecular addition reactions proceed under kinetic control and are associated with high rate constants. Nevertheless, intramolecular 5-exo-trig additions, i.e. cyclizations, proceed with an astonishing degree of diastereoselectivity and often provide complementary selectivities if compared to commonly used methods such as the bromine cyclization of alkenols. Therefore, several useful applications of O-radical cyclizations in the synthesis of functionalized tetrahydrofurans have been discovered in the last few years. A second major reaction channel of alkoxyl radicals is associated with the homolysis of a b-CC bond. This fragmentation proceeds under thermodynamic control and affords a carbonyl compound besides an alkyl radical from the starting alkoxyl radical. Regioselectivities for CC bond homolysis may be predicted by considering strain release (cyclic carbon framework) and the stability of the newly formed carbon radical (cyclic and open chain carbon skeletons). The third major group of alkoxyl radical-based transformations are connected with homolytic substitutions such as intramolecular 1,5-hydrogen shifts which have been applied with considerable success to remote functionalization reactions. In view of the diversity of alkoxyl radical reactions it is the aim of this review to organize basic principles of this type of chemistry and to present its latest useful application in organic synthesis.
Because randomized, clinical trials are not available in this field of indication, the evaluation is based on small case series. Nevertheless, by pooling all experience gained, we conclude that endoscopic closure of iatrogenic gastrointestinal perforations and acute anastomotic leaks by means of the OTSC System is a safe and effective method.
These data convincingly show that NeoHep cells display a phenotype and specific in vitro metabolic functions that are quantitatively and qualitatively comparable in part with those of primary human hepatocytes. These cells could thus be clinically applied in an autologous setting for the treatment of end-stage liver diseases or for improving liver function in patients who have undergone critical liver-mass resection.
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