Adjuvant abemaciclib combined with endocrine therapy for high-risk early breast cancer: safety and patient-reported outcomes from the monarchE study.

BACKGROUND: In monarchE, abemaciclib plus endocrine therapy (ET) as adjuvant treatment of hormone receptor-positive, human epidermal growth factor 2-negative, high-risk, early breast cancer (EBC) demonstrated a clinically meaningful improvement in invasive disease-free survival versus ET alone. Detailed safety analyses conducted at a median follow-up of 27 months and key patient-reported outcomes (PROs) are presented. PATIENTS AND METHODS: The safety population included all patients who received at least one dose of study treatment (n = 5591). Safety analyses included incidence, management, and outcomes of common and clinically relevant adverse events (AEs). Patient-reported health-related quality of life, ET symptoms, fatigue, and side-effect burden were assessed. RESULTS: The addition of abemaciclib to ET resulted in higher incidence of grade ≥3 AEs (49.7% versus 16.3% with ET alone), predominantly laboratory cytopenias [e.g. neutropenia (19.6%)] without clinical complications. Abemaciclib-treated patients experienced more serious AEs (15.2% versus 8.8%). Discontinuation of abemaciclib and/or ET due to AEs occurred in 18.5% of patients, mainly due to grade 1/2 AEs (66.8%). AEs were managed with comedications (e.g. antidiarrheals), abemaciclib dose holds (61.7%), and/or dose reductions (43.4%). Diarrhea was generally low grade (grade 1/2: 76%); grade 2/3 events were highest in the first month (20.5%), most were short-lived (≤7 days) and did not recur. Venous thromboembolic events (VTEs) were higher with abemaciclib + ET (2.5%) versus ET (0.6%); in the abemaciclib arm, increased VTE risk was observed with tamoxifen versus aromatase inhibitors (4.3% versus 1.8%). PROs were similar between arms, including being 'bothered by side-effects of treatment', except for diarrhea. At ≥3 months, most patients reporting diarrhea reported 'a little bit' or 'somewhat'. CONCLUSIONS: In patients with high-risk EBC, adjuvant abemaciclib + ET has an acceptable safety profile and tolerability is supported by PRO findings. Most AEs were reversible and manageable with comedications and/or dose modifications, consistent with the known abemaciclib toxicity profile.

Hermaphrodites and supernumerary testicular lobes in Schistosoma mansoni (Trematoda: Schistosomatidae) analyzed by brightfield and confocal microscopy.

Schistosoma mansoni belongs to the dioecious Schistosomatidae. The occasional observation of males with rudimentary female characteristics is thought to attest the hermaphroditic roots of this parasite. Supernumerary testicular lobes also are recurrently seen in this helminth, but their morphology and origin are elusive. Here, we investigated the morphology of the supernumerary lobes from 15 S. mansoni males and similar structures of 2 females in whole mounts by brightfield and confocal laser scanning microscopy. The follicles in the females were not regarded as testicular lobes, but 1 male had a rudimentary ovary with a residual oviduct posterior to the normal set of testicular lobes and was considered hermaphroditic. In addition, 6 other males contained supernumerary lobes that enclosed fully matured oocytes in variable amounts. In the remaining 8 males, no female characteristics could be seen, and the lobes showed morphologically a more testicular aspect, although this morphology was only confirmed in 1 male where spermatozoids were detected. The process underlying the expression of supernumerary testes or lobes with oocytes is similar and is, at least in part, induced by the host.

Morphological changes in the reproductive organs of male and female Schistosoma mansoni worms caused by streptozotocin, a drug used to induce diabetes mellitus.

Host metabolic changes have been observed to affect Schistosoma mansoni egg production, worm survival and morphology. We examined worms recovered from streptozotocin-induced diabetic mice by morphometric and morphological analysis through brightfield and confocal laser scanning microscopy. Tegument thickness was slightly smaller and changes in the reproductive organs were observed in 23-30% and consecutively 88-100% of the worms. The testicular lobes had a large diminution of cells in one or more of the lobes, which was associated with a lack of spermatozoids in the seminal vesicle. Ovaries were atrophied, manifested by a complete or large reduction in oocytes but other parts of the reproductive system like the vitelline glands were mainly unaffected. Streptozotocin (STZ) instead of hyperglycaemia caused the degeneration since worms from mice injected with a non-diabetogenic dose, or with nicotinamide to prevent diabetes showed the same alterations. The drug did not affect worm survival or pairing. We conclude that STZ, an alkylating agent that provokes chromosome and DNA damage, changes the morphology of ovaries and testicular lobes in S. mansoni worms in vivo. This is the first report of STZ action in helminths and we suggest that STZ affects oogenesis and spermatogenesis and might cause sterilization of schistosomes.

Lower faecal egg excretion in chemically-induced diabetic mice infected with Schistosoma mansoni due to impaired egg maturation.

The effect of streptozotocin-induced diabetes mellitus was studied in mice infected with Schistosoma mansoni. Faecal egg excretion was lower in diabetic mice but worm load and total amount of eggs in the intestine tissue were equal to the control group. Evaluation of an oogram showed a great number of immature dead eggs and a low number of mature eggs in diabetic mice. It was therefore concluded that faecal egg excretion was lower in diabetic mice due to impaired egg maturation.

Lipogenesis in rat tissues following carbohydrate refeeding: spleen lipogenesis is modulated by insulin.

Intraperitoneal administration of [1,2-14C]-acetate to Wistar rats was used to assess tissue lipogenic rates after estimating the incorporation of the label into the tissular lipid fractions. Refeeding the animals with glucose (after an overnight fast) induced an increase in white adipose tissue (4.5 fold), liver (4.1 fold), small intestine (1.9 fold), carcass (2.9 fold) and spleen (3.7 fold) lipogenesis (expressed as the radioactivity present in the lipid fraction corrected by the plasma circulating radioactivity). No changes were found following refeeding in either brain or brown adipose tissue. Administration of mannoheptulose (an inhibitor of insulin secretion) to refed rats completely abolished the increased lipogenesis in white adipose tissue, liver, carcass, spleen and small intestine, thus suggesting that insulin secretion is involved in this phenomenon. This is the first report showing that spleen lipogenesis may be modulated by refeeding via insulin secretion and suggests an important role of this organ on the in vivo lipogenic response of the organism after carbohydrate refeeding.