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Background: The PEARL study showed that palbociclib plus endocrine therapy (palbociclib/ET) was not superior to capecitabine in improving progression-free survival in postmenopausal patients with metastatic breast cancer resistant to aromatase inhibitors, but was better tolerated. This analysis compared patient-reported outcomes. Patients and methods: The PEARL quality of life (QoL) population comprised 537 patients, 268 randomised to palbociclib/ET (exemestane or fulvestrant) and 269 to capecitabine. Patients completed the European Organisation for Research and Treatment of Cancer QLQC30 and QLQ-BR23 and EQ-5D-3L questionnaires. Changes from the baseline and time to deterioration (TTD) were analysed using linear mixed-effect and stratified Cox regression models, respectively. Results: Questionnaire completion rate was high and similar between treatment arms. Significant differences were observed in the mean change in global health status (GHS)/QoL scores from the baseline to cycle 3 (2.9 for palbociclib/ET vs.-2.1 for capecitabine (95% confidence interval [CI], 1.4-8.6; P = 0.007). The median TTD in GHS/QoL was 8.3 months for palbociclib/ET versus 5.3 months for capecitabine (adjusted hazard ratio, 0.70; 95% CI, 0.55-0.89; P = 0.003). Similar improvements for palbociclib/ET were also seen for other scales as physical, role, cognitive, social functioning, fatigue, nausea/vomiting and appetite loss. No differences were observed between the treatment arms in change from the baseline in any item of the EQ-5D-L3 questionnaire as per the overall index score and visual analogue scale. Conclusion: Patients receiving palbociclib/ET experienced a significant delay in deterioration of GHS/QoL and several functional and symptom scales compared with capecitabine, providing additional evidence that palbociclib/ET is better tolerated. Trial registration number: NCT02028507 (ClinTrials.gov). EudraCT study number: 2013-003170-27. 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: The randomized phase III TURANDOT trial performed by the Central European Cooperative Oncology Group (CECOG) compared first-line BEV + paclitaxel (PAC) vs BEV + CAP in HER2-negative mBC in a prospective randomized trial [Lang, Lancet Oncol 2013]. In this trial, HFS was the most common adverse drug reaction in the BEV + CAP arm. In the present subanalysis, we investigated whether the occurrence of HFS constituted a predictor for improved efficacy of BEV + CAP in the study population randomized to this treatment arm. Methods: In the TURANDOT trial, patients with HER2-negative mBC who had received no prior chemotherapy for mBC were randomized to either BEV-PAC (BEV 10 mg/kg d1 & 15 + PAC 90 mg/m2 d1, 8, & 15 q4w) or BEV-CAP (BEV 15 mg/kg d1 + CAP 1000 mg/m2 bid d1-14 q3w). Only patients who were randomized to the BEV-CAP arm and received at least one dose of CAP were included in the present analysis. Cox proportional hazard models with time-dependent covariate "HFS of any grade" and "HFS grade" were used to analyze the association between HFS and OS or PFS. In addition, landmark (LM) analyses were performed analyzing the impact of HFS occurrence within the first 3 treatment months on PFS and OS. Results: Baseline characteristics of patients with HFS (n=154) versus no HFS (n=123) were well balanced and showed no significant differences. Table 1 shows that with the occurrence of HFS, the hazard for progression or death was reduced by > 40%, while the risk reduction (RR) was >55% for OS. Moreover, with increasing HFS-grade an increasing RR was observed for OS. In patients with and without HFS in the first 3 months, the median PFS after the 3 months LM were 10 and 6.2 months (logrank test p=0.0026), respectively, and the corresponding OS rates at 2 years after the 3 months LM were 63% and 44% (log rank test, p=0.0842), respectively. Updated OS results will be presented at the conference. Cox Proportional Hazards Models for PFS and OS with HFS as Time-dependent CovariateUnivariateMultivariate*EndpointTime depent variableHazard ratio (95%Cl)p-valueHazard ratio (95%Cl)p-valuePFSHFS(Yes vs No)0.577(0.431,0.772)0.00020.558(0.409,0.760)0.0002HFS Grade 10.639(0.440,0.927)0.01840.536(0.350,0.821)0.0042HFS Grade 20.481(0.321,0.720)0.00040.487(0.320,0.741)0.0008HFS Grade 30.641(0.411,0.999)0.04950.740(0.466,1.178)0.2043OSHFS(Yes vs No)0.417 (0.273, 0.637) Conclusion: HFS is a strong predictor for prolonged PFS and OS in mBC patients receiving BEV + CAP first-line treatment. Early occurrence of HFS and HFS severity might be used for treatment modifications and patient motivation. Detection of biomarkers for HFS could strengthen this approach. Citation Format: Zielinski C Christoph, Lang Istvan, Beslija Semir, Kahan Zsuzsanna, Moshe J Inbar, Stemmer M Salomon, Anghel Rodica, Vrbanec Damir, Messinger Diethelm, Brodowicz Thomas. Hand-foot-syndrome (HFS) is a strong predictor for OS and PFS in HER2-negative metastatic breast cancer (mBC) treated with first-line capecitabine (CAP) + bevacizumab (BEV): Results of a subanalysis of the randomized phase III CECOG TURANDOT trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-06-10.

The Yasur volcano in the Vanuatu archipelago is an outstanding source of infrasonic waves due to its regular activity. This volcano is permanently monitored by the IS22 infrasound station located in New Caledonia, about 400 km from it, and by one microbarometer installed close to its crater. A multiyear monitoring of Yasur is proposed to validate consistently the Naval Research Laboratory Ground to Space (NRL-G2S) semiempirical atmospheric model up to the stratosphere. The results of propagation modeling accurately explain seasonal changes as well as small short-timescale variations of the infrasonic observables. The azimuthal deviation is predicted with an uncertainty in general lower than 0.5 degrees. The fluctuations of the trace velocity and the celerity are simulated with errors as large as 5 m/s. This study demonstrates that the use of appropriate propagation tools along with the NRL-G2S specifications provides accurate enough results for most of the long-range observations for the purpose of operational infrasound monitoring.

The aim of this study was to evaluate the prevalence of simple sequence variation in the BRCA2 gene. To this end, 71 breast and breast-ovarian cancer (HBC/HBOC) families along with 95 control individuals from a wide range of ethnicities were analyzed by means of denaturing high-performance liquid chromatography (DHPLC) and direct sequence analysis. In the coding (10 257 bp) and non-coding (2799 bp) sequences of BRCA2, 82 sequence variants were identified. Three different, apparently disease-associated BRCA2 mutations were found in six HBC/HBOC families (8%): two splice site mutations in introns 5 and 21, and one frameshift mutation in exon 11. In the coding region, 53 simple sequence variants were found: 35 missense mutations, one 2 bp deletion (CT) resulting in a stop at codon 3364, one nonsense mutation with a stop at codon 3326, one deletion of a complete codon (AAA) resulting in the loss of leucine, and 15 silent mutations. In the non-coding region, 26 polymorphisms were detected. Of the 79 sequence variants that were not obviously disease-associated, eight were detected only in HBC/HBOC families. The remaining 71 variants were identified in both HBC/HBOC families and control individuals. Sixty three sequence variants (80%) were specific for a continent. Forty two percent (33 out of 79) of the sequence variants were detected exclusively in Africa, though only 13% of the 332 chromosomes screened were of African origin. Our data indicate that, in BRCA2, simple sequence variation is frequent [in the coding region 1 in 194 bp (straight theta = 2.2 x 10(-4)), and in the non-coding region 1 in 108 bp (straight theta = 4.4 x 10(-4)), respectively].

Human mesenchymal stem cells (MSCs) are thought to be multipotent cells which primarily reside in the bone marrow. Besides their well-known ability to replicate as undifferentiated cells and to differentiate into diverse lineages of mesenchymal tissues, they were recently suggested to also give rise to haematopoietic and leukaemic/cancer stem cells. In this study, the relationship between MSCs and leukemic stem cells in patients with either chronic myelogenous leukaemia (CML) or the more primitive variant, Ph+ bi-phenotypic leukaemia was investigated.Cultured MSCs from 5 patients with CML and 3 patients with bi-phenotypic Ph+ leukaemia, all of them positive for BCP-ABL, were analysed with conventional cytogenetics, fluorescence in situ hybridisation (FISH) and polymerase chain reaction (PCR) for the presence of t(9;22) and BCR-ABL. MSCs were characterised phenotypically with surface markers (+CD73, +CD90, +CD105, -CD34, -CD45) and functionally through their potential to differentiate into both adipocytes and osteoblasts.MSCs could be cultivated from seven patients. These cells were BCR-ABL negative when analysed with conventional cytogenetics and FISH. Further cytogenetic analysis revealed a normal set of chromosomes without any aberrations. Two patients were BCR-ABL-positive when analysed with PCR, probably as a result of MSC contamination with macrophages.MSCs in patients with CML or Ph+ bi-phenotypic leukaemia are not related to the malignant cell clone.

To design, implement and evaluate a PC-based medical viewing application including image postprocessing for DICOM images for use within an existing hospital infrastructure.A user-friendly DICOM compliant viewing application including image postprocessing (spatial frequency and contrast enhancement) and HL7 communication ability was designed and implemented on PC basis to run under Windows OS. To assess its quality compared to high-end workstations, an ROC analysis was performed.The use of image postprocessing on a PC significantly improved the perception of low-contrast details in computed radiographs. Review at a radiological workstation was superior to review at a PC with image postprocessing.

Amplification of HER-2 oncogene was analysed in DNAs obtained from 291 primary human mammary carcinomas. 52/291 (18%) were found to contain amplified HER-2 oncogene. Moderate amplification (2- to 5-fold) was noted in 36/291 (12%). Thirteen tumors (4.5%) had a copy number of 5 to 10. A 10- to 20-fold and greater than 20-fold amplification was observed in 2 and 1 patient, respectively. Sample sizes allowed the determination of estrogen receptor (ER) and progesterone receptor (PgR) levels in 253/291 primary breast cancers. HER-2 gene amplification was noted in 14% of ER+ patients and in 28% of ER- patients, respectively (P = 0.02). Similarly a significantly greater number of PgR- primary mammary carcinoma exhibited an amplification of the HER-2 gene compared to PgR+ cases (22% vs. 16%, P = 0.01). Although statistically not significant, tumors with HER-2 gene amplification were found to have lower levels of ER and PgR. No association of HER-2 amplification with the androgen receptor and EGF receptor was observed. Present data combine to suggest that tumor progression is more stringently controlled by the oncogene upon loss of hormone dependency. Differences found in HER-2 amplification between steroid receptor positive and negative tumors could be helpful to define a specific subset of women to whom adjuvant therapy should be directed.

Immunotherapy with intravenous recombinant human interleukin-2 (rh IL-2) may be accompanied by hypotension and the emergence of capillary leak syndrome. Nitric oxide (NO) is supposed to be responsible for both side effects. The aim of the current investigation was to elucidate the relationship between pro- and anti-inflammatory cytokines and the production of NO in eight tumor patients receiving intravenous rh IL-2 continuously over a time period of 120 hours. Markers of systemic inflammation, as well as nitrate plasma levels, were consecutively determined. Significant changes in the levels of pro-inflammatory cytokines IL-6 and IL-8 were observed (p0.05). In contrast to the anti-inflammatory cytokine IL-10, which did not increase significantly, the serum concentrations of the soluble tumor necrosis factor receptors (sTNFr) I and II rose continuously and significantly during the observation period (p0.05). In parallel, a significant rise in nitrate plasma levels was observed (p0.05). Moreover, there were highly significant correlations between nitrate and IL-6 serum levels (p0.05), nitrate and sTNFr-I (p0.05), nitrate and sTNFr-II (p0.05), and between IL-6 and IL-10 (p0.05), respectively. We conclude that immunotherapy with IL-2 promotes a pro-inflammatory state, parallelled by an increased production of nitric oxide. Although anti-inflammatory responses accompany this process, they are not able to diminish the production of nitric oxide.

The current third consensus on the systemic treatment of non-small-cell lung cancer (NSCLC) builds upon and updates similar publications on the subject by the Central European Cooperative Oncology Group (CECOG), which has published such consensus statements in the years 2002 and 2005 (Zielinski CC, Beinert T, Crawford J et al. Consensus on medical treatment of non-small-cell lung cancer--update 2004. Lung Cancer 2005; 50: 129-137). The principle of all CECOG consensus is such that evidence-based recommendations for state-of-the-art treatment are given upon which all participants and authors of the manuscript have to agree (Beslija S, Bonneterre J, Burstein HJ et al. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20 (11): 1771-1785). This is of particular importance in diseases in which treatment options depend on very particular clinical and biologic variables (Zielinski CC, Beinert T, Crawford J et al. Consensus on medical treatment of non-small-cell lung cancer--update 2004. Lung Cancer 2005; 50: 129-137; Beslija S, Bonneterre J, Burstein HJ et al. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20 (11): 1771-1785). Since the publication of the last CECOG consensus on the medical treatment of NSCLC, a series of diagnostic tools for the characterization of biomarkers for personalized therapy for NSCLC as well as therapeutic options including adjuvant treatment, targeted therapy, and maintenance treatment have emerged and strongly influenced the field. Thus, the present third consensus was generated that not only readdresses previous disease-related issues but also expands toward recent developments in the management of NSCLC. It is the aim of the present consensus to summarize minimal quality-oriented requirements for individual patients with NSCLC in its various stages based upon levels of evidence in the light of a rapidly expanding array of individual therapeutic options.

Although the description and interpretation of cancer genetics has been at the core of cancer research for more than a century, in this decade genomic medicine is set to profoundly transform every aspect of cancer care. Already, the anecdotal cases of individuals who have not responded to conventional chemotherapy but for whom whole genome sequencing has identified a gene target for directed therapy with remarkable clinical effect [1], point to a time in the not-too-distant future when cancer genome sequencing will be a routine adjunct to the clinico-pathological 'work-up' of a newly diagnosed cancer. For now, the identification of genes central to cancer biology is generating highly relevant diagnostic, prognostic and therapeutic information that has already translated to the clinic. The extraordinary pace of change is set to continue. The new era of personalised cancer medicine will touch every aspect of cancer care-from patient counselling, to cancer diagnosis, tumour classification, treatment and outcome-that demands a new level of in-depth education and collaboration between researchers, cancer specialists, patients and other stakeholders. In this position paper, ESMO sets out the current status in the field of personalised cancer medicine and addresses issues and challenges for the medical oncology community.