Search

Summary Background Chemoradiotherapy is the standard of care for unresected locally advanced squamous cell carcinoma of the head and neck. We aimed to assess if addition of avelumab (anti-PD-L1) to chemoradiotherapy could improve treatment outcomes for this patient population. Methods In this randomised, double-blind, placebo-controlled, phase 3 study, patients were recruited from 196 hospitals and cancer treatment centres in 22 countries. Patients aged 18 years or older, with histologically confirmed, previously untreated, locally advanced squamous cell carcinoma of the oropharynx, hypopharynx, larynx, or oral cavity (unselected for PD-L1 status), an Eastern Cooperative Oncology Group performance status score of 0 or 1, and who could receive chemoradiotherapy were eligible. Patients were randomly assigned (1:1) centrally by means of stratified block randomisation with block size four (stratified by human papillomavirus status, tumour stage, and nodal stage, and done by an interactive response technology system) to receive 10 mg/kg avelumab intravenously every 2 weeks plus chemoradiotherapy (100 mg/m2 cisplatin every 3 weeks plus intensity-modulated radiotherapy with standard fractionation of 70 Gy [35 fractions during 7 weeks]; avelumab group) or placebo plus chemoradiotherapy (placebo group). This was preceded by a single 10 mg/kg avelumab or placebo lead-in dose given 7 days previously and followed by 10 mg/kg avelumab or placebo every 2 weeks maintenance therapy for up to 12 months. The primary endpoint was progression-free survival by investigator assessment per modified Response Evaluation Criteria in Solid Tumors, version 1.1, in all randomly assigned patients. Adverse events were assessed in patients who received at least one dose of avelumab or placebo. This trial is registered with ClinicalTrials.gov , NCT02952586 . Enrolment is no longer ongoing, and the trial has been discontinued. Findings Between Dec 12, 2016, and Jan 29, 2019, from 907 patients screened, 697 patients were randomly assigned to the avelumab group (n=350) or the placebo group (n=347). Median follow-up for progression-free survival was 14·6 months (IQR 8·5–19·6) in the avelumab group and 14·8 months (11·6–18·8) in the placebo group. Median progression-free survival was not reached (95% CI 16·9 months–not estimable) in the avelumab group and not reached (23·0 months–not estimable) in the placebo group (stratified hazard ratio 1·21 [95% CI 0·93–1·57] favouring the placebo group; one-sided p=0·92). The most common grade 3 or worse treatment-related adverse events were neutropenia (57 [16%] of 348 patients in the avelumab group vs 52 [15%] of 344 patients in the placebo group), mucosal inflammation (50 [14%] vs 45 [13%]), dysphagia (49 [14%] vs 47 [14%]), and anaemia (41 [12%] vs 44 [13%]). Serious treatment-related adverse events occurred in 124 (36%) patients in the avelumab group and in 109 (32%) patients in the placebo group. Treatment-related deaths occurred in two (1%) patients in the avelumab group (due to general disorders and site conditions, and vascular rupture) and one ( Interpretation The primary objective of prolonging progression-free survival with avelumab plus chemoradiotherapy followed by avelumab maintenance in patients with locally advanced squamous cell carcinoma of the head and neck was not met. These findings may help inform the design of future trials investigating the combination of immune checkpoint inhibitors plus CRT. Funding Pfizer and Merck KGaA, Darmstadt, Germany.

Summary Background Trifluridine/tipiracil showed activity and was well tolerated in a phase 2 study of pretreated patients with advanced gastric cancer done in Japan. We investigated whether the treatment was efficacious compared with placebo in a global population. Methods TAGS was a randomised, double-blind, placebo-controlled, phase 3 trial done in 110 academic hospitals in 17 countries. Patients aged 18 years or older with histologically confirmed, non-resectable, metastatic gastric adenocarcinoma (including adenocarcinoma of the gastroesophageal junction) as defined by the American Joint Committee on Cancer staging classification (7th edition) who had received at least two previous chemotherapy regimens and had experienced radiological disease progression were eligible for inclusion. Patients were randomly assigned (2:1) via dynamic randomisation from a centralised interactive voice-response system to receive either oral trifluridine/tipiracil (35 mg/m2 twice daily on days 1–5 and days 8–12 every 28 days) plus best supportive care or placebo plus best supportive care. Participants were allocated to groups by study-site personnel. Randomisation was stratified by region (Japan vs rest of world), ECOG performance status (0 vs 1), and previous treatment with ramucirumab (yes vs no). Both patients and investigators were masked to treatment allocation. The primary endpoint was overall survival. Efficacy was assessed in the intention-to-treat population and safety in all patients who received at least one dose of treatment. This trial is registered with ClinicalTrials.gov , number NCT02500043 . The trial, including follow-up of all participants, has been completed. Findings Between Feb 24, 2016, and Jan 5, 2018, 507 patients were enrolled and randomly assigned, 337 to the trifluridine/tipiracil group and 170 to the placebo group. Median overall survival was 5·7 months (95% CI 4·8–6·2) in the trifluridine/tipiracil group and 3·6 months (3·1–4·1) in the placebo group (hazard ratio 0·69 [95% CI 0·56–0·85]; one-sided p=0·00029, two-sided p=0·00058). Grade 3 or worse adverse events of any cause occurred in 267 (80%) patients in the trifluridine/tipiracil group and 97 (58%) in the placebo group. The most frequent grade 3 or worse adverse events of any cause were neutropenia (n=114 [34%]) and anaemia (n=64 [19%]) in the trifluridine/tipiracil group and abdominal pain (n=15 [9%]) and general deterioration of physical health (n=15 [9%]) in the placebo group. Serious adverse events of any cause were reported in 143 (43%) patients in the trifluridine/tipiracil group and 70 (42%) in the placebo group. One treatment-related death was reported in each group (because of cardiopulmonary arrest in the trifluridine/tipiracil group and because of toxic hepatitis in the placebo group). Interpretation Trifluridine/tipiracil significantly improved overall survival compared with placebo and was well tolerated in this heavily pretreated population of patients with advanced gastric cancer. Trifluridine/tipiracil could be a new treatment option in this population who represent a high unmet medical need. Funding Taiho Oncology and Taiho Pharmaceutical.

Head and neck squamous cell carcinoma (HNSCC) is among the 10 most common cancers worldwide, with increasing incidence.1 Approximately 10% of patients with HNSCC will be diagnosed with metastatic disease, and even when treated early, around half will have disease recurrence.2,3 The platinum-based doublet chemotherapy with cetuximab regimen has been the most widely-used therapy and considered standard of care (SoC) since it was proven effective in 2007 for recurrent/metastatic (R/M) HNSCC in the first-line setting.3,4 However, patients typically progress even after aggressive first-line therapy, and, until recently, the available options (e.g. cetuximab, methotrexate, and taxanes) have delivered limited survival benefits.3 Durvalumab is an immunotherapeutic agent that blocks the interaction between programmed cell death ligand 1 (PD-L1) and its receptors.5 Durvalumab demonstrated encouraging response rates and duration of response (DoR) with a manageable safety profile in patients with HNSCC.6 Although monotherapy agents that block the programmed cell death protein 1 (PD-1)/PD-L1 axis have shown clinical activity, immunotherapy combinations have the potential to improve upon monotherapy activity.7e9 Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and PD-L1/PD-1 pathways have largely non-redundant roles, suggesting that blockade of both could have additive or synergistic effects.10 Indeed, the combination of durvalumab and tremelimumab, an anti-CTLA-4 monoclonal antibody, was explored based on improved efficacy over monotherapy in other solid tumor types.7 This observation, in addition to the activity demonstrated by durvalumab in earlier R/M HNSCC studies, served as the rationale to evaluate durvalumab and tremelimumab in patients with R/M HNSCC. Several studies, including the EAGLE study, were initiated to evaluate combination immunotherapy regimens in various patient groups.11,12 The EAGLE study was the first phase III study to investigate durvalumab and tremelimumab in patients with R/M HNSCC who had progressed after platinumbased therapy. During the conduct of the EAGLE study, anti-PD-1 monoclonal antibodies were approved for use for R/M HNSCC progression following a platinum-based regimen. Treatment with these immunotherapies resulted in a median overall survival (OS) of 7.5e8.4 months.13,14 These immunotherapies are now recommended for second-line treatment as monotherapies for patients with R/M HNSCC.3,13,14 More recently, immunotherapy alone or in combination with platinum-based chemotherapy has shown improvements in OS in the first-line setting, underscoring the clinical utility of immunotherapy in HNSCC.15 Here, we report the results of the randomized phase III EAGLE trial evaluating durvalumab and durvalumab plus tremelimumab versus SoC therapies in patients with R/M HNSCC who have progressed following a platinumcontaining regimen.

Summary Background Aromatase inhibitors are a standard of care for hormone receptor-positive locally advanced or metastatic breast cancer. We investigated whether the selective oestrogen receptor degrader fulvestrant could improve progression-free survival compared with anastrozole in postmenopausal patients who had not received previous endocrine therapy. Methods In this phase 3, randomised, double-blind trial, we recruited eligible patients with histologically confirmed oestrogen receptor-positive or progesterone receptor-positive, or both, locally advanced or metastatic breast cancer from 113 academic hospitals and community centres in 20 countries. Eligible patients were endocrine therapy-naive, with WHO performance status 0–2, and at least one measurable or non-measurable lesion. Patients were randomly assigned (1:1) to fulvestrant (500 mg intramuscular injection; on days 0, 14, 28, then every 28 days thereafter) or anastrozole (1 mg orally daily) using a computer-generated randomisation scheme. The primary endpoint was progression-free survival, determined by Response Evaluation Criteria in Solid Tumors version 1·1, intervention by surgery or radiotherapy because of disease deterioration, or death from any cause, assessed in the intention-to-treat population. Safety outcomes were assessed in all patients who received at least one dose of randomised treatment (including placebo). This trial is registered with ClinicalTrials.gov, number NCT01602380. Findings Between Oct 17, 2012, and July 11, 2014, 524 patients were enrolled to this study. Of these, 462 patients were randomised (230 to receive fulvestrant and 232 to receive anastrozole). Progression-free survival was significantly longer in the fulvestrant group than in the anastrozole group (hazard ratio [HR] 0·797, 95% CI 0·637–0·999, p=0·0486). Median progression-free survival was 16·6 months (95% CI 13·83–20·99) in the fulvestrant group versus 13·8 months (11·99–16·59) in the anastrozole group. The most common adverse events were arthralgia (38 [17%] in the fulvestrant group vs 24 [10%] in the anastrozole group) and hot flushes (26 [11%] in the fulvestrant group vs 24 [10%] in the anastrozole group). 16 (7%) of 228 patients in in the fulvestrant group and 11 (5%) of 232 patients in the anastrozole group discontinued because of adverse events. Interpretation Fulvestrant has superior efficacy and is a preferred treatment option for patients with hormone receptor-positive locally advanced or metastatic breast cancer who have not received previous endocrine therapy compared with a third-generation aromatase inhibitor, a standard of care for first-line treatment of these patients. Funding AstraZeneca.

Background Microsatellite-stable metastatic colorectal cancer is typically unresponsive to immunotherapy. This phase 3 study was designed to assess atezolizumab plus cobimetinib in metastatic colorectal cancer. Here, we report the comparison of atezolizumab plus cobimetinib or atezolizumab monotherapy versus regorafenib in the third-line setting. Methods IMblaze 370 is a multicentre, open-label, phase 3, randomised, controlled trial, done at 73 academic medical centres and community oncology practices in 11 countries. Patients aged at least 18 years with unresectable locally advanced or metastatic colorectal cancer, baseline Eastern Cooperative Oncology Group performance status of 0–1, and disease progression on or intolerance to at least two previous systemic chemotherapy regimens were enrolled. We used permuted-block randomisation (block size four) to assign patients (2:1:1) via an interactive voice and web response system to atezolizumab (840 mg intravenously every 2 weeks) plus cobimetinib (60 mg orally once daily for days 1–21 of a 28-day cycle), atezolizumab monotherapy (1200 mg intravenously every 3 weeks), or regorafenib (160 mg orally once daily for days 1–21 of a 28-day cycle). Stratification factors were extended RAS status (wild-type vs mutant) and time since diagnosis of first metastasis (

Background CASPIAN is an open-label, phase III study of first-line durvalumab (D), ± tremelimumab (T), plus etoposide and either cisplatin or carboplatin (EP) for the treatment of pts with ES-SCLC. In a planned interim analysis (IA), D+EP significantly improved OS vs EP alone (primary endpoint; HR 0.73 [95% CI 0.59–0.91]; p = 0.0047). We report prespecified exploratory results at this IA for pts recruited in Asia. Methods Treatment-naive pts with ES-SCLC were randomised (1:1:1) to D 1500 mg + EP q3w; D 1500 mg + T 75 mg + EP q3w; or EP q3w. Pts in the immunotherapy arms received up to 4 cycles of EP followed by maintenance D q4w until progression. Pts in the EP arm received up to 6 cycles of EP and PCI (investigator’s discretion). Investigator’s choice of cisplatin or carboplatin (stratification factor) was permitted. Data cutoff: 11 March 2019. Results Of the 537 pts in the D+EP and EP arms, 76 (14.2%) were randomised in Japan, South Korea, Taiwan or China (Asia subgroup). Some differences were observed in baseline characteristics between the Asia subgroup and overall population. Median OS for D+EP vs EP in the Asia subgroup was 14.8 vs 11.9 months (HR 0.87 [95%CI 0.45, 1.64]). More pts in the Asia subgroup vs the overall population received subsequent anticancer therapy (63.2 vs 43.2%; balanced between arms). Incidence of any cause SAEs was higher in the Asia subgroup vs the overall population regardless of treatment; AEs leading to discontinuation was less. In the Asia subgroup, for D+EP vs EP, the incidence of any cause grade 3/4 AEs was 62.9 vs 76.9%; respective incidences of SAEs and AEs leading to discontinuation were: 42.9 vs 48.7% and 5.7 vs 7.7%. The D+T+EP arm continues to final analysis. Table . LBA15 Durvalumab + EP EP Overall (n = 268) Asia subgroup (n = 35) Overall (n = 269) Asia subgroup (n = 41) Baseline characteristics Median age, years (range) 62 (28–82) 65 (40–82) 63 (35–82) 67 (46–82) Male, % 70.9 85.7 68.4 82.9 Ever/never smoker, % 91.8/8.2 97.1/2.9 94.4/5.6 95.1/4.9 WHO PS 0/1, % 36.9/63.1 31.4/68.6 33.5/66.5 19.5/80.5 Disease stage III/IV, % 10.4/89.6 11.4/88.6 8.9/91.1 2.4/97.6 OS Median OS, mo (95% CI) 13.0 (11.5–14.8) 14.8 (10.3–NR) 10.3 (9.3–11.2) 11.9 (8.0–18.9) OS HR * (95% CI) 0.73 (0.59–0.91) p = 0.0047 † 0.87 (0.45–1.64) - - 18-mo OS rate, % (95% CI) 33.9 (26.9–41.0) 39.2 (19.9–58.2) 24.7 (18.4–31.6) 32.1 (14.6–51.1) * Stratified Cox proportional hazards; † Primary endpoint Conclusions In the CASPIAN overall population, D+EP improved OS vs EP; results were consistent in this prespecified subgroup of patients recruited in Asia. The safety profile of D+EP in the Asia subgroup was also consistent with the overall population, with no new signals identified. Clinical trial identification NCT03043872 (Release date, 6 February 2017) EudraCT number: 2016-001203-23. Editorial acknowledgement Rebecca Douglas, PhD of Cirrus Communications (Macclesfield, UK), an Ashfield company, funded by AstraZeneca. Legal entity responsible for the study AstraZeneca PLC. Funding AstraZeneca. Disclosure M. Nishio: Honoraria (self): Ono Pharmaceutical; Honoraria (self): Bristol-Myers Squibb; Honoraria (self): Pfizer; Honoraria (self): Chugai Pharmaceutical; Honoraria (self): Eli Lilly; Honoraria (self): Taiho Pharmaceutical; Honoraria (self): AstraZeneca; Honoraria (self): MSD; Honoraria (self): Novartis; Honoraria (self): Boehringer Ingelheim; Honoraria (self): Sankyo Healthcare; Honoraria (self): Merck Serono; Research grant/Funding (self): Ono Pharmaceutical; Research grant/Funding (self): Bristol-Myers Squibb; Research grant/Funding (self): Pfizer; Research grant/Funding (self): Chugai Pharmaceutical; Research grant/Funding (self): Eli Lilly; Research grant/Funding (self): Taiho Pharmaceutical; Research grant/Funding (self): AstraZeneca; Research grant/Funding (self): MSD; Research grant/Funding (self): Novartis; Research grant/Funding (self): Astellas, All outside the submitted work. K. Hotta: Research grant / Funding (self), Grants and personal fees: AstraZeneca / Lilly / Bristol-Myers Squibb; Travel / Accommodation / Expenses, Personal fees: MSD / Ono / Nipponkayaku / Taiho / Boehringer Ingelheim / Chugai. C-H. Chiu: Honoraria (self): AstraZeneca; Honoraria (self): Boehringer Ingelheim; Honoraria (self): Bristol-Myers Squibb; Honoraria (self): Chugai Pharmaceutical; Honoraria (self): Eli Lilly; Honoraria (self): Merck Sharp & Dohme; Honoraria (self): Novartis; Honoraria (self): Ono Pharmaceutical; Honoraria (self): Pfizer; Honoraria (self): Roche; Honoraria (self): Takeda. K. Azuma: Honoraria (self), Lecture fees: Ono Pharmaceutical Co Ltd / Bristol-Myers Squibb / AstraZeneca KK / Chugai Pharmaceutical. M. Ozguroglu: Advisory / Consultancy: Janssen / Sanofi / Astellas; Honoraria (self): Novartis / Roche / Janssen / Sanofi / Astellas; Travel / Accommodation / Expenses: Bristol-Myers Squibb / Janssen. J. Bar: Research grant / Funding (institution): MSD / AstraZeneca / Roche / BMS / Takeda / AbbVie / Pfizer; Travel / Accommodation / Expenses, Personal fees: AstraZeneca / MSD / Boehringer Ingelheim / Roche / BMS / Takeda / AbbVie / Pfizer / VBL. Y. Chen: Research grant / Funding (self): AstraZeneca / Ipsen / Roche / Bristol-Myers Squibb; Travel / Accommodation / Expenses, Personal fees: AstraZeneca / Genentech / Bristol-Myers Squibb / Merck / Novartis / Takeda / Eli Lilly / Guardant Health / Pfizer / Array Biopharma. J.W. Goldman: Research grant / Funding (self): AstraZeneca/MedImmune / Eli Lilly / Genentech / Bristol-Myers Squibb / Array BioPharma; Research grant / Funding (self): Celgene / AbbVie; Advisory / Consultancy: AstraZeneca / Genentech; Advisory / Consultancy: Lilly; Speaker Bureau / Expert testimony, Speakers' Bureau: Merck. N. Byrne: Full / Part-time employment, Contractor: AstraZeneca; Shareholder / Stockholder / Stock options: AstraZeneca. P.J. Laud: Full/Part-time employment: AstraZeneca, Contractor. N. Shire: Full / Part-time employment: AstraZeneca; Shareholder / Stockholder / Stock options: AstraZeneca. L. Paz-Ares: Honoraria (self): Roche/Genentech / Lilly / Pfizer/ Boehringer Ingelheim / BMS / MSD / AstraZeneca / Merck Serono; Honoraria (self): PharmaMar / Novartis / Celgene / Sysmex / Amgen / Incyte; Travel / Accommodation / Expenses: Roche / AstraZeneca / AstraZeneca Spain / MSD / BMS / Lilly / Pfizer; Leadership role, Myself: Genomica; Leadership role, An immediate family member: European Medicines Agency; Spouse / Financial dependant, Other relationship: Novartis / Ipsen / Pfizer / Servier / Sanofi / Roche / Amgen / Merck.

Background In the phase III CASPIAN trial, durvalumab (D) in combination with etoposide plus either cisplatin or carboplatin (EP) significantly improved the primary endpoint of OS vs EP alone in pts with extensive-stage small-cell lung cancer (ES-SCLC). Here we describe clinically relevant analyses for D + EP vs EP based on PD-L1 expression, progression patterns and PROs. Methods Tx-naive ES-SCLC (WHO PS 0/1) pts received 4 cycles of EP plus D q3w followed by maintenance D q4w or up to 6 cycles of EP q3w + prophylactic cranial irradiation (PCI; investigator's discretion). PD-L1 expression in optional archival tissue was tested by VENTANA PD-L1 (SP263) immunohistochemistry assay. PROs were assessed using EORTC QLQ-C30/LC13 with changes from baseline analysed by time to deterioration (TTD) per Cox proportional hazards. Results As of 11 March 2019, 265 and 266 pts had received D + EP and EP, respectively. Of 277 with evaluable samples (D + EP, 151; EP, 126), PD-L1 expression was low (5% and 22% of pts with expression ≥1% in tumour (TC) and immune cells (IC), respectively). Evaluating PD-L1 expression as a continuous variable in either TC or IC indicated no significant impact of PD-L1 on Tx effect between arms for OS (P=0.54 and 0.23, respectively); nor for PFS and ORR. Progression patterns were similar, although fewer pts developed new lesions at first progression with D + EP vs EP (41.4% vs 47.2%), including lung lesions (8.6% vs 15.2%). The incidence of new brain/CNS metastases was similar between arms (11.6% vs 11.5%), despite PCI allowance in the control arm only. Baseline PRO scores were comparable across all symptoms and functional domains. TTD was longer across all PROs for D + EP (favourable HRs, many with upper 95% CIs Conclusions D + EP provided significant OS benefit over EP alone, while preserving QoL and increasing the time to worsening of symptoms and functioning. PD-L1 expression was low and did not appear to be a predictive biomarker for D + EP. Clinical trial identification NCT03043872 (release date: February 6, 2017). Editorial acknowledgement Medical writing support was provided by Andrew Gannon, MA, MS, of Cirrus Communications (New York, NY), an Ashfield company, and funded by AstraZeneca. Legal entity responsible for the study AstraZeneca PLC. Funding AstraZeneca PLC. Disclosure L. Paz-Ares: Leadership role: Genomica; Honoraria (self), Travel / Accommodation / Expenses, Spouse / Financial dependant: Roche; Honoraria (self), Travel / Accommodation / Expenses: AstraZeneca; Honoraria (self), Travel / Accommodation / Expenses: MSD; Honoraria (self), Travel / Accommodation / Expenses: Bristol-Myers Squibb; Honoraria (self), Travel / Accommodation / Expenses: Lilly; Honoraria (self), Travel / Accommodation / Expenses, Spouse / Financial dependant: Pfizer; Honoraria (self), Spouse / Financial dependant: Novartis; Spouse / Financial dependant: Ipsen; Spouse / Financial dependant: SERVIER; Spouse / Financial dependant: Sanofi; Honoraria (self), Spouse / Financial dependant: Amgen; Honoraria (self), Spouse / Financial dependant: Merck; Honoraria (self): Boehringer Ingelheim; Honoraria (self): PharmaMar; Honoraria (self): Celgene; Honoraria (self): Sysmex; Honoraria (self): Incyte. J.W. Goldman: Advisory / Consultancy, Research grant / Funding (institution): AstraZeneca; Advisory / Consultancy, Research grant / Funding (institution): Genentech; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Speaker Bureau / Expert testimony: Merck; Research grant / Funding (institution): Bristol-Myers Squibb; Research grant / Funding (institution): Array BioPharma; Research grant / Funding (institution): Celgene; Research grant / Funding (institution): AbbVie. M.C. Garassino: Honoraria (self): MSD; Honoraria (self): BMS; Honoraria (self): AstraZeneca; Honoraria (self): Roche. K. Hotta: Honoraria (self), Research grant / Funding (institution): AstraZeneca; Honoraria (self), Research grant / Funding (institution): Lilly; Honoraria (self): MSD; Honoraria (self), Research grant / Funding (institution): BMS; Honoraria (self): Ono; Honoraria (self): Nipponkayaku; Honoraria (self): Taiho; Honoraria (self): Boehringer Ingelheim; Honoraria (self): Chugai. N. Reinmuth: Honoraria (self), Non-remunerated activity/ies: AstraZeneca; Honoraria (self), Non-remunerated activity/ies: Bohrigner Ingelheim; Non-remunerated activity/ies: AbbVie; Honoraria (self), Non-remunerated activity/ies: Hoffmann-La Roche; Honoraria (self): MSD SHARP & DOHME GMBH; Honoraria (self): Takeda; Honoraria (self), Non-remunerated activity/ies: Bristol-Myers Squibb; Honoraria (self), Non-remunerated activity/ies: Pfizer. Y. Shrestha: Shareholder / Stockholder / Stock options, Full / Part-time employment: AstraZeneca. N. Patel: Shareholder / Stockholder / Stock options, Full / Part-time employment: AstraZeneca. H. Mann: Full / Part-time employment: AstraZeneca. H. Jiang: Shareholder / Stockholder / Stock options, Full / Part-time employment: AstraZeneca. M. Ozguroglu: Honoraria (self), Honoraria (institution), Advisory / Consultancy, Travel / Accommodation / Expenses: Janssen; Honoraria (self), Honoraria (institution), Advisory / Consultancy: Sanofi; Honoraria (self), Honoraria (institution), Advisory / Consultancy: Astellas; Travel / Accommodation / Expenses: BMS. Y. Chen: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): AstraZeneca; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Genetech; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Brystol-Myers Squibb; Honoraria (self), Speaker Bureau / Expert testimony: Merck; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Novartis; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Takeda; Honoraria (self), Speaker Bureau / Expert testimony: Eli-Lilly ; Honoraria (self), Speaker Bureau / Expert testimony: Guardant Health; Honoraria (self), Advisory / Consultancy: Pfizer; Honoraria (self), Advisory / Consultancy: Array Biopharma; Research grant / Funding (institution): ISPEN; Research grant / Funding (institution): Roche. All other authors have declared no conflicts of interest.

Background The equivalent efficacy between SB3, a proposed trastuzumab biosimilar, and the trastuzumab reference product (TRZ) in terms of the breast pathologic complete response rate after neoadjuvant therapy in patients with early or locally advanced human epidermal growth factor receptor 2-positive breast cancer was demonstrated in the previous report. Here, we report the final safety, immunogenicity and survival results after neoadjuvant-adjuvant treatment. Patients and methods Patients were randomised 1:1 to receive neoadjuvant SB3 or TRZ for 8 cycles concurrently with chemotherapy (4 cycles of docetaxel followed by 4 cycles of 5-fluorouracil/epirubicin/cyclophosphamide). Patients then underwent surgery, followed by 10 cycles of adjuvant SB3 or TRZ as randomised. End-points included safety, immunogenicity, event-free survival (EFS) and overall survival through the adjuvant period. Results Of 875 patients randomised, 764 (SB3, n = 380; TRZ, n = 384) completed the study. The median follow-up duration was 437 days in the SB3 group and 438 days in the TRZ group. The incidence of treatment-emergent adverse events was comparable between groups (SB3, 97.5%; TRZ, 96.1%) during the overall study period. Up to the end of study, the overall incidence of antidrug antibody was low in both treatment groups (3 patients each). EFS was comparable between groups with a hazard ratio (SB3/TRZ) of 0.94 (95% confidence interval, 0.59–1.51) and EFS rates at 12 months of 93.7% for SB3 and 93.4% for TRZ. Conclusions Final safety, immunogenicity and survival results of this study further support the biosimilarity established between SB3 and TRZ. Trial registration ClinicalTrials.gov ( NCT02149524 ); EudraCT ( 2013-004172-35 ).

Background CASPIAN is a phase 3, open-label study of 1L platinum-etoposide (EP) ± durvalumab (D) ± tremelimumab (T) for pts with ES-SCLC. D+EP significantly improved OS vs EP alone (HR 0.73 [95% CI 0.59–0.91]; p = 0.0047) at a planned interim analysis. Rates of all-cause AEs and AEs leading to discontinuation were similar between arms. Immune-mediated AEs (imAEs) were higher with D+EP vs EP, while numerically fewer pts in the D+EP arm had serious AEs (SAEs; 30.9 vs 36.1%). Here we present further safety, PK and immunogenicity results. Methods Treatment-naive pts with ES-SCLC were randomised 1:1:1 to D 1500 mg + EP q3w, D 1500 mg + T 75 mg + EP q3w, or EP q3w. Investigator’s choice of carboplatin or cisplatin was allowed. In the IO arms, pts received 4 cycles of EP, followed by D 1500 mg q4w until progression; up to 6 cycles of EP and optional PCI were permitted in the control arm. Safety, PK and immunogenicity were secondary endpoints. Results 265 pts received D+EP and 266 received EP. Serum concentrations were within the expected range for D and were similar across both arms for EP. Of 201 anti-drug antibody (ADA)-evaluable pts in the D+EP arm, 11 (5.5%) were +ve for ADA to D at baseline only; no pts were +ve for treatment-emergent ADA or neutralising antibodies. The most common AEs, grade 3/4 AEs and SAEs in both arms were haematological toxicities. These were well managed using standard therapies per local practice; colony stimulating factor use was 50.4% in the D+EP arm and 56.9% in the EP arm, and 12.7% and 20.8% received blood transfusions. When events that coincided with cycles 5 and 6 of EP in the control arm were removed, the overall SAE rate was similar between arms (30.9% for D+EP vs 30.1% for EP). Most imAEs were low grade, endocrine-related and managed with corticosteroid or endocrine therapy; median time to onset was generally >60 days (table). Table . LBA2 D+EP (n = 265) EP (n = 266) imAE (group term) * Any grade, n (%) Grade ≥3, n (%) Median time to onset, † days (range) Any grade, n (%) Grade ≥3, n (%) Median time to onset, † days (range) Any imAE 52 (20) 13 (5) – 7 (3) 2 (1) – Hypothyroid 24 (9) 0 141 (42–283) 2 (1) 0 63 (62–64) Hyperthyroid 14 (5) 0 85.5 (22–372) 0 0 – Pneumonitis 7 (3) 2 (1) 191 (80–365) 2 (1) 2 (1) 177 (141–213) Hepatic 7 (3) 6 (2) 93 (31–256) 0 0 – Dermatitis/rash 4 (2) 0 33.5 (16–91) 2 (1) 0 31 (27–35) Diarrhoea/colitis 4 (2) 1 (0.4) 28 (9–114) 1 (0.4) 0 64 (64–64) Thyroiditis 4 (2) 0 144 (43–260) 0 0 – Type 1 diabetes 4 (2) 4 (2) 104 (38–316) 0 0 – * imAEs with incidence ≥2% in either arm are shown. † Time from first dose to onset of any grade imAEs. Conclusion In CASPIAN, the incidence of ADA to D was low and the safety profile of D+EP was consistent with previous reports of both D and EP. Clinical trial identification NCT03043872 (release date: February 6, 2017). Editorial acknowledgement Medical writing support, which was in accordance with Good Publication Practice (GPP3) guidelines, was provided by Craig Turner, MSc, of Cirrus Communications (Macclesfield, UK), an Ashfield company, and was funded by AstraZeneca. Legal entity responsible for the study AstraZeneca PLC. Funding AstraZeneca. Disclosure M. Ozguroglu: Advisory / Consultancy, Advisory board participation: Janssen / Sanofi / Astellas; Honoraria (self): Novartis / Roche / Janssen / Sanofi / Astellas; Travel / Accommodation / Expenses: Bristol-Myers Squibb / Janssen. J.W. Goldman: Advisory / Consultancy: AstraZeneca / Genentech / Lilly; Research grant / Funding (self): AstraZeneca/MedImmune / Eli Lilly / Genentech / Bristol-Myers Squibb / Array BioPharma / Celgene / AbbVie; Speaker Bureau / Expert testimony: Merck. N. Reinmuth: Travel / Accommodation / Expenses, Personal fees and non-financial support: AstraZeneca / Boehringer-Ingelheim / Hoffmann La-Roche / Bristol-Myers Squibb / Pfizer; Non-remunerated activity/ies, Non-financial support: Abbvie; Travel / Accommodation / Expenses, Personal fees: MSD Sharp & Dohme / Takeda. Y. Chen: Research grant / Funding (self): AstraZeneca / ISPEN / Roche / Bristol-Myers Squibb; Travel / Accommodation / Expenses, Personal fees: AstraZeneca / Genentech / Bristol-Myers Squibb / Merck / Novartis / Takeda / Eli Lilly / Guardant Health / Pfizer / Array Biopharma. K. Hotta: Research grant / Funding (self), Grants and personal fees: AstraZeneca / Lilly / Bristol-Myers Squibb; Travel / Accommodation / Expenses, Personal fees: MSD / Ono / Nipponkayaku / Taiho / Boehringer-Ingelheim / Chugai. F. Verderame: Research grant / Funding (self): AstraZeneca. M. Thomas: Full / Part-time employment: AstraZeneca. Y. Zheng: Full / Part-time employment: AstraZeneca; Shareholder / Stockholder / Stock options: AstraZeneca. A. Lloyd: Full / Part-time employment: AstraZeneca. H. Jiang: Full / Part-time employment: AstraZeneca; Shareholder / Stockholder / Stock options: AstraZeneca. L. Paz-Ares: Leadership role, Myself: Genomica; Leadership role, Immediate family member: European Medicines Agency; Honoraria (self), Myself: Roche/Genentech, Lilly, Pfizer, Boehringer-Ingelheim, Bristol-Myers Squibb, MSD, AstraZeneca, Merck Serono, PharmaMar, Novartis, Celgene, Sysmex, Amgen, Incyte; Travel / Accommodation / Expenses, Myself: Roche, AstraZeneca, AstraZeneca Spain, Merck, MSD, Bristol-Myers Squibb, Lilly, Pfizer; Spouse / Financial dependant, Other relationship [immediate family member]: Novartis, Ipsen, Pfizer, Servier, Sanofi, Roche, Amgen, Merck. All other authors have declared no conflicts of interest.

Background Pancreatic cancer (PC) is the 4th deadliest cancer in Europe, with more than 95% of those affected dying from the disease and is set to be the second greatest cause of death from cancer by 2020.(ECPC, European Cancer Patient Coalition) FOLFIRINOX regimen is the standard 1st-line treatment for PC patients with good performance status; however, there is still no standard of care in 2nd-line therapy for patients failed FOLFIRINOX. EndoTAG-1 is a novel formulation of cationic liposomes embedded with Paclitaxel, which specifically displays antivascular and antiangiogenic activity. By binding and internalizing at tumor endothelial cells after intravenous administration, the cytostatic and cytotoxic activities of paclitaxel are targeted to the activated tumor endothelial cells. Trial design •Patients with measurable locally advanced and/or metastatic adenocarcinoma of the pancreas failed on FOLFIRINOX treatment will be screened and randomized into one of the two arms in the study (n = 218). •ArmA: EndoTAG-1 and Gemcitabine Patients will be administrated with EndoTAG-1 (22 mg/m²) twice weekly plus gemcitabine (1000 mg/m²) once weekly for 1 cycle (8 weeks), which consisting of 3 weeks of treatment and 1 week rest, followed by 3 weeks of treatment and 1 week rest. The treatment will be kept until any one of the following occurs: progressive disease or unacceptable toxicity or withdrawal of consent. •ArmB: Gemcitabine Patients will be administrated with Gemcitabine (1000 mg/m²) once weekly for 1 cycle (8 weeks), which consisting of 3 weeks of treatment and 1 week rest, followed by 3 weeks of treatment and 1 week rest. The treatment will be kept until any one of the following occurs: progressive disease or unacceptable toxicity or withdrawal of consent. Clinical trial identification NCT03126435, other study ID numbers:CT4006. Legal entity responsible for the study SynCore Biotechnology Co., Ltd. Funding SynCore Biotechnology Co., Ltd. Disclosure All authors have declared no conflicts of interest.

Background: This Phase III, randomised, double-blind, multicentre trial (FALCON; NCT01602380) compared the selective estrogen receptor (ER) degrader (SERD) fulvestrant with anastrozole in patients with ER- and/or progesterone receptor-positive locally advanced or metastatic breast cancer who had not received prior hormonal therapy. Methods: Patients were randomised 1:1 to fulvestrant (500 mg IM on Days 0, 14, 28, then each 28 days) or anastrozole (1 mg daily). The primary endpoint was progression-free survival (PFS), assessed via RECIST 1.1, surgery/radiotherapy for disease worsening, or death. Secondary endpoints were: overall survival (OS); objective response rate (ORR, complete response [CR] or partial response [PR]); duration of response (DoR); expected DoR (EDoR); clinical benefit rate (CBR; CR, PR, or stable disease ≥24 weeks); duration of clinical benefit (DoCB); expected DoCB (EDoCB); health-related quality of life (HRQoL); and safety.

Some of the participants share their memories and photos from the VII World Congress of Music Therapy, held in Vitoria-Gasteiz, Spain in 1993.

The isolation and purification of human kidney hexosaminidases A and B was carried out. Regulation of the supramolecular organization and catalytic activity of hexosaminidases was investigated in the bis(2-ethylhexyl)sulphosuccinate reversed micellar system modeling the enzyme microenvironment in the lysosomes. It was shown that hexosaminidases A and B associate forming 280-300-kDa dimeric complexes under these conditions. At pH 4.75, the hexosaminidases A and B can be isolated from kidney tissue only in the form of this complex.

The switching of amorphous double layered binary and ternary rare-earth (RE) cobalt alloy films with perpendicular anisotropy in the layers is studied. Specimens are prepared by ion-plasma sputtering in Ar atmosphere on glass or silicon substrates. Hysteresis loops are measured from both sides of the film by the polar Kerr effect method. An X-ray diffractometer and an Auger electron spectrometer are used for structure investigation and composition analysis. A microdispersed polycrystalline RE oxide region with a thickness of about 10 nm are detected both on the free surface of the film and on the interlayer boundary. It is found that neither oxidized interlayer nor the surface influences the switching of the upper layer, but that hysteresis loops from down one strongly distort when exposition time exceeds five minutes. An explanation of the pecularities of the switching mechanism of oxidation of the film surface is proposed. >

Isolation and purification on human kidney hexosaminidases A and B (EC 3.2.1.30) were carried out. The regulation of the supramolecular organization and catalytic activity of the hexosaminidases in the AOT reversed micellar system modelling the enzyme microenvironment in the lysosomes, were investigated. It was found that under these conditions hexosaminidases A and B associate to form a 280-300 kDa dimeric complex. At pH 4.75 hexosaminidases A and B can be isolated from kidney tissue only within the composition of the complex.

The author reports the use of a new type of an Elektronika MK-52 programmed microcalculator for processing the results of biochemical studies. In contrast to other designs manufactured in this country, it is supplied with semifixed memory that permits storage of programs and data in the calculator after feeding switch off. Two new programs are suggested for estimating chorionic gonadotropin activity and for estimating liposome count in a preparation, and basic operations with the calculator are described as exemplified by these programs. The third program suggested by the author is intended for plotting various calibration straight lines; basing on this program the author demonstrates the use of memory enlargement units manufactured for this calculator.

It is the focus of this paper to look at the idea of resistance as providing information on the primary object experience. Using this information, the music therapist needs to assess his or her role in playing music during the session, in the same way that he or she assesses verbal interventions.

At present the most accurate and most widely used method of measuring vibrations in engineering is the method of holographic interferometry. For several reasons, it is very difficult to construct a universal holographic schema (UHS) that would make it possible with one holograph to determine and make a comparative analysis of the vibration amplitudes. It is shown in the present work that construction of the UHS becomes possible when investigating vibrations of objects with properties of symmetry. The chief examples used are the pinpointing of points near which parts of the surface are subjected to maximum displacements due to dynamic forces, and where the vectors of observation and lighting are made to coincide with the displacement vectors in accordance with the discovered regularities of spatial displacements of the investigated set of points.

The authors attempt to determine the natural frequencies of oscillation for impeller blades in turbine expansion engines, in order to reduce the likelihood of metal fatigue from intense oscillations due to the nonuniformity of flow and of the geometry of the blades. Diagrams accompanying the article represent the system for excitation and analysis of the vibrations, and a set of holographic interferograms shows the results obtained by the Powell-Stetson method of investigating the impeller blades' oscillations at different natural frequencies. The authors conclude that, since the elimination of resonance under service conditions may not be feasible, a change in the geometry of the blade may be a more rational solution.

Fatigue failure of rotors of turbocharger systems is prevented by various methods of surface plastic deformation which increase their fatigue strength and service life. One of the most effective methods is hardening with spheres in an ultrasound field, described in this paper. A diagram of the unit for ultrasonic hardening of the surface of rotors is presented. As a result of the development of equipment and selection of the conditions of the finishing operations of treatment of the rotors, it was simple to introduce the hardening process in commercially produced turbocharger systems.

Some natural (Gal-Cer, Lac-Cer, desyalylated gangliosides) and synthetic (HMGal) glycolipids differing in the length of the bridge linking the terminal galactose with the hydrophobic moiety were incorporated into the liposome membranes. The precipitation of the thus obtained vesicles induced by galactose-specific lectin RCA was studied. It was shown that when the amount of the glycolipids used for the incorporation into the liposomes (1 mol. %) was the same, the vesicles with HMGal or Gal-Cer incorporated into them did not precipitate in the presence of lectin, whereas the liposomes with incorporated Lac-Cer or desyalylated gangliosides did precipitate. It was thus concluded that in order for galactose-containing liposomes precipitation by lectin RCA1 to be induced, galactose should be separated from the liposome membrane with a distance not less than 7 A. The nature of lectin-induced nonspecific precipitation of ganglioside-containing liposomes, ganglioside mycelles and cardiolipin-lecithine liposomes containing lactosylceramide was investigated. Some nonspecific ionic interactions of negatively charged liposomes and ganglioside mycelles with lectin were observed, which disappeared with a rise in the NaCl concentration up to 150-200 mM.

Precipitation induced by different lectins has been studied in the presence of some aminoacids. It was shown that precipitates formed by lectins from Ricinus communis (RCA1), Canavalia ensiformis (Con A), Euonymus europaeus (Eel) in the presence of appropriate carbohydrate-containing molecules disappeared after cysteine addition, like after addition of specific carbohydrate precipitation inhibitors. It is assumed that cysteine residues of RCA1, Con A and Eel lectins are essential for their carbohydrate binding activity.

DNA associated with nuclear envelopes was isolated from rat liver nuclear lysate using centrifugation in sucrose gradient. The specific radioactivity of DNA obtained in nuclear envelope was compared with that of overall nuclear DNA at different stages of the S-period after partial hepatectomy and 1-15 min following intravenous injection of 3H-thymidine. It was found that at various steps of the cell cycle (19, 24 and 27 hrs following partial hepatectomy) the specific radioactivities of nuclear membrane-linked and overall nuclear DNAs do not show any significant differences. No noticeable selective synthesis or initiation of DNA replication on the nuelear envelope were observed either.

Gangliosides in aqueous media of low ionic strength (2-5 mM NaCl) and in concentrations over the critical ones (10(-5) M) form micellas which do not differ from liposomes as regards the chromatographic behavior on Sepharose 4R, with a molecular weight of greater than or equal to 10(7) dalton. In aqueous media of a higher ionic strength (greater than or equal to 20 mM NaCl), gangliosides form micellas which are eluted during chromatography in far later fractions than liposomes 70-80 nm in diameter, with a molecular weight of (1-5) X 10(5) dalton. It is assumed that the conclusions about ganglioside incorporation into the liposomal membrane made on the basis of their peaks coincidence are correct, provided that ganglioside-containing liposomes are obtained and chromatographed under high ionic strength (greater than or equal to 20 mM NaCl).

Inclusion of some glycosides, gangliosides and ceruloplasmin into large (300-400 nm in diameter) unilamellar liposomes was performed. About 100% of the gangliosides, 30-50% of ceruloplasmin and 3-5% of the glycosides were incorporated into the phospholipid vesicles under these conditions. The liposomes containing ceruloplasmin or gangliosides, in contrast to the glycoside-containing vesicles, were precipitated in the presence of agglutinin from Ricinus communis. The interaction of phospholipid vesicles containing gangliosides with rat hepatocytes "in vitro" was studied. It was found that the incorporation of gangliosides into the liposomal membrane increased the liposomal lipid uptake by 50% as can be judged from the uptake of radioactive cholesterol. Possible mechanisms of incorporation of carbohydrate-containing compounds into liposomes are discussed. It is concluded that beside the density of carbohydrates the degree of their exposure on the liposomal membrane is important for specific interactions of the vesicles with lectins.

Base composition and reassociation kinetics of DNA from chromatin-nuclear membrane complex of rat liver cells at different stages of the cell cycle. The complex isolated in low ionic strength solutions contains about 9% of total nuclear DNA, and its density in sucrose solution is 1.27 g/cm2. DNA, isolated from the complex, is homogenous in its molecular weight (approximately 2-10(6) daltons) and is similar in its base composition to total nuclear DNA. However, DNAs from complexes, isolated at interphase and different S-phases of the cell cycle, differ from total nuclear DNA in reassociation kinetics: DNAs from complexes are enriched by approximately 10% with unique nucleotide sequences. It is concluded from the similarity of reassociation kinetics, that molecular population of nuclear membrane-bound DNA does not change considerably throughout the cell cycle.

The content of 5-methyl cytosine in rat liver DNA increases 1,7-fold 8 hours after intraperitoneal injection of hydrocortisone (5 mg per 100 g animal weight). The content of GC, physicochemical parameters (Tm, delta T, etc.) and DNA renaturation pattern did not show any changes. No changes were observed in the pattern of H3-thymidine incorporation into rat liver DNA: after hydrocortisone injection the radioactivity was found to be equally distributed in all isolated sequences of DNA, differing in the degree of reiteration (specific radioactivities of these DNA, fractions are very similar). Thus, the molecular population of DNA in liver cells remains unchanged, which suggests that the hormone-induced increase in the 5-methyl cytosine content is due to a change in the DNA methylation level. The methyation level of unique sequences (COt greater than 600), i. e. that of structural genes, does not undergo any essential changes. The reversible methylation of DNA regulated by hormones seems to be one of the mechanisms controlling gene activity.