[Immune checkpoint inhibitors in lung cancer]

Immune checkpoint inhibitors (ICI) have emerged as an important treatment strategy in lung cancer in recent years. Implementation and approval status of each approved ICI will be presented by summarizing the most important phase III studies of nivolumab, pembrolizumab, atezolizumab and durvalumab. ICI are used as mono- or combination therapy with chemotherapy according to programmed cell death 1 ligand 1 (PD-L1) status and therapy line.

The Use of Bioelectrical Impedance to Assess Shelf-Life of Beef Longissimus Dorsi

ObjectivesTo evaluate quality attributes of beef longissimus dorsi (LD) during 15 d of simulated retail display using surface and internal bioelectrical impedance analysis (BIA) measurement techniques.Materials and MethodsThe experiment was designed as a split-plot with loin as the whole-plot and pairekd steaks as the sub-plot. Display day (DD) was treated as the sub-plot treatment. Postmortem age time (PM) and DD were treated as fixed effects. Beef strip loins (N = 18; IMPS #180), obtained from 3 commercial processors (PM = 27, 34, or 37 d), were fabricated into 12 2.54-cm thick steaks (N = 216). Steaks were subdivided into 6 consecutively cut pairs and pairs were randomly assigned to one of 6 display days: 0, 3, 6, 9, 12, and 15. For all pairs, one steak was allocated to microbiological analysis and pH and the paired steak for BIA, objective color assessment, proximate composition, and TBARS. Surface BIA (S-BIA) and internal BIA (I-BIA) assessment were compared. Steaks were packaged on styrofoam trays with a moisture absorbent pad, overwrapped with polyvinyl chloride film, and displayed under fluorescent lighting at 0–4°C in coffin-style retail cases.ResultsThere was a PM × DD interaction (P < 0.05) for S-BIA values. From d 0 to 12 of display, steaks aged 27 d had higher (P < 0.05) S-BIA values than steaks aged 34 and 37 d; however, on d 15 of display, steaks aged 34 d had 22% higher (P < 0.05) S-BIA values than steaks aged 37 d, but had similar (P > 0.05) values compared to steaks aged 27 d. There was no PM × DD interaction (P < 0.05) for I-BIA values; however, an effect on PM and DD was found (P < 0.05). Steaks aged 27 d were 17% higher for I-BIA values (P < 0.05) than 37 d, but similar (P > 0.05) to steaks aged 34 d. For all PM aging times, d 0 had the lowest (P < 0.05) I-BIA values among all display days with 81.44. D 3 was the second lowest (P < 0.05) and 8% higher than d 0 for I-BIA values. D 6 was 16% higher (P < 0.05) than d 3 but similar (P > 0.05) to d 9 and d 12. D 12 and D 15 were similar (P > 0.05). There was a DD × BIA method interaction (P < 0.05). On d 0, 3, and 6, BIA values were different (P < 0.05); however, after d 6 onward, BIA values were similar (P > 0.05). Covariance component was smaller in I-BIA than S-BIA. There were no PM × DD interactions (P > 0.05) for a* and b* values; however, there was an interaction for L* values. Postmortem aging had no effect (P > 0.05) on L*; however, an effect on a* and b* was found (P < 0.05). For APC populations, there was a PM × DD interaction (P < 0.05). No PM × DD interaction or PM effect (P > 0.05) were found for TBARS; however, there was a DD effect (P < 0.05). There was no PM day × DD interaction (P > 0.05) or PM day (P > 0.05) for moisture content. Display day (P < 0.05) had an effect on moisture content. Moderate negative correlations occurred between S-BIA values and a*, b*, and moisture content with –0.48, –0.46, and –0.46, respectively; and –0.51, –0.48, and –0.43, respectively, for I-BIA. Conversely, moderate positive correlation was found between S-BIA values and APC and TBARS with 0.34 and 0.53, respectively; and 0.29 and 0.51, respectively, for I-BIA.ConclusionI-BIA has potential for use to assess shelf-life of retail steaks and it was more precise than S-BIA; however, I-BIA may translocate bacteria into the muscle. Protein degradation and WHC should be evaluated to better understand BIA changes over time.

Improved Upper Limit on the Neutrino Mass from a Direct Kinematic Method by KATRIN

We report on the neutrino mass measurement result from the first four-week science run of the Karlsruhe Tritium Neutrino experiment KATRIN in spring 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are energy analyzed by a high-resolution MAC-E filter. A fit of the integrated electron spectrum over a narrow interval around the kinematic end point at 18.57 keV gives an effective neutrino mass square value of (-1.0_{-1.1}^{+0.9})  eV^{2}. From this, we derive an upper limit of 1.1 eV (90% confidence level) on the absolute mass scale of neutrinos. This value coincides with the KATRIN sensitivity. It improves upon previous mass limits from kinematic measurements by almost a factor of 2 and provides model-independent input to cosmological studies of structure formation.

Impact of TP53 mutation status on systemic treatment outcome in ALK-rearranged non-small-cell lung cancer

Background

We analyzed whether co-occurring mutations influence the outcome of systemic therapy in ALK-rearranged non-small-cell lung cancer (NSCLC).

Patients and methods

ALK-rearranged stage IIIB/IV NSCLC patients were analyzed with next-generation sequencing and fluorescence in situ hybridization analyses on a centralized diagnostic platform. Median progression-free survival (PFS) and overall survival (OS) were determined in the total cohort and in treatment-related sub-cohorts. Cox regression analyses were carried out to exclude confounders.

Results

Among 216 patients with ALK-rearranged NSCLC, the frequency of pathogenic TP53 mutations was 23.8%, while other co-occurring mutations were rare events. In ALK/TP53 co-mutated patients, median PFS and OS were significantly lower compared with TP53 wildtype patients [PFS 3.9 months (95% CI: 2.4–5.6) versus 10.3 months (95% CI: 8.6–12.0), P < 0.001; OS 15.0 months (95% CI: 5.0–24.9) versus 50.0 months (95% CI: 22.9–77.1), P = 0.002]. This difference was confirmed in all treatment-related subgroups including chemotherapy only [PFS first-line chemotherapy 2.6 months (95% CI: 1.3–4.1) versus 6.2 months (95% CI: 1.8–10.5), P = 0.021; OS 2.0 months (95% CI: 0.0–4.6) versus 9.0 months (95% CI: 6.1–11.9), P = 0.035], crizotinib plus chemotherapy [PFS crizotinib 5.0 months (95% CI: 2.9–7.2) versus 14.0 months (95% CI: 8.0–20.1), P < 0.001; OS 17.0 months (95% CI: 6.7–27.3) versus not reached, P = 0.049] and crizotinib followed by next-generation ALK-inhibitor [PFS next-generation inhibitor 5.4 months (95% CI: 0.1–10.7) versus 9.9 months (95% CI: 6.4–13.5), P = 0.039; OS 7.0 months versus 50.0 months (95% CI: not reached), P = 0.001).

Conclusions

In ALK-rearranged NSCLC co-occurring TP53 mutations predict an unfavorable outcome of systemic therapy. Our observations encourage future research to understand the underlying molecular mechanisms and to improve treatment outcome of the ALK/TP53 co-mutated subgroup.

Alectinib versus chemotherapy in crizotinib-pretreated anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer: results from the phase III ALUR study

Background

This is the first trial to directly compare efficacy and safety of alectinib versus standard chemotherapy in advanced/metastatic anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC) patients who have progressed on, or were intolerant to, crizotinib.

Patients and methods

ALUR (MO29750; NCT02604342) was a randomized, multicenter, open-label, phase III trial of alectinib versus chemotherapy in advanced/metastatic ALK-positive NSCLC patients previously treated with platinum-based doublet chemotherapy and crizotinib. Patients were randomized 2 : 1 to receive alectinib 600 mg twice daily or chemotherapy (pemetrexed 500 mg/m² or docetaxel 75 mg/m², both every 3 weeks) until disease progression, death, or withdrawal. Primary end point was investigator-assessed progression-free survival (PFS).

Results

Altogether, 107 patients were randomized (alectinib, n = 72; chemotherapy, n = 35) in 13 countries across Europe and Asia. Median investigator-assessed PFS was 9.6 months [95% confidence interval (CI): 6.9–12.2] with alectinib and 1.4 months (95% CI: 1.3–1.6) with chemotherapy [hazard ratio (HR) 0.15 (95% CI: 0.08–0.29); P < 0.001]. Independent Review Committee-assessed PFS was also significantly longer with alectinib [HR 0.32 (95% CI: 0.17–0.59); median PFS was 7.1 months (95% CI: 6.3–10.8) with alectinib and 1.6 months (95% CI: 1.3–4.1) with chemotherapy]. In patients with measurable baseline central nervous system (CNS) disease (alectinib, n = 24; chemotherapy, n = 16), CNS objective response rate was significantly higher with alectinib (54.2%) versus chemotherapy (0%; P < 0.001). Grade ≥3 adverse events were more common with chemotherapy (41.2%) than alectinib (27.1%). Incidence of AEs leading to study-drug discontinuation was lower with alectinib (5.7%) than chemotherapy (8.8%), despite alectinib treatment duration being longer (20.1 weeks versus 6.0 weeks).

Conclusion

Alectinib significantly improved systemic and CNS efficacy versus chemotherapy for crizotinib-pretreated ALK-positive NSCLC patients, with a favorable safety profile.

Trial registration

ClinicalTrials.gov NCT02604342; Roche study MO29750

[The national Network Genomic Medicine (nNGM) : Model for innovative diagnostics and therapy of lung cancer within a public healthcare system]

BACKGROUND

Since 2012, the Network Genomic Medicine (NGM) has been providing a large number of lung cancer patients from referring partner sites with comprehensive molecular-pathological diagnostics on the single diagnostic platform at the University Hospital Cologne. In addition, the network headquarters in Cologne interprets the findings in close interdisciplinary coordination between pathologists and oncologists, provides information on innovative treatment options, and evaluates the personalized therapies using the central database. As part of one of its largest single grants in 2018, the German Cancer Aid (DKH) rolled out this interdisciplinary and intersectoral care model to all existing DKH-funded German comprehensive cancer centers at the time of the initial application.

GOAL

Presentation of the treatment reality within the national Network Genomic Medicine (nNGM) with its core elements and actors (network centers and intersectoral clinical partners sites).

METHODS

This article is based on our own experience in NGM and nNGM and includes a summary of the currently applicable guidelines for reimbursement and an overview of the treatment landscape in the field of molecular-pathological diagnostics in Germany.

RESULTS

The focus of nNGM is on the implementation of innovative molecular diagnostics and personalized therapy in broad clinical routine in Germany. This is enabled by developing molecular-pathological diagnostics within the network centers on an ongoing basic, interdisciplinary counseling of referring partner sites, offering innovative clinical trials, and performing central evaluation. In particular, a focus of nNGM is the development of regional networks to treat the affected lung cancer patients close to home at the partner sites whenever possible.

DISCUSSION

Interdisciplinary teams are essential for the success of a broad implementation of molecular-pathological diagnostics. nNGM addresses a severe deficit in German lung cancer care and in the future will be expanded to further network centers while meeting the defined quality criteria.