Deficiencies in health-related quality-of-life assessment and reporting: a systematic review of oncology randomized phase III trials published between 2012 and 2016

Quality of life (QoL) is a relevant end point and a topic of growing interest by both scientific community and regulatory authorities. Our aim was to review QoL prevalence as an end point in cancer phase III trials published in major journals and to evaluate QoL reporting deficiencies in terms of under-reporting and delay of publication. All issues published between 2012 and 2016 by 11 major journals were hand-searched for primary publications of phase III trials in adult patients with solid tumors. Information about end points was derived from paper and study protocol, when available. Secondary QoL publications were searched in PubMed. In total, 446 publications were eligible. In 210 (47.1%), QoL was not included among end points. QoL was not an end point in 40.1% of trials in the advanced/metastatic setting, 39.7% of profit trials and 53.6% of non-profit trials. Out of 231 primary publications of trials with QoL as secondary or exploratory end point, QoL results were available in 143 (61.9%). QoL results were absent in 37.6% of publications in the advanced/metastatic setting, in 37.1% of profit trials and 39.3% of non-profit trials. Proportion of trials not including QoL as end point or with missing QoL results was relevant in all tumor types and for all treatment types. Overall, 70 secondary QoL publications were found: for trials without QoL results in the primary publication, probability of secondary publication was 12.5%, 30.9% and 40.3% at 1, 2 and 3 years, respectively. Proportion of trials not reporting QoL results was similar in trials with positive results (36.5%) and with negative results (39.4%), but the probability of secondary publication was higher in positive trials. QoL is not included among end points in a relevant proportion of recently published phase III trials in solid tumors. In addition, QoL results are subject to significant under-reporting and delay in publication.

Gene therapy approaches in the non-human primate model of Parkinson's disease

The field of gene therapy has recently witnessed a number of major conceptual changes. Besides the traditional thinking that comprises the use of viral vectors for the delivery of a given therapeutic gene, a number of original approaches have been recently envisaged, focused on using vectors carrying genes to further modify basal ganglia circuits of interest. It is expected that these approaches will ultimately induce a therapeutic potential being sustained by gene-induced changes in brain circuits. Among others, at present, it is technically feasible to use viral vectors to (1) achieve a controlled release of neurotrophic factors, (2) conduct either a transient or permanent silencing of any given basal ganglia circuit of interest, (3) perform an in vivo cellular reprogramming by promoting the conversion of resident cells into dopaminergic-like neurons, and (4) improving levodopa efficacy over time by targeting aromatic L-amino acid decarboxylase. Furthermore, extensive research efforts based on viral vectors are currently ongoing in an attempt to better replicate the dopaminergic neurodegeneration phenomena inherent to the progressive intraneuronal aggregation of alpha-synuclein. Finally, a number of incoming strategies will soon emerge over the horizon, these being sustained by the underlying goal of promoting alpha-synuclein clearance, such as, for instance, gene therapy initiatives based on increasing the activity of glucocerebrosidase. To provide adequate proof-of-concept on safety and efficacy and to push forward true translational initiatives based on these different types of gene therapies before entering into clinical trials, the use of non-human primate models undoubtedly plays an instrumental role.

Methicillin-resistant Staphylococcus aureus: epidemiology and antimicrobial susceptibility experiences from the University Hospital 'Luigi Vanvitelli' of Naples

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the important pathogens worldwide showing resistance to several widely used antibiotics. This has made the treatment of MRSA infections harder, especially due to their prevalence in the hospital setting. We evaluated the antibiotic susceptibility patterns of healthcare-associated MRSA infections with a focus on Vancomycin Intermediate S. Aureus (VISA) and macrolide-licosamide-streptogramin B (MLS_B) phenotypes. A total of 417 Staphylococcus aureus (S. aureus) cases were isolated between January 2017 and December 2018, through several clinical specimens collected from the University Hospital 'Luigi Vanvitelli' of Naples. We identified bacterial strains using Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) and antimicrobial susceptibility using Phoenix BD (Becton Dickinson, NJ, USA). Out of the total 417 S. aureus cases, 140 were MRSA (33.6%) and of these, 50% were soft tissue infections. All MRSA and Methicillin sensible S.aureus MSSA isolates were susceptible to linezolid and daptomycin. Two MRSA cases exhibited intermediate resistance to vancomycin and were of constitutive MLS_B phenotype. Among the MRSA strains, 11.4% were constitutive and 43.6% were inducible MLS_B phenotypes and 8.6% were macrolide-streptogramin B phenotype. This study characterized the epidemiological status, antibiotic resistance patterns, and current prevalent phenotypes of healthcare-associated MRSA. This knowledge can aid clinicians in improving the antimicrobial stewardship program by adapting appropriate guidelines for the proper use of MRSA antibacterial agents.

Renzini MR, Buratini J, Da. Canto M. P–152 Morphokinetic and maternal profiles of embryos derived from centrally granulated oocytes vary with their ability to implant

Study question

Does oocyte central granularity (CG) impact embryo morphokinetics and does this change with embryo implantation ability and maternal profile?

Summary answer

Oocyte CG slows fertilization and cleavage morphokinetics in overall derived embryos, but not in those capable to implant, an ability associated with lower maternal age.

What is known already

Oocyte morphology is easily accessible after pre-ICSI oocyte denudation, but the implications of morphological alterations for oocyte developmental competence are not entirely known. The presence of a centrally located granular area in the ooplasm was previously associated with alterations in the actin cytoskeleton and meiotic spindle, both potentially affecting meiosis completion, fertilization dynamics and embryo mitotic divisions. In fact, we have recently reported lower fertilization rates and delayed pronuclei fading and first cleavage associated with the presence of CG in oocytes subjected to ICSI.

Study design, size, duration

Retrospective analysis including 1378 control ICSI cycles providing only morphologically normal oocytes (1225 patients) and 220 CG cycles (201 patients) providing normal and CG oocytes, from July 2014 to March 2020. Morphokinetic parameters were compared between embryos from control and CG oocytes, as well as among embryos from control oocytes reaching implantation (C-I) and embryos from CG oocytes achieving (CG-I) or not (CG-NI) implantation. Maternal profiles were compared between CG-I and CG-NI.

Participants/materials, setting, methods

Oocytes were recovered from patients after controlled ovarian stimulation and ovum pick-up. Following ICSI, embryo culture was performed in a time-lapse incubator with annotation of time of pronuclei fading (tPNf) and cleavage times t2, t3, t4, t5 and t8. Morphokinetic data were retrospectively coupled with implantation outcomes of single transfers and of double transfers achieving double or no implantation. Differences were assessed with Chi-square and Kruskal Wallis tests.

Main results and the role of chance

Patients providing CG oocytes (n = 201) presented higher maternal age (37.4 ± 4.4 vs. 36.7 ± 4.3; p = 0.005), higher basal FSH (8.52 ± 3.7 vs. 7.62 ± 2.8 IU/L; p = 0.002) and lower AMH levels (2.2 ± 2.2 vs. 2.9 ± 3.1 ng/mL; p < 0.001) compared to control patients (n = 1225). Morphokinetic parameters from tPNf to t4 were faster in embryos derived from oocytes with normal morphology (control; n = 6947) compared to embryos derived from CG oocytes (n = 382; tPNf: 24.0 ± 3.8 vs. 24.6 ± 3.6; t2: 27.0 ± 4.3 vs. 27.6 ± 4.1; t3: 37.0 ± 5.7 vs. 37.4 ± 5.7; t4: 39.4 ± 6.4 vs. 40.1 ± 6.2 hours; p < 0.05). In addition, CG-NI (n = 103) embryos were slower than CG-I (n = 13) and C-I (n = 226) embryos for tPNf, t2, t3, t4 and t8 (p < 0.05), while CG-I did not differ from C-I embryos (p > 0.05; tPNf: 22.4 ± 2.6 vs. 22.0 ± 2.5; t2: 24.9 ± 2.7 vs. 24.6 ± 2.8; t3: 36.0 ± 3.5 vs. 35.4 ± 3.0; t4: 36.7 ± 3.5 vs. 36.7 ± 3.6 hours, for C-I and CG-I, respectively). Finally, patients providing CG-I embryos (n = 10) were younger than those providing CG-NI embryos (n = 65; 31.3 ± 4.6 vs. 38.0 ± 3.9; p < 0.05).

Limitations, reasons for caution

Our study is subjected to the intrinsic limitations of a retrospective analysis, the results presented could have been affected by variables that are uncontrolled for. Other studies are necessary to assess the impact of CG on clinical outcomes.

Wider implications of the findings: The findings indicate that early developmental morphokinetics and maternal age constitute valid parameters for the decision of whether to transfer CG-derived embryos, as well as for the transfer prognosis.

Trial registration number

Not applicable

MET exon 14 skipping mutations in non-small-cell lung cancer: real-world data from the Italian biomarker ATLAS database

BACKGROUND

Mesenchymal-epithelial transition (MET) exon 14 (METex14) skipping mutation is a rare alteration in non-small-cell lung cancer (NSCLC), occurring in about 3%-4% of cases. Here we report disease and patient characteristics, and efficacy and tolerability of MET inhibitors among advanced METex14 NSCLC patients from the Italian real-world registry ATLAS.

MATERIALS AND METHODS

Clinical-pathological and molecular data, and treatment efficacy/tolerability outcomes were retrospectively collected from the ATLAS registry.

RESULTS

From July 2020 to July 2023 a total of 146 METex14 advanced NSCLC patients were included across 27 Italian centers. Median age was 74 years, and most patients were male (52%), with an Eastern Cooperative Oncology Group performance status < 2 (72%) and adenocarcinoma subtype (83%). One hundred and twenty-five out of 146 (86%) patients received at least one line of systemic anticancer therapy. Fifty-six (38%) were treated with capmatinib and 34 (23%) with tepotinib. 29% and 52% of them received targeted treatment in the first and second line, respectively. In the cohort of patients treated with MET inhibitors, the response rate (RR) was 37% (33% in previously treated patients and 46% in treatment-naïve) with a disease control rate of 62%. With a median follow-up of 10.8 months, progression-free survival was 6.6 months [95% confidence interval (CI) 4.3-8.3 months] and overall survival was 10.7 months (95% CI 7.2-19.3 months). In patients with measurable brain metastases (17 cases), the intracranial RR was 41%. Grade ≥3 treatment-related adverse events (TRAEs) occurred in 12% of patients with grade 3 peripheral edema in 7% of cases. A fatal adverse reaction occurred in one patient due to pneumonitis. TRAEs-related dose reduction and discontinuation were reported in 6% and 8% of cases, respectively.

CONCLUSION

Capmatinib and tepotinib represent an effective treatment option in NSCLC patients with METex14. Real-world efficacy outcomes are worse than those reported in prospective clinical trials. Their activity is more pronounced in the treatment-naïve population, suggesting that this is the right setting in the management of patients with METex14.